MedicalResearch.com 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.
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MedicalResearch.com 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.
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MedicalResearch.com 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.
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MedicalResearch.com 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 16802Medical 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…)
MedicalResearch.com Interview with:
Sophie von Stumm BSc MSc PhD
Department of Psychology
Goldsmiths University of London
London, United Kingdom
Medical Research: What is the background for this study?
Dr. von Stumm: At the Hungry Mind Lab (www.hungrymindlab.com), which I direct, we study individual differences in lifespan cognitive development. In particular, I am interested in factors that influence change in cognitive ability and knowledge. One such factor is breastfeeding, which some previous studies suggested to be associated children's intelligence and IQ gains while others failed to find a relationship.
Medical Research: What are the main findings?
Dr. von Stumm: For this study, which was published last week in PloS One (link:http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138676), data were analyzed from more than 11,000 children born in the UK between 1994 and 1996. The children had been repeatedly assessed on IQ: the first time they were tested on intelligence at age 2, and then again repeatedly throughout childhood, overall 9 times, until the age of 16 years. We found that having been breastfed versus not having been breastfed was not meaningfully associated with children's IQ differences at age 2 and also not with differences in children's IQ gains until age 16. That is not to say that breastfeeding may not have other benefits for children's development but our study strongly suggests that breastfeeding is not important for children's IQ. (more…)
MedicalResearch.com Interview with:
Gayatri Mirani MD and
Tulane University School of Medicine
New Orleans, Louisiana
Paige L. Williams, PhD
Department of Biostatistics
Harvard T. H. Chan School of Public Health
Boston, MA 02115
Medical Research: What is the background for this study
Response: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in HIV-related opportunistic infections and deaths in US youth, but both continue to occur. IMPAACT P1074, a long-term US-based prospective multicenter cohort study funded through NIH was conducted from April 2008 to June 2014. We reviewed complications and mortality rates in HIV-infected US youth enrolled in this study. Comparisons were made with a previous observational cohort study, P219C. While P219C was conducted from 2000 to 2007, we restricted our analysis to 2004-2007 in order to evaluate changes over the past decade.
A total of 1201 HIV-infected youth were enrolled in the IMPAACT P1074 study, with most (1040, or 90%) infected with HIV at birth. The overall study population was 52% female, 58% black non-Hispanic and 28% Hispanic. Their mean age at the first chart abstraction was 17.4 (±5.4 Std. Dev.) years. The majority were on cART, had a stable CD4 count (baseline mean > 500 cells/mm3) and a suppressed viral load over a median follow-up of 3.7 years. The P219C group was younger, with a mean age of 11.9 (±5.0 Std. Dev.) years at the start of the 2004-2007 follow-up period.
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MedicalResearch.com Interview with:
Avni Y Joshi, MD, MSc
Assistant Professor of Pediatrics and Medicine
Pediatric and Adult Allergy / Immunology
Cellular and Molecular Immunology Laboratory
Mayo Clinic
Medical Research: What is the background for this study? What are the main findings?
Dr. Joshi: We sought to quantify the risk of asthma outcomes in children with asthma who are exposed to second hand tobacco smoke (SHS).
This was a pooled analysis of 25 studies that were included for looking at asthma outcomes in children.
Children with asthma who were exposed to second hand tobacco smoke (SHS) were nearly twice as likely to be hospitalized as compared to children with asthma who were not exposed to second hand tobacco smoke exposure.
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MedicalResearch.com Interview with:
Avik Chatterjee, MD, MPH
Physician, Boston Health Care for the Homeless Program
Instructor, Harvard Medical School
Associate Epidemiologist, Division of Global Health Equity, Brigham and Women's Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Chatterjee: Substance use, sexual activity and violent behaviors are common during adolescence. Understanding risk factors for these behaviors will improve our ability to prevent them and their sequelae. The Chaos, Hubbub and Order Scale (CHAOS) is a measure of household physical and social disorder, and higher CHAOS score, as reported by parents, has been shown to be correlated with less self-regulatory behavior in children. Thus, CHAOS could be a risk factor for the above behaviors in adolescents. We used data from the RISE study, in which 929 adolescents completed face-to-face and computer-assisted (for sensitive questions) interviews about their health behaviors to analyze the relationship between CHAOS score and risky health behaviors. We found that students with highest CHAOS score, compared to those with zero CHAOS score, had elevated odds for tobacco use (3x), alcohol use (2.5x), any substance use at school (6x) and fighting in the past 12 months (2x).
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MedicalResearch.com Interview with:
Dr. Ziming Xuan ScD, SM, MA
Assistant Professor, Community Health Sciences
School of Public Health
Boston UniversityMedical Research: What is the background for this study?
Dr. Xuan: With respect to background, among the 15000 some teenagers died annually in the US, the 3 leading causes of death were unintentional injuries, homicide, and suicide. Among these fatal youth injuries, 83% homicides were gun-related, and about half of suicides involved a gun (45%).
So, The purpose of the study was to investigate the association between state gun law environment and youth gun carrying in the United States, and whether this association is mediated by adult gun ownership.
Medical Research: What are the main findings?Dr. Xuan:
Among 38 states in our study, 5.7%of high school students living in the 19 states with stricter gun laws carried a gun in past 30 days while 7.3% of students living in states with the weaker gun laws carried a gun.
A 10-point increase in the strictness of the state gun law score was associated with a 9% decrease in the odds of youth gun carrying.
Across states, restrictive gun laws may reduce youth gun carrying by limiting adult gun ownership.
MedicalResearch.com Interview with:
Juliana F. W. Cohen, ScD, ScM
Harvard T. H Chan School of Public Health
Assistant Professor Department of Health Sciences
School of Science and Engineering
Department of Health Sciences, Merrimack College
North Andover, MAMedical Research: What is the background for this study? What are the main findings?
Dr. Cohen: There is a substantial amount of variation in the amount of time students have to eat lunch because there are no national standards for lunch period lengths. This study found that when students had less than 20 minutes of seated time in the cafeteria, they were less likely to select a fruit and consumed significantly less of their entrees, milk and vegetables compared with students who had at least 25 minutes to eat their lunch.
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MedicalResearch.com Interview with:Renee M. Johnson, PhD, MPH
Assistant Professor
Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health
Deputy Director, Drug Dependence Epidemiology Training Program (DDET)
Baltimore MD
Medical Research: What is the background for this study? What are the main findings?
Dr. Johnson: There has been a lot of policy change with regard to marijuana. Several states have enacted laws regarding medical marijuana and decriminalization, and now four states and the District of Columbia have legalized use for adults. Along with these policy changes, there’s been concern that adolescent marijuana use would skyrocket. This prompted me to think about what’s happened over the past 15 years, and so I decided to examine past 15-year trends in adolescent marijuana use among US high school students.
Our research team analyzed data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance Study, or YRBS. It is a nationally-representative survey of high school students. A lot of the information we have about adolescents’ risk behavior comes from the YRBS.
What we found is that marijuana use among US high school students has gone down over the time period. In 1999, 47% of high school students reported lifetime use of marijuana. By 2013, 41% reported lifetime use. Use was lowest in 2009, with 37% of high school students reporting lifetime use. The increase in use from 2009 to 2013 was not statistically significant, so we aren’t sure whether it represents random fluctuation or whether it indicates a reversal in trend.
We also found that gender differences have gotten smaller over the time period, reflecting a real change. Boys have historically had higher rates of use, but that’s changing. In 1999, 51% of boys and 43% of girls reported lifetime marijuana use. By 2013, 42% of boys and 39% of girls reported lifetime use.
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MedicalResearch.com Interview with:
Yang Bai
Graduate research assistant
Department of Kinesiology
College of Human Science
Iowa State University, Ames, IA
Medical Research: What is the background for this study? What are the main findings?Yang Bai: The last national youth physical fitness survey that covered the full developmental age range was conducted more than 25 years ago. A new study conducted by The Cooper Institute known as the NFL PLAY 60 FITNESSGRAM Partnership Project offers potential to study youth fitness on a national level. The NFL PLAY 60 FITNESSGRAM Partnership Project is a participatory research network that tracks health and fitness data from over 1000 schools across the country.
The present study describes the distribution of health-related fitness in 1st-12th grade youth from this large nationwide sample of schools. The main finding included that the fitness levels varied greatly based on gender and age and the percentage of youth had adequate aerobic fitness and healthy BMI were low. For example, there were 62.1％ to 37.6％ (different from grade 4th to 12th) boys meeting the requirements for healthy aerobic capacity, and the range for girls were 50.8％to 26.1％. Aerobic capacity among boys started to decline in the sixth grade, while girls experienced a continual decline with age. There was less variation among boys and girls with a healthy BMI, which ranged 52.7% to 65.0%.
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MedicalResearch.com Interview with: Annemarie Schalkwijk, MSc/MD
PhD candidate, GP in training
Diabetes Research Group
EMGO Institute for Health and Care Research
VU University Medical Center
Amsterdam The Netherlands
Medical Research: What is the background for this study?
Dr. Schalkwijk: Overweight and obese children are at increased risk of becoming overweight and obese adults and therefore are an important risk factor for developing type 2 diabetes. It is known from the literature that being overweight or obese is associated with environmental, parental and socioeconomic status (SES) characteristics. However, the interdependence of these variables has not been studied before.Therefore, the aim of our study is to assess the influence of the amount of green space, accessibility to a garden and the safety of the surroundings during ages 3-5 on being overweight or obese at age 7. Furthermore, we want to assess if parental choices and SES moderate or mediate this influence.
Medical Research: What are the main findings?Dr. Schalkwijk: Statistically significant associations (p≤0.05) were found between low levels green space, not having access to a garden, shabbiness of the neighborhood and childhood obesity (OR (95% CI) respectively: 1,14 (1,02-1,27), 1,35 (1,16-1,58), 1,22 (1,05-1,42)). Parental determinants were related to the environmental determinants and childhood overweight/obese but did not moderate or mediate the association between the latter two. Therefore no parental variables were left in the model. As for SES, the highest level of education in the household did diminish the magnitude of the associations found between the environmental determinants and being overweight/obese. In the final model the remaining significant associations with childhood overweight/obese were no garden access for lower educated households and shabbiness of the neighborhood for higher educated households (OR (95% CI) respectively: 1,38 (1,16-1,58), 1,38 (1,12-1,70). We can conclude from our study, that environmental factors do have an association with children being overweight or obese. However, these associations are complex and might not be as distinct as previously assumed.
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MedicalResearch.com Interview with:
Prof. Dr. Holger Lode
Clinical Immunology, Pediatrics
University of Greifswald, Greifswald
Medical Research: What is the background for this study?
Response: Neuroblastoma is a cancer in childhood with one of the highest death rates. Standard treatment is already very intensive. It includes chemotherapy, surgery, radiation, high dose chemotherapy followed by autologous stem cell transplantation. However, the progress made in improving survival rates is still poor.
The use of an immune-modulatory treatment with a neuroblastoma specific monoclonal antibody ch14.18 (100 mg/m2 /cycle) in combination with cytokines and 13cis retinoic acid (13 cis RA) has shown benefit for patients with this disease [1]. This antibody targets ganglioside GD2 abundantly expressed on neuroblastoma with limited to no expression on healthy tissue. Low expression of GD2 on pain fibers is associated with an on-target side effect of the treatment, which is the induction of neuropathic pain. Approval of ch14.18 (dinutuximab) for the treatment of children with neuroblastoma has been provided by FDA.
In Europe, ch14.18 was not available for a long time. There were several reasons why the antibody in the US could not be given to children in Europe. Therefore a new development of this side of the Atlantic was initiated following the remanufacturing of the antibody in CHO cells [2] (dinutuximab beta) and was made available within clinical trials of the SIOPEN group. The SIOPEN group is a network of leading European pediatric oncology centers to improve outcome for children with neuroblastoma (http://www.siopen.org), similar to the COG (children`s oncology group in the USA; https://www.childrensoncologygroup.org).
Following the recloning procedure, ch14.18/CHO was first evaluated for safety in a Phase I study [3], which confirmed the tolerability and showed activity at a dosing regimen of 20 mg/m2 given by 8 hour infusions on 5 consecutive days. Dinutuximab beta is further developed by Apeiron Biologics.
The current way to apply 100 mg /m2 / cycle is by 4 short term infusions of 25 mg/m2/day each over 8 hrs on 4 consecutive days. The entire treatment consists of 5 cycles. The drawback is that STI is associated with a high amount of intravenous morphine required to make this treatment tolerable for patients. Also the rate of inflammatory side effects observed is substantial.
Clinical observation indicates that if patients treated by STI suffer from pain despite analgesic treatments, a decrease in speed of antibody infusion improves this on target toxicity. Therefore, we hypothesized that significant prolongation of the time of antibody infusion will improve tolerability of that treatment, but at the same time maintains clinical activity and efficacy in high risk neuroblastoma patients.
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MedicalResearch.com Interview with:
Jessica M. Robbins, PhD
Adjunct Assistant Professor
Public Health Epidemiologist
Philadelphia Department of Public HealthMedical Research: What is the background for this study?
Response: The rapid increase in child obesity rates across the US in recent decades has affected Philadelphia as it has other cities. The Philadelphia Department of Public Health has worked with the School District of Philadelphia to analyze data on students' heights and weights to determine trends in obesity since the 2006-2007 school year. Data we had examined through the 2009-2010 school year indicated that the prevalence of obesity and severe obesity were declining in this population, and notably were declining in African-American and Hispanic students as well. We updated the analyses with data through the 2012-2013 school year to see if that trend had continued.
Medical Research: What are the main findings?
Response: Overall, the prevalence of obesity and particularly of severe obesity continued to decline, although more slowly than in the earlier period. However, there were some disturbing disparities, with improvement largely limited to boys. Girls in grades kindergarten through 5 and Hispanic girls actually saw increased obesity since 2009-2010.
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MedicalResearch.com Interview with:
Ana C. Krieger, MD, MPH, FCCP, FAASM
Medical Director, Center for Sleep Medicine
Associate Clinical Professor
Departments of Medicine, Neurology and Genetic Medicine
Weill Cornell Medical College - Cornell University
Associate Attending
NewYork-Presbyterian Hospital
Rockefeller University Hospital
Medical Research: What is the background for this study? What are the main findings?Dr. Krieger: For many years, sleep researchers have been concerned about sleep deprivation in adolescents. Our study shows that high school students have shorter sleep duration on the nights following the spring Daylight Saving Time adjustment. This sleep loss was associated with a decline in daytime vigilance and cognitive performance on the week following DST.
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MedicalResearch.com Interview with:
Monika Goyal, MD
Pediatric emergency medicine
Children’s National Hospital
Washington, DC
Medical Research: What is the background for this study? What are the main findings?
Dr. Goyal: Appendicitis is a painful surgical condition and adequate analgesia, particularly with opioids, are considered one of the mainstays of management. We found that almost half of all children diagnosed with appendicitis did not receive any analgesia. Furthermore, among the patients that did receive analgesia, there were marked racial differences with black children having lower rates of opioid medication receipt than white children, even after we took pain scores or acuity level into account.
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MedicalResearch.com Interview with:
Merja Nermes, MD
Dept. of Pediatrics
Turku University Hospital
Turku, Finland
Medical Research: What is the background for this study? What are the main findings?
Response: Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease. Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive. Our results are the first to show that specific bifidobacteria present in pets can be transferred to the infant gastrointestinal tract during a close contact. Bifidobacteria in general are a part of the microbiota in healthy breast fed infants, and many studies have shown that human-specific bifidobacteria have beneficial effects to health, e.g. lower the risk of allergic disease. The same might hold true for bifidobacteria of animal origin which may enhance and strengthen the development of the infants´ immune system to be protective against allergies.
Our results showed that animal-derived bifidobacteria were found in a higher proportion in infants of pet-keeping families than in those without such exposure. We also found that B. thermophilum (pet-derived Bifidobacterium) was associated with a lower risk for atopic sensitization at 6 months of age.
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MedicalResearch.com Interview with:
Brian A. Primack, MD, PhD
Associate Professor of Medicine, Pediatrics, and Clinical and Translational Science
Director, Center for Research on Media, Technology, and Health
Assistant Vice Chancellor for Research on Health and Society
University of Pittsburgh School of Medicine
Pittsburgh, PA 15213
Medical Research: What is the background for this study?
Dr. Primack: Adolescents and young adults who have never smoked traditional cigarettes are now using e-cigarettes. It is unclear whether these people are at risk for progression to traditional cigarette smoking. Therefore, we followed 694 non-smokers ages 16-26 who did not intend on taking up smoking for 1 year.
Medical Research: What are the main findings?
Dr. Primack: At baseline, only 16 of the 694 participants had used e-cigarettes. However, those individuals were significantly more likely to start smoking traditional cigarettes by the 1-year follow-up. In fully adjusted models, baseline e-cigarette use was independently associated with both progression to smoking (AOR = 8.3, 95% CI = 1.2-58.6) and to susceptibility (AOR = 8.5, 95% CI = 1.3-57.2).
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MedicalResearch.com Interview with:
Henrik Ullman, MD, PhD Candidate
Department of Neuroscience
Karolinska Institutet
Stockholm, Sweden
Megan Spencer-Smith, PhD
School of Psychological Sciences
Monash University
Melbourne, Australia
Medical Research: What is the background for this study? What are the main findings?
Response: Infants born preterm are at risk for school-age cognitive and academic impairments. While some will suffer severe impairments, many more will experience mild impairments, and it is these children who might not raise sufficient concern for referral and intervention. Identifying early markers and methods for classifying preterm infants at risk for school-age impairments, many years before difficulties emerge, would provide important information for clinicians in advising families regarding intervention and ongoing monitoring.
Brain alterations are common in preterm populations. Any brain alterations associated with school-age impairments are likely already present in the neonatal period but are not detected with the current standard clinical and radiological evaluations.
In this study we wanted to see how well we could use advanced analysis of volumetric and diffusion MRI collected in the neonatal period from 224 very preterm children to predict cognitive functions at five and seven years of age. We used statistical models to look for localised regions as well as machine learning methods to correlate patterns in the neonatal MRI data that could predict school-age outcomes.
We found that localised volumes in the insula and basal ganglia as well as a distributed patterns of diffusion MRI could predict working memory and early mathematical skills even after co-varying for important perinatal clinical factors.
It has previously been shown that quantitative and pattern analysis can catch subtle patterns in MRI data not easily detected by eye and may predict cognitive development. The current study builds further on these results showing clinically relevant predictions in preterm children.
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MedicalResearch.com Interview with:Brian D. Elbel, PhD, MPH
Associate professor, Departments of Population Health, Division of Health and Behavior and Medicine, Division of General Internal Medicine
Marie Bragg, PhD
Assistant professorDepartment of Population Health
Jonathan Cantor, MS
Department of Population Health, Section on Health Choice, Policy and Evaluation
NYU Langone Medical CenterMedicalResearch: What is the background for this study? Response: On July 17th, 2014 the New York City Council proposed the “Healthy Happy Meals” bill in an effort to improve the nutritional value of fast food restaurant meals marketed to children. The bill states a restaurant cannot offer an incentive item (i.e. a toy) in combination with the purchase of a meal unless the meal met several nutritional standards.
The meals with toys would be required to:
Be less than 500 hundred calories total
Be less than 600 milligrams of sodium total
Have less than 35% of total calories come from fat
Have less than 10% of total calories come from saturated fat
Have less than 10% of total calories come from added sugar
Contain one half cup of fruit or vegetable or one serving of whole-grain products
This study examined potential reductions in purchased calories, sodium and percentage of calories from fat that could occur among children if the policy were to go into effect.
MedicalResearch: What are the main findings?Response: Researchers collected receipts for fast food purchases for 422 children who were accompanied by 358 adults. On average, adults purchased 600 calories for each child, with 36 percent of those calories coming from fat. One third of the children in the sample had a children’s meal, with 98% of the purchased children’s combination meals would be restricted from handing out a toy with the meal if the bill passed.
If the bill passed, there would be a 9% reduction in calories purchased for kid’s meals, the equivalent of 54 calories. Similarly, researchers found that there would be a 10% (83 mg) reduction in sodium purchased and a 10% reduction in the percentage of calories from fat purchased for children. This all assumes that children ordered what they did previously but the meals meet the nutrition criteria.
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MedicalResearch.com Interview with:
Beate W. Hygen PhD Student
Department of Psychology
Norwegian University of Science and Technology Social Science
Medical Research: What is the background for this study?
Response: The study is part of the Trondheim Early Secure Study (TESS) conducted at the Department of Psychology, Norwegian University of Science and Technology (NTNU) and NTNU Social Science. The main aim of TESS is to detect risk and protective factors with regards to children’s mental health and well-being. TESS examines multiple factors which may play a role in children`s development.
There is substantial research, based on diathesis-stress theorizing, indicating that some individuals, including children, are more susceptible to the negative effects of contextual adversity than are others. However, according to differential susceptibility theory, such "vulnerable" individuals may also be the ones that benefit the most from positive environmental conditions. Thus, some individuals are more malleable for "better and for worse" to environmental exposures. The articleChild exposure to serious life events, COMT, and aggression: Testing differential susceptibility theory was designed to examine if the COMT polymorphism moderated the effect of early-life adversity on aggressive behavior. Thus, we sought to competitively evaluate which model of person X environment interaction best accounted for the anticipated differential effects of life event stress on children's aggressive behavior.
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MedicalResearch.com Interview with:
Daryl R. Cheng, MBBS
Monash Children's Hospital
Victoria, Australia
Medical Research: What is the background for this study? What are the main findings?Response: Inanimate objects worn and used by health care workers (HCW), such as neckties and stethoscopes, have been shown to be reservoirs for potential pathogens. Of particular concern in the pediatric setting are identity (ID) badges and lanyards.
Many pediatric health care workers use them not only for
identification but also as a distraction tool during examination or procedures. Children have an increased tendency to place these items in their mouth as health care workers lean over to examine or care for them, therefore completing the chain of transmission for a potential nosocomial infection.
Whilst previous studies have demonstrated that ID badges and lanyards worn by health care workers may harbor pathogenic bacteria , there is paucity of comparative data suggesting that ID badges may be similarly contaminated with viral pathogens.
However, given the higher incidence of viral infections in pediatrics up to 50% of preterm infants screened during their hospital stay y had viruses detected in their nasopharynx, further evaluation of the viral burden and potential for nosocomial transmission of prevalent viruses are of both clinical and economic significance.
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MedicalResearch.com Interview with:
Stephanie J. Crowley, Ph.D.
Assistant Professor
Biological Rhythms Research Laboratory
Department of Behavioral Sciences
Rush University Medical Center
Chicago, IL 60612
Medical Research: What is the background for this study? Dr. Crowley: Your readers may have seen recent reports by the American Academy of Pediatrics and the CDC about problems with early morning school bells for teens and the need to push school start times later. These recent calls for later school start times come from data showing that biological processes make it challenging for a teen to get enough sleep and be rested for school when they have to wake up very early for school. One of these biological processes is the circadian timing system, which is the approximate 24-hour brain clock that regulates the timing of sleep and wake. During the teen years, the brain clock is shifted later making it more difficult for many teens to fall asleep early enough to get sufficient sleep on school nights.
Medical Research: What are the main findings?
Dr. Crowley: Melatonin suppression, as tested in this new study, is a good indication of how light affects the circadian system. Our findings show that even a very small amount of light (similar to “romantic mood lighting”) in the evening suppressed melatonin levels in the middle-school-aged adolescents. Because evening light “seen” by the brain clock shifts the clock later in time, the message is that biologically-driven later sleep times starts at this early age and needs to be considered when managing school and sleep schedules.
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MedicalResearch.com Interview with:
Jeffrey R. Kaiser, MD, MA
Professor of Pediatrics and Obstetrics and Gynecology
Section of Neonatology
Baylor College of Medicine
Texas Children's Hospital
Houston, TX 77030
Medical Research: What is the background for this study? What are the main findings?
Dr. Kaiser: The continuous utero-placental-umbilical infusion of glucose ends at birth, and levels decrease during the first 1–2 hours stimulating counterregulatory hormones and promoting successful glucose homeostasis in healthy newborns. This is important because the newborn brain principally uses glucose for energy, and prolonged and severe hypoglycemia has been linked with poor long-term neurodevelopment. Most previous newborn hypoglycemia-outcome studies, however, are problematic because they did not control for maternal educational level and socioeconomic status, factors that are highly associated with childhood neurodevelopment and academic success. Further, little is known about whether newborn transient hypoglycemia (1 low value followed by a second normal value), frequently considered to be a normal physiological phenomena with no serious sequelae, is associated with poor academic achievement. To address this knowledge gap, we compared initial newborn glucose values from the universal glucose-screening database, available only at the University of Arkansas for Medical Sciences (UAMS), to their matched student achievement-test scores in 4th grade (10 years later).
After controlling for gestational-age group, race, gender, multifetal gestation, insurance, maternal education, and gravidity, we observed transient hypoglycemia in a heterogeneous cohort of newborns born at a university hospital was associated with lower fourth-grade achievement-test scores—real-world assessments that predict high school graduation, college attendance, and long-term adult economic success.
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MedicalResearch.com Interview with:
Gary S. Marshall, M.D.
Professor of Pediatrics
Chief, Division of Pediatric Infectious Diseases
Director, Pediatric Clinical Trials Unit
University of Louisville School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Marshall: The infant immunization schedule has become crowded. That’s great news, in a sense, because it means that our children have become better protected against more diseases. At the same time, this has led to well child visits during which many shots are recommended, and some parents want to limit the number of injections their children receive at one time. This leads to deferrals, poor timeliness and decreased coverage rates, all of which could impair protection. This study shows that a hexavalent vaccine—one that combines diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccines in one syringe—is safe and just as immunogenic as the currently used component vaccines.(more…)
MedicalResearch.com Interview with:
Jennifer B. Kane PhD
Assistant professor of Sociology
University of California, Irvine
Medical Research: What is the background for this study? Dr. Kane: We know that low-birth-weight babies are more susceptible to later physical and cognitive difficulties and that these difficulties can sharpen the social divide in the U.S. But knowing more about what causes low birth weight can help alleviate this intergenerational perpetuation of social inequality through poor infant health. This study was designed to expand our knowledge of these causes.
Medical Research: What are the main findings?Dr. Kane: This study found that risk factors for low birth weight extend far beyond pregnancy—dating all the way back to women’s early life environment as well as to conditions dating back three generations. For example, a woman’s own weight at birth, as well as her education level and marital status pre-pregnancy can have repercussions for two generations, putting her children and grandchildren at higher risk of low birth weight.
This study also discovered new pathways of risk that contribute to poor infant health. For example, intergenerational transmissions of maternal education, potentially reflecting parent-child socialization or role modeling, appear to have a long-term influence on birth outcomes of future generations.
In addition, this study showed that intra-generational and inter-generational processes work in conjunction with one another to place some infants at higher risk of low birth weight.
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MedicalResearch.com Interview with:
Edward D. Barker, PhD
Developmental Psychopathology Group
Department of Psychology, King’s College London
Institute of Psychiatry London
Medical Research: What is the background for this study?Dr. Barker: The study looks at how the brain may be affected by experiences that happen early in life and adolescence. It has been known for a long time now that people who experience intense adversity are at increased risk of developing depression and other psychiatric problems. Previous research has also shown that both adversity and depression can affect the development of the brain and lead to altered brain structure. In this study, we wanted to examine how early adversity and depression relate to altered brain structure when you examined each within a specific temporal order (i.e., adversity, then depression/anxiety, then brain structure). This study design allowed us to examine not only the effects of adversity and depression, but also if some of the variation in brain structure associated with depression may also be explained by early adversity.
Other researchers have previously suggested that some of the variation in brain structure observed in depressed patients may relate to early adversity, but no previous study has examined this prospectively like we did, using the Avon Longitudinal Study of Parents and Children.
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MedicalResearch.com Interview with:
Arpitha Chiruvolu MD FAAP
Neonatologist
Baylor University Medical Center
Department of Neonatology
Dallas, TX 75246MedicalResearch: What is the background and main findings of the study?Dr.Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes.
We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort.
Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort. A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities.
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MedicalResearch.com Interview with:
George K Siberry, MD, MPH, Medical Officer
Maternal and Pediatric Infectious Disease (MPID) Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, MD
Medical Research: What is the background for this study?
Dr. Siberry: Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger.
Medical Research: What are the main findings?
Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control. When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection. For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment.
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MedicalResearch.com 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.
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