Exploration During Adolescence Critical To Obtaining Wisdom Needed To Navigate Adulthood

MedicalResearch.com Interview with:

Dan Romer PhD Research director, Annenberg Public Policy Center Director of its Adolescent Communication Institute University of Pennsylvania

Dr. Dan Romer

Dan Romer PhD
Research director, Annenberg Public Policy Center
Director of its Adolescent Communication Institute
University of Pennsylvania

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

Response: In recent years, findings from research in developmental neuroscience indicate that the myelination of the prefrontal cortex (PFC) extends into the third decade of life, proceeding more slowly than in other brain regions. Because subcortical and sensory brain regions appear to mature earlier, this and other findings have been taken as evidence that adolescents may have less ability to control their behavior than children do. These findings spawned theories of “imbalanced” adolescent brain development that were proposed to explain heightened vulnerability to risky behavior and adverse health outcomes during adolescence.

Although there is little doubt that as adolescents enter adulthood, they are at risk for many health outcomes that can accompany the initiation of such behaviors as driving, having sex, using drugs, and playing sports. But most adolescents make it through this period of development without serious health consequences. Thus, the argument that a brain deficit is responsible for such adverse health outcomes seemed to overgeneralize effects that only occur for a minority of adolescents. Furthermore, when my colleagues and I examined the evidence in support of imbalance theories, we found it unconvincing. Indeed, it seemed that findings from neuroscience were interpreted through the lens of stereotypes about adolescents that conflate exploration with impulsivity. That is, many of the risky behaviors that attract adolescents are novel activities that reflect lack of experience rather than lack of control over behavior.  Continue reading

Despite Sleep Benefits To Teens, Only Half of Parents Support Later School Start Times

MedicalResearch.com Interview with:

Galit Dunietz, Ph.D., MPH Doctor of Philosophy Department of Neurology University of Michigan  Ann Arbor MI

Dr. Dunietz

Galit Dunietz, Ph.D., MPH
Epidemiologist, Sleep Disorders Center
Department of Neurology
University of Michigan
Ann Arbor MI

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

Response: Insufficient sleep has a negative impact on health, cognition and mood and is linked to motor vehicle accidents. However, sleep loss in adolescents has become an epidemic and arises in part from biological processes that delay sleep and wake timing at the onset of puberty. This biology does not fit well with early school start times (before 8:30 a.m.). Despite recommendations from the American Academy of Pediatrics and the American Academy of Sleep Medicine to delay school start times, most schools in the U.S. have current start times before 8:30 a.m.

In this nationally representative study of US parents of teens, we examined whether parents supported or opposed later school start times (after 8:30 a.m.). We also examined what may have influenced their opinions.

We found that only about half of surveyed parents of teens with early school start times supported later school start times. Opinions appeared to depend in part on what challenges and benefits were expected to result from the change.

For example, parents who expected an improvement in their teen’s academic performance or sleep quantity tended to support the change, whereas parents that expected negative impact on afterschool activities or transportation opposed delays in school start times.  We also found that parents had misconception about sleep needs of their adolescents, as the majority perceived 7-7.5 hours of sleep as sufficient, or possibly sufficient even at this young age when 8-10 hours are typically recommended.

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Risk Factors for Adverse Events in Emergency Procedural Pediatric Sedation

MedicalResearch.com Interview with:

Maala Bhatt MD, MSc., FRCPC Director, Pediatric Emergency Research Staff Physician, Emergency Medicine  Children's Hospital of Eastern Ontario

Dr. Bhatt

Maala Bhatt MD, MSc., FRCPC
Director, Pediatric Emergency Research
Staff Physician, Emergency Medicine
Children’s Hospital of Eastern Ontario 

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

Response: Procedural sedation, defined as the administration of medications to minimize pain and awareness, has become standard practice in pediatric emergency departments worldwide to facilitate short, painful procedures such as orthopedic reduction and complex laceration repairs. Although emergency department sedation is regarded as safe, serious adverse events have been reported. The incidence of these events has been difficult to determine due to the infrequency of their occurrence and lack of large, multi-center surveillance studies focused on systematic detection of adverse events. Previous studies of emergency department sedation have been limited by single-center design and small sample sizes. These studies have not been able to reliably predict sedation-related adverse events, their severity or impact on patients.

To improve understanding of the safety and comparative effectiveness of ED procedural sedation, we conducted a large multi-center cohort study using standardized outcome measures that are valid and relevant to clinical practice. Our primary objective was to determine which practices lead to the best outcomes in children undergoing emergency department procedural sedation.

MedicalResearch.com: What are the main findings?

Response: We enrolled 6,295 patients undergoing parenteral procedural sedation for a painful procedure in one of six Canadian pediatric emergency departments from July 2010 to February 2015.

The overall incidence of adverse events in our population was 11.7%. Oxygen desaturation (5.6%) and vomiting (5.2%) were the most common events. Serious adverse events and significant interventions in response to an adverse event were rare occurring in only 1.1% and 1.4% of patients respectively.

We found that choice of sedation medication had the biggest impact on the incidence of adverse events and need for significant interventions in response to those events. The incidence of serious adverse events and significant interventions was lowest among patients sedated with ketamine-alone and highest among patients sedated with combination drugs ketamine+propofol and ketamine+fentanyl. We also found that pre-procedural opioid administration was strongly associated with increased odds of oxygen desaturation, vomiting and need for significant interventions, regardless of sedation medication.

Higher doses of ketamine were associated with increased odds of oxygen desaturation and vomiting. These findings are in opposition to the common belief that ketamine does not exhibit a dose-response relationship.

We also found that pre-procedural anti-emetics were associated with a 50% reduction in the odds of vomiting. However, based on published evidence, use in children under five years may not be as advantageous as their baseline risk is much lower.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Procedural sedation for children provided by Emergency Physicians in these tertiary care pediatric emergency departments is safe and effective with low rates of serious adverse events (1.1%) and significant interventions (1.4%). Ketamine, Ketamine and Propofol and Propofol alone are all effective and safe in the hands of competent/experienced providers, however using ketamine alone is associated with fewer serious adverse events and significant interventions.

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

Response: Our finding that administering opioids prior to sedation increases the odds of oxygen desaturation, vomiting and the need for significant interventions is interesting. Future work could focus on the timing of opioid administration and the incidence of adverse events. We are also interesting in understanding the longer term effects of sedation medications, controlling for age.

Disclosures: This study was supported by a Canadian Institutes of Health Research Team Grant in Pediatric Emergency Medicine.

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

Citation:

Bhatt M, Johnson DW, Chan J, Taljaard M, Barrowman N, Farion KJ, Ali S, Beno S, Dixon A, McTimoney CM, Dubrovsky AS, Sourial N, Roback MG, for the Sedation Safety Study Group of Pediatric Emergency Research Canada (PERC). Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children. JAMA Pediatr. Published online August 21, 2017. doi:10.1001/jamapediatrics.2017.2135

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

 

 

 

 

 

 

Preterm Babies Still At Risk of Developmental Delays

MedicalResearch.com Interview with:
Dr. Andrei Morgan and Dr.Veronique Pierrat

Obstetrical, Perinatal, and Pediatric Epidemiology Team,
Epidemiology and Biostatistics Sorbonne
Cité Research Center INSERM, Paris France
Descartes University, Paris, France
Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France. 

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

Response: The risk of neurodevelopmental and behavioural disabilities remains high in children and adults born preterm. In the 2000s, outcomes of neonates born extremely preterm was described in several settings, but the outcome of neonates born very and moderately preterm was rarely reported. However, in absolute numbers, these infants represent a larger proportion of preterm births and account for more children with long-term deficits and learning disabilities.

EPIPAGE-2 is a national study which aims to study short and long term outcomes of children born at 22-26 weeks’gestation, 27-31 weeks’gestation and 32-34 weeks’gestation in France in 2011. We also compared results from this study with the first EPIPAGE study, carried out in 1997. At two years of age, neuro motor and sensory impairment, as well as overall development, were investigated by sending questionnaires to the attending physician and the parents.

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Risky Behaviors Linked To Contact Lens–Related Eye Infections Among Adults and Adolescents

MedicalResearch.com Interview with:

Dr. Jennifer R. Cope MD Medical Officer Division of Foodborne, Waterborne, and Environmental Diseases National Center for Emerging and Zoonotic Infectious Diseases CDC

Dr. Cope

Dr. Jennifer R. Cope MD
Medical Officer
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
CDC

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

Response: Wearing contact lenses can increase your chances of getting a severe eye infection. Eye infections can lead to serious problems, including blindness. All contact lens wearers can help prevent serious eye infections by correctly wearing and caring for their contact lenses.

Eighty-one percent of young adults, 85% of adolescents, and 88% of older adults regularly did at least one risky behavior related to their contact lenses. The most frequently reported risk behaviors in adolescents were not visiting an eye doctor as least annually, sleeping or napping in lenses, and swimming in lenses.

Among young adults and older adults, the most frequently reported risk behaviors were replacing lenses at intervals longer than those prescribed, replacing lens storage cases at intervals longer than those recommended, swimming in lenses, and sleeping or napping in lenses.

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Neonatal Hypoglycemia Linked To Neurodevelopmental Outcomes at 4.5 Years

MedicalResearch.com Interview with:

Jane E. Harding, DPhil Liggins Institute The University of Auckland Auckland, New Zealand

Prof. Harding

Jane E. Harding, DPhil
Liggins Institute
The University of Auckland
Auckland, New Zealand

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

Response: Neonatal hypoglycaemia – low blood sugars in newborns – affects up to one in six babies born. It involves a sustained dip in blood sugar levels following birth. Blood glucose is the only fuel for babies’ brains (adults have alternative, back-up sources). So, if left untreated, this condition can cause developmental brain damage and lowered education outcomes later in life.

In developed economies, as many as a third of babies born are at risk. Risk factors include being born smaller or larger than usual, preterm babies and babies whose mothers have any form of diabetes – this last a growing group, with the rising incidence of gestational (pregnancy-related) diabetes.

We wanted to systematically track a cohort of babies to see if hypoglycaemia in babies affects their long-term health and development. So we designed the CHYLD study – Children with Hypoglycaemia and their Later Development. We are following 614 New Zealand babies born at risk of low blood sugar levels (neonatal hypoglycemia) into childhood to see if the condition affects their later growth and development. Our team includes researchers from the Liggins Institute, the University of Auckland, Waikato Hospital, the University of Canterbury and the University of Waterloo.

Half of the babies in the study were diagnosed with, and treated for low blood sugars. Seventy percent received extra, continuous monitoring of their blood sugar levels, which detected in some babies low levels that were not diagnosed by the heel-prick tests.

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Does Maternal Preeclampsia Increase Risk of Retinopathy in Premature Infants?

MedicalResearch.com Interview with:

Mary Elizabeth Hartnett, MD, FACS, FARVO Professor of Ophthalmology, Vitreoretinal Service and Surgery Principal Investigator Retinal Angiogenesis Laboratory Director of Pediatric Retina, Adjunct Professor of Pediatrics John A. Moran Eye Center Salt Lake City UT 84132

Dr. Hartnett

Mary Elizabeth Hartnett, MD, FACS, FARVO
Professor of Ophthalmology, Vitreoretinal Service and Surgery
Principal Investigator Retinal Angiogenesis Laboratory
Director of Pediatric Retina, Adjunct Professor of Pediatrics
John A. Moran Eye Center
Salt Lake City UT 84132

On behalf of the co-authors: Julia Shulman, Cindy Weng, Jacob Wilkes, Tom Greene, M. Elizabeth Hartnett

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

Response: Maternal preeclampsia causes morbidity to mothers and infants worldwide. Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. This study was done to gain insight into the effects of preeclampsia on ROP in a clinical population.

The literature is mixed with some reports that preeclampsia increases risk of Retinopathy of prematurity, whereas others suggest preeclampsia is protective or has no effect. The presence of circulating anti-angiogenic factors in preeclamptic mothers that can enter the fetal circulation lends biologic plausibility to the notion that maternal preeclampsia might interfere with developing vascular beds in the fetus, such as the retina, and potentially lead to severe ROP. However, a report using an experimental model provided evidence that uteroplacental insufficiency, a characteristic of preeclampsia, led to protective mechanisms in the offspring that reduced oxygen-induced retinopathy and promoted overall growth.

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“Positive Manifold” : Vocabulary and Reasoning Skills Reinforce Each Other In Adolescents

MedicalResearch.com Interview with:

Dr Rogier Kievit PhD Cambridge Neuroscience

Dr. Kievit

Dr Rogier Kievit PhD
Cambridge Neuroscience

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

Response: One of the most robust findings in psychology is the so-called ‘positive manifold’ – The fact that people who are better at cognitive task A are, on average, also better at task B (and C, D etcetera). Despite over a hundred years of empirical investigations, we don’t really know why this is the case. Here, we aimed to investigate the mechanisms that underlie the positive manifold. To do so, we studied almost 800 adolescents and young adults from Cambridge and London (the NSPN study; Www.nspn.org

We measured both their abstract reasoning skills (e.g. solving a puzzle) and vocabulary knowledge (e.g. example) on two occasions, about 1.5 years apart.

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

Response: Our main finding was that abstract reasoning skills and vocabulary knowledge seem to reinforce each other during development. In other words, the adolescents who started out with higher vocabulary abilities had largest increases in reasoning skills, and those with better reasoning skills gained more vocabulary knowledge. This is exciting as we know mathematically that such a process can (at least partially) help explain the emergence of the positive manifold.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: That cognitive abilities interact with each other during development. It is tempting (also for scientists!) to think about skills like memory, reading and as separate domains. However, in reality they are part of a larger network of cognitive, mental and emotional processes that interact throughout the lifespan. We simple can’t fully understand humans as psychological agents by taking only ‘snapshots’.

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

Response: The field of psychology has recently realized it needs to increase sample sizes to gain robust knowledge about human behaviour and mental processes. I think the next step is realizing the importance of studying development (i.e. testing people on multiple occasions) as a way to look at longstanding questions in new and exciting ways. Secondly, we find that that mathematical models are a very exciting way to translate theories into directly testable propositions – Although such models are always oversimplifications, they often move scientific debates forward.

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

Response: With the emergence of experience sampling methods (e.g. performing cognitive tests on smartphones), ideally combined with longitudinal brain imaging, I think the next two decades will prove an incredibly exciting time for understanding human cognition.

Disclosures: The Medical Research Council Cognition and Brain Sciences Unit is part of the University of Cambridge, funded through a strategic partnership between the MRC and the University.

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

Citation:

Rogier A. Kievit et al, Mutualistic Coupling Between Vocabulary and Reasoning Supports Cognitive Development During Late Adolescence and Early Adulthood, Psychological Science (2017). DOI: 10.1177/0956797617710785

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

Children from Socially and Economically Disadvantaged Families Have Increased Cardiovascular Risks

MedicalResearch.com Interview with:
Lead author, Dr Richard Liu, MCRI Ph.D. student and
Senior author – Professor David Burgner PhD
The Child Health CheckPoint Investigator Group
Murdoch Children’s Research Institute
The Royal Children’s Hospital
Parkville, Victoria, Australia

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

Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis.

We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood.

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No Clear Health Benefits of Dogs and Cats for Children

MedicalResearch.com Interview with:

Layla Parast PhD Statistician RAND

Dr. Parast

Layla Parast PhD
Statistician
RAND

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

Response: This study examined the association between pet ownership, specifically dog or cat ownership, and children’s physical and mental health. There has been a lot of previous work looking at this association and these previous results seemed to show that kids with pets have better health than those without pets. The hypothesis has been that pets can improve children’s health by increasing physical activating and improving young people’s empathy skills.

We used data from over 5,000 households in California which was obtained from the California Health Interview Survey and looked at physical and mental health outcomes among children in households with pets vs. without pets.

We found that children in households with pets do have better health than those without pets, but that after we account for factors such as family income and housing type, for example, there is no evidence of an association between pet ownership and health. That is, households that have pets are more likely to be higher income, to be in a house as opposed to an apartment, and to have healthier adults in the household, for example – and these factors are also associated with better child health.

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