Youth With Autism Use Emergency Rooms At Markedly Increased Rate

MedicalResearch.com Interview with:

Guodong Liu, PhD  Assistant Professor Division of Health Services and Behavioral Research Department of Public Health Sciences, A210 Penn State University College of Medicine Hershey, PA 17033

Dr. Guodong Liu

Guodong Liu, PhD 
Assistant Professor
Division of Health Services and Behavioral Research
Department of Public Health Sciences, A210
Penn State University College of Medicine
Hershey, PA 17033

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

Response: Adolescents with autism spectrum disorder (ASD) use emergency department services four times as often as their peers without autism, according to Penn State College of Medicine researchers. The findings suggest that youth with autism may need better access to primary care and specialist services.

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

Response: Although there was no significant increase in autism rates among adolescents in the study over the nine-year period, emergency department use in adolescents with autism increased five-fold, from 3 percent in 2005 to 16 percent in 2013. During the same time period, emergency department use in adolescents without an autism diagnosis remained steady at around 3 percent.  there could be a link between this underutilization of preventive care services and overuse of emergency department services.

On average, adolescents with autism had a four-time higher risk of visiting the emergency department than adolescents without ASD.  Older adolescents with autism also visited the emergency department more often than their younger counterparts. A third of middle and late adolescents in this group had medical emergencies, compared to just one-tenth of early adolescents.  Females and individuals living in rural areas were more likely to visit the emergency room than males and those living in urban areas.

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

Response: We want to see more data on adolescents with ASD to confirm his findings. We are planning a similar study of emergency department use in adolescent Medicaid patients with autism. Our goal is to plot an unbiased nationally representative picture of how this special population fares in terms of their emergency department usage and, in related work, hospitalizations.

We are also searching for modifiable factors that could be addressed to reduce emergency visits and resulting hospitalizations in adolescents with autism. 

MedicalResearch.com: Is there anything else you would like to add?

Response: These Young ASD patients need to be actively taken care of and monitored. There should be better communication between these adolescents and their caregivers and with their regular pediatricians and specialists. If we can do those kinds of things we may help them have less frequent emergencies. This study was published by the Journal of Autism and Developmental Disorders.

I have no disclosures.

Lead author: Dr. Guodong Liu, assistant professor of public health sciences, Penn State University College of Medicine.

Other researchers on this study were Amanda M. Pearl, PhD and Michael J. Murray, MD, Department of Psychiatry; Lan Kong, PhD, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences; and Douglas L. Leslie, PhD, Division of Health Services and Behavioral Research, Department of Public Health Sciences, all at Penn State College of Medicine.

Penn State College of Medicine Junior Faculty Development Program funded this research.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Guodong Liu, Amanda M. Pearl, Lan Kong, Douglas L. Leslie, Michael J. Murray. A Profile on Emergency Department Utilization in Adolescents and Young Adults with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 2016; 47 (2): 347 DOI: 10.1007/s10803-016-2953-8

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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How Does Fruit Juice Affect Weight Gain in Children?

MedicalResearch.com Interview with:

Brandon Auerbach, MD, MPH Acting Instructor Division of General Internal Medicine University of Washington

Dr. Auerbach

Brandon Auerbach, MD, MPH
Acting Instructor
Division of General Internal Medicine
University of Washington

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

Response: The question of whether 100% fruit juice causes poor health outcomes in children, such as weight gain, has been a subject of controversy. On one hand, 100% fruit juice contains vitamins and nutrients that many children lack, is often cheaper than whole fruit, and may help kids with limited access to healthy food meet their daily fruit requirements.

On the other hand, leading nutrition experts have expressed concern that fruit juice contains amounts of sugar equal to or greater than those of sugary drinks like regular soda. Guidelines from the American Academy of Pediatrics warn that 100% juice can be a significant source of calories and contribute to obesity if consumed excessively.

Our main finding was that consuming 1 serving/day of 100% fruit juice was not associated with weight gain in children. Children ages 1 to 6 years gained a small amount of weight, but not enough to negatively impact health. Children ages 7 and older gained no weight. We did not study amounts of 100% fruit juice higher than 1 serving/day.

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Number Of Epipen Prescriptions for Kids Skyrockets

MedicalResearch.com Interview with:
Lavanya Diwakar, FRCPath

Honorary consultant in immunology
Queen Elizabeth Hospital, Birmingham, and
Research fellow in health economic
University of Birmingham
Birmingham UK

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

Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK.
We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens.

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High School Students Increasingly Specializing in One Sport

MedicalResearch.com Interview with:

Michael G. Ciccotti, MD Professor of Orthopaedic Surgery Rothman Institute Chief of Sports Medicine, and Director of the Sports Medicine Fellowship Thomas Jefferson University

Dr. Michael Ciccotti

Michael G. Ciccotti, MD
Professor of Orthopaedic Surgery
Rothman Institute
Chief of Sports Medicine, and
Director of the Sports Medicine Fellowship
Thomas Jefferson University

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

Response: No doubt sports plays a huge role in the United States and all over world with millions of young people between the ages 6 and 18 participating in an organized sport on a regular basis.

Over the past decade, there has been a tremendous focus on youth single sport specialization (SSS), with pressure from coaches, parents and the athletes themselves to participate in one sport year round. Many participants, coaches and parents believe that early specialization may allow the young athlete to become better and progress more quickly in their sport, perhaps allowing them a greater chance of becoming a professional athlete. This drive toward early specialization has been fueled by popular icons i.e. Tiger Woods (golf) and Lionel “Leo” Messi (soccer) as well as by media hits such as Friday Night Tykes (young football players) and The Short Game (7-year old golfers). The pop-psych writer, Malcolm Gladwell, whose The 10,000 Hour Rule (in his book Outliers) holds that 10,000 hours of “deliberate practice” are needed to become world-class in any field may have also encouraged the specialization trend.

There is little doubt that youth sports may encourage a lifelong interest in a healthy lifestyle as well as improved self-esteem and social relationships. The flip side is that extreme training and singular focus on a sport can lead to stress on the developing musculo-skeletal system, a pressure to succeed at all costs, reduced fun, burnout and sometimes social isolation.

The dilemma we are beginning to scratch the surface of is does single sport specialization enhance the likelihood of getting to an elite level and does it increase the risk of injury? There is a growing sense in the medical community that SSS raises injury risk without enhancing progression to a higher level.

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Should Teenagers Be Able To Get Oral Contraceptives Over The Counter?

MedicalResearch.com Interview with:

Krishna K. Upadhya, M.D., M.P.H. Division of General Pediatrics & Adolescent Medicine Department of Pediatrics Johns Hopkins University School of Medicine Baltimore, MD 21287

Dr. Upadhya

Krishna K. Upadhya, M.D., M.P.H.
Division of General Pediatrics & Adolescent Medicine
Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD 21287

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

Response: Our study reviewed medical literature to examine the question of whether minor teens should be treated differently from older women with regard to a future over the counter oral contraceptive product.  Our analysis found that oral contraceptive pills are safe and effective for teens and there is no scientific rationale to restrict access to a future oral contraceptive pill based on age.

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Acute Kidney Injury Is A Frequent Complication of Pediatric Diabetic Ketoacidosis

MedicalResearch.com Interview with:

Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada

Dr. Panagiotopoulos

Constadina Panagiotopoulos, MD, FRCPC
Department of Pediatrics, Endocrinology & Diabetes Unit
British Columbia Children’s Hospital
Vancouver, British Columbia, Canada

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

Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema.

One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors.

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Prenatal Tobacco Smoke Raises Risk of Atopic Dermatitis in Offspring

MedicalResearch.com Interview with:

Dr. Saskia Trump PhD Helmholtz-Centre for Environmental Research – UFZ Department of Environmental Immunology Leipzig, Germany

Dr. Saskia Trump

Dr. Saskia Trump PhD
Helmholtz-Centre for Environmental Research – UFZ
Department of Environmental Immunology
Leipzig, Germany

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

Response: Environmental chemicals have long been discussed to contribute to the exacerbation or even the development of allergic diseases. In our study we were particularly interested in the effect of tobacco smoke exposure, which is the main source for indoor benzene exposure, on regulatory T cell (Treg) function and its relation to the development of childhood atopic dermatitis (AD). Tregs play a critical in controlling T effector cell activity by avoiding overexpression. A deficiency in this T cell subset increases the risk for allergic inflammation.

We have previously described that exposure to tobacco smoke during pregnancy can decrease the number of regulatory T cells (Treg) in the cord blood and predispose the child to the development of AD (1). In this subsequent study we were interested in the underlying mechanism involved.

Benzene itself is not considered to be toxic, however its metabolization leads to the formation of highly reactive molecules. In humans for example the metabolite 1,4-benzochinone (1,4-BQ) can be found in the blood as a consequence of benzene exposure.

To further assess the effect of benzene on Treg and the development of AD we combined in vitro studies, evaluating the impact of 1,4-BQ on human expanded Treg, with data from our prospective mother-child cohort LINA. The LINA study, recruited in Leipzig, Germany, is a longitudinal evaluation of mother-child pairs with respect to lifestyle and environmental factors that might contribute to disease development in the child. Based on this deeply phenotyped cohort we were able to translate our in vitro findings to the in vivo scenario.

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Physical Activity In Decline For Most Kids By School Age

MedicalResearch.com Interview with:
Professor John J Reilly
University of Strathclyde Glasgow
Physical Activity for Health Group
Scotland, UK 

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

Response: There is Concern that levels of physical activity among modern children are typically very low, well below the amounts recommended for their physical & mental health, well-being, and academic attainment.

It has been assumed for many years that physical activity levels begin to become a problem at adolescence, and this adolescent decline in activity is especially marked in girls.

MedicalResearch.com: What are the main findings?

1. Physical activity- in our sample of 545 individuals studies at ages seven, nine, 12, and 15 using activity monitors for six to seven days at each time point- was already low and was in decline from age seven, well before adolescence.

2. The physical activity decline was not especially marked at adolescence, or in girls.

3. In a minority of boys (19% of boys) and girls (12% of girls) physical activity was maintained at a relatively high level from age seven to 15 years. these are interesting exceptions to the general pattern.

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

Response: We should no longer see girls,or adolescents, as the only high risk groups for low physical activity; the entire population is at high risk.

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

Response: Efforts to promote or maintain physical activity need to start well before adolescence, and should not just focus on girls. Physical activity seems to be in decline in most children by the time they start school. We need to address more research and policy effort at lifestyles of younger children of both sexes.

We also need to direct more research effort at the interesting minority in both sexes who maintained a relatively high physical activity from age seven to 15 years. We don’t know why they were different to the rest – for example, were they more engaged in sport ? – and understanding why and how they differed from the rest of the population would help us develop strategies for preventing the age-related decline in physical activity in future.

There are no conflicts of interest to declare. The work was funded by the UK MRC and the Scottish Government Chief Scientist Office.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Farooq MA, Parkinson KN, Adamson AJ, et al

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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paul.gallagher@strath.ac.uk

 

Poor Sleep In Early Childhood Linked to Later Cognitive and Behavioral Problems

MedicalResearch.com Interview with:

Dr. Elsie M. Taveras, MD MPH Chief, Division of General Pediatrics Director, Pediatric Population Health Management Director, Raising Healthy Hearts Clinic

Dr. Taveras

Dr. Elsie M. Taveras, MD MPH
Chief, Division of General Pediatrics
Director, Pediatric Population Health Management
Director, Raising Healthy Hearts Clinic
MassGeneral Hospital for Children

MedicalResearch.com: What are the primary findings of this study and why are they important?

Response: The primary findings of this study are that children who get an insufficient amount of sleep in their preschool and early school age years have a higher risk of poor neurobehavioral functioning as reported by their mothers and independently by their teachers at age 7. These behaviors included poorer executive function and more hyperactivity/inattention, emotional symptoms, conduct problems, and peer relationship problems.

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Many Summer Camps Need More Training On Food Allergy Treatment

MedicalResearch.com Interview with:
Margaret T. RedmondMD
Nationwide Children’s Hospital
Columbus, Ohio 

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

Response: Food allergies are becoming more prevalent and can cause a life threatening reaction if not managed correctly. Much of the previous focus has been on food allergy in the school setting and little was known about the camp setting.

Analysis of survey data from camp directors, medical personnel and staff reveal that there are deficiencies of training and policy at camps that could place food allergic campers at increased risk of reaction. A prospective registry of epinephrine administration from 51 camps revealed an increased rate of epinephrine administration compared to school data. Continue reading

Mouse Allergens Drives Asthma Symptoms In Many Children

MedicalResearch.com Interview with:

Elizabeth C. Matsui, MD MHS Professor of Pediatrics, Epidemiology, and Environmental Health Sciences Johns Hopkins University Baltimore, MD 21287

Dr. Matsui

Elizabeth C. Matsui, MD MHS
Professor of Pediatrics, Epidemiology, and Environmental Health Sciences
Johns Hopkins University
Baltimore, MD 21287 

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

Response: We designed this study after our previous work indicated that mouse allergy was common among low-income children living in some urban neighborhoods in the US, that these children also had high levels of mouse allergen exposure in their homes, and that children who are both allergic to mice and exposed to high levels of mouse allergen are at greater risk of asthma symptoms, emergency room visits and hospitalization.   Given this background, we designed a randomized clinical trial to determine if an intensive professionally delivered mouse intervention was better than education about mouse control in reducing asthma symptoms and lowering home mouse allergen levels.

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Vitamin D During Fetal Life and Bone Health in Children at Age 6

MedicalResearch.com Interview with:
Audry H. Garcia PhD

Scientist Department of Epidemiology
Erasmus MC, University Medical Center Rotterdam
Rotterdam, the Netherlands 

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

Response: Fetal bone mineralisation requires an adequate transfer of calcium to the fetus by the end of the pregnancy. Considering that vitamin D is required to maintain normal blood concentrations of calcium, adequate 25-hydroxyvitamin D (25[OH]D) concentrations in pregnant women seem to be crucial for bone development of the offspring. Maternal vitamin D deficiency during pregnancy has been associated with abnormal early skeletal growth in offspring and might be a risk factor for decreased bone mass in later life. Several studies have linked vitamin D deficiency in fetal life to congenital rickets, craniotabes, wide skull sutures and osteomalacia. However, the evidence of long-lasting effects of maternal vitamin D deficiency during pregnancy on offspring’s skeletal development is scarce and inconsistent, and has led to contradictory recommendations on vitamin D supplementation during pregnancy.

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