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. 

Continue reading

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.

Continue reading

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.

Vaccines Prevent Disease and Death – Why Are Some US Children Not Vaccinated?

MedicalResearch.com Interview with:
"Vacuna influenza / Flu vaccine" by El Alvi is licensed under CC BY 2.0Kathryn M. Edwards, M.D.
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics
Professor of Pediatrics
Vanderbilt University School of Medicine

Dr. Edwards discusses the statement from the Infectious Diseases Society of America (IDSA) regarding the Centers for Disease Control and Prevention’s new data on child vaccine rates across the United States.

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

Response: To monitor the uptake of vaccines the CDC conducts a National Immunization Survey each year.  This survey is conducted by random-digit dialing (cell phones or landlines) of parents and guardians of children 19-35 months of age.  The interviewers ask the families who provides the vaccines for their children and if these providers can be contacted to inquire about the immunizations received.  The overall response rate to the telephone survey was 26% and immunization records were provided on 54% of the children where permission was granted.  Overall 15, 333 children had their immunization records reviewed.

When comparing immunization rates for 2017 and 2016, the last two years of the study, several new findings were discovered.

First the overall coverage rate for 3 doses of polio vaccine, one dose of MMR, 3 doses of Hepatitis b, and 1 dose of chickenpox vaccine was 90%, a high rate of coverage.  Children were less likely to be up to date on the hepatitis A vaccine (70%) and rotavirus vaccine (73%). Coverage was lower for children living in rural areas when compared with urban areas and children living in rural areas had higher percentages of no vaccine receipt at all (1.9%) compared with those living in urban areas (1%).

There were more uninsured children in 2017 at 2.8% and these children had lower immunization rates.  In fact 7.1% of the children with no insurance were totally unimmunized when compared with 0.8% unimmunized in those with private insurance. Vaccine coverage varies by state and by vaccine. Continue reading

Girls More Likely To Develop Post-Concussive Symptoms After Head Injury

MedicalResearch.com Interview with:

Dr. Ewing-Cobbs PhD Professor in the Department of Pediatrics McGovern Medical School University of Texas Health Science Center at Houston Harriet and Joe Foster Chair in Cognitive Neuroscience

Dr. Ewing-Cobbs

Dr. Linda Ewing-Cobbs PhD
Professor in the Department of Pediatrics
McGovern Medical School
University of Texas Health Science Center at Houston
Harriet and Joe Foster Chair in Cognitive Neuroscience

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

Response: Children may have long-lasting psychological and physical symptoms after an injury. Post-concussive symptoms (PCS) are nonspecific cognitive, physical, and mood symptoms such as difficulty concentrating, headache, and irritability. These symptoms occur in approximately 15 to 30% children after mild traumatic brain injury (TBI). Although PCS often resolve within one month, some children experience symptoms for longer periods of time.

Continue reading

Genetic Locus Linked to Migraine Risk in African American Children

MedicalResearch.com Interview with:
"DNA model" by Caroline Davis2010 is licensed under CC BY 2.0Hakon Hakonarson, MD, PhD
Corresponding Author
Xiao Chang, PhD
Lead Author
The Center for Applied Genomics
Children’s Hospital Philadelphia
PhiladelphiaPennsylvania

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

Response: Migraine is a genetic disorder characterized by recurrent and intense headaches often accompanied by visual disturbances. Genome-wide association studies (GWASs) are a powerful hypothesis-free tool for investigating the genetic architecture of human disease. Currently, multiple GWASs have been conducted on European adults with migraine that have successfully identified several migraine susceptibility genes involved in neuronal and vascular functions.

Considering the prevalence of migraines varies across ethnicities, the genetic risk factors may be different in patients of African ancestries and European ancestries. In addition, if migraine presents at an early age (childhood), it may reflect elevated biological predisposition from genetic factors or increased susceptibility to environmental risk factors.

We performed the first GWAS to investigate the susceptibility genes associated with migraine in African-American children. The main out come was that common variants at the 5q33.1 locus in the human genome are associated with migraine risk in African-American children. The genetic underpinnings at this locus responsible for this finding are less relevant in patients of European ancestry.  Continue reading

One Type of ART in HIV-Positive Pregnant Women Likely Increases Risk of Neurological Problems in Children

MedicalResearch.com Interview with:

Claudia Syueping Crowell, MD Lead author of the study Assistant professor of pediatrics University of Washington and  Seattle Children's Hospital

Dr. Syueping Crowell

Claudia Syueping Crowell, MD
Lead author of the study
Assistant professor of pediatrics
University of Washington and
Seattle Children’s Hospital

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

  • This research was conducted as part of the SMARTT (Surveillance Monitoring for ART Toxicities) study, which is an observational cohort study of HIV exposed uninfected children with the overall aim of studying the long-term safety of fetal and infant exposure to prophylactic antiretroviral (ARV) therapy.
  • This particular analysis was conducted in response to prior studies that showed an increased risk of seizures and other neurologic conditions in children who were exposed to ARVs in utero.
  • The aim of our study was to determine if in utero exposure to any particular ARV is associated with the diagnosis of neurologic conditions later in infancy and childhood.
  • In our cohort of 3747 HIV-exposed uninfected children we found 237 children who had neurologic conditions, 16 of whom were exposed to efavirenz in utero and 4 of whom were exposed to dolutegravir in utero.
  • The most common neurologic diagnoses were microcephaly, febrile seizures, non-febrile seizures and eye related disorders.
  • When comparing various antiretroviral medications, we found that children of women whose ART regimen included efavirenz were more likely to be diagnosed with a neurologic condition than children of women whose ART regimen did not include efavirenz (9.6% vs. 6.2%). This translated to a 60% higher risk of being diagnosed with a neurologic condition in the efavirenz exposed group after controlling for other risk factors.
  • We also found a suggestion of an association between in utero dolutegravir exposure and later diagnosis of a neurologic condition but the number of children exposed to dolutegravir was small (number of exposed children = 94). 

Continue reading

Most Overweight or Obese Children Will Stay So

MedicalResearch.com Interview with:

Antje Körner, M.D Center for Pediatric Research University Hospital for Children and Adolescents University of Leipzig Germany

Dr. Körner

Antje Körner, M.D
Center for Pediatric Research
University Hospital for Children and Adolescents
University of Leipzig
Germany

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

Response: We were interested to find out, when (at what age) obesity in children emerges, whether there is something such as an critical age.

There are many opinions on that but very few well-powered studies. We tracked weight/BMI development of more than 51,000 children from infancy to adolescence. We see, that it is clearly early childhood – the preschool years when obesity sets in in the children. If a child is obese at one or up to two years of age, chances are about 50:50 to return to normal weight; with 3 years of age, most children with overweight or obesity will stay so, almost 90%.

When we look at it dynamically, we see the strongest increase in excessive weight between 2 and 6 years of age in those adolescents who are obese. Even after that young age there is steady further increase in additional weight gain, hence worsening of obesity. 

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

Response: Our intention is to raise awareness that obesity sets in at that very young age. Often you hear of “innocent puppy fat” in the very young children, which will grow away. According to our data you cannot rely on returning to normal weight as soon as 3 years of age.

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

Response: Therefore, we have to think more in means of prevention. This early childhood is the age where habits are formed. Hence every day life should be structured in a healthy way and environment should favour a healthy life style. 

Citation:

Acceleration of BMI in Early Childhood and Risk of Sustained Obesity

Mandy Geserick, M.Sc., Mandy Vogel, Ph.D., Ruth Gausche, M.B.A., Tobias Lipek, M.D., Ulrike Spielau, M.Sc., Eberhard Keller, M.D., Roland Pfäffle, M.D., Wieland Kiess, M.D., and Antje Körner, M.D.

October 4, 2018
N Engl J Med 2018; 379:1303-1312
DOI: 10.1056/NEJMoa180352

Oct 5, 2018 @ 12:41 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.

 

Parents Need To Talk Frequently To Their Children About Sexual Safety

MedicalResearch.com Interview with:

Laura M. Padilla-Walker, PhD Professor, School of Family Life Associate Dean, College of Family, Home, and Social Sciences Brigham Young University

Dr. Padilla-Walker

Laura M. Padilla-Walker, PhD
Professor, School of Family Life
Associate Dean, College of Family, Home, and Social Sciences
Brigham Young University

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

Response: The current study included approximately 500 teens that we followed for 8 years starting at approximately age 14.

In this particular study, we explored how parent-child sex communication regarding sexual safety changed from ages 14-18, and then how this change was associated with children’s sexual outcomes at age 21. Though we would hope and expect that parents would discuss sexual safety with their children at increasing levels as children age, findings from this study suggested low and unchanging levels of parent-child sex communication over time. In other words, parents are talking very little to their children about sexual safety, and how much they talk to children isn’t changing from age 14 to 18.

In addition, mothers reported significantly higher levels of sex communication than did children and fathers, suggesting that mothers think they talk about sexuality more than children think they do. Though this is an issue of perception, what the child perceives is generally a more important predictor of positive outcomes. Mothers also reported talking with their sons less than their daughters, though sex communication with sons increased over time and by age 18 mothers reported the same (relatively low) levels of sex communication with both daughters and sons.

That being said, initial levels and positive change in parent-child sex communication was associated with safer sex at age 21, suggesting that parents SHOULD talk with their children more and at increasing levels over time, because these factors are associated with positive child outcomes.

Continue reading

Breastfeeding May Alter Gene That Influences How Children Deal With Stress

MedicalResearch.com Interview with:

Barry M. Lester, PhD Center for the Study of Children at Risk Warren Alpert Medical School, Brown University Women and Infants Hospital of Rhode Island Providence, Rhode Island;

Dr. Lester

Barry M. Lester, PhD
Center for the Study of Children at Risk
Warren Alpert Medical School, Brown University
Women and Infants Hospital of Rhode Island
Providence, Rhode Island;
 

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

Response: We know from rodent studies that maternal care or nurturing behavior can change the rat pups physiologic response to stress. More nurturing behavior makes it easier for rat pups to relax after stress. Not only that, these changes are permanent, they last into adulthood and there is evidence that these changes can be passed on to the next generation. With animal studies you can unlock the mechanism for this in ways that you can’t do with humans and we know from the rodent studies that the mechanism for these changes has to do with changes in gene activity.

Nurturing behavior controls a specific gene that regulates the infant’s physiological response to stress. In other words, we are looking at maternal behavioral programming of a gene that can make, in our case, a human infant less physiologically reactive to stress.

The physiological reactivity to stress that we studied was the production of the stress hormone cortisol. Cortisol is part of the body’s flight or fight reaction, the body’s major response to stress and too much or too little cortisol can be harmful and is related to a wide range of mental and physical health disorders in children and adults. The concerns about separating immigrant children from their parents that we read about every day in the paper are based on this same physiological system, where brain structures that control cortisol production are damaged by the stress of separation. 

Continue reading

Almost 2 Million Children Suffer Traumatic Brain Injury Each Year

MedicalResearch.com Interview with:

Juliet Haarbauer-Krupa, PhD Senior Health Scientist Division of Unintentional Injury Prevention CDC

Dr. Haarbauer-Krupa

Juliet Haarbauer-Krupa, PhD
Senior Health Scientist
Division of Unintentional Injury Prevention
CDC

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

  • Traumatic brain injury in children results in a large number of emergency department visits each year and can result in long term difficulties
  • The purpose of this study was to estimate lifetime prevalence of TBI in children based on a nationally representative sample of U.S. parents/adults and to describe the association between TBI and other childhood health conditions.
  • CDC researchers examined the National Survey of Children’s Health, a cross-sectional telephone survey of U.S. households, to provide a national estimate of TBI in children.

Continue reading

“Head CT Choice” Educates Parents of Children with Mild Head Injury

MedicalResearch.com Interview with:

Erik P. Hess MD MSc Professor and Vice Chair for Research Department of Emergency Medicine UAB Medicine | The University of Alabama at Birmingham Birmingham Alabama 35249

Dr. Hess

Erik P. Hess MD MSc
Professor and Vice Chair for Research
Department of Emergency Medicine
UAB Medicine
he University of Alabama at Birmingham
Birmingham Alabama 35249

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

Response: 450,000 children present to U.S emergency departments each year for evaluation of head trauma.  Physicians obtain head computed tomography (CT) scans in 37%-50% of these patients, with less than 10% showing evidence of traumatic brain injury and only 0.2% that require neurosurgical treatment.

In order to avoid unnecessary CT scans and to limit radiation exposure, the Pediatric Emergency Care Applied Research Network (PECARN) developed clinical prediction rules that consist of 6 readily available factors that can be assessed from the history and physical examination.  If none of these risk factors are present, a CT scan is not indicated.

If either of 2 high risk factors such as signs of a skull fracture are present, CT scanning is indicated.

If 1 or 2 non-high risk factors are present, then either CT scanning or observation are recommended, depending on considerations such as parental preference, clinician experience and/or symptom progression.

In this study we designed a parent decision aid, “Head CT Choice” to educate the parent about the difference between a concussion – which does not show up on a CT scan – and a more serious brain injury causing bleeding in or around the brain.  The decision aid also shows parents their child’s risk for a serious brain injury – less than 1% risk in the majority of patients in our trial – what to observe their child at home for should they opt not to obtain a CT scan, and the advantages and disadvantages of CT scanning versus home observation.

In our trial, we did not observe a difference in the rate of head CT scans obtained in the ED but did find that parents who were engaged in shared decision-making using Head CT Choice were more knowledgeable about their child’s risk for serious brain injury, has less difficulty making the decision because they were clearer about the advantages and disadvantages of the diagnostic options, and were more involved in decision-making by their physician.  Parents also less frequently sought additional testing for their child within 1 week of the emergency department visit.

Continue reading

Could a Low-Gluten Diet During Pregnancy Protect Offspring from Diabetes?

MedicalResearch.com Interview with:
Knud Josefsen, senior researcher
Bartholin Institute, Rigshospitalet,
Copenhagen K, Denmark

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

Response: In a large population of pregnant women, we found that the risk of the offspring being diagnosed with type 1 diabetes before the age of 15.6 years (the follow up period) was doubled in the group of women ingesting the highest amounts of gluten (20-66 g/day) versus the group of women ingesting the lowest amounts of gluten (0-7 g/day). For every additional 10 grams of gluten ingested, the risk for type 1 diabetes in the child increased by a factor of 1.31.

It the sense that it was a hypothesis that we specifically tested, we were not surprised. We had seen in animal experiments that a gluten-free diet during pregnancy protected the offspring from diabetes, and we wanted to see if we could prove the same pattern in humans. There could be many reasons why we would not be able to show the association, even if it was there (sample size, low quality data, covariates we could not correct for and so on), but we were off course pleasantly surprised that we found the association that we were looking for, in particular because it is quite robust Continue reading

Mouth Microbiome Linked to Childhood Obesity

MedicalResearch.com Interview with:

Dr. Sarah J.Carnahan Craig PhD

Dr. Carnahan Craig

Dr. Sarah J.Carnahan Craig PhD
Postdoctoral Scholar
Makova Lab
Biology Department
Center for Medical Genomics
Penn State University

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

Response: This study stems from a long standing collaboration with pediatrician, Ian Paul at Penn State Hershey Medical School (and a co-author on this paper). Ian is very interested in understanding and preventing childhood obesity. It also is part of a much larger, collaborative study objective, lead by Ian and Leann Birch (another co-author), to understand social/behavioral contributors to childhood obesity, how a responsive parenting intervention can prevent childhood overweight/obesity, and the biological factors that contribute to the disease. This is an important research area as childhood obesity is a public health problem — one in three children are overweight or obese. A fuller understanding of factors that contribute to childhood obesity, how to identify children who are at risk for developing childhood obesity, and methods to prevent childhood obesity are of critical importance.

MedicalResearch.com: What are the main findings?

Response: The main finding from this paper is that the oral microbiota (the collection of bacteria that live in the mouth) are significantly related to young child growth patterns. The surprising part of this finding was that we observed this result with the oral microbiota and not the gut microbiota. The oral microbiota (in comparison to the gut microbiota, which has been associated with obesity in many previous studies) are largely understudied, especially in young children. The gut microbiome we found to be strongly influenced by diet; when the two are considered together, there is a significant relationship with child growth patterns.

Additionally, our team developed novel statistical methods to use child growth curves as a more comprehensive outcome rather than an outcome of weight at a single time point (i.e. it uses more of the information about how a child is growing). These methods allow us to better detect the relationship between child growth and the microbiota; they increase our power. 

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

Response: Readers should take away that there are many factors that contribute to obesity and obesity prevention – along with a healthy diet and exercise, biological factors, such as the microbiota for instance, could potentially be an important consideration. Additionally, we’re in the early stages of truly understanding how these microbes influence health. Importantly, we are unable to make any kind of causal conclusions – meaning we don’t know if the microbes are influencing the growth patterns, is health/environment influencing the microbes, or is it both directions.  

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

Response: One of the limitations of this study is that it looks at the microbiota at a single time point, at two years after birth –  this is a dynamic community, so we are really only seeing a snapshot of what is happening. Additionally, the study is retrospective in that the microbiota is sampled at two years and the growth trajectory is made of measurements from birth through two years. Because of this, we might be missing important dynamics happening earlier in life. A more comprehensive study would be to sample the microbiota at all the time points you are sampling growth, health, and other information — this is a study we are currently doing. We hope that by building on this study and examining the microbiota (both oral and gut) longitudinally and in concert with the social, environmental, and health data that we will be closer to a fuller understanding, which could potentially identify children who are most at risk of developing childhood obesity and be prime candidates for obesity intervention programs.  

Citation: 

Sarah J. C. Craig, Daniel Blankenberg, Alice Carla Luisa Parodi, Ian M. Paul, Leann L. Birch, Jennifer S. Savage, Michele E. Marini, Jennifer L. Stokes, Anton Nekrutenko, Matthew Reimherr, Francesca Chiaromonte, Kateryna D. Makova. Child Weight Gain Trajectories Linked To Oral Microbiota Composition. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-31866-9

Sep 19, 2018 @ 9:27 pm

 

 

 

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Steep Increase in Adversity-Related Hospital Admissions for Teenage Girls

MedicalResearch.com Interview with:

Dr Ruth Blackburn PhD  UKRI Innovation Fellow UCL Institute of Health Informatics

Dr Ruth Blackburn PhD 
UKRI Innovation Fellow
UCL Institute of Health Informatics 

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

Response: In England one child in every classroom is admitted to hospital with an adversity related injury (i.e. violence, intentional self-injury, or drug or alcohol misuse) between the ages of 10 and 19 years. These young people are more likely than their classmates to be re-admitted to hospital or to die within 10 years.

We investigated how the rate of hospital admissions with an adversity related injury has changed over time among young people aged 10-24 years, using administrative data for National Health Service hospitals in England.

We found that between 2012 and 2016, rates of admission with an adversity related injury (including intentional self-injury) increased steeply for girls, with the biggest increase (6% per year) among 15-19 year olds. During the same time period, rates of admission with an adversity related injury decreased in boys aged 15-24 years (4-5% per year) but increased slightly for 10-14 year olds (3% per year).  Continue reading

CDC Identifies Risk Factors for Adverse Childhood Experiences

MedicalResearch.com Interview with:

Melissa T. Merrick, PhD Behavioral Scientist,  Surveillance Branch, Division of Violence Prevention CDC

Dr. Merrick

Melissa T. Merrick, PhD
Behavioral Scientist,
Surveillance Branch, Division of Violence Prevention
CDC

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

Response: Childhood experiences build the foundation for health throughout a person’s life. Adverse childhood experiences (ACEs) are potentially traumatic experiences, which occur in childhood. Exposure to ACEs, especially for young people without access to safe, stable, nurturing relationships and environments, can impact health in many ways, including increased risk of chronic disease, engagement in risky behaviors, limited life opportunities, and premature death.

Continue reading

Prenatal Exposure to Air Pollution May Affect Newborn’s Thyroid Function

MedicalResearch.com Interview with:

Carrie Breton ScD Associate Professor and Director of the MADRES Center  Division of Environmental Health Los Angeles, CA 90032

Dr. Breton

Carrie Breton ScD
Associate Professor and Director of the MADRES Center
Division of Environmental Health
Los Angeles, CA 90032

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

Response: I am interested in how the environment can influence our very early development, starting in the womb. I have studied the health effects of air pollutants on children for several years and wanted to focus now on the earliest windows of susceptibility.  Thyroid hormones play a critical role in fetal growth and development. We knew we could get information on newborn thyroid levels from the California Department of Public Health’s newborn screening program therefore look at this question in our study population.

We found that exposure to high levels of PM2.5 and PM10 throughout most of pregnancy affected TT4 levels in newborns. Continue reading

More Than 2 Million High School Students Have Used Marijuana in an E-Cigarette

MedicalResearch.com Interview with:

Katrina Trivers, PhD, MSP Lead author and lead epidemiologist Office on Smoking and Health CDC

Dr. Trivers

Katrina Trivers, PhD, MSP
Lead author and lead epidemiologist
Office on Smoking and Health
CDC

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

Response: Although we’ve seen considerable declines in the use of regular cigarettes among U.S. youth over the past several decades, the tobacco product landscape is evolving, and the use of other tobacco products have become increasingly popular. For example, as of 2014, e-cigarettes have become the most commonly used tobacco product among US youth. During 2011-2015, e-cigarette use increased 900% among U.S. high school students before declining in 2016. No change was observed in 2017, with about 2 million youth, including 12% of high school students and 3% of middle school students, reporting they had used e-cigarettes in the past 30 days.

This is a public health concern because the use of any form of tobacco product is unsafe among youth, irrespective of whether it’s smoked, smokeless, or electronic. The U.S. Surgeon General has concluded that the aerosol emitted from e-cigarettes is not harmless. It can contain harmful ingredients, including nicotine, carbonyl compounds, and volatile organic compounds known to have adverse health effects. The nicotine in these products is of particular concern given that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.

In recent years, many youth have also been using other psychoactive substances in e-cigarettes, including cannabinoids and other illicit drugs. This could have been fueled, in part, by shifts in the social acceptability and access to cannabis as several states have or are considering legalized cannabis sales for adults. A previous CDC study found that in 2015, almost 1 in 3 students reported using e-cigarettes with non-nicotine substances. However, it wasn’t possible to identify what exactly those substances were based on the question. Given the high concurrent use of tobacco and other substances, including cannabis, a more detailed question was added to a future survey to assess the use of cannabis in e-cigarettes among U.S. youth. This study presents the findings from that question.

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