MedicalResearch.com Interview with: Maria Nygren
Division of Pediatrics
Linköping University, Sweden
MedicalResearch:What is the background for this study? What are the main findings?Response: What factors that cause type 1 diabetes is still unknown, but we know that environmental factors are involved besides the genetics. Since the incidence of type 1 diabetes among children have increased worldwide in recent decades, it is important to find out the reasons behind the disease to hopefully be able to prevent new cases.
We have in a prospective study of over 10000 children and their parents in Sweden investigated if psychological stress can be a risk-factor, and found that childhood experience of serious life events (such as death/illness in family, divorce, new adult/child in the family) was associated with increased risk for diagnosis of type 1 diabetes up to 14 years of age.
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MedicalResearch.com Interview with:
Holly Gooding, MD, MS
Harvard T.H. Chan School of Public Health
Instructor in Pediatrics at Harvard Medical School
Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital Division of General Internal Medicine
Brigham and Women’s Hospital Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Gooding: As an adolescent medicine physician, I primarily care for patients between the ages of 12 and 30, although I first trained in internal medicine. One of the things I noticed when I started working with this age group is that pediatric and adult guidelines differ for many conditions. Cholesterol treatment is one condition that comes up frequently, because the NHLBI and the AAP recommend screening youth ages 17 to 21 for cholesterol problems.
The study team and I set out to discover the proportion of American youth ages 17 to 21 who would meet criteria for pharmacologic treatment of abnormal cholesterol levels if clinicians applied the pediatric versus the adult guidelines. We found that 2.6% of young people ages 17 to 21 would qualify for pharmacologic treatment of abnormal LDL cholesterol levels under the pediatric guidelines, but less than 1% would qualify under the adult guidelines. This translates to almost 500,000 youth qualifying for treatment under the pediatric guidelines, but only about 78,000 under the adult guidelines. Those who met pediatric criteria had lower LDL levels but higher proportions of high blood pressure, smoking, and obesity.
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MedicalResearch.com Interview with:
Professor of Pediatrics Hans Bisgaard, MD, DMSc
Copenhagen Prospective Studies on Asthma in Childhood
Herlev and Gentofte Hospital,
University of Copenhagen, Denmark
Medical Research: What is the background for this study?Dr. Bisgaard: Extended breast-feeding is recommended for
newborn children at risk of allergy-associated diseases, but the
evidence of a protective effect on sensitization and these diseases
remains elusive.
Medical Research: What are the main findings?Dr. Bisgaard: Exclusive breastfeeding does not affect
sensitization in early childhood or associated diseases at 7 years
of age in at-risk children.
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MedicalResearch.com Interview with:
Elizabeth Lowenthal, MD MSCE
Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Medical Research: What is the background for this study? What are the main findings?
Dr. Lowenthal: Between 2005 and 2012, HIV related deaths declined by 30% worldwide. However, during the same time period, HIV related deaths increased 50% among adolescents. Over 90% of HIV-infected children and adolescents live in sub-Saharan Africa and HIV is the leading cause of death among adolescents in Africa. Treatment is available that can allow babies born with HIV to live to be healthy adults. However, strict adherence to these medicines is necessary and often becomes a great challenge during adolescence. In our study of 300 adolescents (ages 10-19) in Botswana, my team found that adolescents who come to clinic without a parent or guardian have a 4.5X greater odds of failing their HIV treatment.
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MedicalResearch.com Interview with:
Dr. Julie Magno Zito, PhD
University of Maryland, Baltimore, MD 21201
MedicalResearch: What is the background for this study?Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.
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MedicalResearch.com Interview with:
Dr. Michele Jonsson Funk, PhDResearch Associate Professor, Dept of EpidemiologyDirector, Methods Core, Center for Women’s Health ResearchUniversity of North Carolina at Chapel Hill and
Dr. Wendy Camelo Castillo, MD, PhD
Post-doctoral fellow at the University of Maryland
Medical Research: What is the background for this study?
Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable).
Medical Research: What are the main findings?
Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ). The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively. (more…)
MedicalResearch.com Interview with:
Dr Anne K Detjen, MD
Child Lung Health ConsultantInternational Union Against Tuberculosis and Lung Disease
Medical Research: What is the background for this study? What are the main findings?Dr. Detjen: The bacteriological diagnosis of tuberculosis (TB) in children is challenging due to the difficulty in obtaining specimens such as sputum and the lack of an accurate and accessible diagnostic test. In most cases, diagnosis is made on clinical grounds based on a contact history and a combination of signs and symptoms. We included 15 studies in a systematic review and meta-analysis of Xpert for the diagnosis of pulmonary TB in children.
The accuracy of Xpert for diagnosing TB in children is suboptimal, and the majority of children will still have to be diagnosed clinically. However, in settings where it replaces smear microscopy Xpert will increase the likelihood of bacteriological confirmation of TB as well as MDR TB among children. Xpert does not increase the number of confirmed TB cases among culture-negative children. We also found that smear status highly impacted Xpert results, i.e. a higher yield among smear positive compared to smear negative children. Smear positivity increases with bacillary load and might be a proxy for disease severity. Unfortunately, we were not able to assess the performance among children with different stages of disease severity since this was not classified in any of the studies included.
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MedicalResearch.com Interview with:
Joyce Maalouf MS MPH
Nutrition Epidemiologist
CDC, Atlanta
Medical Research: What is the background for this study? What are the main findings?
Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity.
Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods.
In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods.
To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010.
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MedicalResearch.com Interview with:Donald M Lloyd-Jones, MD/ScM
Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor
Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology
Northwestern University Feinberg School of MedicineMedicalResearch: What is the background for this study? What are the main findings?Dr. Lloyd-Jones: Previous studies have examined the associations of cardiovascular health, as defined by the American Heart Association, with outcomes in younger and middle-aged adults. Prior studies have also examined the status (i.e., prevalence) of cardiovascular health in adults across the age spectrum, and in adolescents ages 12-19 years. However, no study to date has examined the status of cardiovascular health in children under 12 years of age, so we sought to define it in detail using nationally-representative data.
Overall, although we have inadequate surveillance systems to monitor cardiovascular health optimally in our youngest children, this study shows that there are concerning signals that they are losing the intrinsic cardiovascular health they are born with, even well before age 12 years. The implications for loss of cardiovascular health before adulthood have been well established, with earlier onset of cardiovascular diseases, cancer and other diseases, earlier mortality, lower quality of life and many other adverse consequences.
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MedicalResearch.com Interview with:
Sabine Roza MD Ph.D. and
Ayesha Sajjad MD, Phd student
Department of Child and Adolescent Psychiatry & Psychology
Department of Psychiatry, Erasmus MC,
Rotterdam, The Netherlands.
Medical Research: What is the background for this study? What are the main findings?
Dr. Roza: WHO guidelines recommend six months of exclusive breastfeeding followed by partial breastfeeding until two years for overall optimum growth and development of children. However, the role of breastfeeding duration on child cognitive development remains a topic of continual debate. Previous research has shown mixed results on the role of breastfeeding duration and exclusivity on child IQ. Several methodological differences in study design inhibit comparisons of these studies and thus limit their generalizability. Furthermore, the association of breastfeeding with child cognitive development is subject to confounding by various factors especially maternal IQ. Therefore, we aimed to study the association between breastfeeding duration and breastfeeding exclusivity with non-verbal IQ in children. We used data the Generation R Study, which is a prospective cohort study from fetal life until young adulthood. Due to the large variability in ethnic backgrounds in our study participants, we focused on non-verbal IQ. In a large sample of 3761 children aged on average 6 years, we found an initial advantage of 0.32 points in non-verbal IQ for every increasing month of breastfeeding, which strongly attenuated after adjustments were made for child factors, maternal factors, sociodemographic factors, parental lifestyle and maternal IQ. Similar attenuation of effect sizes was observed for breastfeeding duration as a categorical variable and duration of exclusive breastfeeding.
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MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities,
CDC
Medical Research: What is the background for this study? Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers. NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat.
Medical Research: What are the main findings?
Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation.
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MedicalResearch.com Interview with:Marc Ellsworth, M.D
Neonatology fellow at the
Mayo Clinic Children’s Center
MedicalResearch: What is the background for this study? Dr. Ellsworth: Inhaled Nitric Oxide (iNO) is a drug that has FDA approval for use in neonates >34 weeks gestational age. It is used for severe respiratory failure secondary to pulmonary hypertension. However, it has been previously shown that neonatologists have been using this medication off-label and especially in the most premature neonates. Over the last 10 years there have been multiple large studies trying to determine a clinical use (ie long term benefit) for iNO in preterm neonates (patients where there is no FDA approval for iNO use currently). Despite evidence of short term benefit (improved clinical stability) use of this drug has not been shown to improve long-term outcomes (death and chronic lung disease) in premature neonates. As a result of these findings the National Institute of Child Health and Human Development (NICHD) released a consensus guideline in 2011 indicated that available evidence did not support the routine use of iNO in preterm neonates and discouraged this use of this expensive therapy in preterm neonates. Similarly, in 2014 the American Academy of Pediatrics issued a similar statement with similar recommendations.
In 2014 a group of NICUs (collectively called the Neonatal Research Network) associated with the NICHD published a report showing that the use of Inhaled Nitric Oxide in preterm infants (ie off-label) decreased following the report in 2011.
However, I did not feel that these NICUs were representative of the United States alone as the Neonatal Research Network consists of only a handful of NICUs (~15) and is directly associated with the NICHD. As a result I wanted to get a better idea of Inhaled Nitric Oxide use in a population based study to see if the trends were similar (ie use of iNO has been decreasing) on a much larger, more representative scale. (Editorial comment: My anecdotal experience was that rates of iNO use off-label have not decreased in preterm neonates since the 2011 report).
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MedicalResearch.com Interview with:
Su-Ying Wen, MD
Chief of Department of Dermatology,
Taipei City Hospital, Renai Branch, Taipei City, Taiwan
Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei City, Taiwan
Medical Research: What is the background for this study? What are the main findings?
Dr. Su-Ying Wen: Though herpes zoster is seen as a disease of the elderly, it can affect individuals in any age group including children. There are limited population-based data regarding pediatric herpes zoster.
We reported a higher incidence rate of pediatric herpes zoster than in previous studies. The higher incidence observed in this population-based study might be because it was measured in a cohort of children who were all infected with varicella rather than as other reports including individuals free of varicella infection in the denominator. Children younger than 2 years at the diagnosis of varicella had a significantly higher risk and shorter duration of developing herpes zoster. (more…)
MedicalResearch.com Interview with:
Dr. Roy Kim, MD
Depts. Endocrinology and Pediatrics
UT Southwestern Medical Center
Medical Research: What was the problem you were focused on?Dr. Kim: We were focused on the problem of adolescent metabolic syndrome, a major public health problem. Our objective was to determine whether nut intake is linked with any difference in odds for metabolic syndrome in US adolescents.
Medical Research: How is metabolic syndrome defined?Dr. Kim: In general it is diagnosed when there are 3 or more of the following things: increased belly fat, high blood pressure, high fasting glucose, elevated triglycerides, and low HDL cholesterol.
Medical Research: How did you do your study?Dr. Kim: We used data from the National Health and Nutrition Examination Survey (NHANES), years 2003-2010, to examine health status and the diet history for 2,322 US adolescents age 12 to 19 years.
Dr. Kim: Our first major finding was that adolescents who ate at least 12.9 grams of nuts per day - this is the equivalent of about 1 ounce of nuts 3 times per week – had a dramatically lower odds for metabolic syndrome compared to adolescents who ate less than that amount. The odds for nut-consumers was only about 43% of the odds for non-consumers. This remained true after controlling for age, gender, race, income, and dietary factors including sugar, fruit, and vegetable intake.
Our second major finding was that average nut intake is very low among US adolescents – only about 5 grams per day - and more than 75% of US adolescents eat no nuts at all on a typical day.
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MedicalResearch.com Interview with:
Anita Kozyrskyj Ph.D
Professor, Department of Pediatrics
University of Alberta
Medical Research: What is the background for this study? What are the main findings?
Prof. Kozyrskyj: Our study determined what "good" gut bacteria were present in 166 full-term infants enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) Study. Funded by CIHR and AllerGen NCE, this landmark study involves more than 3,500 families and their newborn infants across Canada. Gut bacteria were identified by DNA sequences extracted from infant poop.
Infants with a fewer number of different bacteria in their gut at 3 months of age were more likely to become sensitized to foods such as milk, egg or peanut, by the time they were 1 years old. Infants who developed food sensitization also had altered levels of two specific types of bacteria, Enterobacteriaceae and Bacteroidaceae, compared to infants who didn’t. (more…)
MedicalResearch.com Interview with:
Courtney Benjamin Wolk, Ph.D.
Postdoctoral Researcher
Center for Mental Health Policy and Services Research
Perelman School of Medicine Department of Psychiatry
University of Pennsylvania Philadelphia, PA 19104
Medical Research: What is the background for this study? What are the main findings?Response: Previous research investigating the relationship between anxiety and suicidality has been mixed. An ongoing question in the field has been whether anxiety disorders independently increase risk for suicidal ideation and behavior or if the high co-occurrence of anxiety and mood symptoms or other shared demographic factors are driving relationships that have been observed between anxiety and suicidality.
We examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts 7 to 19 years after treatment with cognitive-behavioral therapy, more commonly referred to as CBT. Our results indicated that participants who responded favorably to cognitive-behavioral therapy during childhood had lower rates of lifetime, past month, and past two-week suicidal ideation endorsement than treatment non-responders. This was the case across both self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, though plans and attempts were infrequently endorsed in our sample, limiting the ability to detect findings.
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MedicalResearch.com Interview with:
Dr. Kevin Vagi, Ph.D
Division of Violence Prevention,
CDC’s Injury Center.
MedicalResearch: What is the background for this study? What are the main findings?Dr. Vagi: Although there has been research on teen dating violence (TDV) for several decades, the subject has only received attention as a public health concern in recent years. Over time, prevalence estimates of physical teen dating violence victimization from CDC’s national Youth Risk Behavior Survey (YRBS) (first measured in 1999) have remained around 9% with similar rates among female and male students. Until recently, there have been no ongoing national studies of sexual TDV to our knowledge.
This article describes new physical and sexual teen dating violence victimization questions first administered in the 2013 YRBS, shares the prevalence and frequency of TDV and national estimates using these new questions, and assesses associations of teen dating violence experience with health-risk behaviors. By including questions on both physical and sexual TDV, we are able to look at those youth who experienced physical TDV only, sexual TDV only, both physical and sexual TDV, any TDV, and none. These distinctions were important when investigating health outcomes associated with different types or combinations of TDV, as some health-risk behaviors have been shown to be associated with certain types of teen dating violence but not others.
In 2013, among high school students who dated, 1 in 5 females and 1 in 10 males experienced physical and/or sexual TDV in the 12 months before the survey. The majority of students who experienced physical and sexual teen dating violence experience it more than once. Students who experienced both physical and sexual TDV are more likely to have other health-risks, such as suicidal ideation and behavior, fighting, carrying a weapon, being electronically bullied, alcohol and drug use, and risky sexual behaviors. This report also offers the first national estimate of sexual TDV. Findings suggest that comprehensive prevention efforts should focus on helping students develop healthy relationship skills to prevent teen dating violence and other risk behaviors. (more…)
MedicalResearch.com Interview with:
Dr. Yang Lu Ph.D
Los Angeles Biomedical Research Institute
Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic interventions, and cost effectiveness studiesMedicalResearch: What is the background for this study?Response: Non-adherence is a serious issue in type 1 diabetes management. It leads to
poor glycemic control and peaks in adolescence and young adulthood. Peer
support is critical for young patients yet few studies examined whether
pairing youth with slightly older and more experienced peers with diabetes
improves their diabetes self-management and glycemic control.
This study had two aims:
(1) assess whether adolescents (as prospective mentees) and young
adults (as prospective mentors) with diabetes would be interested in peer
mentoring as a way to improve adherence, and
(2) identify contents and delivery modes for a peer mentoring topic from the perspective of patients and their parents. Fifty-four adolescents and 46 young adults with type 1
diabetes were surveyed.
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MedicalResearch.com Interview with:
Rebecca S. Williams, MHS, PhD
University of North Carolina at Chapel Hill
Chapel Hill, NC
MedicalResearch: What is the background for this study? Dr. Williams: In recent years, the e-cigarette industry has ballooned into a multi-billion dollar market, with at least 466 brands and 7764 unique flavors of e-cigarettes sold online. With both smokers and people who never smoked turning to e-cigarettes, there are concerns about their safety, lack of regulation and accessibility to teens. The CDC reported that 17% of high school seniors use e-cigarettes, more than twice as many as use traditional cigarettes; furthermore, that hundreds of thousands of youth annually are using e-cigarettes who never smoked cigarettes.
Our previous studies of Internet cigarette sales indicated that Internet Tobacco Vendors did a poor job of preventing sales to minors, which helped inform development of state and federal regulations to regulate such sales. In 2013, North Carolina passed a law requiring age verification for online e-cigarette sales. This study was the first study to examine age verification used by Internet e-cigarette vendors and the first to assess compliance with North Carolina’s e-cigarette age verification law.
MedicalResearch: What are the main findings?Dr. Williams: It was very easy for minors to buy e-cigarettes online. It took little effort for them to bypass the age verification practices of the vendors because there was very little use of rigorous age verification. With only 5 orders rejected by vendors due to age verification, there was a youth e-cigarette purchase success rate of 94.7%. No vendors used age verification at delivery, and few used rigorous methods of age verification that could potentially block youth access. While 7 vendors claimed to use age verification techniques that could potentially comply with North Carolina’s law, only one actually did.
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MedicalResearch.com Interview with:
David C. Rettew, MD
Associate Professor of Psychiatry and Pediatrics
Director, Child & Adolescent Psychiatry Fellowship
Director, Pediatric Psychiatry Clinic
University of Vermont College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Rettew: We did this study because while everyone knew that antipsychotic medication rates were going up, there was very little data that drilled deeper and was able to get at the question about the appropriateness of this increase.
There’s good news and bad news in this study. The bad news is that our data show that about half the time, kids are not being treated with antipsychotic medications according to best practice guidelines. The good news is that it doesn’t look like these medications are being used casually or in a knee jerk way. In the vast majority of cases, youth are getting to this class of medications only after many other things have failed.
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MedicalResearch.com Interview with:
Ina S. Santos (on behalf of the co-authors)
Iná S. Santos, MD, PhD
Professora Titular Depto Medicina Social
Programa Pós-graduação Epidemiologia
Universidade Federal de Pelotas, Brasil
MedicalResearch: What is the background for this study? What are the main findings?Response: Early regulatory problems (excessive crying, sleeping and feeding problems in infancy) have been considered early markers for similar processes of inadequate or under-controlled behavior in childhood and psychosocial problems in childhood are associated with psychological disorders later in life. The prevalence of excessive crying during the first 3 months of life in representative community-based samples from high-income countries has been reported to range between 14% and 29%.
There is no consensus regarding the definition of excessive crying. A frequently used definition is the excessive paroxysmal crying, that is most likely to occur about the same time every day (usually in the late afternoon or evenings) without any identifiable cause in an otherwise healthy baby aged 2 weeks to 4 months and lasting more than three hours per day, occurring in more than three days in any week for three weeks (rule of three) that is typically known as colic. Others give less emphasis to the amount of crying and give relevance to maternal or parental stress due to the child unresponsiveness to soothing or to the maternal perception of the intensity of crying.
Negative consequences of excessive crying on maternal and child health have been described: it is associated with early weaning from breast milk, frequent changes of formulae, and maternal mental symptoms, besides being the most common proximal risk factor for shaken baby syndrome.
In a study conducted in a middle-sized city located in Southern Brazil, 4231 children enrolled in the 2004 Pelotas Birth Cohort were followed-up from birth to four years of age. At the 3-month post-partum follow-up mothers were asked whether their infants cried more, less or as the same as others of the same age. Infants whose mothers perceived them as crying more than others of the same age were classified as “crying babies”. When the cohort reached four years old, all children were screened to assess their risk of presenting psychological problems. After taking into account a series of maternal and child characteristics (like, maternal age, maternal level of education, type of delivery, gestational age at birth, and child sex, among others) “crying babies” were at increased risk of presenting behavior problems in comparison to “non-crying babies”.
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MedicalResearch.com Interview with:
Dave Kennaway, PhD Professor
Lloyd Cox Senior Research Fellow,
Head Circadian Physiology Laboratory
School of Paediatrics and Reproductive Health
Robinson Research Institute,
Faculty of Health Sciences, Medical School,
University of Adelaide Australia
MedicalResearch: What is the background for this review? What are the main findings?Dr. Kennaway: There is evidence that melatonin is being prescribed to for sleep disorders in children and adolescents who are developing normally despite the fact that there have been no properly designed studies on the effects of prolonged administration to children. In countries where melatonin has been registered, it is for use as a monotherapy for the short term treatment of primary insomnia, characterised by poor quality of sleep in patients who are aged 55 years and over. Use in Paediatrics is always “off-label”. After more than 50 years of melatonin research in animals there is overwhelming evidence that melatonin administration affects many organ systems. These include important effects on the reproductive organs of rodents, cats, ruminants and primates and melatonin is in fact registered as a veterinary drug for this purpose. The effects of melatonin, however, go beyond the potential reproductive consequences, including effects on cardiovascular, immune and metabolic systems. It is clear that many paediatricians, practitioners and parents are unaware of this.
MedicalResearch: What should clinicians and patients take away from your report?Dr. Kennaway: Clinicians and patients need to recognise that melatonin is a hormone and not a drug developed for a specific purpose or illness. There have been no appropriate trials in children addressing the effects of prolonged administration of melatonin in children. Given the extensive literature on the role of the hormone in normal physiology it is unlikely that such trials would ever be approved. Should endocrine or other abnormalities appear in the future in children previously treated with melatonin it will not be tenable to argue that we were surprised.
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MedicalResearch.com Interview with:
Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329
MedicalResearch: What is the background for this study? What are the main findings?Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009. The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children. Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.
During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died. Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%). One or more viruses were detected in 1,472 (66%) of these children. Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%). The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period. The highest incidence was among children younger than 2 years old (62.2/10,000). Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia. Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia. Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%). The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests. (more…)
MedicalResearch.com Interview with:
Brian Elbel, PhD, MPH
Associate Professor, Department of Population Health;
Associate Professor, Department of Medicine
Population Health NYU School of Medicine
Medical Research: What is the background for this study? What are the main findings?Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children. No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating. We did not find, at least one year after the store opened, any appreciable change in shopping or eating.
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MedicalResearch.com Interview with:
Professor Kathy Cottingham PhD
Departmental of Biological Sciences
Dartmouth University Hanover, NH
Medical Research: What is the background for this study? What are the main findings?
Professor Cottingham: Arsenic is a naturally occurring element that occurs in high concentrations in groundwater in certain parts of the world, including here in New Hampshire. Exposure to high concentrations of arsenic in water has a number of potential health consequences, including cancer, cardiovascular disease, diabetes, obesity, adverse birth outcomes, and altered immune systems. Effects of lower-dose exposures are still under investigation, but emerging evidence suggests similar effects as higher doses.
In the U.S., public drinking water sources are regulated to have arsenic below a maximum contaminant level of 10 micrograms of arsenic per liter of water. However, private wells are not regulated, and there is no requirement to test water in private wells to ensure that the water is safe to drink.
The New Hampshire Birth Cohort, led by Dr. Margaret Karagas, is an ongoing longitudinal study of pregnant women who drink water from private wells. This study quantified arsenic exposure in 72 infants born to women in the cohort, using urine samples and exposure modeling.
Our results show that in general, exposure to arsenic during early infancy is quite low, regardless of how the infants were fed (breast milk vs. formula).
However, a few formula-fed infants were highly exposed to arsenic, likely due to high concentrations of arsenic in the drinking water used to mix their powdered formula.
Arsenic concentrations in breast milk - and in the urine of infants fed only with breast milk - were very low.
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MedicalResearch.com Interview with:
Yeyi Zhu, PhD
IRTA Postdoctoral Fellow
Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development,
NIH
MedicalResearch: What is the background for this study? What are the main findings?Dr. Zhu: Currently in the US, nearly two thirds of reproductive-aged women are overweight or obese. Moreover, the amount of weight gained during pregnancy can have immediate and long-lasting impacts on health of a woman and her infant. Previous evidence implicates that excessive gestational weight gain above the Institute of Medicine guidelines is related to high birthweight (>4000 g), a marker of intrauterine over-nutrition which may impose a greater risk of offspring’s obesity and metabolic diseases in later life.
Given that more than one third of children and adolescents are overweight or obese in the US, it is of great public health significance to improve our understanding of determinants and mediators of childhood obesity. The length of breast feeding and age at introduction of solid foods are infant feeding practices that are potentially modifiable in early life. We therefore examined whether birthweight and infant feeding practices, specifically length of breast feeding, mediate the relationship between maternal gestational weight gain and childhood growth in the National Children’s Study Formative Research in Anthropometry, a cross-sectional multi-ethnic study of 1387 mothers and their children aged 0-5.9 years in the US (2011-2012).
We illustrated that the intergenerational relationship between maternal gestational weight gain and early childhood growth (i.e., z scores for weight-for-age, weight-for-height, and body mass index-for-age) largely acts through birthweight rather than directly on childhood growth. Further, given the negative association of breastfeeding duration with childhood anthropometrics, longer length of breastfeeding suppressed the positive associations of gestational weight gain and birthweight with childhood growth. In addition, analysis by ethnicity revealed that these associations were only significant in non-Hispanic White and non-Hispanic Black participants as opposed to Hispanics and other ethnicities.
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MedicalResearch.com Interview with:
Katherine M. Keyes, Ph.D.
Assistant Professor of Epidemiology
Columbia University
Mailman School of Public Health
New York, NY 10032
Medical Research: What is the background for this study? What are the main findings?
Dr. Keyes: The Monitoring the Future study is an annually conducted survey of 8th, 10th, and 12th grade high school students in the United States, covering a wide range of adolescent health behaviors. The same questions on adolescent sleep were queried every year since 1991, allowing us to examine historical trends in the amount of sleep adolescents report. We found that there have been substantial decreases in the proportion of adolescents who report 7 or more hours of sleep on a regular basis, across all age groups and across all demographic groups. In the most recent years, after age 15, less than half of adolescents report regularly getting 7 or more hours of sleep every night. Given the importance of sleep in both the short and the long term for adolescent health, these findings suggest substantial public health concern. (more…)
MedicalResearch.com Interview with:
Julia Jaekel PhD
Department of Developmental Psychology
Ruhr-University Bochum in Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Jaekel: Recent reports suggest that delayed school entry (DSE) may be beneficial for children with developmental delays. However, studies of the effects of DSE are inconclusive. Our study investigated the effects of delayed school entry versus age-appropriate entry (ASE) in a large sample after minimizing selection bias and accounting for confounding effects of preschool knowledge. We found that delayed school entry has no effect on Year 1 teacher ratings of academic performance. In contrast, DSE children’s standardized mean test scores of mathematics, reading, writing and attention at 8 years of age were lower than ASE children’s mean scores.
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MedicalResearch.com Interview with:
Markus Juonala, MD, PhD
University of Turku Finland
Medical Research: What is the background for this study? What are the main findings?
Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness.
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