MedicalResearch.com Interview with: Antti Saari, M.D. Department of Pediatrics University of Eastern Finland and Kuopio University Hospital Kuopio Finland MedicalResearch: What is the background for...
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:
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:
Mark Brittan MD MPH
Assistant Professor, Pediatric Hospital Medicine
Children's Hospital Colorado
University of Colorado School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Brittan: As hospitals face reimbursement penalties for excess readmissions, clinicians are increasingly focused on improving care transitions in order to reduce readmissions. We are interested in learning about feasible ways to reduce pediatric readmissions so that we can improve the quality of care and experience of children and families who are being discharged from the hospital. The purpose of this study was to assess whether outpatient follow-up visits after hospital discharge can help to prevent readmissions. We chose to examine this question in a population of medically complex children enrolled in Medicaid. Children with medical complexity account for a growing proportion of pediatric hospitalizations and inpatient costs. These children are often dependent on technology (for example, ventilator machines, feeding tubes, and chronic indwelling catheters), and can have very complex care plans and medication regimens. Publically insured children are also vulnerable to increased hospital utilization and may not always have optimal or easy access to outpatient services. Showing a relationship between post-discharge outpatient visits and fewer readmissions would suggest that improvements in coordination of care or access to outpatient follow-up care may help to reduce readmissions in these children. To assess this relationship, we retrospectively analyzed 2006-2008 Colorado Medicaid claims data from which we were able to gather demographic, clinical, and visit information for all enrollees.
In our study, we excluded children who were readmitted within 3 days of hospital discharge so that we could evaluate children who had a chance to follow-up. The study cohort included 2415 medically complex children aged 6 months to 18 years who were hospitalized at least once. Of these children, 6.3% were readmitted on days 4 – 30 after hospital discharge. Almost 22% of the children had an outpatient follow-up visit within 3 days of discharge, and 40% had a visit on days 4-29 after discharge. In the final analysis, we found expected associations between readmission and previously described risk factors, including number of patient comorbidities and longer initial hospital length of stay. Examining the relationship between outpatient follow-up and readmission, we found that children with later outpatient follow-up visits (days 4-29) were significantly less likely to be readmitted than those who did not have an outpatient visit on days 4-29 after discharge.
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MedicalResearch.com Interview with:
Samuel Dominguez MD
Departments of Pediatric Infectious Diseases
Children's Hospital Colorado and University of Colorado School of Medicine Aurora, CO
Medical Research: What is the background for this study? What are the main findings?
Dr. Dominguez: Due to global poliovirus eradication efforts, clusters of acute flaccid paralysis (AFP) and/or cranial nerve dysfunction in children are rare and associated with few pathogens, primarily enteroviruses and flaviviruses. Our study reports the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of EV-D68 respiratory illness, strengthening the potential link between EV-D68 and neurologic disease in children.
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MedicalResearch.com Interview with:
Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford
Department of Primary Care and Public Health Sciences
King’s College London, London, UK
Medical Research: What is the background for this study? What are the main findings?
Response: Overweight and obesity in children have increased dramatically since the 1960s with important clinical and economic impacts, especially among those who become obese adults. Consequently, understanding trends in obesity is of increasing importance for monitoring population health and informing policy initiatives. Current trends suggest that a majority of the world’s population will be either overweight or obese by 2030. However, recent reports suggest that the increasing trend in overweight and obesity in children may have leveled off since 2000. But, in many countries data are based on a limited number of time points and relatively small surveys, limiting definitive conclusions and not allowing examining trends in subgroups by sex and age. Moreover, only a few countries have data on younger children (aged under 6 years).
Our study aimed to use primary care electronic health records to examine prevalence of overweight and obesity in 2 to 15 year old children in England and to compare trends over two decades, from 1994 to 2003 and from 2004 to 2013.
Medical Research: What are the main findings?
Response: We found that currently about a third of children in the UK are overweight or obese. We also found that overweight and obesity prevalence increased during decade 1 (1994-2003) but stabilized in decade 2 (2004-2013). This was observed in both sexes and the in younger age groups (2-5 year and 6-10 year). However, rates continued to increase in older children (11-15 year), albeit at a slower speed than in decade 1 (1994-2003).
(more…)MedicalResearch.com Interview with: Karin B. Michels, MPH, PhD, ScD Department of Epidemiology, Harvard School of Public Health Channing Division of Network Medicine, Department...
MedicalResearch.com Interview with:
Dr Laila J Tata PhD
Associate Professor in Epidemiology
Faculty of Medicine & Health Sciences
University of Nottingham
Medical Research: What is the background for this study? What are the main findings?
Response: Over the last decades there has been increased clinical awareness of coeliac disease (CD) partially because of improvements in the accuracy and availability of diagnostic tests, however, we do not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary socioeconomic group. Funded by CORE/Coeliac UK and conducted at the University of Nottingham, this study analysed 2,063,421 children aged less than 18 years who were registered with general practices (primary care doctors) across the United Kingdom contributing to their routine electronic health records to The Health Improvement Network (THIN) database between 1993 and 2012. The study found 1,247 children were diagnosed with coeliac disease, corresponding to about 1 new case in every 10,000 children each year. Girls consistently had more diagnoses than boys and whilst the incidence of new celiac disease cases among children up to age 2 years remained stable over time, diagnoses in older children almost tripled over the past 20 years. Moreover, the study found a socioeconomic gradient in celiac disease diagnoses, such that children living in less socioeconomically deprived areas were about twice as likely to be diagnosed as those from more deprived areas. This pattern held for boys and girls and for all ages.
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MedicalResearch.com Interview with:
James Tao, MD, Ph.D
Assistant Professor Director, EEG Lab
Department of Neurology, The University of Chicago, IL.
Medical Research: What is the background for this study? What are the main findings?
Dr. Tao: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with chronic uncontrolled epilepsy. Patients often died in sleep, in bed, and unwitnessed. They were often found in prone position. These circumstances of SUDEP are remarkably similar to those of sudden infant death syndrome (SIDS). In our study, we found that 73% of 253 SUDEP patients were died in prone position. These findings suggest that sudden unexpected death in epilepsy may share the mechanisms similar to SIDS.
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MedicalResearch.com Interview with:
Ji Su Hong, MD
Department of Psychiatry
Washington University School of Medicine St. Louis, MO
Medical Research: What is the background for this study? What are the main findings?
Dr. Ji Su Hong: The estimated prevalence of preschool conduct disorder is 3.9%-6.6%. Approximately 1 out of 20 preschoolers has conduct disorder. Disruptive behaviors are common in the preschool period of development. However, to date we have not had scientific data to help guide clinicians to distinguish between normal disruptive behaviors in preschoolers and behaviors that are markers of later Conduct disorder at school age.
There were common misbehaviors which were found in preschoolers with mental health problems as well as healthy preschoolers. Those were losing temper, low intensity destruction of property and deceitfulness/stealing.
Preschoolers who exhibited high-intensity defiant behavior, aggression toward people or animals, high-intensity destruction of property, peer problems and deceitfulness, including stealing, were more likely to have preschool conduct disorder and they were more likely to be diagnosed with a conduct disorder at school-age. (more…)
MedicalResearch.com Interview with:
Terisa P. Gabrielsen, PhD, NCSP
Assistant Professor, School Psychology
Dept. of Counseling Psychology and Special Education
Brigham Young University, Provo, UT 84602
Medical Research: What is the background for this study? What are the main findings?
Dr. Gabrielsen: One of the keys to improving outcomes for individuals with outcomes is to begin intervention as early as possible, which means we need to identify autism symptoms as early as possible, preferably during the early toddler years. The current study grew out of a screening feasibility study to see what would happen if pediatricians followed the AAP guidelines for screening every child for autism at ages 18 and 24 months as part of their regular pediatric care appointments. That study was conducted in a large, independent community pediatrics practice. We found that universal screening of 796 patients helped to identify 10 toddlers with autism who had not previously been referred for evaluations. Physicians had previously identified 3 others with autism in the group, and toddlers with other delays, such as language delays, were also identified through the screening process. We wondered what some possible causes were for the low rate of autism referrals and designed the current study to look for what information was available to a pediatrician during the timespan of a typical pediatric exam. We found that even in toddlers with autism, a brief (10-minute) sample contains an overwhelming ratio of typical behaviors (averaging 89%) compared to infrequent atypical behaviors (11%) that would indicate the presence of autism. We had autism experts identifying the behaviors from videos of the evaluations of children in the previous study, so they had many luxuries that a clinician doesn't have during an exam (i.e., ability to focus on one aspect of development, ability to rewind and re-view behaviors). After watching the 10-minute video observations, we asked our experts, "Would you refer this child for an autism evaluation?" We found that even the experts missed referring a child for an autism evaluation 39% of the time when the only data available were the brief observations.
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MedicalResearch.com Interview with:
Prof. H. Szajewska
The Medical University of Warsaw
Department of Paediatrics
Warsaw, Poland
Medical Research: What is the background for this study?
Dr. Szajewska: Proton pump inhibitors (PPIs) are increasingly being used in the management of irritability and excessive crying in young infants. For example, a 7-fold increase in PPI prescriptions for infants was demonstrated in one US-based study. While differences among countries may occur, over-prescription of PPIs for infants remains a problem. The use of PPIs is mainly based on the assumption that these symptoms are attributable to gastroesophageal reflux or gastroesophageal reflux disease. Indeed, in infants, common symptoms of both conditions include regurgitation or vomiting associated with irritability or crying. However, there is still uncertainty with regard to the role of proton pump inhibitors for the management of excessive crying and irritability.
Dr. Szajewska: What are the main findings?
We aimed to examine whether proton pump inhibitors are effective in the management of excessive crying and irritability in infants. Only 5 randomized controlled trials fulfilled the inclusion criteria, so the evidence remains limited. There was variability in how crying/irritability outcomes were reported, but all trials used reliable methods. Some trials showed a decrease in crying/irritability from baseline to the end of the intervention; a similar effect was observed in the control group. However, no significant differences between the treatment groups were observed. (more…)
MedicalResearch.com Interview with:
Yvonne Wu MD
Professor of Clinical Neurology and Pediatrics
UCSF School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Wu: Newborn infants commonly have elevated bilirubin levels, manifested as jaundice, because the body's mechanisms for breaking down bilirubin have not yet fully matured. Although high bilirubin levels are almost always well tolerated, extremely high bilirubin levels may lead to brain injury, or kernicterus, which in turn can cause a very severe form of cerebral palsy. When bilirubin levels are extremely high, or when bilirubin levels remain high despite phototherapy, it is recommended that an exchange transfusion be performed to prevent brain injury and cerebral palsy. The American Academy of Pediatrics (AAP) has published recommendations on when an exchange transfusion should be performed, based on bilirubin level, age of infant and other clinical factors. However, no previous study had examined the actual risk of cerebral palsy in infants whose bilirubin levels exceeded the exchange transfusion thresholds.
Among 500,000 newborns born at Kaiser Permanente Northern California over a 17-year period, we found 1833 who had at least one bilirubin level above the AAP exchange transfusion level. There were only 3 cases of cerebral palsy due to kernicterus in this group, even though only 42 (2.3%) of them had received exchange transfusions. All 3 infants had bilirubin levels at least 5 mg/dL above the AAP exchange transfusion threshold and all 3 infants had 2 or more other risk factors for brain damage, including prematurity, sepsis, hypoxia and the hereditary blood disorder G6PD deficiency. We did not identify any cases of kernicterus among otherwise well term babies, even at bilirubin levels that exceeded the AAP exchange transfusion threshold.
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MedicalResearch.com Interview with:
Jonathan Olsen
Institute of Primary Care and Public Health
Cardiff University Heath Park Cardiff
MedicalResearch: What is the background for this study? What are the main findings?
Response: Molluscum Contagiosum is a common skin condition in children which has a prevalence of between 5.1% to 8% in children aged 14 years and under. Strikingly however, there is little epidemiological evidence describing the natural history, transmission between family members and impact upon quality of life of molluscum contagiosum. Our research aimed to address this gap in evidence by conducting a prospective cohort study of UK children recruited by clinical and self-referral using the validated Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP).
We recruited 306 children during 2013 and showed that on average lesions will last for 12 months, however 30% still had lesions at 18 months and 13% still had lesions at 24 months. Most children experienced only a small effect on their quality of life from the condition, however 1 in 10 experienced a large or very large impact on their quality of life. The condition was shown to be highly contagious with further transmission between children living in the same household as an index case shown in 40%.
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