Pediatrics
08 Mar Kids Who Watch A Lot of TV Still Do So As Adults, Adding to Obesity Risk
MedicalResearch.com Interview with: [caption id="attachment_22478" align="alignleft" width="133"]
Dr. Chance York[/caption]
Dr. Chance York PhD
School of Journalism and Mass Communication
Kent State University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. York: A number of studies have examined the effects of heavy television viewing during childhood on childhood levels of Body Mass Index (BMI), but my study added a new element to this literature: it explores the long-term effects of TV viewing on adult-era BMI.
The major takeaway is that heavy television viewing during childhood results in an individual propensity to watch TV much later in life, and this propensity to watch television results in increased BMI. In other words, kids who watch a lot of television tend to remain heavy TV users as adults, and the fact that they're heavy TV viewers as adults has a separate, unique effect on their adult BMI.
08 Mar Could Busy Streets and Improved Environment Reduce Teen Homicides?
MedicalResearch.com Interview with: [caption id="attachment_22373" align="alignleft" width="180"]
Dr.Alison Culyba[/caption]
Alison Culyba, MD MPH
Adolescent Medicine Advanced Research Fellow
Craig-Dalsimer Division of Adolescent Medicine
Children’s Hospital of Philadelphia
PhD Candidate, Epidemiology
Department of Epidemiology and Biostatistics
Perelman School of Medicine at the University of Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Culyba: Youth violence is a major public health problem. Homicide is the second leading cause of death among all adolescents in the U.S., and the number one cause of death among African American adolescents. Prom prior research, we know that where you live and where you spend time has a major impact on health, and that making changes to environments, such as greening vacant lots and remediating abandoned buildings, can significantly reduce crime. However, much less is known about the relationship between adolescent’s immediate surroundings and the risk of homicide. The goal of this study was to examine associations between neighborhood environmental features, such as streets, buildings, and natural surroundings and adolescent homicide. We conducted a population-based case control study of 143 adolescents, ages 13 to 20, who were victims of homicides in Philadelphia and 155 matched controls in the same range, who were outdoors in Philadelphia at the same time that the homicides occurred. To assess features in the immediate environments of homicide victims and control individuals, trained field staff stood on the street corner of each homicide and control location and took a series of photographs that we stitched together into 360-degree high resolution panoramas, which we assessed for environmental features. After accounting for many individual and neighborhood contextual factors, we found that the odds of homicide was significantly lower in locations with street lighting, pedestrian infrastructure, public transportation, parks, and maintained vacant lots.
04 Mar Cesarean Section May Increase Risk of Childhood Leukemia
MedicalResearch.com Interview with: [caption id="attachment_22359" align="alignleft" width="180"]
Dr. Erin Marcotte[/caption]
Erin Marcotte, Ph.D.
Assistant Professor
Division of Epidemiology and Clinical Research
Department of Pediatrics
University of Minnesota
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Marcotte: Recently there have been several studies that indicate a higher risk of immune-related disorders, such as type-I diabetes, asthma, and allergies, among children born by cesarean delivery. Our analysis used pooled data from 13 independent studies of childhood leukemia that were conducted in 9 different countries. We used data on over 33,000 children to investigate the relationship between birth by cesarean delivery and risk of childhood leukemia. We did not find an association between cesarean delivery overall and childhood leukemia. However, when we looked at emergency cesarean deliveries and pre-labor (planned) cesarean deliveries separately, we found a 23% increase in risk of acute lymphoblastic leukemia among children born by pre-labor cesarean delivery.
29 Feb Fewer Pediatric Abusive Head Trauma In States With Paid Family Leave
MedicalResearch.com Interview with: [caption id="attachment_16316" align="alignleft" width="200"]
Dr. Joanne Klevens[/caption]
Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.
29 Feb Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections
Posted at 16:41h
in Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory
MedicalResearch.com Interview with:
[caption id="attachment_22065" align="alignleft" width="150"]
Dr. Suzanne Schuh[/caption]
Suzanne Schuh, MD, FRCP(C), ABPEM
The Hospital for Sick Children affiliated with the
University of Toronto
Medical Research: What is the background for this study?
Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home.
The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.
25 Feb Minority Kids With Asthma Likely To Miss Days of School
MedicalResearch.com Interview with: [caption id="attachment_22192" align="alignleft" width="130"]
Dr. Joy Hsu[/caption]
Joy Hsu, MD, MS
Air Pollution and Respiratory Health Branch
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
CDC Atlanta GA 30341
Medical Research: What is the background for this study?
Dr. Hsu: Asthma is a leading cause of missed school days related to chronic illness.
This study is based on survey data from 2006 to 2010 on children aged 17 years and younger with asthma from 35 states and the District of Columbia.
24 Feb Being Born in Winter, or To A Smoker, Worsens Children’s Lung Health
MedicalResearch.com Interview with: [caption id="attachment_21974" align="alignleft" width="135"]
Dr. Julia Dratva[/caption]
Dr. med. Julia Dratva, MD MPH
Medical Specialist Prevention and Public Health
FMH Scientific project
leader
MAS Versicherungsmedizin/Studienkoordinationleitung
Dept. Epidemiology and Public Health
Swiss Tropical and Public Health Institute
Socinstrasse 57, P.O. Box, 4002 Basel,
Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors.
23 Feb Does Mom’s Anxiety During Pregnancy Make Her Child A Fussy Eater?
Posted at 23:11h
in Author Interviews, Depression, Eating Disorders, Mental Health Research, Nutrition, OBGYNE, Pediatrics
MedicalResearch.com Interview with:
[caption id="attachment_21832" align="alignleft" width="200"]
Dr. Lisanne De Barse[/caption]
Lisanne de Barse PhD
Department of Epidemiology
Erasmus Medical Center Rotterdam
MedicalResearch: What is the background for this study?
Dr. de Barse: Fussy (or “picky”) eating behaviour, which is characterised by consistent rejection of particular foods, is common in childhood and a source of concern for parents. It is not well understood what affects fussy eating. It is, however, well known that internalizing psychiatric problems of parents (i.e. anxiety and depression) have an impact on children’s health and development. Studies have also shown that mothers’ internalizing problems during the child’s preschool period was linked to child fussy eating. It was not clear whether the child’s eating problems causes stress and psychiatric symptoms in mothers or whether mothers’ symptoms predict child eating behaviour. Nor was it known what potential impact the dads’ state of mind have. The purpose of this study was to examine whether mothers’ and fathers’ internalizing problems during pregnancy and during the child’s life predicts child fussy eating.
MedicalResearch: What are the main findings?
Dr. de Barse: Our main findings indicate that mothers’ anxiety and depressive symptoms during pregnancy could have an influence on children’s fussy eating. This was irrespective of mothers’ internalizing symptoms at the child’s preschool period. We also found indications that fathers’ anxiety and depressive symptoms might influence children’s fussy eating behaviour. This was studied in Generation R, a study that has been tracking the health and wellbeing of children from conception onwards, conducted by the Erasmus Medical Centre, in Rotterdam, the Netherlands.
22 Feb Families of Children With Complex Health Conditions Face Financial and Social Hardships
MedicalResearch.com Interview with: [caption id="attachment_21916" align="alignleft" width="200"]
Dr. Joanna Thomson[/caption]
Joanna Thomson MD MPH
Assistant Professor
Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Medical Research: What is the background for this study? What are the main findings?
Response: Children with medical complexity have lifelong and complex illnesses. These children account for a disproportionate amount of pediatric health care use. The lives of families are affected – both financially and socially. We sought to characterize the challenges these families face through examination of financial and social hardships. In a cohort of families with children who receive care at Cincinnati Children’s Complex Care Center, four out of five families reported experiencing at least one hardship. The striking frequencies observed, despite relatively high measures of household socioeconomic status, suggest that these families face great challenges. For example, families frequently experienced the need to borrow money and expected little to no help from family or friends.
In order to benchmark the hardships experienced by families of children with medical complexity, we compared the hardships they experienced to those faced by the families of children with asthma in the Greater Cincinnati Asthma Risks Study. After accounting for key demographic and socio-economic differences between the two groups, families of children with medical complexity experienced similar to higher levels of financial and social hardship. For instance, families of children with medical complexity were over two times as likely to report the inability to pay their rent or mortgage than families of children with asthma.
22 Feb Gestational Diabetes Raises Risk of Low Milk Supply in Breastfeeding Moms
MedicalResearch.com Interview with: [caption id="attachment_21895" align="alignleft" width="200"]
Dr. Laurie Nommsen-Rivers[/caption]
Laurie A. Nommsen-Rivers, PhD, RD, IBCLC
Assistant Professor, UC Department of Pediatrics
Cincinnati Children's Hospital Medical Center
Medical Research: What is the background for this study?
Dr. Nommsen-Rivers: Breastfeeding provides important benefits for mother and infant. Exclusive breastfeeding—that is, without any other food or fluids provided to the infant—is recommended for the first six months of life by multiple public health organizations. Some mothers, despite their best efforts, have difficulty establishing and sustaining sufficient milk production to support exclusive breastfeeding. Our previous research suggested that mothers with less optimal glucose tolerance are at risk for prolonged delays in time between birth and the establishment of copious milk production. We wanted to extend this finding by probing if mothers who had diabetes in pregnancy, as a sign of less optimal glucose tolerance, are at greater risk of sustained low milk production. “Glucose tolerance” refers to the body’s ability to metabolize glucose and maintain a healthy blood sugar level, which is orchestrated by the hormone insulin. For a long time, we did not consider insulin to play a role in milk production, but we are now learning that insulin plays an essential role in milk production.
18 Feb Guidelines for Autism Screening Require More Research
MedicalResearch.com Interview with: [caption id="attachment_21766" align="alignleft" width="142"]
Dr. David Grossman[/caption]
Dr. David Grossman MD MPH
Vice chair of the U.S. Preventive Services Task Force
Professor at the University of Washington Schools of Public Health and Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Grossman: The Task Force cares deeply about the challenges that children affected by autism and their families face in getting the care and support they need. This was the first time that we assessed the evidence around screening young children for autism, and our recommendation was informed by a review of the most up-to-date science, which included randomized trials, observational studies, and research from a number of Federal health agencies. We concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder in children for whom no concerns of autism have been raised by their parents or a clinician. This is an I statement, which is not a recommendation against screening, but a call for more research on screening and treatment in young children who don’t have obvious symptoms. It is important to note that this recommendation will not affect insurance coverage for autism screening, which is currently covered under the Affordable Care Act as a result of the American Academy of Pediatrics’ Bright Futures Guidelines.
16 Feb Social Factors Impact Children’s Hospitals’ Readmissions
MedicalResearch.com Interview with: [caption id="attachment_21532" align="alignleft" width="145"]
Dr. Marion Sills[/caption]
Marion R. Sills, MD, MPH
Associate Professor, Departments of Pediatrics and Emergency Medicine
University of Colorado School of Medicine
Medical Research: What is the background for this study?
Dr. Sills: My co-authors and I know that studies show that patients who are poorer or are minorities are readmitted at higher rates than other patients, and that readmissions penalties, which are far more commonly applied in relation to readmissions of adult patients, have been shown to punish hospitals for the type of patients that they serve, rather than purely for the quality of care they provide. Currently, these penalties impact hospitals treating Medicare patients in all 50 states but only impact readmissions of children in 4 states, although other states are considering implementing these penalties. This was our rationale for exploring the impact of patients’ social determinants of health (factors like race, ethnicity, health insurance and income) on how likely it was that a hospital would be penalized for readmissions under a typical state-level pay-for-performance measure based on hospital readmissions. Readmissions penalties are designed to penalize hospitals that provide lower quality care. However, without adjusting for social determinants of health factors, these pay-for-performance measures may unfairly penalize hospitals based on the type of patient they treat as well as the quality of care they provide.
Medical Research: What are the main findings?
Dr. Sills: We found that risk adjustment for social determinants of health factors changed hospitals’ penalty status on a readmissions-based pay-for-performance measure. Without adjusting the pay-for-performance measures for social determinants of health, hospitals may receive penalties partially related to patient factors beyond the quality of hospital care.
12 Feb Acetaminophen During Pregnancy Linked To Childhood Asthma
MedicalResearch.com Interview with: [caption id="attachment_21542" align="alignleft" width="133"]
Maria C. Magnus[/caption]
Maria C. Magnus
Norwegian Institute of Public Health
Oslo Norway
Medical Research: What is the background for this study? What are the main findings?
Response: Researchers have found that developing asthma can be linked to pregnant women and infants being exposed to paracetamol, (acetaminophen) by testing that the association was not simply linked to the complaint for which the person is taking paracetamol. The findings were published in the International Journal of Epidemiology
Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway compared associations between several conditions during pregnancy (with and without the use of paracetamol) and asthma developing in the 114,500 children in the study. They examined asthma outcomes at ages three and seven and evaluated the likelihood of the association being as a result of the three most common uses of paracetamol in pregnancy: pain, fever, and influenza.
The results showed that 5.7 per cent of the children had current asthma at age three, and 5.1 per cent had asthma at age seven. The research found that there was a strong link between children who had asthma at age three who had been exposed to paracetamol as during pregnancy or infancy. The strongest association was seen if the mother used paracetamol during pregnancy for more than one complaint with a child having asthma at three years old.
12 Feb Babies’ Intestinal Microbiome Affected By Family Diet
MedicalResearch.com Interview with [caption id="attachment_21538" align="alignleft" width="103"]
Prof. Tine Rask Licht[/caption]
Tine Rask Licht, Professor
Head of Research Group on Gut Microbiology and Immunology
Technical University of Denmark
National Food Institute Søborg
Medical Research: What is the background for this study? What are the main findings?
Response: During childhood, the intestinal microbiota is under establishment. This period thus represents a ’window’, where the microbiota is likely to be more susceptible to be affected by external factors such as diet. Currently, it is well known that breast feeding has a major impact on the microbiota of young infants, but only very few studies have addressed the effect of the ‘next step’ in diet exposure, represented by complementary feeding.
We studied two cohorts of children, born to normal-weight and obese mothers, respectively, and mapped the composition of bacteria in their fecal microbiota at age 9 months and 18 months. We found that at 9 months, the microbiota was clearly affected by the composition of the complementary diet, but not by maternal obesity.
09 Feb Wheezing in Early Childhood Linked to Reduced Lung Function By Adolescence
MedicalResearch.com Interview with: [caption id="attachment_21421" align="alignleft" width="180"]
Dr. Meghan Azad[/caption]
Dr. Meghan B. Azad PhD
Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and
Children’s Hospital Research Institute of Manitoba
Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study
Medical Research: What is the background for this study?
Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure. Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.
Medical Research: What are the main findings?
Dr. Azad: Wheezing is common in babies and young children. Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS).
We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15.
By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers.
08 Feb Too Much Screen time Raises Risk of Pre-Diabetes in Children
Posted at 20:59h
in Author Interviews, Diabetes, Exercise - Fitness, JAMA, Lifestyle & Health, Pediatrics
MedicalResearch.com Interview with:
[caption id="attachment_21397" align="alignleft" width="160"]
Mélanie Henderson[/caption]
Mélanie Henderson, MD, FRCPC, PhD
Pediatric Endocrinologist and Assistant Clinical Professor
Division of Endocrinology and Diabetes
University of Montreal/Centre Hospitalier Universitaire Ste-Justine
Montréal, Québec
Medical Research: What is the background for this study? What are the main findings?
Dr. Henderson: Dysregulation in insulin sensitivity and insulin secretion are the basic elements in the pathophysiology of type 2 diabetes. There is extensive data suggesting that better lifestyle habits are associated with the prevention or the delay in onset of type 2 diabetes in adults, with improved lifestyle habits having been more effective than pharmacologic agents at diabetes prevention in one study. Little work however has been done to determine whether this holds true in children. Cross-sectional studies in youth have found conflicting results and no study has considered the combined effect of physical activity, fitness and sedentary behavior on insulin dynamics in children.
Understanding the impact of lifestyle habits on insulin dynamics in childhood has become paramount, given that less than 7% of Canadian children are currently meeting physical activity guidelines and that 1/3 of school-aged Canadian children and 2/3 of Canadian teenagers are exceeding the current guidelines in terms of screen time, which advocate for a maximum of 2 hours daily.
Our study shows that adiposity is the central predictor of insulin dynamics in children, and that physical activity and screen time play an important role, in part through their effect on adiposity. Thus, establishing and maintaining a highly physically active lifestyle early on in life, while minimizing sedentary behaviour (specifically screen time) appear to be important strategies to consider to prevent type 2 diabetes in youth.
05 Feb Video Interaction Project Improved School Readiness In Impoverished Children
MedicalResearch.com Interview with: [caption id="attachment_21333" align="alignleft" width="112"]
Dr. Alan Mendelsohn[/caption]
Alan Mendelsohn, MD
Associate professor, Departments of Pediatrics and Population Health
Adriana Weisleder, PhD
[caption id="attachment_21334" align="alignleft" width="100"]
Dr. Adriana Weislander[/caption]
Research scientist,
Department of Pediatrics
NYU Langone Medical Center
Medical Research: What is the background for this study? What are the main findings?
Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise.
The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals.
The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half. These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.
04 Feb Single Gene Rearrangement Uses Three Paths To Cause Rare Brain Tumor
Posted at 18:52h
in Author Interviews, Brain Cancer - Brain Tumors, Genetic Research, Pediatrics, University of Pennsylvania
MedicalResearch.com Interview with:
[caption id="attachment_21295" align="alignleft" width="112"]
Dr. Adam Resnick[/caption]
Dr. Adam C. Resnick, Ph.D
Assistant Professor of Neurosurgery
Faculty, Abramson Cancer Center
Director of Children's Brain Tumor Tissue Consortium
Division of Neurosurgery
Director, CHOP/PENN Department of Neurosurgery Brain Tumor Tissue BiorepositoryDirector for Neurosurgical Translational Research, Division of Neurosurgery
Children's Hospital of Philadelphia
[caption id="attachment_21297" align="alignleft" width="150"]
Payal Jain[/caption]
Payal Jain, PhD Candidate
Division of Neurosurgery, Children's Hospital of Philadelphia
Department of Neurosurgery
Cell and Molecular Biology Graduate Group
Gene Therapy and Vaccines Program
Perelman School of Medicine
University of Pennsylvania Philadelphia, Pennsylvania
Medical Research: What is the background for this study? What are the main findings?
Response: This study originates from our long-standing interest in studying pediatric low-grade gliomas (PLGGs), which are the most commonly diagnosed brain tumor in children. While several PLGGs have been found to harbor mutations/gene fusions driving the mitogen-associated protein kinase (MAPK) pathway leading to clinical trials testing MAPK inhibitors, these tumors remain poorly categorized and not enough is known about specific genetic mutations driving different tumor sub-types and the potential for specific targeted therapeutics.
Our current study encompasses analysis of the largest combined genomic dataset of pediatric low-grade gliomas samples. In doing this we, identified the MYB-QKI gene fusion, a non-MAPK related event, as the common genetic event driving a rare PLGG sub-type, called angiocentric gliomas. We have reported a novel tri-partite mechanism by which MYB-QKI mediates its oncogenic effect, this being the first report of a single gene rearrangement utilizing three different paths to cause cancer.
- First, this gene rearrangement activates MYB, which is a proto-oncogene that is normally not expressed in the developed brain.
- Second, we found that the rearrangement leads to translocation of QKI-related enhancers close to MYB’s promoters, thereby driving MYB-QKI expression in these tumors. Furthermore, MYB-QKI can also regulate its expression in a positive feedback loop.
- Third, the tumor suppressor activities of QKI are disrupted in MYB-QKI. Such collaboration of genetic and epigenetic dysregulation in a single genetic rearrangement has previously not been reported.
03 Feb Genetic Risk Score Linked To Childhood Weight Gain and Body Fat
MedicalResearch.com Interview with: [caption id="attachment_21247" align="alignleft" width="144"]
Dr.Steinsbekk[/caption]
Silje Steinsbekk PhD
Associate Professor
Dept. of Pschology
Norwegian University of Science and Technology
Medical Research: What is the background for this study?
Dr. Steinsbekk: More than every third American child is overweight or obese. Childhood obesity is associated with multiple negative health outcomes such as metabolic syndrome and hypertension, as well as mental health problems, reduced self-esteem and impaired quality of life. Further, overweight and obesity tend to persist from childhood into adulthood, and the risk of adult overweight increases the longer a child has been overweight. Identifying modifiable factors contributing to the development and continuity of unhealthy weight is therefore needed.
Genome-wide association studies (GWAS) have identified genetic risks for obesity and these genetic risks have shown to influence development of obesity partly by accelerating weight gain in childhood. Identification of mechanisms through which genetic risks for obesity accelerate weight gain in childhood can therefore provide insight into the developmental pathogenesis of obesity and thus inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Appetite traits may therefore be targets of intervention to protect children against the effect of genetic predispositions to develop obesity. However, such a preventive approach presupposes that appetite traits indeed transmit the genetic effect upon later development of obesity. Notably, cross-sectional studies cannot establish whether appetite traits precede the development of obesity or are caused by it—a critical piece of information for clinicians seeking treatment targets to prevent childhood obesity. We therefore aimed to test whether genetic risk for obesity was associated with rapid childhood BMI growth and if this genetic effect was mediated by appetite traits, following a representative sample of Norwegian children from age 4 to 8.
02 Feb Obesity Genes Also Affected By Environment
MedicalResearch.com Interview with: [caption id="attachment_21225" align="alignleft" width="180"]
Profa. Silveira[/caption]
Profa. Patrícia Pelufo Silveira, MD, PhD
Universidade Federal do Rio Grande do Sul
Brazil
Medical Research: What is the background for this study? What are the main findings?
Response: Previous studies have shown that women who carry a certain gene variant (namely the 7-repeat allele of the dopamine type 4 receptor) have increased risk for obesity, especially if they also suffer from eating disorders. We have also demonstrated that girls who have this gene variant prefer to eat more fat when allowed to choose. However, for some neuropsychiatric conditions, this gene was shown to function as a “plasticity gene”. That is to say that being a carrier makes the individual more or less vulnerable to the disease, depending if the environment in which the person lives is bad (more risk) or good (less risk for the disease). This is called the “differential susceptibility” model.
Therefore, in this paper, we wondered if the above described higher fat intake already reported in 7-repeat girls could be modified by the social environment in which they are raised. We saw that if a girl has the gene variant and is raised in a poorer environment, she is more likely to prefer to eat fat in her diet as we knew. However, if she has the gene variant but is raised in a better socioeconomic environment, she actually eats less fat in her regular diet compared to her counterparts who do not carry the gene variant. This is important because we change the focus from the gene (previously "blamed" for increasing fat preference and obesity as the years pass by) to the environment, as the genetic association will increase or decrease the risk according to the conditions in which the child is raised.
02 Feb Proton Radiation Therapy: Treats Pediatric Brain Tumor With Fewer Long Term Side Effects
Posted at 01:08h
in Author Interviews, Brigham & Women's - Harvard, Cancer Research, Lancet, Pediatrics, Radiation Therapy
MedicalResearch.com Interview with:
[caption id="attachment_21220" align="alignleft" width="120"]
Dr. Torunn Yock[/caption]
Dr. Torunn Yock, MD
Director, Pediatric Radiation Oncology
Associate Professor, Harvard Medical School
Radiation Oncology Quality Assurance
Massachusetts General Hospital, Proton Center
Boston, MA
Medical Research: What is the background for this study?
Dr. Yock: Proton radiotherapy is a highly targeted form of radiation therapy that can spare normal tissues better than standard x-ray/photon based radiotherapy. Because, all side effects from radiotherapy come from radiation dose to normal healthy tissues, it is widely believed that proton radiotherapy has great potential to mitigate the side effects of treatment, both acute and long term side effects. There have been many planning studies that show that proton radiation can achieve a more highly conformal dose distribution and appear to spare 50% or more normal tissue from unnecessary irradiation. However, there have been only a handful of retrospective studies that report disease control and side effects of treatment. While the technology looked promising, the definitive clinical data has been lacking to date. Because of this lack of clinical outcome data, the role and benefit of proton radiotherapy has been a subject of great debate in the oncology community. Critics assert that proton radiotherapy is expensive and unproven and therefore a leading culprit in escalating costs of oncologic health care. Proponents assert that when used in the appropriate patient setting, the margin of benefit in terms of improved health outcomes, outweighs the increased cost of treatment.
We embarked on this study to answer help answer the call for prospectively collected clinical outcome data to better define the most appropriate role for proton radiotherapy. Importantly, this study addresses both disease control and side effects of treatment in a pediatric medulloblastoma cohort of children.
Medical Research: What are the main findings?
Dr. Yock: This study shows that disease control in the pediatric medulloblastoma population is very much the same as that which is achieved by photon based radiotherapy treatments. However, more importantly, late side effects commonly attributed to radiotherapy such as neurocognitive decline over time and hearing loss appear to be improved compared with published photon treated cohorts of pediatric medulloblastoma patients. Additionally, adverse late side effects on the cardiopulmonary, GI, and reproductive systems were essentially eliminated.
02 Feb High Fiber Diet In Early Life May Reduce Breast Cancer Risk
MedicalResearch.com Interview with: [caption id="attachment_21216" align="alignleft" width="144"]
Dr. Maryam Farvid[/caption]
Dr. Maryam S. Farvid, PhD
Takemi Fellow
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Farvid: Previous studies of fiber intake and breast cancer have almost all been non-significant, but none of them examined diet during adolescence or early adulthood, a period when breast cancer risk factors appear to be particularly important. Current study supports protective role of dietary fiber intake on breast cancer. The women who reported the highest amount of fiber consumed during high school, about 28 grams daily, had a 16% lower risk of overall breast cancer compared with those who said they consumed an about 15 grams a day. Also highest verses lowest intake of fiber during early adulthood was associated with a 19% lower risk of overall breast cancer. The associations were more apparent for premenopausal breast cancer than postmenopausal breast cancer. Each 10 grams increase in adolescent fiber intake may lead to a 20% lower risk of premenopausal breast cancer, as was a 15% for overall breast cancer.
01 Feb Most Adolescents With Depression Do Not Receive Follow Up Care
[caption id="attachment_21201" align="alignleft" width="200"]
Dr. Briannon O'Connor[/caption]
MedicalResearch.com Interview with:
Briannon O'Connor PhD
New York University Child Study Center
Department of Child and Adolescent Psychiatry
New York University School of Medicine
New York
Medical Research: What is the background for this study? What are the main findings?
Dr. O'Connor: a. As the health care system continues to emphasize accountability for providing high quality care, the development of meaningful quality standards is critical. This study came from NCQA’s work to develop these quality measures for adolescent depression care. Prior to this study, little was known about what routine care looked like for adolescents who showed up at their primary care visits with significant symptoms of depression.
This study looked at follow up care documented in an electronic health record in the three months after an adolescent was first identified with significant symptoms of depression.
Medical Research: What is the background for this study? What are the main findings?
Dr. O'Connor: Key findings from this study include:
- Most adolescents (nearly two-thirds) with newly prescribed depression symptoms received some treatment, usually including psychotherapy, within the first 3 months after depression symptoms were first identified.
- Among those adolescents who were prescribed antidepressant medications, 40% had no other follow up care in three months, which is quite concerning since current black box warnings highlight the risk for increased suicidality for youth prescribed antidepressants and clearly recommend close monitoring in the few months following initial prescription.
- There were low rates of other follow up care events in the three month follow up period: 19% of adolescents did not receive any follow up care at all, 36% did not receive any treatment, and the majority (68%) lacked documentation that symptoms were monitored or re-assessed using a valid questionnaire
- The sites that participated in the study are highly regarded health care institutions, often looked to as leaders in cutting-edge care. Thus, results from this study, discouraging as they are, may overstate the quality of care in other settings.
29 Jan Antidepressants May Raise Suicide and Aggression Risk in Youth
MedicalResearch.com Interview with: [caption id="attachment_21081" align="alignleft" width="92"]
Tarang Sharma[/caption]
Tarang Sharma, PhD candidate
Nordic Cochrane Centre, Rigshospitalet
University of Copenhagen, Faculty of Health and Medical Sciences,
Denmark
Medical Research: What is the background for this study? What are the main findings?
Response: These newer antidepressants are some of the most prescribed medications in the world and previous research in the area has suggested an increased suicide risk on these drugs in young people, but only when unpublished clinical study report data is used. Such risk is missing when the published articles are considered due to severe selective reporting and publication bias.
In our study we found that the research design of most of the trials was very poor and there were major discrepancies in the reporting, leading to the under-estimation of harms. Despite these problems we still found that both suicidality and aggression were more than doubled in children and adolescents on antidepressants compared to those on placebo.
27 Jan Proximity to Supermarkets Decreases Childhood BMI
[caption id="attachment_20783" align="alignleft" width="150"]
Dr. Lauren Fiechtner[/caption]
MedicalResearch.com Interview with:
Lauren Fiechtner MD MPH
Director of Nutrition
Division of Pediatric Gastroenterology and Nutrition
Massachusetts General Hospital for Children
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Fiechtner: In previous studies, we investigated if distance to a supermarket was associated with a child’s BMI or weight status. These were cross-sectional studies measuring only one point in time. We wondered if distance to a supermarket modified how much children in a behavioral intervention improved their weight or dietary intake. In particular we examined 498 children participating in the Study of Technology to Accelerate Research, which was a randomized controlled trial to treat childhood obesity in Eastern Massachusetts. The intervention included computerized clinician decision support plus a family self-guided behavior change intervention or a health coach intervention, which included text messages to the family to promote behavior change. We found that children living closer to supermarkets were able to increase their fruit and vegetable intake and decrease their BMI z-score more during the intervention period than children living farther from supermarkets.
25 Jan Most Cerebral Palsy Not Due To Poor Delivery Technique
[caption id="attachment_20937" align="alignleft" width="165"]
Dr. Muraskas[/caption]
MedicalResearch.com Interview with:
Jonathan Muraskas M.D.
Professor of Pediatrics and OB/Gyne
Neonatal and Maternal Fetal Medicine
Director Neonatal-Perinatal Research
Loyola University Stritch School of Medicine
Loyola University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process.
In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours.
22 Jan Strong Home Life Can Counteract Prenatal Effects of Methamphetamine
More on Pediatrics on MedicalResearch.com MedicalResearch.com Interview with: Lynne M. Smith, MD FAAP LA BioMed lead researcher Vice Chair for Academic Affairs Professor of Clinical Pediatrics Department of Pediatrics Division of Neonatology Medical Director, High Risk Infant Follow-up Program Associate Program Director, Neonatal-Perinatal Fellowship Training Program Co-Director, Third Year Medical Student Clerkship Founding co-Leader, Schwartz Rounds at Harbor-UCLA David Geffen School of Medicine at UCLA Harbor-UCLA Medical Center Torrance, CA Medical Research: What is the background for this study? What are the main findings? Dr. Smith: It is the first study of its kind, and it holds hope for improving outcomes for children exposed to the methamphetamine in the womb. The study found that while prenatal methamphetamine exposure can lead to targeted behavioral issues, a supportive home environment significantly decreases the severity and risk of these issues. The study is a follow-up to the Infant Development, Environment and Lifestyle (IDEAL) study, which is a prospective, multi-center, longitudinal study of children exposed to methamphetamine in the womb. It is designed to address some of the limitations of earlier studies. The IDEAL study enrolled children from Los Angeles; Des Moines, IA; Tulsa, OK, and Honolulu, HI, who had been exposed to methamphetamine in utero. Previous reports from the IDEAL study documented the outcomes up to age 5 and found emotional issues and attention deficit hyperactivity disorders in the children with prenatal methamphetamine exposure. The new study surveyed 290 children enrolled in IDEAL up to age 7.5 years and found a strong relation between prenatal methamphetamine exposure and rule-breaking and aggressive behavior. It also found a strong relation between adversities in the home and rule-breaking and aggressive behavior. Among the adverse conditions considered were maternal substance abuse, extreme poverty, changes in the primary caregiver, sexual abuse of the caregiver and maternal depression. The researchers concluded that while prenatal methamphetamine exposure is strongly related to behavioral and emotional control issues, early adversities may be a strong determinant of behavioral outcomes.20 Jan Antipsychotics Raise Risk of Diabetes in Youth
Posted at 22:02h
in Author Interviews, Diabetes, JAMA, Mental Health Research, Pediatrics, Pharmacology
[caption id="attachment_20681" align="alignleft" width="210"]
Dr. Christoph Correll[/caption]
More on Mental Health on MedicalResearch.com
MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
Hofstra Northwell School of Medicine
Hempstead, New York, USA
Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Manhasset, New York,
Medical Director, Recognition and Prevention
The Zucker Hillside Hospital,
Department of Psychiatry
Medical Research: What is the background for this study?
Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment.
Medical Research: What are the main findings?
Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.6 times and three times higher compared with 298,803 healthy controls. Furthermore, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.1 times and 1.8 times higher compared with 1,342,121 psychiatric patients not exposed to antipsychotics. Main modifiable risk factors for type 2 diabetes development in antipsychotic-treated youth were treatment with the antipsychotic olanzapine and longer antipsychotic exposure time.
20 Jan Water Jets In Schools Provide One Key To Reducing Childhood Obesity
More on Obesity from MedicalResearch.com MedicalResearch.com Interview with: [caption id="attachment_20772" align="alignleft" width="178"]
Dr. Brian Elbel[/caption]
Brian Elbel, PhD, MPH, Associate Professor, Department of Population Health, NYU Langone Medical Center
Amy Schwartz, PhD, Director, New York University Institute for Education and Social Policy, and the Daniel Patrick Moynihan Chair in Public Affairs, Syracuse University
Michele Leardo, MA, Assistant Director
New York University Institute for Education and Social Policy
Medical Research: What is the background for this study? What are the main findings?
Response: New York City, as well as other school districts, is making tap water available to students during lunch by placing water dispensers, called water jets, in schools. Surprisingly, drinking water was not always readily available in the lunchroom. Water jets are part of a larger effort to combat child obesity.
We find small, but statistically significant, decreases in weight for students in schools with water jets compared to students in schools without water jets. We see a .025 reduction in standardized body mass index for boys and .022 for girls. We also see a .9 percentage point reduction in the likelihood of being overweight for boys and a .6 percentage point reduction for girls. In other words, the intervention is working.