Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults

MedicalResearch.com Interview with:
Charlotte Björkenstam PhD

Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm

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

Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.

We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.

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Exposure To Furry Pets During Pregnancy and Babyhood May Help Keep Your Child Lean

MedicalResearch.com Interview with:

Anita Kozyrskyj, PhD Department of Pediatrics Faculty of Medicine & Dentistry University of Alberta

Dr. Anita Kozyrskyj

Anita Kozyrskyj, PhD
Department of Pediatrics
Faculty of Medicine & Dentistry
University of Alberta

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

Response: We have known for a while that early-life exposure to household pets can reduce risk for allergic disease; new studies also suggest a benefit in preventing overweight. Our pilot study in 2013 showed that postnatal pet exposure increases the number of different beneficial microbes in the infant gut. My team of 12, including first author and Albert Innovates-Health Solutions (AIHS) postdoctoral fellow Hein Min Tun, took the science one step closer to understanding this connection in our recently published work in the Microbiome journal. In a study of 746 infants from the Canadian Healthy Infant Longitudinal Development Study (CHILD) birth cohort, we investigated the impact of pet exposure during pregnancy or afterwards on infant gut microbes, and whether this depended on how infants were born.

In infants born vaginally or by cesarean section, pet exposure during pregnancy or pre and postnatally up to 3 months after birth increased the amounts of 2 bacteria found on dogs and cats. One is Ruminococcus, linked to lower rates of allergies in children. The other is a relatively unknown microbe, Oscillospira, reported to promote leanness. Another important finding suggested that contact with pets during pregnancy could reduce transmission of vaginal GBS (group B Streptococcus) during birth.

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Radiation Exposure in the Pediatric Patient: What Every Orthopaedist Should Know

MedicalResearch.com Interview with:
Ayesha Rahman, MD

Chief Orthopaedic Surgery Resident
NYU Langone Medical Center.

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

Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow.

Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.

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Pediatric Death Fall Worldwide, But Still Disproportionately Affect Poorer Countries

MedicalResearch.com Interview with:
Dr. Nicholas Kassebaum, MD Assistant Professor

Institute for Health Metrics and Evaluation
University of Washington

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

Response: Reducing deaths of young children has been an international priority over the past few decades, and much progress has been made in this regard. Comprehensive and timely measurement of death and disease burden among children and adolescents is essential for improving the health of young people. Analyzing the latest estimates from the Global Burden of Disease (GBD), the current study quantifies and describes levels and trends of mortality and disease burden among children and adolescents under the age of 19 from 1990 to 2015.

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Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates Not Linked To Poor Neurodevelopmental Outcomes

MedicalResearch.com Interview with:

Prof. Olivier Baud MD Chef de Service, Réanimation et Pédiatrie Néonatales Team leader, INSERM U1141 Université Paris-Diderot, Sorbonne Paris Cité Département Hospitalo-Universitaire "PROTECT" Hôpital Robert Debré, Paris, France

Prof. Baud

Prof. Olivier Baud MD
Chef de Service, Réanimation et Pédiatrie Néonatales
Team leader, INSERM U1141
Université Paris-Diderot, Sorbonne Paris Cité
Département Hospitalo-Universitaire “PROTECT”
Hôpital Robert Debré, Paris, France

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

Response: Preterm birth is frequently associated with perinatal inflammation, a major risk factor for bronchopulmonary dysplasia (BPD). Because glucocorticoids alleviate systemic inflammation, they have been proposed as a therapeutic option in very preterm infants. Early dexamethasone therapy led to short-term benefits but was associated with cerebral palsy and other adverse neurodevelopmental events. Early treatment with low-dose hydrocortisone has been reported to improve short-term outcomes in extremely preterm infants. However, its safety remains to be assessed with regard to the long-term neurodevelopmental outcomes.

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Antibiotics in Pregnancy Increase Children’s Risk of Otitis Media and Ventilation Tubes

MedicalResearch.com Interview with:
Hans Bisgaard, MD, DMSc

Professor of Pediatrics
The Faculty of Health Sciences
University of Copenhagen
Copenhagen University Hospital, Gentofte
Copenhagen, Denmark

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

Response: The consumption of antibiotics is increasing worldwide. Antibiotics alter the maternal bacterial colonization and by vertical transmission this can affect the offspring. An unfavorable microbiome may increase the disease propensity of the offspring.
Otitis media is one of the most common infections in early childhood. We hypothesized that antibiotic consumption in pregnancy can increase the children’s risk of otitis media.
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Adolescents Perinatally Infected with HIV Are At Increased Risk of Serious Physical and Mental Health Problems

MedicalResearch.com Interview with:

Anne M Neilan, MD,MPH Assistant In Medicine, Massachusetts General Hospital Research Fellow, Harvard Medical School Department: Medicine Service Division: Infectious Disease Department: Pediatric Service Massachusetts General Hospital Boston, MA 02114

Dr. Neilan

Anne M Neilan, MD,MPH
Assistant in Medicine and Pediatrics
Massachusetts General Hospital
Instructor at Harvard Medical School
Department: Medicine Service
Division: Infectious Disease
Department: Pediatric Service
Massachusetts General Hospital
Boston, MA 02114

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

Response: Adolescents infected with HIV – either at birth or later in life – experience poorer health outcomes compared to adults with HIV in nearly every respect. This study found that U.S. youth infected with HIV around the time of their birth are at higher risk throughout their adolescence and young adulthood for experiencing serious health problems, poor control of the HIV virus (having high levels of HIV virus in their bodies and fewer CD4 immune cells which protect the body from infection), or death. The study also found that among those with good HIV control, serious health problems are rare.

By combining data from two large, long-term U.S. studies – the Pediatric HIV/AIDS Cohort Study (PHACS, www.phacsstudy.org) and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT, www.impaactnetwork.org) Network – we were able to study the health of more than 1,400 perinatally HIV-infected children, adolescents and young adults ages 7 to 30 years between 2007 and 2015. The study found that youth ages 13 to 30 were most likely to have poor HIV control AIDS-related illnesses, and death compared to younger participants. Among 18 – 30 year-olds, the study found that poor control of the HIV virus – meaning higher levels of HIV virus and lower levels of CD4 immune cells which protect the body from infection –35 percent of the time, increasing the risk that these youth would stop responding to certain HIV medications and could transmit HIV to others. These findings are consistent with other U.S. and European reports. Despite being engaged in health care, the number of deaths among youth born with HIV in the U.S. is 6 to12 times higher than for youth without HIV of the same age, sex and race.

Along with HIV-related health problems, the most commonly reported health conditions concerned mental health and brain and nervous system development. Many women in the study also had sexually transmitted infections, which was found to be associated with lower CD4 immune cell counts. This may suggest a biological mechanism or may reflect that patients who have difficulty with their medications are also engaging in more frequent risky sexual behaviors.

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Pediatric Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the US

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

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

Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults.

However, little is known about the epidemiology of pediatric SJS/TEN.

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How Does Fruit Juice Affect Weight Gain in Children?

MedicalResearch.com Interview with:

Brandon Auerbach, MD, MPH Acting Instructor Division of General Internal Medicine University of Washington

Dr. Auerbach

Brandon Auerbach, MD, MPH
Acting Instructor
Division of General Internal Medicine
University of Washington

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

Response: The question of whether 100% fruit juice causes poor health outcomes in children, such as weight gain, has been a subject of controversy. On one hand, 100% fruit juice contains vitamins and nutrients that many children lack, is often cheaper than whole fruit, and may help kids with limited access to healthy food meet their daily fruit requirements.

On the other hand, leading nutrition experts have expressed concern that fruit juice contains amounts of sugar equal to or greater than those of sugary drinks like regular soda. Guidelines from the American Academy of Pediatrics warn that 100% juice can be a significant source of calories and contribute to obesity if consumed excessively.

Our main finding was that consuming 1 serving/day of 100% fruit juice was not associated with weight gain in children. Children ages 1 to 6 years gained a small amount of weight, but not enough to negatively impact health. Children ages 7 and older gained no weight. We did not study amounts of 100% fruit juice higher than 1 serving/day.

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High School Students Increasingly Specializing in One Sport

MedicalResearch.com Interview with:

Michael G. Ciccotti, MD Professor of Orthopaedic Surgery Rothman Institute Chief of Sports Medicine, and Director of the Sports Medicine Fellowship Thomas Jefferson University

Dr. Michael Ciccotti

Michael G. Ciccotti, MD
Professor of Orthopaedic Surgery
Rothman Institute
Chief of Sports Medicine, and
Director of the Sports Medicine Fellowship
Thomas Jefferson University

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

Response: No doubt sports plays a huge role in the United States and all over world with millions of young people between the ages 6 and 18 participating in an organized sport on a regular basis.

Over the past decade, there has been a tremendous focus on youth single sport specialization (SSS), with pressure from coaches, parents and the athletes themselves to participate in one sport year round. Many participants, coaches and parents believe that early specialization may allow the young athlete to become better and progress more quickly in their sport, perhaps allowing them a greater chance of becoming a professional athlete. This drive toward early specialization has been fueled by popular icons i.e. Tiger Woods (golf) and Lionel “Leo” Messi (soccer) as well as by media hits such as Friday Night Tykes (young football players) and The Short Game (7-year old golfers). The pop-psych writer, Malcolm Gladwell, whose The 10,000 Hour Rule (in his book Outliers) holds that 10,000 hours of “deliberate practice” are needed to become world-class in any field may have also encouraged the specialization trend.

There is little doubt that youth sports may encourage a lifelong interest in a healthy lifestyle as well as improved self-esteem and social relationships. The flip side is that extreme training and singular focus on a sport can lead to stress on the developing musculo-skeletal system, a pressure to succeed at all costs, reduced fun, burnout and sometimes social isolation.

The dilemma we are beginning to scratch the surface of is does single sport specialization enhance the likelihood of getting to an elite level and does it increase the risk of injury? There is a growing sense in the medical community that SSS raises injury risk without enhancing progression to a higher level.

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Acute Kidney Injury Is A Frequent Complication of Pediatric Diabetic Ketoacidosis

MedicalResearch.com Interview with:

Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada

Dr. Panagiotopoulos

Constadina Panagiotopoulos, MD, FRCPC
Department of Pediatrics, Endocrinology & Diabetes Unit
British Columbia Children’s Hospital
Vancouver, British Columbia, Canada

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

Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema.

One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors.

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Physical Activity In Decline For Most Kids By School Age

MedicalResearch.com Interview with:
Professor John J Reilly
University of Strathclyde Glasgow
Physical Activity for Health Group
Scotland, UK 

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

Response: There is Concern that levels of physical activity among modern children are typically very low, well below the amounts recommended for their physical & mental health, well-being, and academic attainment.

It has been assumed for many years that physical activity levels begin to become a problem at adolescence, and this adolescent decline in activity is especially marked in girls.

MedicalResearch.com: What are the main findings?

1. Physical activity- in our sample of 545 individuals studies at ages seven, nine, 12, and 15 using activity monitors for six to seven days at each time point- was already low and was in decline from age seven, well before adolescence.

2. The physical activity decline was not especially marked at adolescence, or in girls.

3. In a minority of boys (19% of boys) and girls (12% of girls) physical activity was maintained at a relatively high level from age seven to 15 years. these are interesting exceptions to the general pattern.

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

Response: We should no longer see girls,or adolescents, as the only high risk groups for low physical activity; the entire population is at high risk.

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

Response: Efforts to promote or maintain physical activity need to start well before adolescence, and should not just focus on girls. Physical activity seems to be in decline in most children by the time they start school. We need to address more research and policy effort at lifestyles of younger children of both sexes.

We also need to direct more research effort at the interesting minority in both sexes who maintained a relatively high physical activity from age seven to 15 years. We don’t know why they were different to the rest – for example, were they more engaged in sport ? – and understanding why and how they differed from the rest of the population would help us develop strategies for preventing the age-related decline in physical activity in future.

There are no conflicts of interest to declare. The work was funded by the UK MRC and the Scottish Government Chief Scientist Office.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Farooq MA, Parkinson KN, Adamson AJ, et al

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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paul.gallagher@strath.ac.uk