Asthma Improvement Collaborative Reduced ER Visits and Hospitalizations in Medicaid Population

MedicalResearch.com Interview with:

Dr. Carolyn M. Kercsmar, MD Co-Director, Division of Pulmonary Medicine Director, Asthma Center Cincinnati Children’s Hospital Medical Center Department of Pediatrics, University of Cincinnati, College of Medicine Cincinnati, Ohio

Dr. Kercsmar

Dr. Carolyn M. Kercsmar, MD
Co-Director, Division of Pulmonary Medicine
Director, Asthma Center
Cincinnati Children’s Hospital Medical Center
Department of Pediatrics, University of Cincinnati, College of Medicine
Cincinnati, Ohio 

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

Response: Asthma is the most common chronic condition of childhood and is responsible for substantial morbidity and health care costs, in large portion as a result of emergency room visits and hospitalizations. Moreover, children who live in poverty and are members of minority groups are disproportionately affected.

Our paper reports the results of a quality improvement project that spanned the inpatient, outpatient and community settings and resulted in significant reduction in emergency department visits and hospitalizations for asthma in urban children insured by Medicaid.

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

Response: Broad based interventions that are based on the chronic care model and involve changes in health care systems across multiple setting and disciplines can improve asthma outcomes.

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

Response: Future work should focus on replicating these findings in other settings and with other personnel, such as community health workers as interventionalists and a formal economic evaluation of the cost-effectiveness of the program. 

Disclosures: This work was supported by Cincinnati Children’s Hospital Medical Center and in part by a grant from Health Information Technology Beacon Program to the Cincinnati Children’s Hospital Medical Center and grant 90BC00116/01 for development of web-based asthma registry and health care use alerts. 

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

Citation:

Kercsmar CM, Beck AF, Sauers-Ford H, Simmons J, Wiener B, Crosby L, Wade-Murphy S, Schoettker PJ, Chundi PK, Samaan Z, Mansour M. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community. JAMA Pediatr. Published online September 18, 2017. doi:10.1001/jamapediatrics.2017.2600

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

 

 

 

 

 

Maternal Blood Pressure Rise During Pregnancy Linked To Increased Risk Of Childhood Obesity

MedicalResearch.com Interview with:

Duo Li, PhD Chief professor of Nutrition Institute of Nutrition and Health Qingdao University, China. 

Dr. Duo Li

Duo Li, PhD
Chief professor of Nutrition
Institute of Nutrition and Health
Qingdao University, China. 

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

Response: Childhood obesity is becoming an emerging public health issue worldwide, owing to its association with a variety of health problems at younger ages in adulthood, including obesity, type 2 diabetes and cardiovascular diseases. Identification of prenatal and early life risk factors is key for curbing the epidemic of the childhood obesity.

Main finding of the present study is that among pregnant women, elevated blood pressure is associated with a greater risk of overweight and obesity for their children.

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Chronic Hives In Children Resolve Slowly

MedicalResearch.com Interview with:

Hives-Urticaria Wikipedia image

Hives-Urticaria
Wikipedia image

Elena Netchiporouk, MD, FRCPC, MSc
Dermatology Resident – PGY5 and
Dr. Moshe Ben-Shoshan, MD, FRCPC, MSc
McGill University

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

Response: We have followed a pediatric cohort of 139 patients with chronic urticaria (CU) (hives) between 2013 and 2015 in a single tertiary care center and assessed the comorbidities, the rate of resolution and determined predictors of resolution.

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Large Trial Evaluates Inhaled Nitric oxide on Survival Without Pulmonary Dysplasia in Preterm Infants

MedicalResearch.com Interview with:

Shabih U. Hasan, MD, DCH, FRCPC Professor and Staff Neonatologist, Alberta Health Services Department of Pediatrics, Cumming School of Medicine University of Calgary

Dr. Hasan

Shabih U. Hasan, MD, DCH, FRCPC
Professor and Staff Neonatologist, Alberta Health Services
Department of Pediatrics, Cumming School of Medicine
University of Calgary

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

Response: Approximately 8% of all infants are born prematurely (preterm birth <37 weeks postmenstrual age). Preterm infants have many challenges including establishment of adequate pulmonary gas exchange. Due to not yet fully developed lungs, preterm infants require respiratory support consisting of respirators and other forms of non-invasive ventilation modalities and supplemental oxygen.  Bronchopulmonary dysplasia (BPD) is the commonest morbidity among very low birth weight infants as 40% of survivors at postmenstrual age <30 weeks develop BPD. This is a serious condition as it can lead to short- and long-term pulmonary complications, increased hospital visits and neurodevelopmental impairment. BPD is defined where preterm infants require respiratory support and/or supplemental oxygen at 36 weeks postmenstrual age.

A number of therapeutic and non-therapeutic modalities have been used to prevent BPD including inhaled nitric oxide (iNO).  In 2006, the NO CLD trial demonstrated that iNO prevented BPD (Relative benefit 1.81; CI 1.27-2.59, P = 0.006) if used according to the NO CLD Protocol (Ballard et al., New England Journal of Medicine, 355:343-353, 2006). Our study (NEWNO; Newborns treated with Nitric Oxide) was designed to replicate the NO CLD study.
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More Teenage Boys Becoming Fathers

MedicalResearch.com Interview with:

Maureen Pirog PhD Rudy Professor of Policy Analysis School of Public and Environmental Affairs Indiana University

Dr. Pirog

Maureen Pirog PhD
Rudy Professor of Policy Analysis
School of Public and Environmental Affairs
Indiana University 

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

Response: We analyzed parenthood, education and income statistics over a long time span from two groups of about 10,000 people — those born in 1962-64 and those born in 1980-82.

  • Teen fathers and mothers came increasingly from single-mother families with disadvantaged backgrounds.
  • The proportion of teen mothers or fathers living with their partners didn’t change, but far fewer were married.
  • The birth rates to teenage girls across the two groups didn’t change, but the reported rate of teenage fatherhood increased, a seemingly contradictory conclusion. For example, 1.7 percent of the men in the older group were fathers by the time they were 17, while in the younger group, nearly double that number were dads. About 8 percent of the 17-year-old females in both groups were mothers.

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Joint Physical Custody Better For Children’s Psychological Health

MedicalResearch.com Interview with:

Malin Bergström PhD Center for Health Equity Studies  Karolinska Institutet  

Dr. Bergstrom

Malin Bergström PhD
Center for Health Equity Studies
Karolinska Institutet  

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

Response: The increase in children who move between their parent’s homes after a divorce is one of the major changes in children’s life circumstances during the last decade. Spending equal amounts of time in both parents’ homes means that these children move fifty times a year. Child experts have claimed this to be stressful and potentially harmful to children’s attachment relations to their mothers. Especially for children this young the practice of joint physical custody has been questioned.

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New Assay Can Distinguish Between Viral and Bacterial Infections in Kids

MedicalResearch.com Interview with:
Prof. Alain Gervaix
Head of the Emergency Division
Department of Children and Adolescents
University Hospitals of Geneva
Switzerland

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

Response: Many are familiar with the following ‘seemingly’ simple clinical dilemma that occurs on a daily basis across the world. A patient visits the doctor with a fever. Commonly, assigning a diagnosis comes down to deciding whether the infection is bacterial or viral. Accordingly, the doctor decides if to treat or not to treat with antibiotics. The problem is that bacterial and viral infections often present with very similar symptoms, causing uncertainty that leads to antibiotics being used, in many instances, when they are not needed. This antibiotic misuse contributes to the rise of antimicrobial resistance, one of the biggest health threats of the 21st century.

Host biomarkers hold great promise as routine diagnostic tools that can assist doctors in making correct antibiotic treatment decisions, as they overcome key limitations of currently applied pathogen-based tests. Recently, a novel host-assay (ImmunoXpert™) for differentiating bacterial from viral infections was developed and validated to yield high sensitivity and specificity. The three-protein host-assay comprises tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), Interferon gamma-induced protein-10 (IP-10) and C-reactive protein (CRP).

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Childhood Tackle Football Linked To Increased Risk of Depression and Cognitive Issues In Adulthood

MedicalResearch.com Interview with:

Michael Alosco, PhD NRSA Postdoctoral Fellow Boston University Alzheimer’s Disease & CTE Center Boston University School of Medicine 

Dr. Alosco

Michael Alosco, PhD
NRSA Postdoctoral Fellow
Boston University Alzheimer’s Disease & CTE Center
Boston University School of Medicine 

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

Response: TThe goal of this study was to investigate whether playing youth tackle football, particularly before the age of 12, is associated with worse emotional, behavioral, and cognitive difficulties later in life. Participants in this study included 214 former amateur and professional American football players who were part of the LEGEND study at Boston University. Participants had an average age of 51. 43 played high school football, 103 played college football, and there were 68 professional American football players. The former players were divided into two groups: those who began playing tackle football before age 12 and those who began at age 12 or older. Participants received telephone-administered cognitive tests and completed online measures of depression, behavioral regulation, apathy, and executive functioning, such as initiating activity, problem-solving, planning, and organization. Results from former players who started playing tackle football before the age of 12 were compared to those of participants who started playing at age 12 or later.

The study showed that participation in tackle football before age 12 increased the odds for having problems with behavioral regulation, apathy and executive functioning by two-fold and increased the odds for clinically elevated depression scores by three-fold. These findings were independent of the total number of years the participants played football or at what level they played, such as high school, college, or professional. Even when a specific age cutoff was not used, younger age of exposure to tackle football corresponded with worse clinical status.

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Cheap Cigarettes in Europe Associated With Increased Infant Mortality

MedicalResearch.com Interview with:

Filippos Filippidis MD MPH PhD Lecturer in Public Health School of Public Health Imperial College London London

Dr. Filippidis

Filippos Filippidis MD MPH PhD
Lecturer in Public Health
School of Public Health
Imperial College London
London

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

Response: Smoking kills millions of people every year. It is well established that increasing tobacco prices is the most effective way to reduce tobacco consumption and hence mitigate the devastating effects of tobacco on health. Taxation on tobacco products is high in the European Union, which makes cigarettes less affordable. However, transnational tobacco companies are known to manipulate prices, ensuring that cheap or ‘budget’ cigarettes are still available. This is particularly important for younger smokers and those of low socioeconomic status who are more sensitive in price increases.

Smoking during pregnancy, as well as exposure of pregnant women and babies to cigarette smoke increase infant mortality. There is also evidence that increasing tobacco prices is associated with lower infant mortality. However, researchers typically use average or premium cigarette prices. We analysed 54 million births from 23 European Union countries to see if the differential between average priced and budget cigarettes (i.e. the availability of cigarettes much cheaper than average priced ones) is associated with infant mortality.

We found that increasing average cigarette prices by 1 Euro per pack was associated with 0.23 fewer deaths per 1,000 live births in the same year and an additional 0.16 fewer deaths per 1,000 live births in the following year. A 10% increase in the price differential between budget and average priced cigarettes was associated with 0.07 more deaths per 1,000 live births the following year. This means that 3,195 infant deaths could potentially have been avoided in these 23 countries if there was no price difference between cigarette products over the 10-year study period.

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Healthy Behaviors and Academic Success Go ‘Hand in Hand’

MedicalResearch.com Interview with:

Catherine N. Rasberry, PhD Health Scientist, Division of Adolescent and School Health CDC Atlanta

Dr.Raspberry

Catherine N. Rasberry, PhD
Health Scientist, Division of Adolescent and School Health
CDC Atlanta

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

Response: For many years, researchers have documented links between health-related behaviors and educational outcomes such as letter grades, test scores, and other measures of academic achievement. However, many of those studies are becoming out-of-date or have used samples that were not nationally representative. The aim of this study was to see if previous findings held in a current, national sample of high school students.

Consistent with previous studies, our findings revealed that regardless of sex, race/ethnicity and grade-level, high school students who received mostly A’s, mostly B’s, or mostly C’s had higher levels of most protective health-related behaviors and lower levels of most health-related risk behaviors. For example, we found that:

  • Students who reported receiving mostly Ds and Fs, were nine times more likely than students who received mostly As to report having ever injected any illegal drugs.
  • Also, students who reported receiving mostly Ds and Fs were more than four times more likely than students who received mostly As to report that they had four or more sexual partners.
  • Conversely, students who reported receiving mostly As were twice as likely as students who received mostly Ds and Fs to report eating breakfast every day in the past week.

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Small Kit Can Easily Detect Food Allergens On-Site

MedicalResearch.com Interview with:

Lee, Hakho, PhD Department of Systems Biology Harvard Medical School Boston, Massachusetts

Dr. Lee

Lee, Hakho, PhD
Department of Systems Biology
Harvard Medical School
Boston, Massachusetts

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

Response: The incidence of food allergy is increasing worldwide, particularly among children, and yet no handy test is available for general public. We wanted to solve this issue. Our pilot test showed wide variation in allergen contents in packaged food products and restaurant meals. Hidden allergens (like gluten in salad dressing, likely from additives) were also found.

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Adverse Birth Outcomes and Agricultural Pesticide Use in the San Joaquin Valley of California

MedicalResearch.com Interview with:

Ashley Larsen, PhD Assistant professor Bren School of Environmental Science & Management University of California, Santa Barbara

Dr. Larsen

Ashley Larsen, PhD
Assistant professor
Bren School of Environmental Science & Management
University of California, Santa Barbara

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

Response: The relationship between pesticides and adverse birth outcomes has been recognized as an important question for quite some time, and there have been many good studies on the topic. Since randomly exposing people to different levels of pesticides is clearly unethical, researchers focused on the health consequences of non-occupational pesticide exposure often have to choose between detailed studies that follow a couple hundred or couple thousand individuals through pregnancy or larger scale studies that use easier to observe, but less accurate metrics of pesticide exposure (e.g. nearby crops or crop types). Here we tried to provide complementary insight by bridging the gap between detail and scale using detailed pesticide use data and individual birth certificate records for hundreds of thousands of births in an agriculturally dominated region of California. While we found negative effects of pesticide use on birth outcomes including low birth weight, preterm birth and birth abnormalities, these effects were generally in the magnitude of a 5-9% increase in probability of an adverse outcome, and only observed for individuals exposed to very high levels of pesticides.

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Maternal Cell Phone Use Did Not Adversely Affect Children’s Language or Motor Skills At Age 5

MedicalResearch.com Interview with:

Jan Alexander, MD,PhD Norwegian Institute of Public Health Oslo Norway

Dr. Alexander

Jan Alexander, MD,PhD
Norwegian Institute of Public Health
Oslo Norway 

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

Response: The background for this study was the widespread uncertainty and general concern among the public about increasing exposure to weak radio frequency electromagnetic fields (EMF-RF). The concern on whether using your cell phone while pregnant can harm your foetus are mainly due to the extensive use of cell phones, that emit EMF-RF. Even though the RF-EMF exposure that may reach the foetus is very low, evidence from previous epidemiological studies with mothers and children are inconsistent as to whether EMF-RF emission from cell phone might harm the developing brain of the foetus. This includes also animal experiments where the exposure may be very different from that in humans.

We therefore studied the association between maternal cell phone use during pregnancy and child’s neurodevelopment at 3 and 5 years. We included around 45,000 mother and their children from all over Norway from the Norwegian Mother and Child Study (MoBa study) and used language development as the outcome because we in previous studies found this parameter to be sensitive to exposure to neurotoxicants. T

here was no evidence of a harmful effect of the mother using her cell phone during pregnancy on her child’s neurodevelopment at 3 and 5 years. Surprisingly, we even found that the more the mother was using her cell phone during pregnancy the better language and motor skills her child had at 3 years of age. We observed no associations when the child was 5 years old.

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Weight Gain Early In Pregnancy Linked To Higher Birthweight Babies

MedicalResearch.com Interview with:

Leanne M. Redman MS, PhD LPFA Endowed Fellowship Associate Professor Pennington Biomedical Research Center Baton Rouge, Louisiana

Dr. Redman

Leanne M. Redman MS, PhD
LPFA Endowed Fellowship
Associate Professor
Pennington Biomedical Research Center
Baton Rouge, Louisiana 

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

Response: Two well-documented risk factors for aberrant weight gain and obesity is whether your mother was obese when she was pregnant and the amount of weight she gained.

Up until now few studies have asked questions about whether the pattern of weight gain in pregnancy affect outcomes in offspring, such as birth weight.

In a cohort of over 16,000 pregnant women and infants, we found that regardless of the obesity status (BMI) of the mother at the time of pregnancy, weight gain that occurs up until week 24, had the strongest effect on infant birth weight. Infants born to mothers who had weight gain in excess of the 2009 IOM guidelines from conception until week 24, had a 2.5 times higher likelihood of being born large for gestational age. The weight gain that occurred after 24 weeks until delivery, did not attenuate this risk.

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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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More Babies Experiencing Neonatal Drug Withdrawal After Exposure To Opioids and Psychotropic Meds

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
Assistant 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: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood.

In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.

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Nearly 20% of Children May Not Have Normal Hearing

MedicalResearch.com Interview with:

Dr. Carlijn M. P. le Clercq, MD Speech and Language Pathology, Pediatrics, Otolaryngology Erasmus MC , Rotterdam 

Dr. Carlijn M. P. le Clercq

Dr. Carlijn M. P. le Clercq, MD
Speech and Language Pathology, Pediatrics, Otolaryngology
Erasmus MC , Rotterdam

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

Response: There has been increasing interest for acquired hearing loss among children, and concerns about its prevalence possibly rising over time. One of the questions that come up, is whether there is an association with the growing use of portable music players with headphones, including smartphones and tablets. There have been few longitudinal studies to explore this relation.

In order to examine this relation, among other factors, we have conducted a formal hearing screening among more than 5000 9- to 11-year-old children from a population-based birth cohort in the Netherlands.

Our study showed that nearly one in five children did not have normal hearing. Of the cohort, 7.8% of the children showed signs of permanent hearing loss.

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Mobile Message Delivery Can Help Parents Learn Safe Infant Sleep Practices

MedicalResearch.com Interview with:

Rachel Y. Moon, M.D. Division Head, General Pediatrics Professor of Pediatrics University of Virginia School of Medicine Charlottesville, VA 22908

Dr. Moon

Rachel Y. Moon, M.D.
Division Head, General Pediatrics
Professor of Pediatrics
University of Virginia School of Medicine
Charlottesville, VA 22908

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

Response: Approximately 3500 babies die suddenly and unexpectedly during sleep in the US every year. Even though there are safe sleep recommendations, many parents do not follow them because of misinformation or misconceptions.

Therefore we tested 2 complementary interventions to promote infant safe sleep practices. The first was a nursing quality improvement intervention aimed at ensuring that mothers would hear key messages and that there was appropriate role modeling of safe sleep practices by hospital personnel.

The second was a mobile health intervention, in which mothers received videos and text messages or emails with safe sleep information during the baby’s first two months of life. We randomized mothers to receive either the safe sleep interventions or breast-feeding interventions (the control interventions). Mothers who received the mobile health intervention reported statistically significantly higher rates of placing their babies on their back, room sharing without bed sharing, no soft bedding use, and pacifier use, compared with mothers who received a control intervention. Although the nursing quality improvement intervention did not influence infant safe sleep practices, there was an interaction such that mothers who received both the safe sleep nursing quality improvement intervention and the safe sleep mobile health intervention had the highest rates of placing their babies on the back.

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Stress of 911 Linked To Decrease In Male Babies Born With Birth Defects

MedicalResearch.com Interview with:
Parvati Singh B. Tech, MBA, MPA
PhD student, Department of Public Health,
University of California, Irvine and
Dr. Tim Bruckner, first author

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

Response: This study builds upon earlier research by our group which showed that male fetal deaths rose and the number of liveborn males fell after the 9/11 attacks. Here we show that, in California, the number of live born males with birth defects fell after 9/11.

This finding appears consistent with the notion that frail male gestations, such as those with defects, may have been lost in utero as a result of the stress induced by the 9/11 attacks.

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Lifestyle-Based Tool Estimates Premature Cardiovascular Events in Young Adults

MedicalResearch.com Interview with:

Holly Gooding, MD, MSc Assistant Professor of Medicine and Pediatrics, Harvard Medical School Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Division of General Internal Medicine, Brigham and Women's Hospital Boston, MA

Dr. Gooding

Holly Gooding, MD, MSc
Assistant Professor of Medicine and Pediatrics
Harvard Medical School
Division of Adolescent/Young Adult Medicine
Boston Children’s Hospital
Division of General Internal Medicine
Brigham and Women’s Hospital
Boston, MA

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

Response: Dr Stephanie Chiuve and colleagues at the Harvard TH Chan School of Public Health developed the Healthy Heart Score to predict the risk of heart disease in older adults based on lifestyle factors measured in middle age. We have known for some time that the precursor to heart disease – known as atherosclerosis – actually starts in childhood and adolescence. We calculated the Healthy Heart Score for young adults ages 18-30 years old and found it works in this age group as well.

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Babies Find Nipples To Nurse Because of Higher Areolar Temperature

MedicalResearch.com Interview with:
Francesca Volpe Psy.D and Prof. Vincenzo Zanardo Division of Perinatal Medicine, Policlinico Abano Terme Abano Terme, Italy
Francesca Volpe Psy.D and
Prof. Vincenzo Zanardo
Division of Perinatal Medicine, Policlinico Abano Terme
Abano Terme, Italy

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

Response: Newborn infants, placed skin-to-skin on their mother’s chest instinctively have the ability to crawl to their mother’s breast, exploring with their hands and massaging the breast to support the first feed.  Left undisturbed, the infant will make several attempts until it finds and latches onto the nipple and begins to nurse.

What leads mammalian infants who are placed on their mothers’ chests to seek out, without any assistance, the nipple and to attach themselves to it to nurse is not fully understood. When we turned our attention to the thermal properties of the female’s nipple-areolar complex (NAC) in lactating mothers soon after birth, we found that it had a higher temperature and pH value and lower elasticity with respect to the surrounding breast skin. We hypothesised that the higher temperature could help the newborn infant to locate the nipple and to latch onto it, leading to the first sucking experience.  In addition, the diffusion of odorous molecules is presumably enhanced by the relatively high surface temperature of the areola in view of the rich supply of blood capillaries that irrigate the region. There is, in fact, some scientific evidence that show that infants respond to the odours released by the breasts of lactating women; breast odours, which are enhanced by the skin’s greater warmth, are another factor that facilitates breastfeeding by helping the infant to recognize its mother participating in the mother-to-infant bonding.

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High Dose Vitamin D No Advantage In Preventing Pediatric Viral Infections

MedicalResearch.com Interview with:

Jonathon Maguire MD MSc FRCPC Scientist, Li Ka Shing Knowledge Institute

Dr. Maguire

Jonathon Maguire MD MSc FRCPC
Scientist, Li Ka Shing Knowledge Institute
Staff Pediatrician, Department of Pediatrics, St. Michael’s Hospital

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

Response: Vitamin D has been hypothesized as being protective of seasonal viral upper respiratory tract infections.  In this randomized clinical trial, high dose wintertime vitamin D supplementation (2000 IU/day) was compared with standard-dose vitamin D supplementation (400 IU/day) among 703 children.  The number of laboratory confirmed viral upper respiratory tract infections was not statistically different between groups.

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Breastfeeding Rates Increase But Racial Gaps Persist

MedicalResearch.com Interview with:

Dr. Erica H. Anstey PhD Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion  Immunization Services Division National Center for Immunization and Respiratory Diseases CDC

Dr. Anstey

Dr. Erica H. Anstey PhD
Division of Nutrition, Physical Activity and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Immunization Services Division
National Center for Immunization and Respiratory Diseases
CDC

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

Response: The American Academy of Pediatrics (AAP) recommends that infants are breastfed exclusively for about the first 6 months and that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. Although breastfeeding initiation and duration rates have increased overall in the United States, breastfeeding rates vary by geographic location, socioeconomic, and race/ethnic groups. Breastfeeding initiation and duration have been historically and consistently lower among black infants compared with white and Hispanic infants.

There are many factors that influence a woman’s decision to start and continue breastfeeding. These include knowledge about breastfeeding, cultural and social norms, family and social support, and work and childcare environments. Some barriers to breastfeeding are disproportionately experienced by black women, including earlier return to work, inadequate receipt of breastfeeding information from providers, and lack of access to professional breastfeeding support.

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American Academy of Family Physicians Foundation Launches Highlight on VACCINATIONS 4 TEENS to Help Address Teen Under-Vaccination

 

MedicalResearch.com Interview with:

Hughes Melton, MD, MBA, FAAFP AAFP Foundation president

Dr. Melton

S. Hughes Melton, MD, MBA, FAAFP
AAFP Foundation president

MedicalResearch: What is the background for this initiative? What are the main vaccinations that teens should have?

 Response: The Centers for Disease Control and Prevention (CDC) recommends adolescents receive four immunizations – two of which are administered as multi-dose series – to help protect against meningococcal meningitis caused by serogroups A, C, W and Y; human papillomavirus (HPV); tetanus, diphtheria and pertussis (Tdap); and influenza (flu).1 Despite these recommendations, millions of teens remain vulnerable to serious infectious disease.2,3

Family physicians are well equipped to immunize their patients against a host of common infectious diseases and improve public health. However, discussing teen vaccinations during annual appointments may present challenges due to other issues teens and their parents/guardians may be focused on at this age. The American Academy of Family Physicians Foundation (AAFP Foundation) launched Highlight on VACCINATIONS 4 TEENS to help remind family physicians and their care teams to make immunization a priority at these key appointments for teens.

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Brain Imaging Confirms Boys and Girls Experience Depression Differently

MedicalResearch.com Interview with:

Jie-Yu Chuang PhD Department of Psychiatry University of Cambridge Cambridge, United Kingdom

Dr. Jie-Yu Chuang

Jie-Yu Chuang PhD
Department of Psychiatry
University of Cambridge
Cambridge, United Kingdom 

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

Response: Men and women appear to suffer from depression differently, and this is particularly striking in adolescents. By 15 years of age, girls are twice as likely to suffer from depression as boys. There are various possible reasons for this, including body image issues, hormonal fluctuations and genetic factors, where girls are more at risk of inheriting depression. However, differences between the sexes don’t just involve the risk of experiencing depression. Men are more liable to suffer from persistent depression, whereas in women depression tends to be more episodic. Compared with women, depressed men are also more likely to suffer serious consequences from their depression, such as substance abuse and suicide. Despite this, so far, most researchers have focused on depression in women, likely because it is more common. As a result, we’d like to make people more aware of the sex difference issue in depression.

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BLISS – Baby Led Introduction To Solids – May Make Feeding Less Fussy

MedicalResearch.com Interview with:
Dr. Anne-Louise M. Heath and

Professor Rachael Taylor
Co-Principal Investigators for the BLISS study.

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

Response: Conventional approaches to complementary feeding generally advise parents to spoon-feed their infant pureed foods, gradually progressing to greater variety and texture so that by the time the infant is one year of age, they are eating more or less what the family does.

Baby-led weaning (BLW) is an alternative approach where the infants feeds themselves right from the start of complementary feeding. Because children of this age cannot use utensils, this means hand-held foods are necessary. Advocates of BLW suggest that children have a lower risk of obesity because they remain in control of their own food intake, but research examining this issue directly is scarce. Health professionals have also expressed concern that BLW might put the infant at increased risk of iron deficiency (parents might avoid red meat for fear of the infant choking, and iron-fortified cereals are not easy for the infant to feed themselves), growth faltering (if only low energy foods are offered) and choking (from the infant feeding themselves ‘whole’ foods).

Our study therefore examined a version of BLW that had been modified to address these issues (called BLISS – a Baby-Led Introduction to SolidS). Two hundred families took part in our 2-year intervention, with half following traditional feeding practices and half receiving guidance and support to follow our BLISS approach. We found that BLISS children were not less likely to be overweight than those following traditional feeding practices, nor was growth faltering an issue. BLISS child ate about the same amount of food as control children, and their ability to eat to appetite was not different either.

However, it seems that children following a baby-led approach to complementary feeding are less fussy about food, and have a healthier attitude to food, which might make a difference to their health long term.
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Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy

MedicalResearch.com Interview with:

Seetha Shankaran, M.D. Professor, Neonatology Wayne State University School of Medicine

Dr. Shankaran

Seetha Shankaran, M.D.
Professor, Neonatology
Wayne State University School of Medicine

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

Response: The study was performed because infants with moderate or severe hypoxic-ischemic encephalopathy (abnormal neurological exam within 6 hours of birth due to lack of blood and oxygen supply to the brain at birth) have rates of death or survival with disability that were still high in spite of current intensive care including hypothermia.

Whole-body hypothermia, cooling the infant for 72 hours at a depth of 33.5°C that was performed by the Neonatal Research Network funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development was the first trial of this therapy in the USA. We found that hypothermia therapy did decrease the rate of death or survival with disability from 62 to 44%. Since 44% is still high we wanted to see if longer cooling or deeper cooling or both would reduce this rate.

This was a randomized controlled clinical trial to examine whether longer cooling or deeper cooling or both reduced the rate of death or survival with disability among full term neonates with hypoxic-ischemic encephalopathy. The study lasted from October of 2010 to January 2016. 364 infants were enrolled. Neonates were randomly assigned to 4 groups of cooling therapy and the major findings were that neither longer cooling nor deeper cooling nor both were more superior to cooling for 72 hours at 33.5°C.

Our results were surprising because at the time we planned this study there were reports from animal model studies that longer/deeper cooling were more protective to the brain.

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Father’s Involvement In Childrearing Important In Reducing Pediatric Obesity

MedicalResearch.com Interview with:

Michelle S. Wong PhD Department of Health Policy and Management Johns Hopkins School of Public Health Baltimore, Maryland

Dr. Wong

Michelle S. Wong PhD
Department of Health Policy and Management
Johns Hopkins School of Public Health
Baltimore, Maryland
MedicalResearch.com: What is the background for this study?

Response: As background, there haven’t been many studies on how fathers might influence overweight or obesity in their children.

Unsurprisingly most of the research has focused on
the mothers’ influence. Existing studies on fathers have focused on the relationship between their parenting practices (e.g., discipline), as well as feeding and physical activity behaviors, with child overweight or obesity. A few studies found that some father feeding practices were related to higher child BMI, but we don’t know whether fathers’ general caregiving matters.

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Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection.

MedicalResearch.com Interview with:

Peter Carew Lead author, MCRI PhD student  Clinician

Peter Carew

Peter Carew
Lead author, MCRI PhD student
Clinician
The University of Melbourne

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

Response: The age at diagnosis of a congenital hearing loss has dropped over time. This has allowed for earlier fitting of amplification (hearing aids, cochlear implants) and earlier access to education intervention programs, all intended to lessen the impact of hearing loss on development. Much research has focused on the outcomes achieved by children with severe and profound losses, but relatively little attention has been given to milder hearing losses (mild and moderate). Despite this lack of evidence, we are observing children with mild loss being fitted with hearing aids earlier than ever before. From a historical age of fitting not uncommonly at 2 years of age or older, today the largest number of children under 12 months who receive a hearing aid for the first time in Australia have a mild hearing loss in their better hearing ear. To this end, clinical practice may have jumped ahead of the evidence in terms of understanding any benefits children with mild hearing loss receive from having hearing aids earlier.

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USPSTF Recommends Children and Adolescents Be Screened For Obesity

MedicalResearch.com Interview with:

David C. Grossman, M.D., M.P.H. US Preventive Services Task Force Chair Senior Investigator, Kaiser Permanente Washington Health Research Institute Senior Associate Medical Director, Market Strategy & Public Policy Kaiser Permanente Washington Physician, Washington Permanente Medical Group, Pediatrics

Dr. Grossman

David C. Grossman, M.D., M.P.H.
US Preventive Services Task Force Chair
Senior Investigator, Kaiser Permanente Washington Health Research Institute
Senior Associate Medical Director, Market Strategy & Public Policy
Kaiser Permanente Washington
Physician, Washington Permanente Medical Group, Pediatrics

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

Response: Recognizing that obesity is a nation-wide health problem, affecting approximately 17% of 2-to 19-year-old children and adolescents in the U.S., the Task Force finalized its recommendation on screening for obesity in children and adolescents and the benefits and harms of weight management interventions. The Task Force found sufficient evidence to recommend screening for obesity in children and adolescents age 6 years and older and then offering or referring those who are found to be obese comprehensive, intensive behavioral interventions to manage their weight and improve overall health.

MedicalResearch.com: What are the potential benefits and harms of early screening and intervention for obesity in children?

Response: The Task Force found that intensive behavioral interventions for children and adolescents who have obesity can result in benefits of improvement in weight status for up to 12 months’ post-intervention. Additionally, the evidence indicated very little harm from screening and comprehensive, intensive behavioral interventions. This is due to likely minimal harms of using BMI (body mass index), the absence of reported harms of behavioral interventions, and the noninvasive nature of the programs.

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The President’s Malaria Initiative Reduced All-Cause Childhood Mortality

MedicalResearch.com Interview with:

Alexsandra Jakubowski

Aleksandra Jakubowski MPH

Aleksandra Jakubowski, MPH PhD candidate
Department of Health Policy and Management
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

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

Response: The US President’s Malaria Initiative (PMI) provides approximately $600 million annually to fund implementation of key evidence-based malaria prevention and treatment interventions, including insecticide treated nets (ITNs), artemisinin-based combination therapy (ACT), and indoor residual spraying (IRS) to populations in 19 recipient countries in sub-Saharan Africa (SSA). Despite this considerable investment, no study to date has evaluated the impact of PMI on population health outcomes. Previous evaluations have noted improved health outcomes in PMI countries, but comparison groups are needed to establish whether these changes were beyond the declining trends in mortality observed in the rest of the region. Our study sought to generate objective evidence for policy makers about the role this US-funded malaria aid program may have played in curbing child mortality in SSA.

We used a quasi-experimental design known as difference-in-differences to compare trends in health outcomes in PMI-recipient vs. PMI non-recipient countries. We analyzed publicly-available data from 32 countries in SSA spanning a period that included about ten years before and after the introduction of the program.

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Most Youth With Opioid Disorders Do Not Receive Medications For Addiction

MedicalResearch.com Interview with:

Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine

Dr. Hadland

Scott Hadland, MD, MPH, MS
Youth Addiction Specialist
Assistant Professor of Pediatrics
Boston University School of Medicine
Director, Urban Health and Advocacy Track, Boston Children’s Hospital and Boston Medical Center
Associate Program Director, Boston Combined Residency Program in Pediatrics, Boston Medical Center

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

Response: Almost no data have been available on this topic to date.  A recent study showed that teens in subspecialty treatment for opioid addiction were significantly less likely than adults to receive a medication.  Our study was the first to comprehensively look across the health care system, including looking at adolescents and young adults diagnosed with opioid use disorder in outpatient clinics, emergency departments, and inpatient hospitals.

We had three important findings.  First, looking at a large sample of 9.7 million adolescents and young adults between the age of 13 and 25 years, we found that the number of youth diagnosed with opioid use disorder increased six-fold from 2001 to 2014.  This is perhaps not surprising given the national opioid crisis we know to be occurring.

Second, we found that only a minority of youth (1 in 4) received buprenorphine or naltrexone, the two medications available for opioid addiction that can be prescribed in usual medical settings.  These two medications are evidence-based and their use is recommended by the American Academy of Pediatrics.  Utilizing them is critical to ensure that we offer effective treatment early in the life course of addiction, which can help prevent the long-term harms of addiction.

Third, we found significant differences in who received medications.  Whereas approximately 1 in 3 young adults in our study received a medication, only 1 in 10 of the 16- and 17-year-olds we studied received one, and among adolescents under 15 years of age, 1 in 67 received a medication.  Females were less likely than males to receive medications, as were black youth and Hispanic youth relative to white youth.

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Fewer Refined Grains During Pregnancy May Reduce Obesity Risk In Kids

MedicalResearch.com Interview with:

Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Bethesda, MD 20817 

Dr. Zhang

Cuilin Zhang MD, PhD
Senior Investigator, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Bethesda, MD 20817 

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

Response: Refined grains with a high glycemic index and reduced fiber and nutrient content have been linked to increased adiposity and higher risk of metabolic syndrome among adults. Despite these differences and the growing body of literature on the link between maternal diet/nutrition during pregnancy and subsequent offspring health consequences throughout the lifespan, little is known about the intergenerational impact of refined-grain intake during pregnancy on long-term cardio-metabolic outcomes in the offspring.

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When Should Babies Be Introduced To Peanuts, Eggs and Cow’s Milk?

MedicalResearch.com Interview with:

Dr. Malcolm Sears, Professor  MB, ChB, FRACP, FRCPC, FAAAAI Co-director of the CHILD Study Division of Respirology, Department of Medicine, McMaster Universi

Dr. Sears

Dr. Malcolm Sears, Professor
MB, ChB, FRACP, FRCPC, FAAAAI
Co-director of the CHILD Study
Division of Respirology, Department of Medicine,
McMaster University

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

Response: The Canadian Healthy Infant Longitudinal Development (CHILD) Study is a longitudinal birth cohort study commenced in 2008 with 3,495 families across Canada.  We recruited the mothers during pregnancy and are following their children to age 5 with the intent of determining the underlying developmental causes of allergy and asthma.

In the current analysis, we have looked at the relationship between the timing of first introduction of three “allergenic” foods (milk products, egg and peanut) and the likelihood of sensitization to these foods at age 1 year.  We found that earlier introduction was associated with a reduced risk of sensitization, which is consistent with some recent randomized controlled trials.  For instance, infants who avoided cow’s milk product in their first year of life were nearly four times as likely to be sensitized to cow’s milk compared with infants who did consume cow’s milk products before age 12 months.  Similarly, infants who avoided egg or peanut in the first year were nearly twice as likely to be sensitized to those foods compared to infants who consumed them before 12 months of age.

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Opioids Withdrawal in Babies Adding Millions To Health Care Costs

MedicalResearch.com Interview with:

Tammy E. Corr, D.O. Assistant Professor of Pediatrics Division of Newborn Medicine Penn State Hershey College of Medicine

Dr. Corr

Tammy E. Corr, D.O.
Assistant Professor of Pediatrics
Division of Newborn Medicine
Penn State Hershey College of Medicine

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

Response: Recent literature has revealed hospital charges related to neonatal abstinence syndrome (NAS) have increased. However, there are no data available regarding costs of an NAS admission. Because charges are variable and influenced by a number of factors, provider costs to care for a patient offer more meaningful information.

Therefore, we endeavored to determine the incidence of NAS in the United States and estimate the total annual costs and hospital length of stay for an neonatal abstinence syndrome admission as well as the incremental costs and hospital days of admission for an NAS patient compared to a non-NAS admission.

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Maternal Obesity Linked To Increased Risk of Congenital Malformations in Offspring

MedicalResearch.com Interview with:
Dr. Martina Persson

Clinical Epidemiology Unit
Department of Medicine Solna
Karolinska University Hospita

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

Response: It is well known that obesity increases risks of several maternal, fetal and neonatal complications including congenital malformations. However, it has not been clear if risks of malformations are increased also in offspring of normal weight mothers or if risks increase with degree of maternal obesity.

In this study, we found progressively increasing risks of major congenital malformations in the offspring with a mother’s overweight and obesity severity.

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

Response: The most sensitive period of fetal organ development is the first eight weeks of gestation and it is during this time a mother´s BMI may influence risks of malformations. Thus, it is important to try to obtain a normal bodyweight before conception.

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

Response: Our results should be confirmed in other populations and mechanisms behind the increased risks of malformations associated with maternal obesity should be further explored.

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

Response: Obesity is a major health problem in many countries in the world. Preventive measures to halt the obesity epidemic should be implemented at all levels of society.

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

Citation:

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

More Medical Research Interviews on MedicalResearch.com

 

 

 

College Binge Drinkers Also Smoking More Pot In States Where Marijuana Legal

MedicalResearch.com Interview with:

David Kerr PhD Associate professor in the School of Psychological Science College of Liberal Arts Ohio State University 

Dr. Kerr

David Kerr PhD
Associate professor in the School of Psychological Science
College of Liberal Arts
Ohio State University 

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

Response: Oregon legalized sale and use of marijuana for recreational purposes and the part of the law (regarding use) took effect in July 2015. However, there have been no controlled studies of which we’re aware of the possible effects of the Oregon law that take into account the trends toward increased marijuana use across the country and differences in use rates between states that predated the law.

We used survey data on college students in Oregon and in 6 states without recreational legalization to examine the issue.

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Epigenetic Changes Identified In Children Who Develop Early Onset Conduct Problems

MedicalResearch.com Interview with:
Charlotte Cecil, PhD

ESRC FRL Fellow
Edward Barker, PhD
Lab Director, DEVELOPMENTAL PSYCHOPATHOLOGY LAB

Department of Psychology
Institute of Psychiatry, Psychology& Neuroscience
King’s College London

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

Response: Conduct problems (CP) are the most common reason for child treatment referral in the UK, costing an estimated £22 billion per year. Children with CP engage in a range of aggressive and antisocial behaviours (e.g. fighting, stealing, lying), that affect their ability to follow rules and adapt to society, do well in school, and form healthy relationships. Those who do not receive treatment are also at increased risk for many negative outcomes in adulthood, including lower job prospects and earnings, more contact with the police and a lower quality of life. Therefore, it is important to understand how CP develop in the first place, in order to create more effective prevention and intervention strategies.

Studies have found that children who develop conduct problems before the age of 10 (early-onset CP) are at greatest risk for poor outcomes across the lifespan. Compared to other children, those showing early-onset CP tend to have experienced more adversity in early life (e.g. prenatal stress, poverty) as well as having more genetic risk. However, little is known about about how genetic factors interact with environmental influences – especially during foetal development – to increase the risk for early-onset conduct problems.

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Oral Sotagliflozin On Top of Optimized Insulin Significantly Reduced A1C

MedicalResearch.com Interview with:

Prof. Dr. Thomas Danne Chief Physician Diabetology, Endocrinology and General Pediatrics and Clinical Researc Kinder und Junden Krankenhau

Prof. Danne

Prof. Dr. Thomas Danne
Chief Physician Diabetology, Endocrinology and General Pediatrics and Clinical Researc
Kinder und Junden Krankenhaus

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

Response: The double-blind, placebo controlled, Phase 3 study known as inTandem2 randomized 782 adult patients from 99 sites in the EU and Israel with type 1 diabetes on insulin pump or multiple daily injection therapy who had an A1C level entering the study between 7.0% and 11.0%. The three-arm study evaluated two doses of sotagliflozin, 200mg and 400mg, each taken once daily before the first meal of the day, against placebo. Prior to randomization, insulin was optimized for all patients over a six-week period, with the objective of improving glycemic control using insulin alone. After completion of this optimization period, patients were maintained on optimized insulin and randomized to one of two doses of sotagliflozin or placebo, and their baseline, post-optimization A1C was measured.

The mean baseline A1C levels after the six-week optimization period were 7.8%, 7.7% and 7.7% for patients randomized to the placebo, 200mg and 400mg arms, respectively (A1C was 8.4% across all dose arms prior to insulin optimization).

The primary endpoint of the study was change in A1C from baseline after a 24-week period of treatment. The trial has a double-blind long term extension of 28 weeks, with a total treatment duration of 52 weeks. There were 258 patients in the placebo arm, 261 patients in the 200mg dose arm and 263 patients in the 400mg dose arm. The overall mean placebo-adjusted A1C reduction at week 24 was 0.36% in the 200mg dose arm (p<0.001) and 0.35% in the 400mg dose arm (p<0.001). In response to regulatory input, a secondary endpoint to measure “net clinical benefit” was defined for this study as the proportion of patients at week 24 who achieved the standard of care A1C goal of less than 7.0% without any episode of severe hypoglycemia or DKA. 15% of patients in the placebo arm, 32% in the 200 mg dose arm and 32% in the 400mg dose arm achieved this endpoint (p<0.001 for both treatment arms).

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Dramatic Increase in ACL Injuries and Surgery in Adolescent Girls

MedicalResearch.com Interview with:

Mackenzie M. Herzog, MPH PhD Candidate, Injury Epidemiology The University of North Carolina at Chapel Hill 

Mackenzie Herzog

Mackenzie M. Herzog, MPH
PhD Candidate, Injury Epidemiology
The University of North Carolina at Chapel Hill 

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

Response: In 1999, a study by Arendt et al. reported that women were more likely to tear their ACL than men while playing the same sport. Since then, numerous studies have investigated this sex difference in ACL injury, and many prevention programs targeting youth athletes have been developed and tested. Although randomized trials have demonstrated the value of injury prevention programs in reducing the risk of ACL injury, the overall impact of these programs has not been examined in the general population. Our study investigated the net impact of research and prevention efforts over nearly 20 years in reducing ACL injuries by assessing time trends of ACL reconstruction, a consequence of ACL injury, among commercially-insured individuals in the United States.

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Regular Adolescent Cannabis Users More Likely To Have Later Problems with Drugs, Alcohol and Tobacco

MedicalResearch.com Interview with:
Dr Michelle Taylor PhD
Senior Research Associate in Epidemiology
MRC Integrative Epidemiology Unit (IEU)
School of Social and Community Medicine
University of Bristol
Bristol UK

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

Response: Many previous studies have looked at adolescent cannabis use, however most of these look at use at a single time point, for example whether an individual has ever used cannabis at age 16 years, or how regularly a person uses cannabis at age 18. However, as young people do not initiate use at the same time or follow the same pattern of use, using measures at a single time point does not always tell the whole story.
We used a form of statistical modelling using data taken over the course of adolescence to try and characterise underlying patterns of cannabis use across adolescence. We used data from the Avon Longitudinal Study of Parents and Children which had information on cannabis use at six time points between the ages of 13 and 18 years.

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