Program Addresses Racial Inequities in Breastfeeding in Southern US

MedicalResearch.com Interview with:

Dr-Anne Merewood

Dr. Merewood

Anne Merewood PhD MPH
Director, Center for Health Equity, Education, and Research
Associate Professor of Pediatrics, Boston University School of Medicine
Associate Professor of Community Health Sciences
Boston University School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: CHAMPS (Communities and Hospitals Advancing Maternity Practices) worked with hospitals and communities across the southern US to implement the Baby-Friendly Hospital Initiative and decrease racial inequities in breastfeeding rates.

We found that indeed this program significantly reduced the gap between Black and White breastfeeding initiation rates in the 31 hospitals studied, by almost 10%. 

MedicalResearch.com: What should readers take away from your report?

Response: Hospitals and communities can work together in areas where racial disparities are extreme and breastfeeding rates are low, to improve hospital practices around the time of birth. These changes will have an impact on racial gaps in breastfeeding, and will bring more humane and evidence-based care to thousands of women, now and in the future, as the changes are solidified. Improved practices level the playing field for underprivileged groups. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should assess the implementation model to see if it can be applied in other settings. Also, future research needs to examine how well these changes can be sustained. 

Citation:

Addressing Racial Inequities in Breastfeeding in the Southern United States

Anne Merewood, Kimarie Bugg, Laura Burnham, Kirsten Krane, Nathan Nickel, Sarah Broom, Roger Edwards, Lori Feldman-Winter
Pediatrics Jan 2019, e20181897; DOI: 10.1542/peds.2018-1897

Jan 21, 2019 @ 1:31 pm

 

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Zika: Simple General Movement Assessment Tool Can Predict Babies at Risk of Developmental Problems

MedicalResearch.com Interview with:

Karin Nielsen-Saines, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases  David Geffen School of Medicine at UCLA

Dr. Nielsen

Karin Nielsen-Saines, MD, MPH
Professor of Clinical Pediatrics
Division of Pediatric Infectious Diseases
David Geffen School of Medicine at UCLA

MedicalResearch.com: What is the background for this study?

Response: Our study used a very simple evaluation called GMA (General Movement Assessment tool) which checks baby movements at approximately 3 to 5 months of age.

We examined 111 babies exposed to maternal illness during the Zika epidemic in Brazil and 333 control babies without this exposure by GMA at 3 months  and then tested them through standard neurodevelopmental tests at the age of 12 months.

We found that this simple evaluation, which consists of filming a baby lying down on their back for one minute and studying their movements worked extremely well in predicting which babies would or would not have future problems in their neurodevelopment. The study advances knowledge in the area because a simple one minute video of a baby can predict neurodevelopment, something that is extremely hard to determine in young babies.  This is true even in places where sophisticated brain scans are available. By identifying which babies are at risk of developmental problems early on, professionals can rapidly refer these babies to  stimulation programs when they are very young, which increases their chances of having better outcomes. Because the brains of young children respond much better  to stimulation, the timing of interventions to improve their development is very important, that is why they need to be identified early.

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College Students at Increased Risk of Meningitis

MedicalResearch.com Interview with:

Sarah Anne Mbaeyi MD MPH Division of Bacterial Diseases CDC 

Dr. Mbaeyi

Sarah Anne Mbaeyi MD MPH
Division of Bacterial Diseases
CDC 

MedicalResearch.com: What is the background for this study?

Response: College freshman living in residence halls, though not college students overall, have previously been identified as being at increased risk for meningococcal disease. However, these evaluations were conducted in the 1990s when rates of disease were higher, serogroup C was the predominant cause of disease, and before the availability of quadrivalent meningococcal conjugate (MenACWY) or serogroup B meningococcal (MenB) vaccines.

MenACWY vaccine is routinely recommended for all adolescents at age 11 years and 16 years, as well as unvaccinated or undervaccinated college freshmen living in residence halls. MenB vaccine is not routinely recommended for all adolescents or college students, but may be administered to persons aged 16-23 years, with the preferred age of 16-18 years, based on clinical decision-making. Meningococcal vaccines are also recommended during an outbreak, and in recent years MenB vaccines have been used during multiple outbreaks on college campuses.

In this evaluation, we aimed to describe the current epidemiology of meningococcal disease among college-aged young adults in the United States.

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Group B Streptococcus Remain Significant Threat to US Infants

MedicalResearch.com Interview with:

Dr. Nanduri Srinivas Acharya, MBBS, MD, MPH Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Roybal Campus Atlanta, GA 30333

Dr. Nanduri

Dr. Srinivas Acharya Nanduri, MBBS, MD, MPH
Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases
Centers for Disease Control and Prevention
Roybal Campus
Atlanta, GA 3033

MedicalResearch.com: What is the background for this study?

Response: Group B Streptococcus (GBS) is a leading cause of serious illness such as meningitis and sepsis in infants. Among infants, there are two main types of GBS disease. Early-onset GBS disease occurs during the first week of life and late-onset GBS disease occurs from the first week through three months of life. Rates of early-onset disease in the United States have decreased significantly since the 1990s through widespread implementation of intrapartum antibiotic prophylaxis (IAP) guidelines. However, IAP does not prevent late-onset disease. Maternal immunization represents a nonantibiotic strategy to prevent both early and late-onset disease. Multivalent polysaccharide-protein conjugate vaccines are under development against GBS capsular types, with candidate vaccines in phase I and II trials.

Active Bacterial Core surveillance (ABCs) conducts active surveillance for early and late-onset GBS disease among infants in select counties of 10 states, covering about 10% of live births across the United States. We analyzed data from early and late-onset GBS cases identified from ABCs between 2006 and 2015 to describe their epidemiology, incidence trends, and associated strain characteristics. Continue reading

Parental Drinking Linked to Anxiety and Depression in Children

MedicalResearch.com Interview with:

Dr. Ingunn Olea Lund, PhD The Norwegian Institute of Public Health Oslo, Norway

Dr. Ingunn Olea Lund

Dr. Ingunn Olea Lund, PhD
The Norwegian Institute of Public Health
Oslo, Norway

MedicalResearch.com: What is the background for this study?

Response: There are significant amounts of research on children of parents with alcohol use disorders – where the children are shown to be at risk of several adverse outcomes, including mental disorders, substance use disorders, suicide, impaired school performance, and employment problems. There is very little previous research on how other, more normal levels of parental drinking may influence child outcomes, such as mental health. This is a grave oversight, as there are vastly more parents with normal drinking patterns than there are parents who suffer from an alcohol use disorder. This means that there are potentially a lot more cases of adverse effect for children, and the number of children at risk may be higher than previously assumed.

In addition to parents’ alcohol use, several other risk factors in the family that may affect child mental health outcomes, such as parents’ mental health and socio-economic status. Researchers have tended to look at these risk factors separately, but as these risks tend to co-occur, it may be more informative to consider them together.

To our knowledge, this is the first study that examines possible harm from normal levels of parental drinking, alone or in combination with other parental risk factors, on children’s anxiety and depression.

The sample consists of more than 8700 triads: children and both their parents. We combined information from three health registries with survey data where both adolescents and their parents provided information about health and social conditions. The health registers include information about the children ‘s actual contact with the health care system; we used information about whether children received diagnoses and/or treatment for anxiety and/or depression.

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Family Characteristics Linked to Aggressive Behaviors in Boys and Girls

MedicalResearch.com Interview with:

Dr. Richard E. Tremblay, PhD, Professor Department of Pediatrics and Department of Psychology University of Montreal, Montreal, Quebec, Canada School of Public Health, University College Dublin, Dublin, Ireland

Dr. Tremblay

Dr. Richard E. Tremblay, PhD, Professor
Department of Pediatrics and Department of Psychology
University of Montreal, Montreal, Quebec, Canada
School of Public Health, University College Dublin, Dublin, Ireland

MedicalResearch.com: What is the background for this study?  

Response: Adolescent who have frequently use physical aggression are at high risk of school failure, criminal behavior, as well as physical and mental health problems.

A major limit to preventive interventions is our ability to trace the developmental trajectories of physical aggression from infancy to adolescence using a uniform source of information.

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Parents and Grandparents: Baby Proof Your Home!

Safety 1st Cabinet Slide Lock

Safety 1st Cabinet Slide Lock

By: The Experts at Child Safety Store

  • It is recommended that the majority of your childproofing be done at one time. This insures that it is completed before a new capability results in a preventable injury.
  • All lower drawers and cabinets in the kitchen and bathrooms should be latched before he ever learns he can open them. Accessible electrical outlets (both dormant and in-use) protected, vertical cords raised, pool fence installed, stairway gates in place, sharp corners protected, etc. Other items can be added as the need becomes apparent; door alarms, appliance latches, medicine cabinet latches, door knob covers, deadbolt locks, etc.
  • Get down on your child’s level (that’s hands, knees, roll over on your back to get under furniture) and look up. Look around each room carefully as if seeing it for the first time. Crawl around and try to stick your head behind furniture, reach under furniture and feel around to see what is there (sharp springs or staples sticking out, plastic tags, etc.). Get under tables and look up; what would your child’s head hit if he stood up (sharp corners, manufacturer’s labels attached with staples sticking out, glass in the center of an end stand or coffee table).

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Bone Growth Stops Earlier in Today’s Children

MedicalResearch.com Interview with:

Dana L. Duren, PhD Professor, Director of Orthopaedic Research Director of Skeletal Morphology Laboratory Thompson Laboratory for Regenerative Orthopaedics Department of Orthopaedic Surgery Missouri Orthopaedic Institute, University of Missouri Columbia, MO 6521

Dr. Duren

Dana L. Duren, PhD
Professor, Director of Orthopaedic Research
Director of Skeletal Morphology Laboratory
Thompson Laboratory for Regenerative Orthopaedics
Department of Orthopaedic Surgery
Missouri Orthopaedic Institute, University of Missouri
Columbia, MO 6521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The motivation for this study is the apparent accelerated maturity in children in the United States.

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates. Wikipedia Image

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates.
Wikipedia Image

 

We previously demonstrated that skeletal maturity (bone age) is more advanced in today’s children compared to children born in the first half of the 20thCentury (Duren et al., 2015).

n the current study (Boeyer et al., 2018) we show that a significant component of this advanced maturity status is the timing of epiphyseal fusion. In our study, nearly half of the epiphyses of the hand and wrist began or completed fusion significantly earlier in children born after 1995 than those born in the early part of the century, with differences as great as six to ten months for some bones, and mean differences on the order of 4 months in boys and 6 months in girls.  Continue reading

ASH18: RNA Sequencing Identifies More Subtypes of Childhood Leukemia

MedicalResearch.com Interview with:

Charles G. Mullighan, MBBS (Hons), MSc, MD Member, St. Jude Faculty Co-Leader, Hematological Malignancies Program Medical Director, St. Jude Biorepository William E. Evans Endowed Chair St. Judes Children’s Research Hospital Memphis, TN

Dr. Mullighan

Charles G. Mullighan, MBBS (Hons), MSc, MD
Member, St. Jude Faculty
Co-Leader, Hematological Malignancies Program
Medical Director, St. Jude Biorepository
William E. Evans Endowed Chair
St. Judes Children’s Research Hospital
Memphis, TN

MedicalResearch.com: What is the background for this study?

 

Response: B-lineage acute lymphoblastic leukemia (B-ALL) is the commonest form of ALL, and the commonest childhood tumor. It is a leading cause of childhood cancer death. It consists of multiple subtypes defined by genetic alterations. These are often chromosomal translocations that deregulate oncogenes or form fusion proteins. These alterations are disease initiating events and are associated with distinct patterns of leukemic cell gene expression. Most subtypes also have additional mutations that are important for cells to become fully leukemic.

Identifying these initiating genetic changes is very important to identify patients that are likely to respond or do poorly with conventional therapy (multiagent chemotherapy). Also, some identify new opportunities for targeted therapy. However, using standard genetic testing approaches such as chromosomal cytogenetics, about 30% of B-ALL patients don’t have a subtype classifying alteration.

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Black Mothers More Likely To Think Their Sons Have ADHD

MedicalResearch.com Interview with:

George J. DuPaul, PhD Department of Education and Human Services Lehigh University

Dr. DuPaul


George J. DuPaul, PhD

Department of Education and Human Services
Lehigh University

Charles Barrett. Ph.D. School Psychologist Lehigh University

Dr. Barrett

 

Charles Barrett. Ph.D.
School Psychologist
Loudon County Virginia
Public Schools

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Numerous studies have shown that Black children are more likely to receive ratings that are more indicative of displaying externalizing behavior difficulties, including Attention Deficit Hyperactivity Disorder (ADHD).  However, many of these studies included teachers as the informants. Consistent with most teachers in the United States, raters have typically been White females.  For this reason, it is unclear if these outcomes would exist if the rater and child shared the same racial/ethnic background. Additionally, most research in the United States that involved cross-cultural comparisons has used White and Hispanic boys.  Few empirical studies have examined differences between Black and White boys.

The present study sought to address several limitations in the field.  Most notably, cross-cultural comparisons between Black and White boys were included instead of Hispanic and White children.  Next, maternal figures, rather than teachers, were included as the informants.

The present study was developed using a similar methodology that examined Hispanic and White boys’ behavior from the perspective of Hispanic and White teachers (Dominguez de Ramirez & Shapiro, 2005). In sum, we sought to determine if there were differences in how Black and White maternal figures rated Black and White boys who were demonstrating the same level/type of behavior (i.e., sub-clinical levels of ADHD).  Notably, although the boys’ behaviors were the same, maternal ratings were not identical.

Specifically, using the ADHD Rating Scale, Fourth Edition (ARS-4), Black mothers assigned higher ratings to both Black and White boys.

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1 in 40 Children Reported By Parents To Have ASD

MedicalResearch.com Interview with:
Michael Kogan, Ph.D.

Director of the office of Epidemiology and Research
Health Resources and Services Administration’s Maternal and Child Health Bureau

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a study led by the Health Resources and Services Administration’s Maternal and Child Health Bureau, along with researchers from the Centers from Disease Control and Prevention, Harvard, Drexel, and George Washington Universities.  We used the 2016 National Survey of Children’s Health, a nationally representative survey of over 50,000 children that examines the health and well-being of US children, to examine the prevalence, treatment, and health care experiences of children with Autism Spectrum Disorder (ASD).

We found that 1 out of 40 children in the US were reported by their parents to have been diagnosed with Autism Spectrum Disorder.  We also found that children with ASD were significantly less likely to receive services like needed care coordination, referrals to other services, and mental health counseling – even compared to children with other emotional, behavioral or developmental disorders (EBDs).  Parents of children with ASD were also significantly more likely to report being usually or always frustrated in their attempts to get services, again compared to families of children with other EBDs. Finally, we looked at treatment patterns for children with ASD and found that 64% had received behavioral therapy in the year before the interview, and 27% had received medications to treat symptoms of irritability. 

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USPSTF: Interventions to Prevent Child Maltreatment

MedicalResearch.com Interview with:

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper is a board-certified pediatrician and chief of the Division of Ambulatory Pediatrics at Nationwide Children’s Hospital. He is also the deputy editor of Pediatrics.

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations? 

Response: Child maltreatment, which includes abuse and neglect, is a serious health problem that affects too many children in the United States.  Abuse and neglect can have devastating health consequences, including long-term disabilities, depression, physical injury, and even death. In 2016, approximately 676,000 children were subjected to maltreatment, and more than 1,700 children died as a result.

Because this is such an important public health issue, the U.S. Preventive Services Task Force looked at the most recent evidence on whether primary care clinicians can help prevent child maltreatment and its negative consequences.

We found that, unfortunately, there is not enough evidence to recommend for or against these interventions. The Task Force is calling for more research on this important subject so that we can help prevent children from being abused and neglected.    Continue reading

Gene Expression Differences Detected in Toddlers with Autism

MedicalResearch.com Interview with:

Michael Lombardo, PhD Assistant professor of Psychology the University of Cyprus 

Dr. Lombardo

Michael Lombardo, PhD
Assistant professor of Psychology
the University of Cyprus 

MedicalResearch.com: What is the background for this study?

Response: Autism is a diagnostic label we give to children with difficulties in the areas of social-communication and restricted, repetitive stereotyped behaviors and interests. The diagnosis is made based on observations about behavior and is a consensus label, meaning that clinicians can show high degrees of agreement that a given set of behaviors is ‘autism’. But aside from the diagnostic label, there is a fair degree of heterogeneity within patients that have the diagnosis. One way in which patients are heterogeneous is with regard to early language development. Some toddlers with autism are minimally verbal, while at the other end, many toddlers with autism develop language typically. An important question to answer is whether that kind of difference in language development indicates a subtype with different underlying biology.

To examine this question, we first split toddlers with autism into two subtypes defined by their language outcome at 4 years of age. Some toddlers were classified as poor language outcome, because their language performance was 1 standard deviation below typical norms. Other toddlers with autism had relatively good language outcome, as their language performance by 4 years of age was within 1 standard deviation of typical norms.

We also measured the biology behind these two autism subtypes. First we used functional magnetic resonance imaging (fMRI), which is a non-invasive method to look at blood oxygenation response that changes according to a task. Blood oxygenation changes are an indirect measure of neural activity. We used fMRI during natural sleep at around 29 months of age while the toddlers were played language stimuli through headphones to elicit neural responses to speech. Second, we measured molecular aspects of biology, by taking blood samples, isolating leukocyte cells, and then quantifying gene expression for all protein coding genes in the genome, at around the same time as the fMRI scan.

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Probiotics Found Unhelpful in Kids With Outpatient Diarrhea

Stephen Freedman MDCM, MSc Alberta Children's Hospital Foundation Professor in Child Health and Wellness Sections of Pediatric Emergency Medicine and Gastroenterology Alberta Children's Hospital & Research Institute University of Calgary Calgary, AB

Dr. Freedman

MedicalResearch.com Interview with:
Stephen Freedman MDCM, MSc
Alberta Children’s Hospital Foundation Professor in Child Health and Wellness
Sections of Pediatric Emergency Medicine and Gastroenterology
Alberta Children’s Hospital & Research Institute
University of Calgary
Calgary, AB

 MedicalResearch.com: What is the background for this study?

Response: Vomiting and diarrhea remain extremely common diseases in children and are the most common reason children are brought for emergency department care in North America.  While we have options to reduce vomiting there historically has been little physicians can offer to reduce the severity of the diarrhea.

Probiotics have recently emerged as an option with some early evidence of benefit in clinical trials but the studies performed to date have been small and few little research has been conducted in North America in outpatient or emergency department children.

The one study to date that was performed in a US emergency department did not find probiotic use to be beneficial.  Given the increasing importance of clarifying this issue we undertook this study.

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Childhood Lazy Eye (Amblyopia) Linked To Lower Self Perception, Reading Speed and Motor Skills

MedicalResearch.com Interview with:
"i have a lazy eye but it's a good thing" by jessica mullen is licensed under CC BY 2.0Eileen E. Birch, PhD
Director, Crystal Charity Ball Pediatric Vision Evaluation Center
Retina Foundation of the Southwest
Adjunct Professor of Ophthalmology
UT Southwestern Medical Center

 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We previously reported that amblyopia, but not nonamblyopic strabismus or anisometropia, is associated with slower reading speed (Kelly et al  Journal of AAPOS 2015) and that this is related to abnormal eye movements and unstable fixation associated with amblyopia (Kelly et al 2017).  We have also shown that amblyopic children are slower at completing Scantron answer sheets (JAMA Ophthalmology 2018).  We thought that these difficulties experiences in school-age children with amblyopia might affect their self-perception.

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Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery

MedicalResearch.com Interview with:

Marcelo G. Cardarelli, MD A member of Inova Medical Group

Dr. Cardarelli

Marcelo G. Cardarelli, MD
Inova Children’s Hospita
Fairfax, Falls Church, Virginia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Global Humanitarian Medical efforts consume a large amount of resources (nearly $38B in 2016) and donors (Countries, International organizations, WHO, Individuals) make the decisions as to where their funds should be allocated based on cost-effectiveness studies. Most resources go to prevent/treat infectious diseases, sanitation efforts and maternal/child care issues. An insignificant amount of resources is directed to satisfy the surgical needs of the populations in low and middle income countries (LMICs).

The idea behind our project was to find out if it was cost-effective to perform a tertiary surgical specialty (pediatric cardiac surgery) in this context and the answer (at $171 per DALY averted) was an overwhelming yes!

But most importantly, we believe, as many others do, that judging the cost/effectiveness of an intervention in order to decide resources allocation is valid for diseases that can be prevented, but not relevant when it comes to surgical problems that are not preventable.

Instead, we propose the use of another measure of effectiveness, what we call “The Humanitarian Footprint”.

The Humanitarian Footprint represents the long term benefits, as measured by changes in the life expectancy, extra years of schooling and potential lifetime earnings of patients treated surgically during humanitarian interventions.

To our surprise and based on the results, the effects on society of at least this particular surgical intervention were greater than we expected. We suspect this measure can be used in many other surgical humanitarian interventions as well.  Continue reading

Could Sucking the Pacifier Clean Lower Your Baby’s Allergy Antibodies?

MedicalResearch.com Interview with:

Eliane Abou-Jaoude, MD  Allergy and Immunology Fellow Henry Ford Health System Detroit, MichiganEliane Abou-Jaoude, MD 
Allergy and Immunology Fellow
Henry Ford Health System
Detroit, Michigan

MedicalResearch.com: What is the background for this study?

Response: Early life exposure to diverse types of microbes is necessary for healthy immune development and may impact the risk for developing allergic disorders.

Theoretically the transfer of parental microbes to their offspring during infancy can influence a child’s developing gut microbiome and subsequent immune response patterns.

We wished to investigate whether parental pacifier cleaning methods, reported at 6-months of age, were associated with altered serum IgE trajectory over the first 18 months of life. 

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Are Some Dogs Really ‘Allergy Friendly’?

MedicalResearch.com Interview with:
"Dogs and Kids Mix Well" by Tony Alter is licensed under CC BY 2.0Catarina Almqvist Malmros MD, PhD
Professor | Consultant Pediatrician
Dept of Medical Epidemiology and Biostatistics | Karolinska Institutet
Lung and Allergy Unit | Astrid Lindgren Children’s Hospital
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously shown an association between growing up with dogs and a lower risk of childhood asthma (doi: 10.1001/jamapediatrics.2015.3219) but it has been unknown whether this link is modified by characteristics of the dog. Sex of the dog may have an effect on expressed allergens, and uncastrated male dogs release more of a certain allergen than castrated male dogs and female dogs. Some breeds are also described as ‘hypoallergenic’, but there is no scientific evidence whether they are more suitable for people with allergies.

We examined how variables such as sex, breed, number of dogs or size of dog are associated with the risk of asthma and allergy among children with a dog in their home during the first year of life. We included all Swedish children born between January 2001 and December 2004 whose parents had a registered dog in a dog-owner register and linked the data to the Swedish population- and health data registers.

Main findings are that children raised with only female dogs at home had a 16 per cent lower risk of asthma than those with male dogs, and that children living with two or more dogs had a 21 per cent lower risk of asthma than those with only one dog. Importantly, families with parental asthma or allergies had ‘hypoallergenic’ breeds more often than children whose parents did not have asthma or allergies; 11.7% compared to 7.6 . Exposure to these breeds was associated with a 27 per cent higher risk of allergy and no decreased risk of asthma.  Continue reading

Tonsillectomy Often Done When Not Indicated (and vice versa!)

MedicalResearch.com Interview with:

A pair of tonsils after surgical removal Wikipedia image

A pair of tonsils after surgical removal
Wikipedia image

Tom Marshall, MSc, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham, Birmingham, UK

MedicalResearch.com: What is the background for this study?  

Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea).

Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems.

Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.

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No Detectable Developmental Issues in Children Exposed to Anesthesia and Surgery

MedicalResearch.com Interview with:
"Anesthesia" by Liran Szeiman is licensed under CC BY-NC-ND 4.0James D. O’Leary, MD

Department of Anesthesia and Pain Medicine,
Child Health Evaluative Sciences
The Hospital for Sick Children
Department of Anesthesia, University of Toronto
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is substantial evidence from laboratory studies that the developing brain is susceptible to injury from general anesthetic drugs, which culminated in the US Food Drug Administration issuing a safety communication in 2017 stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. Considering the substantial number of children who require general anesthesia every year (almost 3 million in the US annually) even small differences in child development outcomes after surgical procedures that require general anesthesia may have significant public health implications.

Undertaking studies of anesthesia-related neurotoxicity in humans is difficult as adverse child development is a function of the complex interaction between many risk and protective factors. By examining differences between biological siblings in Ontario, Canada, this study seeks to mitigate differences in risk from biological vulnerability and environmental factors, to provide a more accurate estimate of the adverse effects of anesthesia and surgery on child development.

In the current study, young children who had surgical procedures that require general anesthesia were not found to be at increased risk of adverse child development outcomes compared to their biological siblings who did not have surgery. These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes. Continue reading

Girls Recover From Concussions More Slowly Than Boys

MedicalResearch.com Interview with:

Andrée-Anne Ledoux, PhD Children’s Hospital of Eastern Ontario Research Institute Ottawa, Ontario, Canada

Dr. Ledoux

Andrée-Anne Ledoux, PhD
Children’s Hospital of Eastern Ontario Research Institute
Ottawa, Ontario, Canada

MedicalResearch.com: What is the background for this study?

Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care.

The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery.

Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. Continue reading

Twice as Many Pediatric Firearms Deaths in States With Lax Gun Laws

MedicalResearch.com Interview with:

Jordan Stephen Taylor MD POSTDOCTORAL RESEARCH FELLOW PEDIATRIC SURGERY Stanford

Dr. Taylor

Jordan Stephen Taylor MD
POSTDOCTORAL RESEARCH FELLOW
PEDIATRIC SURGERY
Stanford

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Firearms are the second leading cause of death in pediatric patients (ages 1-19). Firearms cause more deaths in this population that cancer or heart disease combined. Our study examined the relationship between state firearm legislation (using the Brady Scorecard and Child Access Prevention (CAP) score) and pediatric firearm mortality. We also examined other state-level factors such as poverty levels, unemployment rate, and high school completion rates. There were several significant findings:

  1. Overall pediatric firearm mortality was inversely correlated with the stringency of state firearm legislation. States with the most stringent firearm legislation had pediatric firearm rates half that of states with more lenient firearm legislation (2.56 deaths per 100,00 children vs 5.00 deaths per 100,000 children. This correlation remained significant even after accounting for other state-level socioeconomic factors.
  2. Pediatric firearm suicide rates were significantly lower in states that had laws specifically designed to prevent children from accessing firearms, including laws that mandate safe storage practices or locks. States with strong CAP laws had rates of pediatric firearm suicides that were four times less than states without such laws. This correlation, as well, remained significant even after accounting for socioeconomic factors.

MedicalResearch.com: What should readers take away from your report?

Response: Pediatric firearm death is a major public health issue. There is a clear discrepancy in where these deaths are occurring. We found that state’s with more lenient laws are having their children die at an alarmingly greater rates. While federal legislation on firearms remains controversial and gridlocked, we found that state legislation could play an important role in preventing pediatric firearm deaths, particularly through passage of child access prevention laws. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Research like this is important to demonstrate to lawmakers and the public that gun legislation can save lives. Currently, only 27 states in the US have any form of Child Access Protection laws. Passing Child Access Prevention laws in the remaining 23 states would be a great starting point for using research like this.

We have no disclosures. 

Citation:

Abstract Title: Strict firearm legislation is associated with lower firearm-related fatalities among children and teens in the United States

Jordan Taylor, MD; Sriram Madhavan, MS; Stephanie Chao, MD
Stanford, CA

Nov 4, 2018 @ 9:12 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Really Scary! Pediatric Pedestrian Fatalities 10x Higher on Halloween

MedicalResearch.com Interview with:
"Halloween Parade 2014" by GoToVan is licensed under CC BY 2.0Dr. John A. Staples, MD
Clinical Assistant Professor
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: At this time last year, my co-author Candace Yip and I noticed an impressive number of advertisements for Halloween-themed parties at bars taped to lamp-posts. We wondered if the combination of dark costumes, dark evenings, alcohol and trick-or-treaters made the streets more dangerous for pedestrians.

To see if our hunch was correct, we examined 42 years of data on all fatal vehicle crashes in the United States between 1975 and 2016. We compared the number of pedestrian fatalities between 5 p.m. and midnight on Halloween with the number during the same hours on control days one week earlier and one week later. We found that 14 pedestrian deaths occurred on the average Halloween, while only 10 pedestrian deaths occurred on the average control evening. This corresponded to a 43% increase in the relative risk of pedestrian fatality on Halloween.

Among children aged 4 to 8 years of age, the risk of death was ten times higher on Halloween evening compared to control evenings. Risks were highest around 6pm, which is prime trick-or-treating time. Absolute risks were small and declined throughout the four decades of the study, but the relative risk increase on Halloween persisted throughout the entire study interval.  Continue reading

Mom’s Voice Makes a Better Smoke Alarm

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

MedicalResearch.com: What is the background for this study?

Response: When residential fires happen at night while people are sleeping, deaths are more likely to occur. Smoke alarms are important for preventing these deaths, yet many young children don’t wake up to traditional high-pitch tone alarms. Children sleep longer and deeper than adults and require louder sounds to awaken than adults. For these reasons, children are less likely to awaken and escape a nighttime home fire. Continue reading

Program Can Help Parents Manage Kids’ Pain from Vaccines

MedicalResearch.com Interview with:

Dr. Anna Taddio BScPhm PhD Professor at the Leslie Dan Faculty of Pharmacy University of Toronto and Senior Associate Scientis The Hospital for Sick Children 

Dr. Taddio

Dr. Anna Taddio BScPhm PhD
Professor at the Leslie Dan Faculty of Pharmacy
University of Toronto and Senior Associate Scientis
The Hospital for Sick Children 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In our prior research, parents have reported they are not educated about how to soothe their infants during painful procedures like vaccinations and that they want to know how they can help. Parents also reported that concerns about their infant’s pain affects their decision-making around vaccination. We therefore set out to target parents for education about how to soothe their infants.

We picked the hospital setting because almost all parents are in the hospital for some period of time following the birth of an infant and already routinely receive education about healthy baby topics. Providing information about pain management was easy to add. We found that about 1 out of 10 parents that were given this information acted on it. 

MedicalResearch.com: What should readers take away from your report?

Response: No parent wants to see their child in pain and a parents’ desire to reduce pain is supported when we provide them with evidence-based strategies to use. These strategies are easy to use, and not only decrease unnecessary infant suffering, they also help parents. Parents are less anxious about their children getting vaccinations. Attending to infant distress is also important for healthy infant development. Targeting parents at the time of birth also ensures that parents will use and advocate for better pain care for their children across different  medical settings and throughout the lifespan.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to find ways to reach more parents so that they can use this information to help their children. We also need to follow parents over time and teach them about the strategies that are helpful for children of different ages. Finally, we need to study how better pain management practices impacts on vaccination rates.

Citation:

Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial Anna Taddio BScPhm PhD, Vibhuti Shah MD, Lucie Bucci MA, Noni E. MacDonald MD, Horace Wong MSc, Derek Stephens MSc

CMAJ 2018 October 22;190:E1245-52. doi: 10.1503/cmaj.180175

Oct 22, 2018 @ 9:53 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.