Allergies, Asthma, Author Interviews, Emergency Care, Pediatrics / 07.11.2015 Interview with: Jill Hanson, MD Children’s Mercy Hospital Kansas City MO  Background from the American College of Allergy, Asthma & Immunology “Asthma is the most common chronic disease in children, and one of the most difficult to manage, which is one of the reasons there are so many emergency department visits for asthma sufferers in the US.” Medical Research: What are the main findings of this study? Dr. Hanson: Our study of asthmatic children found that the number of historical asthma-related acute care visits (i.e. urgent care, emergency department and inpatient admissions) was predictive of future asthma-related acute care visits.  (more…)
Author Interviews, Infections, Pediatrics, Respiratory / 06.11.2015 Interview with: Dominik Mertz, MD, MSc, FMH (CH) Assistant Professor, McMaster University Department of Medicine, Division of Infectious Diseases Associate Membership Department of Clinical Epidemiology and Biostatistics / Pathology and Molecular Medicine Medical Director Infection Prevention & Control, Hamilton Health Sciences Juravinski Hospital and Cancer Center Hamilton, ON, Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Mertz: There was a perception that there was an increase in ICU admissions and deaths, initially in Kansas City and Chicago, which was found to be related to the enterovirus strain EV-D68, which had previously not resulted in any major outbreaks in North America. We have one of the first laboratories that was able to provide a specific EV-D68 PCR routine testing allowing us identify EV-D68 cases and to compare the outcomes in patients infected with this strain to children infected by other rhino/enteroviruses. We found a substantial overlap in how the patients presented between patients with EV-D68 and non-EV-D68 infection. It seems that children infected with EV-D68 were in deed at higher risk for having respiratory distress and needing hospital admission, with children with allergies being at a higher risk. We did not find an increase in more severe outcomes, though, i.e. no higher risk for ICU admission (23 vs 15%) and 0 deaths in the EV-D68 group. We also did not find any evidence of in-hospital transmission of EV-D68. (more…)
Accidents & Violence, Author Interviews, Pediatrics, Race/Ethnic Diversity / 04.11.2015

Bindu Kalesan PhD MPH Director Evan’s Center for Translational Epidemiology and Comparative Effectiveness Research Assistant Professor of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA Interview with: Bindu Kalesan PhD MPH Director Evan’s Center for Translational Epidemiology and Comparative Effectiveness Research Assistant Professor of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118  Medical Research: What is the background for this study? What are the main findings? Dr. Kalesan: Firearm injuries are one of the 3 major causes of death in children in the US. for every 7 pediatric firearm deaths there are 8 children non-fatally injured by a gun. Those that survive will live with disability and severe morbidity. From our earlier studies, we found that this burden of survivorship and injury is different according to race/ethnicity. There is also evidence that Injury related hospitalizations are also associated low-income households and neighborhoods. In the background of gun (violence) control, frequently comparisons are drawn between firearm injuries and motor vehicle accidents. In this study we use nationally representative hospitalization data and compared pediatric firearm-related hospitalization and pedestrian motor vehicle accident hospitalizations to assess whether the risk of firearm related hospitalizations among minorities varies depending on the neighborhood they live. We found that black children were at substantially greater risk of firearm hospitalization as compared to pedestrian motor vehicle hospitalization. This greater risk of firearm hospitalization among black children persisted across neighborhoods. Simply put, the risk of firearm hospitalization versus pedestrian motor vehicle hospitalization among black children was high, regardless of whether they lived in low income or high income neighborhoods.We also found that all minority race children (black, Hispanic and other race) as compared to white children were at a greater likelihood of homicide-firearm hospitalization than of pedestrian motor vehicle hospitalization and all minority race children were significantly less likely to be hospitalized for unintentional firearm than pedestrian injuries in comparison to white children. Therefore, overall we found a minority race disadvantage regardless of whether they lived in high and low-income neighborhoods. (more…)
Author Interviews, Columbia, Compliance, HIV, JAMA, Pediatrics / 04.11.2015 Interview with: Dr. Louise Kuhn PhD Professor, Epidemiology Sergievsky Center Columbia University  Medical Research: What is the background for this study? What are the main findings? Dr. Kuhn: Ritonavir-boosted lopinavir-based antiretroviral therapy is recommended as first-line treatment for HIV-infected infants and young children while efavirenz is recommended for adults and older children. There are several advantages of transitioning HIV-infected children to efavirenz-based treatment as they get older.  These advantages include the possibility of once-daily dosing, simplification of co-treatment for tuberculosis, avoidance of some metabolic toxicities, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. However, there have been concerns about possible reduced viral efficacy of efavirenz-based treatment in children exposed to nevirapine for prevention of mother-to-child transmission.  This is because efavirenz and nevirapine are in the same drug class and the majority of children who become infected despite exposure to nevirapine used for prevention have mutations in their virus that usually predict resistance to this drug class. In this study, we randomized HIV-infected children to two different treatment strategies: In the control strategy they remained on their initial ritonavir-boosted lopinavir regimen; in the alternative strategy they transitioned to an efavirenz-based regimen.  All children had been exposed to nevirapine used (unsuccessfully) to prevent mother to child HIV transmission and were virologically-suppressed (HIV in blood < 50 copies/ml) at the time of enrollment into the study.  We observed excellent virological control in both groups with fewer than 3% of children having levels of HIV in their blood greater than 1000 copies/ml.  Sustained suppression of virus in blood below 50 copies/ml throughout follow-up was achieved in 82% of the children transitioned to efavirenz-based treatment compared to 72% of children remaining on the control treatment. (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 03.11.2015 Interview with: Dr. Tove Fall, PhD Associate Professor in Epidemiology Ingelsson Group Upssala University Medical Research: What is the background for this study? What are the main findings? Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies. (more…)
Asthma, Author Interviews, Immunotherapy, Pediatrics / 31.10.2015 Interview with: Stephen J. Teach, MD, MPH Chair, Department of Pediatrics Children's National Health System Washington, DC  Medical Research: What is the background for this study? What are the main findings? Dr. Teach: Inner-city children aged 6 to 17 years with moderate to severe asthma continue to experience exacerbations at high rates during the fall season despite therapy which follows the guidelines of the National Institutes of Health. These exacerbations are most common among children with a history of prior exacerbations and sensitivities to common indoor allergens who develop an upper respiratory infection with the common cold virus (rhinovirus). The PROSE study found that treatment with omalizumab begun 4 to 6 weeks before the children return to school, significantly reduced exacerbations of asthma in the first 90 days of the school year. This effect was most dramatic among those children who had experienced an exacerbation in the months preceding the beginning of the school year. Omalizumab is an antibody which binds and deactivates the IgE antibody. The IgE antibody serves as the basis for allergic sensitivity. (more…)
Author Interviews, Orthopedics, Pediatrics / 30.10.2015 Interview with: Alex L. Gornitzky Medical Student and Theodore J. Ganley, M.D. Director of Sports Medicine, The Children’s Hospital of Philadelphia Associate Professor of Orthopaedic Surgery, The University of Pennsylvania School of Medicine Medical Research: What is the background for this study? Response: Currently, more than half of all high school students participate in organized athletics, and with increasing participation the incidence of ACL injury and subsequent reconstruction are also rising. Furthermore, researchers also know that adolescent and high school athletes have a number of unique risk factors that differentially affect their ACL injury risk profile as compared to older and/or more experienced athletes. To our knowledge, however, no previous studies have described sport-specific seasonal risk for ACL tears in the high school athlete by gender and by sport. More specifically, parents and athletes currently have no available information to more accurately define what their personal risk is for such an important and devastating injury. Therefore, the purpose of our study was to pool data from across the literature in order to objectively quantify an average high school athlete’s risk for ACL injury per season across a variety of varsity-level sports. If a student is injured while playing sports and the school doesn't deal with the injury correctly then it could make the issue worse. This is why it is important for schools to correctly identify is the player has suffered an ACL injury. If you have suffered an injury at school that wasn't properly dealt with then you may want to check out someone like these new york personal injury lawyers to see if you can get compensation. This study will hopefully help students see the risk of them getting an injury meaning they can take measures to prevent one happening to them. Medical Research: What are the main findings? Response: Overall, there is an approximately 1.6 times greater rate of ACL tear per athletic exposure in high school female athletes as compared to males. On a per-season basis, the highest risk sports in females were soccer, basketball and lacrosse at 1.1%, 0.9% and 0.5% risk of ACL tear per athletic season. Comparatively, in males, the highest risk sports were football, lacrosse and soccer at 0.8%, 0.4% and 0.3% risk of ACL tear per athletic season. Looking further at the year-round, multi-sport athlete, this may correspond to either a 2.5% risk per-year or 10% risk per high school career for the female athlete who participates in soccer, basketball and lacrosse, or 1% and 4%, respectively, for the male athlete who plays football, basketball and baseball. (more…)
Author Interviews, Education, Pediatrics / 29.10.2015 Interview with: Chadi El Saleeby, MD. MS. Assistant Professor of Pediatrics, Harvard Medical School Pediatric Hospital Medicine and Pediatric Infectious Disease Units Mass. General Hospital for Children Boston, MA 02114  Medical Research: What is the background for this study? What are the main findings? Dr. El Saleeby: The Institute of Medicine, the Accreditation Council of Graduate Medical Education, and the American Board of Pediatrics stress the importance of appropriate supervision of trainees to reduce errors, lower patient mortality, and improve quality of care.  However, how appropriate supervision should be implemented in clinical practice is not well defined. After-hours supervision can be especially difficult when attendings or fellows may not be immediately available on-site and residents must determine when to contact a supervising physician regarding a clinical issue. The purpose of this study was to evaluate expectations when a pediatric resident should a contact a supervising physician while working after hours. To that effect, we developed 34 scenarios of the most common or the most serious issues encountered by residents on a general pediatric floor. We included these scenarios in an online survey, which was sent to the residents, fellows and attendings, asking for each scenario, if they would communicate immediately to discuss, or delay communication until the following day. There were two main findings of the study. First, in half of the scenarios, there were significant differences in communication preferences between residents and their supervisors. In all of these 17 discrepant scenarios without one single exception, more supervising clinicians wanted immediate communication compared to the residents. Second, there was no internal agreement between supervising physicians themselves. The junior attendings were more similar in their responses to residents while the more senior group (attendings with 5 or more years of clinical experience) asked to be immediately contacted much more frequently. (more…)
Alcohol, Author Interviews, Pediatrics / 28.10.2015 Interview with: Heather Fay, MHS Program Services FCD Educational Services Newton, MA Medical Research: What is the background for this study? What are the main findings? Response: This study was conducted by FCD Prevention Works, an international non-profit focused on school-based, substance abuse prevention. Using FCD’s database of over 50,000 6th-12th grade student survey responses, we sought to explore the relationship between parental permission of student substance use and negative consequences related to substance use. We compared student alcohol and other drug use in the home, with or without a parent’s knowledge, to students’ self-reported negative consequences related to their own alcohol use. As might be expected, students who used alcohol or other drugs at home without their parents knowing were more likely to report negative consequences in the past 12 months related to their alcohol own use. Students who used at home with their parents knowing were protected against some negative consequences. These students were less likely than students who did not report this behavior to feel guilty about their drinking or regret something they did while drinking. However, these same students were at an increased risk of experiencing negative consequences related to addiction. These consequences included those which are indicative of a mounting dependency on alcohol, such as needing a drink or other drug first thing in the morning, using alcohol or other drugs alone, passing out because of drinking, and getting hurt or injured as a direct result of their alcohol use. (more…)
Alcohol, Author Interviews, Pediatrics / 28.10.2015 Interview with: Daniel J. Dickson, M.A. Graduate Student and Brett Laursen PhD Department of Psychology Florida Atlantic University Medical Research: What is the background for this study? What are the main findings? Response: With age, adolescents spend more time with peers, and engage in drinking behaviors at increasing levels. In particular, girls who reach puberty at earlier ages than their peers are at higher risk for abusing alcohol. This may be because early maturing girls seek out the company of older more mature peers, ​who have greater access to alcohol and (in the case of those prone to delinquency) may be more welcoming to younger girls who are having difficulties with agemates. Our study investigates the association between changes in parental autonomy granting and girls’ alcohol abuse over a three year period (ages 13-16), as a function of timing of pubertal maturation. (more…)
AHA Journals, Author Interviews, Heart Disease, Nutrition, Pediatrics / 28.10.2015 Interview with: Michael DMiedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN Medical Research: What is the background for this study? Dr. Miedema: A healthy diet is an essential component in the prevention of cardiovascular disease. A dietary pattern high in fruits and vegetables has been associated with reduced rates of cardiovascular disease outcomes in multiple observation cohorts of middle-aged and older adults. However, the cardiovascular impact of fruit and vegetable intake in younger adults is less clear. Medical Research: What are the main findings? Dr. Miedema: To evaluate this relationship, we studied 2,506 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study to determine the association between fruit and vegetable intake during young adulthood and subsequent development of coronary artery calcium 20 years later. After adjusting for age, gender, and lifestyle variables, including smoking and physical activity, we found an inverse relationship between fruit and vegetable and subsequent coronary artery calcium across tertiles of fruit and vegetable intake (p-value <0.001). Individuals in the top third of fruit and vegetable intake at baseline had 26% lower odds of developing calcified plaque 20 years later. This inverse linear relationship remained significant after adjusting for fruit and vegetable intake at year 20 as well as after adjustment for other dietary variables such as dairy, nuts, fish, salt, and refined grains. (more…)
Author Interviews, Gluten, Pediatrics / 26.10.2015 Interview with: Maria Ines Pinto Sanchez, MD MSc​ Post-doctoral Clinical ​ Research Fellow and Dr Elena Verdu, MD, PhD Farncombe Family Digestive Health Research Institute McMaster University Health Sciences Centre Hamilton, ON Medical Research: What is the background for this study? What are the main findings? Response: Celiac disease is a condition caused by ingestion of gluten in people with genetic predisposition, in which the finger like projections of the intestinal lining are damaged by inflammation. The “celiac” genes are necessary, but not sufficient, to develop celiac disease. For this reason, it is believed that additional factors could influence the risk of a predisposed child to develop celiac disease. Some studies have indeed suggested that the ideal time for the introduction of gluten to the diet would fall between the 4th and 6th month of life, when gluten should be introduced in “small quantities” and progressively, while maintaining breastfeeding whenever possible. The Nutrition Committee of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition recommended avoiding the introduction of gluten before 4 months and after 7 months of age in an attempt to prevent celiac disease. However, not all clinical studies reached this conclusion and we therefore conducted an updated analysis of the literature published on this subject to evaluate the relationship between time and amount of gluten introduction, breastfeeding and the risk of developing celiac disease. Our systematic analysis revealed that based on the studies published to date there is no strong support that early gluten introduction to an infant’s diet increases the chances to develop celiac disease or that breastfeeding specifically protects from it. (more…)
Author Interviews, Pediatrics, Weight Research / 24.10.2015 Interview with: Brian S. Schwartz, MD, MS Professor of Environmental Health Sciences, Epidemiology, and Medicine Co-director, Program on Global Sustainability and Health Senior Investigator, Geisinger Center for Health Research (Danville, PA) Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 21205 Medical Research: What is the background for this study? What are the main findings? Dr. Schwartz: Sub-therapeutic doses of antibiotics (not a high enough dose to treat an infection in the animal) have been added to animal feeds for decades to promote weight gain. An increasing number of studies of therapeutic uses of antibiotics in humans have reported weight gain, mostly in young children. Using electronic health record data on over 163,000 children between 3 and 18 years of age from the Geisinger Health System, our study was the first one to study the full childhood age range among mostly healthy children; to find effects of antibiotics on weight gain at all ages; to find that the more the cumulative number of antibiotics the greater the weight gain; and that some of the effects were progressive, in that the cumulative number of antibiotics caused an increasing divergence of the body mass index trajectory over time from the trajectory in children who had not received antibiotics. (more…)
Author Interviews, BMJ, Dental Research, Pediatrics, Smoking / 22.10.2015 Interview with: Koji Kawakami, MD, PhD Professor and Chair, Department of Pharmacoepidemiology and Clinical Research Management Graduate School of Medicine and Public Health Director, Science for Innovation Policy Unit, Center for Promotion of Interdisciplinary Education and Research Kyoto University Kyoto city Kyoto Japan Medical Research: What is the background for this study? What are the main findings? Dr. Kawakami: The prevalence of caries in deciduous teeth in developed countries remains high, while established measures for caries prevention in young children is limited to sugar restriction, oral fluoride supplementation and fluoride varnish. In this study of 76920 children in Japan, exposure to tobacco smoke at 4 months of age, which was experienced by half of all children of that age, was associated with an increased risk of caries in deciduous teeth by approximately 2-fold. Medical Research: What should clinicians and patients take away from your report? Dr. Kawakami: Our findings would support extending public health and clinical interventions to reduce secondhand smoke. For example, the chance of education on the harm of secondhand smoke would increase if dentists become aware of the caries risk due to secondhand smoke as well as tobacco smoking of their patients. (more…)
Author Interviews, Heart Disease, JAMA, OBGYNE, Pediatrics / 21.10.2015

Nathalie Auger MD MSc FRCPC Crémazie Est Montréal, Québec Interview with: Nathalie Auger MD MSc FRCPC Crémazie Est Montréal, Québec  Medical Research: What is the background for this study? What are the main findings? Dr. Auger: Congenital heart defects are the most common defects found in infants, but the causes are for the most part unknown. Only about 15-20% can be linked to a clear cause, such as a genetics or maternal infection.  Recently, certain imbalances of angiogenic signaling proteins that control blood vessel development have been identified in individuals with congenital heart defects. Similar imbalances in the same biomarkers have been observed in women with preeclampsia, a serious complication of pregnancy that occurs in 3-5% of pregnant women. Because of this similarity, we sought to determine the relationship that preeclampsia has with the presence of congenital heart defects in infants. What we found was that there was a significant association between preeclampsia and congenital heart defects. In particular, preeclampsia that was diagnosed before 34 weeks of pregnancy was significantly associated with critical and noncritical heart defects and seemed to be the driving factor. There was increased risk for defects involving all general structures of the heart, although the absolute risk of congenital heart defects was low (16.8 per 1,000 infants). (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pediatrics / 18.10.2015 Interview with: Ashley Winning, ScD, MPH Postdoctoral Research Fellow Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Medical Research: What is the background for this study?  Dr. Winning: Several studies have found associations between psychological distress and heart disease and diabetes; however, much of the research has measured distress and disease risk in adulthood and we can’t tell how long people have been distressed or how far-reaching the effects of distress are. Some work has shown that childhood distress is associated with adult health, indicating that distress may start to affect health even earlier in life than we thought. However most of the research has measured distress at a single point in time so we have not been able to answer questions regarding effects of persistent distress or if effects on health are less bad if people become less distressed over time. Medical Research: What are the main findings? Dr. Winning: Distress at any period in the life course was associated with increased cardiovascular and metabolic disease risk in adulthood (age 45). Not surprisingly, those with high levels of distress in both childhood and adulthood had the greatest cardiometabolic risk. The most striking finding is that high levels of childhood distress (measured in childhood) predicted heightened adult disease risk, even when there was no evidence that these high levels of distress persisted into adulthood. (more…)
Author Interviews, Cannabis, CDC, Pediatrics, Tobacco Research / 16.10.2015 Interview with: Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Medical Research: What is the background for this study? What are the main findings? Response: Since 2010, the proportion of U.S. 12th grade students who used marijuana during the preceding 30 days (21.4%) has surpassed the proportion who used cigarettes (19.2%). Negative outcomes associated with cigarette and marijuana use include addiction to one or both substances and diminished cognitive function, which can lead to lower academic achievement. CDC analyzed data from the 1997–2013 national Youth Risk Behavior Surveys (YRBS) among U.S. non-Hispanic white (white), non-Hispanic black (black), and Hispanic students in grades 9–12 to examine trends in the prevalence of current 1) exclusive cigarette or cigar use, 2) exclusive marijuana use, and 3) any use of the three products. CDC further examined the prevalence of current marijuana use among current users of cigarettes or cigars. During 1997–2013, exclusive cigarette or cigar use declined overall by 64%, from 20.5% to 7.4% (p<0.01). However, exclusive marijuana use more than doubled overall from 4.2% to 10.2% (p<0.01). Any cigarette, cigar, or marijuana use decreased overall from 46.1% to 29.9% (p<0.01), whereas marijuana use among cigarette or cigar users increased from 51.2% to 62.4%. Considerable increases were identified among black and Hispanic students toward the end of the study period for exclusive marijuana use and marijuana use among cigarette or cigar users. Increased exclusive marijuana use and use of marijuana among cigarette or cigar users could undermine success in reducing tobacco use among youths. (more…)
Author Interviews, Education, Pediatrics / 16.10.2015

Arielle Borovsky, PhD Assistant Professor Department of Psychology Florida State University Tallahassee, FL 32306 Interview with: Arielle Borovsky, PhD Assistant Professor Department of Psychology Florida State University Tallahassee, FL 32306 Medical Research: What motivated this research? Dr. Borovsky: Early vocabulary learning sets the stage for many other language and academic skills. It is important to understand how this process proceeds normally so that we can identify children who may be in need of other clinical language interventions as early as possible. One of the emerging observations in early vocabulary acquisition research is that while the number of words that infants know is important, the structure of this knowledge also matters. That is, children do not learn words randomly, nor is their vocabulary a representative subset of adult vocabulary. Young children learn words that matter for communication in their daily activities, and these words tend to be related in meaning. It is highly possible that children are learning new language even when watching an Official Video on Youtube. Young children's early semantic structure in vocabulary knowledge suggests is that it may be easier for them to learn new words that have greater connections to their existing knowledge. However, although there had been some promising observational research on this topic, this idea had not yet been experimentally tested. So that is what we decided to do. Medical Research: What did you find? Dr. Borovsky: We found that children were be able to understand new words more effectively when those words had more connections to their exisiting vocabularies. We found this by asking parents of 32 two-year-old children to complete a detailed survey of the words their child says. We then taught these children the same six words and identified for each individual child the three words came from categories that they knew the most about, and the three that came from the child's least well-known categories. In this way, we could control for the child's overall vocabulary size, while selecting words that had relatively more or fewer connections to their own vocabulary. Afterwards, we used an eye-tracking task to test how children understood these high and low connection words. This allowed us to probe the child's knowledge without requiring them to talk or point, they simply had to do what they like to do naturally - watch a simple video on a computer screen with pictures that corresponded to the words they learned. We found that when the new items were named in this computer game, children looked more towards the words that had more connections rather than fewer connections. This suggested that they understood these high density words more easily than the more sparsely connected words. (more…)
Author Interviews, NEJM, Pediatrics / 15.10.2015

Prof. Dr. Dirk Bassler, MSc Department of Neonatology Zurich Interview with: Prof. Dr. Dirk Bassler, MSc Department of Neonatology Zurich Switzerland  Medical Research: What is the background for this study? What are the main findings? Response: The lungs of preterm infants are very vulnerable and these infants frequently develop chronic lung disease, also called bronchopulmonary dysplasia (BPD). BPD is not only a problem of the lungs, it is also a major cause of early death in these infants and if they survive, their risks of respiratory problems in later life and neurodevelopmental impairment are increased when compared to infants without bronchopulmonary dysplasia. Few drugs are available to prevent or to treat BPD and up to this date, no licensed drug for this indication is on the market, neither in Europe nor the USA. Hence additional preventive strategies are needed to reduce the risk of BPD and inhaled glucocorticoids seemed to have a favorable benefit-risk ratio. Medical Research: What are the main findings? Response: A total of 863 preterm infants with a gestational age of less than 28 weeks from 40 study centers in 9 countries (8 European countries and Israel) participated in the Neonatal European Study of Inhaled Steroids (NEUROSIS). The study investigated whether inhaled budesonide, an anti-inflammatory glucocorticoid, would decrease the incidence of bronchopulmonary dysplasia and death in preterm infants. The results show for the first time that inhaled budesonide reduces the incidence of BPD in preterm infants, a finding that is statistically significant. However, in absolute numbers, more infants died during the study period in the budesonide group compared to the placebo group. This difference is not statistically significant and could be caused by chance. Budesonide had a statistically significant positive effect on two more prespecified secondary outcomes: it reduced the rate of infants requiring intubation after completion of study treatment and the frequency of surgery required to close a patent ductus arteriosus, a blood vessel connecting the pulmonary artery to the aorta. The rate of side effects was similar in the budesonide and in the placebo group. (more…)
Author Interviews, JAMA, Mental Health Research, Pediatrics / 15.10.2015 Interview with: Christine Walrath, PhD Public Health Division ICF International New York, New York Medical Research: What is the background for this study? What are the main findings? Dr. Walrath: The study is part of a legislatively mandated evaluation of programs funded by the Garrett Lee Smith Memorial Act, signed into law in 2004 in recognition of the major public health problem of suicide and suicidal behavior in the US. The legislation set aside funding for campuses, states, tribes and US territories to develop, evaluate, and improve early intervention and suicide prevention programs. This is the most widely implemented group of suicide prevention programs in the United States, and allowed a unique opportunity, as reflected in the findings of this study and the study in the American Journal of Public Health in the spring (Walrath, C., Godoy Garraza, L., Reid, H., Goldston, D. B., & McKeon, R. (2015) to demonstrate that comprehensive community based suicide prevention programs appear to be effective in reducing suicide and suicide attempts. As mentioned, this is the second article on the impact of GLS suicide prevention program on youth suicide behavior. The previous one, published in APHA earlier this year, focused on suicide deaths, while this one focuses on suicide attempts. They use different sources for the outcome measures: vital records in one case and a large national survey in the other. In both cases, the county is the unit of analysis. They both take advantage of the availability of a large amount of information for relatively small areas to select counties that are essentially comparable. Making sure that the counties being compared are similar except for the GLS implementation is very important when randomized trials to assess impact of the prevention program are not feasible. The study found a reduction in the rate of suicide attempts among youth 16 to 23 following the implementation of the GLS program in counties exposed to these prevention activities when compared with similar counties that were not exposed to such intervention. The difference is significant and substantial: 4.9 less attempts per thousand youths. There is no evidence of a simultaneous change in the suicide attempt rate among adults, a group that was not targeted by GLS. The findings are consistent with those from the previous study, which found a substantial reduction in suicide mortality among youths 10-24 following GLS implementation: 1.3 fewer deaths per one hundred thousand youths. (more…)
Author Interviews, Heart Disease, JACC, Metabolic Syndrome, Pediatrics / 07.10.2015

Mark Interview with: Mark DeBoer, MD Children's Hospital's Department of Pediatrics University of Virginia  Medical Research: What is the background for this study? What are the main findings? Dr. DeBoer: We have been interested in how the severity of the metabolic syndrome relates to long term risks, both for children and adults.  We formulated a score that takes the different components of the metabolic syndrome (body mass index, blood pressure, fasting blood sugar, triglycerides and high density cholesterol) for an individual and forms a score estimating how severe the metabolic syndrome is in that individual.  When we looked at long-term data from individuals followed for 40 years, we found that children and adults with higher scores were more much likely to develop cardiovascular disease. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Pediatrics / 06.10.2015

Susan Gray MD Division of Adolescent Medicine Boston Children's Hospital Boston, Interview with: Susan Gray MD Division of Adolescent Medicine Boston Children's Hospital Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Gray: This is a study of the health care costs of 13,000 privately insured adolescents (13 to 21 years old) cared for in an association of pediatric primary care practices. We found that a tiny fraction (1%) of adolescents accounted almost a quarter of the expenses of the whole cohort. Mental health disorders were the most common diagnosis among these high cost adolescents. The characteristics most strongly associated with high cost were complex chronic medical conditions, behavioral health disorders, and obesity, but many high cost adolescents had no chronic conditions. Pharmacy costs, especially orphan drug costs, were a surprisingly large contributor to high costs for these privately insured adolescents. Primary care costs were very small in high cost patients. (more…)
Author Interviews, Kaiser Permanente, Pediatrics, Weight Research / 05.10.2015 Interview with: Dr-Corinna-Koebnick Corinna Koebnick, PhD Research scientist with Research & Evaluation Kaiser Permanente Southern California MedicalResearch: Please describe your study, what you were looking for, and why.  Dr. Koebnick: This study is based on the Kaiser Permanente Southern California Children’s Health Study, which includes all children and adolescents 2–19 years of age in Southern California who are actively enrolled in a large, integrated, managed health care system. We examined the body weight from electronic health records of more than 1.3 million children and adolescents 2-19 years of age from 2008 to 2013. The objective of this study was to investigate recent trends in pediatric obesity in Southern California between 2008 and 2013. Several recent studies have investigated national trends in childhood obesity in the United States and indicated that childhood obesity rates may have reached a plateau, but are not declining. Ours is one of the few studies that is large enough to be able to detect small changes in the prevalence of obesity in time periods of less than 10 years. MedicalResearch: What are the findings of this study?  Dr. Koebnick: Our study provides strong indication that the prevalence of overweight and obesity between 2008 and 2013 has not only plateaued, but also is slowly declining. While the decline in overweight and obesity was less pronounced in girls, adolescents, some minority groups and youth living in low income and low education areas, the decline was remarkably stable across all groups and significant even in minority youth and youth of lower socioeconomic status. We found the prevalence of overweight and obesity decreased overall by 2.2 percent and 1.6 percent, respectively. This change corresponds to a relative decline of 6.1 percent in overweight youth and 8.4 percent in obese youth. Although a decline was seen across all groups, the decrease was not as strong in adolescents aged 12-19 years, in girls compared to boys, and Hispanic and black children compared to non-Hispanic whites. (more…)
Author Interviews, Pediatrics, Technology / 05.10.2015

Ichiro Morioka, M.D. Professor of Pediatrics, Kobe University Graduate School of Medicine Chuo-ku, Kobe, Interview with: Ichiro Morioka, M.D. Professor of Pediatrics, Kobe University Graduate School of Medicine Chuo-ku, Kobe, Japan  Medical Research: What is the background for this study? What are the main findings? Dr. Morioka: Japan has the highest survival rate for preterm infants due to recent advanced medical treatment and the availability of Neonatal Intensive Care Units (NICU). Despite this, cases of cerebral palsy and hearing loss caused by neonatal jaundice continue (kernicterus) to occur, with cases reported for at least 2 in every 1000 infants born before the 30th week of gestation. It has also been established that cases of jaundice can worsen even two weeks after birth and thereafter, meaning that there is a need for continuous long-term jaundice monitoring of infants in the NICU. However, jaundice in preterm infants is difficult to detect through physical observations, and monitoring through a daily blood test is not a realistic option. We focused on transcutaneous jaundice monitoring used in daily health tests for full term infants. The bilirubin levels of 85 infants with a birth weight of under 1500 grams were monitored in NICUs at Kobe University, Kakogawa City Hospital, Hyogo Prefectural Kobe Children’s Hospital, Japanese Red Cross Society Himeji Hospital, and Takatsuki General Hospital, and were taken a total of 383 transcutaneous and blood bilirubin measurements at the same time. Through our results we were able to ascertain that the chest and back areas of preterm infants have the highest levels of sensitivity, and transcutaneous bilirubin levels in those areas were close to bilirubin levels in the blood. In addition to expanding the possibilities for transcutaneous monitoring of jaundice in preterm infants, we discovered the optimum area of skin to monitor it. (more…)
Author Interviews, Depression, OBGYNE, Pediatrics / 02.10.2015

Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway Interview with: Marte Handal PhD Division of Epidemiology Norwegian Institute of Public Health Oslo, Norway  Medical Research: What is the background for this study? Dr. Handal: The prevalence of depression during pregnancy is estimated to be as high as between 7 and 15%. It is well understood that untreated maternal depression may be harmful to both the mother and the child. When medical treatment of pregnant women is necessary, selective serotonin reuptake inhibitors (SSRIs) is the most common treatment. However, limited information is available on the potential effect of prenatal exposure to SSRIs on the child’s motor development. Medical Research: What are the main findings? Dr. Handal: We did find a week association between prolonged maternal use of SSRIs during pregnancy and delayed motor development in the child even after we had taken the mothers history of depression and her symptoms of anxiety and depression during and after pregnancy into account. However, only a few children were in the least developed category, corresponding to clinical motor delay, indicating that clinical importance is limited. (more…)
Author Interviews, Biomarkers, Gastrointestinal Disease, Pediatrics / 01.10.2015

Michael P. Sherman, MD, FAAP Professor, Department of Child Health University of Missouri - Columbia Women's and Children's Hospital Columbia, Missouri Interview with: Michael P. Sherman, MD, FAAP Professor, Department of Child Health University of Missouri - Columbia Women's and Children's Hospital Columbia, Missouri 65201  Medical Research: What is the background for this study? Dr. Sherman: We understand eosinophils are inflammatory cells in the lung during asthma attacks. Publications in a Nature journal described how eosinophils come to the lung after airway injury. Since the lung and intestine have the same embryonic source, we theorized that eosinophils would rise in the blood after the onset of necrotizing enterocolitis in preterm human infants. We correctly predicted that a rise in blood eosinophils would predict later complications from this disease. Medical Research: What are the main findings? Dr. Sherman: We found that within two days of disease onset infants could have a rise in eosinophils greater than 5% of the total white blood cell count. If this increase persisted for five or more days, the infant was at risk for later medical or surgical complications including feeding problems, bowel blockage, or intestinal rupture Area under the curve = 0.97, CI: .92-1.0). The babies having this finding were smaller and more premature. (more…)
Author Interviews, NIH, OBGYNE, Pediatrics / 01.10.2015

Dr. Louis Germaine Buck Senior Investigator and Director of the Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health Interview with: Dr. Germaine Louis Buck PhD Senior Investigator and Director of the Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health   Medical Research: What is the background for this study? What are the main findings? Dr. Germaine Buck: We wanted to develop intrauterine standards for ultrasound measured fetal growth, given that none currently exist for contemporary U.S. pregnant women.  Moreover, we wanted to determine if a single standard would be possible for monitoring all pregnant women, or if the standard needed to be tailored to pregnant women’s race/ethnicity.  This added step attempted to address the equivocal data about whether or not race/ethnicity is an important determinant of optimal fetal growth. Analyzing data from 1,737 low risk pregnant women with uncomplicated pregnancies who had 5 ultrasounds done at targeted times during pregnancy, we found significant differences in estimated fetal weight across the 4 maternal race/ethnic groups.  These differences were apparent beginning about 16 weeks gestation and continuing throughout pregnancy.  The differences in these curves were apparent when assessing infant’s birthweight, as well.  Overall, estimated fetal weights while women were pregnant were highest for White mothers followed by Hispanic, Asian, and Black mothers.  A 245 gram difference in estimated fetal weight was observed at 39 weeks gestation between pregnant White and Black women.  This pattern was then observed for measured birth weight, with highest birthweights for White then Hispanic, Asian, and Black infants. Other differences emerged by maternal race/ethnicity for individual fetal measurements:  longest bone (femur & humerus) lengths were observed for Black fetuses emerging at 10 weeks gestation, larger abdominal circumference for White fetuses emerging at 16 weeks gestation, larger head circumference for White fetuses emerging at 21 weeks gestation, and larger biparietal diameter for White fetuses emerging at 27 weeks gestation in comparison to other groups. The race/ethnic differences in fetal size were highly significant and across gestation.  If a single White standard was used for estimating fetal weight for non-White fetuses in pregnant women, between 5% and 15% of their fetuses would have been misclassified as being in the <5th percentile of estimated fetal weight. (more…)
Accidents & Violence, Author Interviews, Pediatrics / 30.09.2015

Nadine Parker M.Sc Injury Prevention Research Office Li Ka Shing Knowledge Institute Keenan Research Centre St. Michael’s Hospital Toronto, Ontario, Interview with: Nadine Parker M.Sc Injury Prevention Research Office Li Ka Shing Knowledge Institute Keenan Research Centre St. Michael’s Hospital Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? Response: TV toppling injuries in children have become increasingly more common in recent years. Including in countries with developing economies where televisions are becoming more affordable. Unfortunately, most people don’t recognize televisions as a hidden home hazard. These easily preventable injuries can be severe or even fatal. Of the deaths due to TV toppling 96% were caused by a head injury. Most of these injuries occur at home with 75% of them unwitnessed by a parent or caregiver. Often furniture such as dressers are used as TV stands but they are not designed to support the weight of TV sets making them unstable. Unfortunately, curious and resourceful young children like to climb these unstable support furniture leading to a toppling event. Play or pushing and pulling the TV set are also common causes of tip-overs. (more…)
Author Interviews, Opiods, Pediatrics, Pharmacology / 29.09.2015

Shannon M. Monnat, PhD Assistant Professor of Rural Sociology, Demography, and Sociology Department of Agricultural Economics, Sociology, and Education The Pennsylvania State University University Park, PA Interview with: Shannon M. Monnat, PhD Assistant Professor of Rural Sociology, Demography, and Sociology Department of Agricultural Economics, Sociology, and Education The Pennsylvania State University University Park, PA 16802  Medical Research: What is the background for this study? What are the main findings? Dr. Monnat: Given concurrent rapid increases in opioid prescribing and adolescent prescription opioid misuse since the 1990s and historical problems with opioid abuse in rural areas, we were interested in whether adolescents in rural areas were more likely to abuse prescription opioids than their peers in urban areas. Adolescence is a really crucial time to study substance abuse disorders because most abuse begins during adolescence, and individuals who begin use before age 18 are more likely to develop a long-term disorder as an adult compared to those who first try a substance later in life. The active ingredient in prescription opioids and heroin is the same. Prescription opioids are highly addictive and can be dangerous if utilized incorrectly. Prescription opioid abuse is currently responsible for over 16,000 deaths in the US annually and has an estimated annual cost of nearly $56 billion dollars. Therefore, it is correctly viewed as a major public health problem. We found that teens living in rural areas are more likely to abuse prescription opioids compared to teens living in large urban areas. Several important factors increased rural teens’ risk of abusing prescription opioids, including that they are more likely to rely on emergency department treatment than their urban peers, they have less risky attitudes and perceptions about substance abuse than their urban peers, and they are less likely to be exposed to drug/alcohol prevention messages outside of the school environment than their urban peers. Rural teens are also buffered by several factors that help to reduce opioid abuse, including stronger religious beliefs, less depression, less peer substance abuse, and less access to illicit drugs. If not for these protective factors, the current epidemic we see in rural areas could be even worse. We also found that both rural and urban adolescents were most likely to report obtaining the prescriptions they abused from friends or family. However, rural adolescents were less likely than urban adolescents to obtain the pills this way. Rural adolescents were more likely than urban adolescents to report getting the pills they abuse directly from physicians.  (more…)