MedicalResearch.com Interview with: Dr. Jun Li, MD, PhD, MPH
Epidemiology and Applied Research Branch
Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion
Medical Research: What are the main findings of the study?Dr. Li: Using the 2001 to 2009 National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) data, which represent 94.2% of the US population, we identified 120,137 pediatric cancer cases with an incidence rate of 171 cases per million children and adolescents.
Overall cancer incidence rates were stable from 2001-2009. However, we found rates were increasing significantly at 1.3% per year in African American children and adolescents. This increase might be partially attributed to the rise among renal tumors and thyroid cancer. We also found rising incidence in thyroid cancer and renal carcinoma among children and adolescents.
As has been previously established, pediatric cancer is more common in males, in white, in adolescents, and in the Northeast. Leukemia is the most common pediatric cancer, followed by central nervous system (CNS) neoplasms, and then lymphomas.
MedicalResearch.com: Interview with:Dr. Steve Turner
Child Health, Royal Aberdeen Children's Hospital
Medical Research: What are the main findings of the study?
Dr. Turner: There is evidence that being small for a given gestational age is associated with a broad range of what could be loosely considered “disadvantageous” outcomes in early childhood, eg increased risk for wheeze, increased blood fat levels, increased blood pressure and low bone mineral density. Many of these outcomes are subclinical – ie unless they were measured no-one would be any the wiser – and what remains to be determined is whether as these individuals grow up these subclinical measurements become important. Follow up may take many years, decades for outcomes such as coronary artery disease and type II diabetes.
MedicalResearch.com Interview with: Cade M. Nylund, MD, MS, FAAP
Major, United States Air Force, Medical Corps
Assistant Professor of Pediatrics
F. Edward Hébert School of Medicine
Uniformed Services University
Medical Research: What are the main findings of the study?Dr. Nylund: The main findings of our study were that among children who were identified as having a diagnosis of Clostridium difficile infection (CDI), CDI was about twice as likely to occur during periods when the child was taking either a proton pump inhibitor or histamine-2 receptor antagonist.
In brief, we performed a type of observational study called a self-controlled case series. Our data source was the military health system database which contains billing records for patients seen in military and civilian facilities. We identified all cases of Clostridium difficile infections in children ages 2-18 over the period of October 2001 to July 2013. We also identified periods when children were prescribed both proton pump inhibitors and histamine-2 receptor antagonists over the same time period. We compared the incidence of CDI during periods prescribed acid suppression medications to periods not prescribed these medications.
MedicalResearch.com Interview with: Dr. Ralph Joseph Diclemente PhD
Behavoral Sciences & Health School Of Public Health
Emory University Atlanta Georgia
Medical Research: What are the main findings of the study? Dr. DiClemente: In our study of 701 African American girls we observed significant and durable reductions in laboratory-confirmed sexually transmitted infections (50% reduction in chlamydial infections and a 60% reduction in gonorrhea) among girls in our intervention group relative to the comparison condition over a 36-month follow-up period. In addition, we observed significant increases in condom use during sex and reductions in sex while using drugs or alcohol. The key finding is the durability of the results - 3 years in the life of an adolescent is a long period.
MedicalResearch.com interview with: Dr. Shannon MacDonald PhD
Department of Pediatrics, University of Calgary, Calgary and
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
Medical Research: What are the main findings of the study?Dr. MacDonald:We found that vitamin K was refused by only a very small number of parents in our study population (0.3%) but that the number appears to be increasing (almost doubling in the past 7 years). The parents that refused vitamin K for their child were more likely to be those that delivered at home and/or with a midwife. We also found that parents who refused vitamin K for their child were also much more likely to go on to refuse all vaccinations by 15 months of age.
MedicalResearch.com Interview with: Dr Prakesh S Shah MSc, MBBS, MD, DCH, MRCP, FRCPC
Professor, Departments of Paediatrics and HPME
Mount Sinai Hospital and University of Toronto
CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research
Director, Canadian Neonatal Network
Toronto Ontario Canada M5G 1X5
Medical Research: What are the main findings of the study?Dr. Shah: The main findings of our study are that by embracing collaborative quality improvement program in 25 of 28 Neonatal ICUs in the country, we were able to show significant reduction in adverse outcomes of necrotizing enterocolitis, severe retinopathy of prematurity and nosocomial infections among preterm neonates born at less than 29 weeks of gestation. This resulted in significant overall reduction of composite outcome of mortality or severe morbidities and improved overall outcomes over 3 years of study period.
MedicalResearch.com Interview with: Suzanne Schuh, MD, FRCP(C), FAAP, ABPEM
Staff Paediatrician, Division of Paediatric Emergency Medicine
Senior Associate Scientist, Research Institute, Hospital for Sick Children
Professor of Paediatrics, University of Toronto
Medical Research: What are the main findings of this study?Dr. Schuh: Our study shows that in previously healthy infants presenting to the Emergency Department with mild to moderate bronchiolitis (a viral lower respiratory tract disease producing breathing distress) who had their oxygen saturation measurements artificially elevated by a physiologically small amount experienced significantly reduced rate of hospitalizations within 72 hours compared to infants with unaltered oximetry readings.
MedicalResearch.com Interview with: Jana Shaw MD, MPH, FAAP
Associate Professor of Pediatrics
Pediatric Infectious Diseases
SUNY Upstate Medical University
750 East Adams Street
Syracuse, NY 13210
Medical Research: What are the main findings of the study?Dr. Shaw: In this study, we looked at exemptions to school immunization requirements in the US during 2009-2010 school year. We found that private schools have higher rates for all types of exemptions (medical, religious, and personal belief/philosophical). In addition, states that permitted personal belief exemptions had higher rates of exemptions overall compared to states that did not allow them.
MedicalResearch.com Interview with: Sharon Levy, M.D., M.P.H.
Director, Adolescent Substance Abuse Program
Assistant Professor in Pediatrics
Boston Children’s Hospital
Medical Research: What are the main findings of the study?Dr. Levy: We found that questions that asked about the frequency of alcohol, tobacco and drug use accurately triaged adolescents into "risk categories". In other words, kids who reported using alcohol or marijuana "once or twice" last year were unlikely to have a substance use disorder, those who reported "monthly" use were very likely to meet diagnostic criteria for a "mild" or "moderate" substance use disorder while those who reported use weekly or more were very likely to meet diagnostic criteria for a "severe" substance use disorder.
MedicalResearch.com Interview with: Pete Dodd (BA, BSc, MMath, PhD)
Research associate in health economic modelling
Health Economics and Decision Science
Regent Court Sheffield
Medical Research: What are the main findings of the study?Dr. Dodd: We found that over 650,000 children under the age of 15 developed tuberculosis in the 22 highest burden countries in 2010, with around 7.6 million becoming infected with the bacillus and more than 50 million harboring latent infection.
Our work points to a much larger gap between notifications and incidence in children compared to adults.
MedicalResearch.com Interview with: David Olds, Ph.D.
Professor of Pediatrics and Director
Prevention Research Center for Family and Child Health
University of Colorado Department of Pediatrics
Aurora, Colorado 80045
Medical Research: What are the main findings of the study?Dr. Olds: We’ve conducted a randomized controlled trial of a program of nurse home visiting for low-income women with no previous live firths during pregnancy and the first two years of the child’s life, with randomization of participants beginning in 1990. In our most recent follow-up of mothers and children in Memphis, those who received nurse-visitation were less likely to have died over a 2-decade period following the child’s birth than those in the control group. Death among mothers and children in these age ranges in the US is rare and extraordinarily important for what it tells us about the health of the population studied in this trial.
For children, the reduction in death was present for preventable causes, that is, sudden infant death syndrome, injuries, and homicide. All of the child deaths for preventable causes were in the control group, for whom the rate was 1.6%. None of the nurse-visited children died of preventable causes.
The reductions in maternal mortality were found for two nurse-visited groups combined for this report: one received prenatal and newborn visitation and a second received visitation during pregnancy and through child age two. Overall, mothers assigned to the control group were nearly 3 times more likely to die than those assigned to the two nurse-visited conditions. The relative reduction in maternal mortality was particularly pronounced for deaths linked to maternal behaviors -- suicide, drug overdose, injuries, and homicide; for these external causes of death, 1.7% of the mothers in the control group had died, compared to 0.2% of those visited by nurses.
MedicalResearch.com Interview with: Dr. Daniel Agardh M.D., Ph.D
Department of Pediatrics
Diabetes and Celiac Disease Unit
Skåne University Hospital
Malmo, Sweden,MedicalResearch: What are the main findings of the study?Dr. Agardh: In this study, we stratify the risk of celiac disease among children according to their HLA genotype and country of residence. We confirm that HLA-DQ2/2 genotype is the major risk factor for early celiac disease, but also show how the risk differs between the participating countries despite of sharing similar HLA risk. This points to the direction of an interaction between HLA and the environment that eventually lead to an autoimmune response in genetic susceptible children.
MedicalResearch.com Interview with: Johanna Petzoldt
Institute of Clinical Psychology and Psychotherapy
MedicalResearch: What are the main findings of the study?Answer: We investigated 286 mother-infant couples from the Maternal Anxiety in Relation to Infant Development (MARI) Study from Dresden (Germany) via standardized interview and questionnaire. We found a robust relation from maternal lifetime anxiety disorders as early as prior to pregnancy to excessive crying in the offspring. Also, the association increased when considering incident anxiety disorders during pregnancy and after delivery.
MedicalResearch.com Interview with: Frank H. Morriss, Jr., MD, MPH
Professor of Pediatrics - Neonatology
University of Iowa Carver College of Medicine
MedicalResearch: What are the main findings of the study?Dr. Morriss: Our aim was to assess the association between surgery performed during the initial hospitalization of very low- birth-weight infants and subsequent death or neurodevelopmental impairment at 18-22 months’ corrected age. We conducted a retrospective cohort analysis of patients who were prospectively enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 to 2009. Surgery was classified by the expected anesthesia type as either major surgery that likely would have been performed under general anesthesia; or minor surgery, that is, procedures that could have been performed under non-general anesthesia and in general were shorter in duration. There were 2,186 major surgery patients and 784 minor surgery patients and more than 9,000 patients who did not undergo surgery.
We found that any surgical procedure increased the adjusted risk of death or neurodevelopmental impairment in low birth weight infants by about 30%. Not all surgical procedures were associated with increased risk, however. Compared with those who did not undergo surgery, patients who were classified as having major surgery had a risk-adjusted odds ratio of death or neurodevelopmental impairment of 1.52 (95% confidence interval 1.24-1.87). However, those who were classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who did not undergo surgery the risk-adjusted odds ratio for neurodevelopmental impairment was 1.56 (95% confidence interval 1.26-1.93), and the risk-adjusted mean Bayley II Mental Developmental Index and mean Psychomotor Developmental Index values were significantly lower.
MedicalResearch.com: Interview with Kay Wang
Academic Clinical Lecturer
Nuffield Department of Primary Care Health Sciences
University of Oxford, Oxford, UK
MedicalResearch: What are the main findings of the study?Dr. Wang: We have found evidence of recent whooping cough infection in 1 in 5 school age children who see their doctor with a persistent cough and in 1 in 6 children who have been fully vaccinated against whooping cough. We have also shown that whooping cough can still cause clinically significant cough in fully vaccinated children.
MedicalResearch.com Interview with: Kay W. Chang, MD
Associate Professor of Otolaryngology and Pediatrics
Department of Otolaryngology
Lucile Packard Children's Hospital at Stanford
Division of Pediatric Otolaryngology
MedicalResearch: What are the main findings of the study?Dr. Chang:At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight.
MedicalResearch.com Interview with: Michelle A. Mendez, PhD
Department of Nutrition
University of North Carolina at Chapel Hill
Gillings School of Public Health
Chapel Hill, NC
MedicalResearch: What are the main findings of the study?Dr. Mendez: Using national surveillance data to examine trends in energy intake among children, we found that there was an initial decline in intakes from 2003-4 through 2007-08, which mirrored evidence that child obesity in the US may have begun to decline in that period. Subsequently, however, in 2009-10, energy intake increased in older children aged 12-19y, and reached a plateau in children aged <11y. This shift is consistent with reports that, particularly in older children, the downward trend in obesity levels may have been reversed in recent years.
MedicalResearch.com Interview with:
Dr. Marcus de Goffau and Dr. Hermie HarmsenDepartment of Medical Microbiology
University Medical Center Groningen
MedicalResearch: What are the main findings of the study?Dr. Marcus de Goffau: In this study we aimed at analysing the gut microbiota composition of children aged 1–5 years with new-onset type 1 diabetes with the microbiota of age-matched healthy controls with a 16S rRNA based method (HITChip). The reason for this selection is that the increase in the incidence of type 1 diabetes worldwide is particularly sharp under the age of 5 years; recent studies indicate that adverse changes in gut microbiota are associated with the development of type 1 diabetes, but little is known about the microbiota in children who have diabetes at an early age. In this study we found that the differences between healthy controls and diabetics change over time, highlighting the importance of a normal gut microbial development. Diabetic children younger than 3 years old often had lower numbers of the Clostridium clusters XIVa and IV, which contain many of the beneficial butyrate producers, than their healthy age-matched controls. The diabetic children older than 3 years have normal numbers of Clostridium clusters XIVa and IV yet not the right species composition; the ones which produce butyrate were underrepresented. The development of the microbiota of diabetic children appears to be one step behind that of healthy controls and/or appears to be going into an aberrant direction. The abundances of other bacteria such as Bacteroides and streptococci were also found to be aberrant in diabetic children.
MedicalResearch.com Interview with Dr. Christopher Wildeman PhD
Associate Professor of Sociology
Faculty fellow at the Center for Research on Inequalities and the Life Course (CIQLE), and at the Institution for Social and Policy Studies (ISPS) at Yale University.
MedicalResearch.com: What are the main findings of the study?Dr. Wildeman: There are four key findings in the study.
First, the cumulative risk of having a confirmed maltreatment report any time between birth and age 18 is much higher than most people would have thought. Fully 1 in 8 American children will experience this event at some point.
Second, the risk of experiencing this event is highly unequally distributed, with Black and Hispanic experiencing it much more than Hispanic, White, and (especially) Asian children. Between 1 in 4 and 1 in 5 Black children will have a confirmed maltreatment report at any time in their childhood. For Native American, the risk is about 1 in 7.
Third, the risk of maltreatment is quite similar for boys and girls.
Finally, the highest risks of child maltreatment are in the first few years of life, suggesting that interventions aiming to diminish maltreatment should focus on parents with very young children.
MedicalResearch.com Interview with: Susan WuMD
Division of Hospital Medicine, Children's Hospital Los Angeles
Assistant Professor of Clinical Pediatrics, Keck School of Medicine of the University of Southern California
MedicalResearch: What are the main findings of the study?Dr. Wu: We performed a randomized trial at 2 urban free-standing children's hospitals, comparing inhaled 3% hypertonic saline to 0.9% normal saline in patients under 24 months with bronchiolitis. Patients with prematurity less than 34 weeks, cyanotic heart disease, chronic pulmonary disease, and previous episodes of wheezing or bronchodilator use were excluded. Patients were 4 mL of study medication nebulized up to 3 times in the emergency department; if admitted, patients continued to receive the assigned study medication three times a day until discharge. A total of 408 patients were analyzed. We found that 28.9% of patients treated with hypertonic saline required hospital admission, compared with 42.6% of patients in the normal saline group.
MedicalResearch.com Interview with: Kimford J. Meador, MD
Department of Neurology & Neurological Sciences
Stanford Comprehensive Epilepsy Center
Stanford University School of Medicine
Stanford, CA 94305-5235.
MedicalResearch: What are the main findings of the study?Dr. Meador:Breastfeeding while taking antiepileptic drugs does not appear to pose a risk to the child's development, and in fact the cognitive outcomes were better for those children who were breastfed vs. those were not.
MedicalResearch Interview with: Dr Gianluca Tognon
University of Gothenburg
MedicalResearch: What are the main findings of the study?Dr. Tognon: We found that eating a pattern rich in vegetables, fruit, nuts, cereal grains and fish, that we call a Mediterranean-like diet was not only inversely associated to being overweight or obese, but also protective against an increase in body mass index and waist circumference at a 2-year follow up.
MedicalResearch.com Interview with: William Kronenberger, Ph.D., HSPP
Professor and Director, Section of Psychology
Acting Vice Chair of Administration
Department of Psychiatry
Indiana University School of Medicine
Riley Child and Adolescent Psychiatry Clinic
MedicalResearch: What are the main findings of the study?Dr. Kronenberger: The main findings of the study are that children with cochlear implants had two to five times the risk of delays in executive functioning compared to children with normal hearing. Executive functioning is the ability to regulate and control thinking and behavior in order to focus and achieve goals; it is important for everything from learning to social skills. The areas of executive functioning that were most affected in children with cochlear implants were working memory, controlled attention, planning, and concept formation. Approximately one-third to one-half of the sample of children with cochlear implants had at least mild delays in these areas, compared to one-sixth or fewer of the normal-hearing sample. We think that reduced hearing experience and language delays cause delays in executive functioning to occur at higher rates in children with cochlear implants.
MedicalResearch.com Interview with:James Chamberlain, MD
Division Chief, Emergency Medicine
Children’s National Health System
MedicalResearch: What are the main findings of the study?Dr. Chamberlain: Contrary to our hypothesis, lorazepam was not superior to diazepam for treating pediatric seizures. Both medications had similar effectiveness (72-73%) and safety (15-16% incidence of assisted ventilation). Lorazepam caused a longer period of sedation prior to waking up. The difference was approximately 15 minutes.
MedicalResearch.com Interview with: Adnan Custovic DM MD PhD FRCP
Professor of Allergy
Institute of Inflammation and Repair
University of Manchester
University Hospital of South Manchester
Manchester M23 9LT, UK
MedicalResearch: What are the main findings of the study?Dr. Custovic: In a longitudinal analysis of the data from our birth cohort study collected from birth to age eleven years, we demonstrated an association between early-life antibiotic prescription and development of wheezing, but not atopy. Furthermore, amongst children with wheezing, antibiotic prescription in infancy increases the risk of subsequent severe wheeze/asthma exacerbations and hospital admissions. This is the first demonstration that children who receive antibiotics in infancy have impaired antiviral immunity later in life, and that early-life antibiotic prescription is associated with variants on chromosome 17q21 locus (which is an asthma susceptibility locus).
Our findings suggest that the association between antibiotics and childhood asthma reported in previous studies arises through a complex confounding by indication, in which hidden factors which increase the likelihood of both antibiotic prescription in early life and subsequent asthma development are increased susceptibility to virus infections consequent to impaired antiviral immunity, and genetic variants on 17q21. Our results raises an important issue that effects which are often attributed to environmental exposures may be a reflection of genetic predisposition.
MedicalResearch Interview with: Charbel El Bcheraoui, PhD, MSc
Acting Assistant Professor, Global Health
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA 98121
MedicalResearch: What are the main findings of the study?Dr. El Bcheraoui: We found a low rate of adverse events associated with male circumcision from U.S. hospital settings, especially if the procedure is performed within the first year of life. The rate of adverse events increased about 10 - 20 times if the procedure was performed later in life.
MedicalResearch.com Interview with: Julie Wang, MD
Associate Professor of Pediatrics
Division of Allergy and Immunology
Icahn School of Medicine at Mount Sinai
New York, NY 10029
MedicalResearch: What are the main findings of the study?Dr. Wang: The results of this study demonstrate that differences in prevalence of reported food allergies exist in elementary schools representing diverse socioeconomic and racial/ethnic characteristic. In this study, we conducted a survey at 4 elementary schools in New York City, 2 private schools that had a predominantly White student body with over 80% of families having paid a full tuition of over $35,000 per year and 2 public charter schools that had a primarily Black and Hispanic student body where over 90% of students qualified for free or reduced price school lunch. The results show a high rate of reported food allergy, with rates significantly higher in the private school population as compared to the public charter school population.
MedicalResearch.com Interview with Tessa Schurink-van 't Klooster
Epidemiologie en Surveillance
RIVM - Centrum Infectieziektebestrijding
3720 BA Bilthoven
MedicalResearch: What are the main findings of the study?Answer: The main finding of this study was that we observed no differences in mortality rate ratios for females compared to males related to the type of last offered vaccination in DTP- and MMR-eligible age groups.
MedicalResearch.com Interview with: Dana Dabelea, MD, PhD
Professor and Associate Dean, Faculty Affairs
Colorado School of Public Health
University of Colorado Denver
Aurora, CO 80045
MedicalResearch.com: What are the main findings of the study?Dr. Dabelea: We found that the proportion of US youth living with Type 1 Diabetes has increased by at least 21% over a period of only 8 years. This increase was seen in both boys and girls, most age-groups and race/ethnic groups. While we do not completely understand the reasons for this increase, since the causes of Type 1 Diabetes are still unclear, it is likely that something has changed in our environment- both in the US and elsewhere in the world- causing more youth to develop the disease, maybe at increasingly younger ages.
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