Author Interviews, Nutrition, Pediatrics / 21.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23661" align="alignleft" width="129"]Juliana F.W. Cohen, ScD, ScM Merrimack College, Department of Health Sciences North Andover MA 01845 Adjunct Assistant Professor of Nutrition Harvard T.H. Chan School of Public Health Dr. Juliana F. Cohen[/caption] Juliana F.W. Cohen, ScD, ScM Merrimack College, Department of Health Sciences North Andover MA 01845 Adjunct Assistant Professor of Nutrition Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Dr. Cohen: Back in 2012, Massachusetts enacted both the updated USDA standards for school meals and healthier standards for snacks in schools that were similar to the upcoming, fully implemented national "Smart Snacks" standards.  We examined the impact of these standards on school food revenues and school meal participation. MedicalResearch.com: What are the main findings? Dr. Cohen: After schools had time to acclimate to the changes, schools revenues remained high. While students spent less money on snacks, more children were now participating in the lunch program so school food revenues were not impacted long-term.
Author Interviews, Diabetes, Metabolic Syndrome, OBGYNE, Pediatrics, University Texas, Weight Research / 21.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23639" align="alignleft" width="150"]Antonio Saad, MD Fellow in Maternal Fetal Medicine University of Texas Medical Branch at Galveston. Dr. Antonio Saad[/caption] Antonio Saad, MD Fellow in Maternal Fetal Medicine & Critical Care Medicine University of Texas Medical Branch at Galveston MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Saad: Recently the WHO announced an alarming news, the prevalence of diabetes has increased four fold in the past quarter-century. The major factors attributed for this increase included excessive weight, and obesity. In the US alone, two thirds of people are either overweight or obese. There are shocking numbers that should alert physicians, patients and government officials for awareness and interventions that we can alter the path away from this drastic epidemic. In light of recent events, our group strongly believes that poor diet during pregnancy predisposes offspring in adult life to develop obesity and diabetes through fetal programming. High fructose introduction into our food chain has coincided with the obesity and diabetes epidemics. Hence, we designed an animal study where we fed pregnant mice with either regular diet or high fructose diet until delivery. Then we looked at the offspring, at 12 months of age. We looked at  their blood pressure, glucose tolerance tests, insulin resistance,  and weights. We also tested for serum marker of metabolic dysfunction and used computed tomography imaging to assess for liver fat infiltration and percent visceral adipose tissue. To our surprise, these offspring (mothers were fed high fructose diet) developed several features of metabolic syndrome.  Female offspring’s cardiovascular and metabolic function at one year of age (adulthood) had increased weight, blood pressure, visceral adiposity, liver fat infiltrates and  insulin resistance with impaired glucose tolerance).  The  male counterparts were limited to high blood pressure  and glucose intolerance. Keeping in mind that the amount of fructose given to these animals were equivalent to daily soda cans consumption in humans.
Author Interviews, JAMA, Pediatrics, Surgical Research / 18.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23541" align="alignleft" width="120"]Thomas J. Sandora, M.D., M.P.H. Senior Associate Physician in Medicine; Hospital Epidemiologist; Medical Director, Infection Control Boston Children’s Hospital Associate Professor of Pediatrics, Harvard Medical School Dr. Thomas Sandora[/caption] Thomas J. Sandora, M.D., M.P.H. Senior Associate Physician in Medicine; Hospital Epidemiologist; Medical Director, Infection Control Boston Children’s Hospital Associate Professor of Pediatrics, Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sandora: Giving antibiotics before certain types of operations results in lower rates of surgical site infections. However, there are limited data about which pediatric operations require antibiotic prophylaxis. We examined national variability in antibiotic prophylaxis for the 45 most commonly performed pediatric operations at children's hospitals in the U.S. We found that antibiotic use was considered appropriate for only 64.6% of cases, with a high degree of variability within procedures and between hospitals.
Accidents & Violence, Author Interviews, Pediatrics / 18.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23537" align="alignleft" width="134"]Dr. Lara B. McKenzie PhD MA Principal Investigator Center for Injury Research and Policy The Research Institute Nationwide Children’s Hospital Dr. Laura McKenzie[/caption] Dr. Lara B. McKenzie PhD MA Principal Investigator Center for Injury Research and Policy The Research Institute Nationwide Children’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. McKenzie: Skateboarding is a popular recreational sport and participation has increased the last several decades, faster than any other sport or recreation activity between 1998 and 2007 (National Sporting Goods Association Sports Participation in 2007). With growing participation, has come an increasing rate of injuries from skateboarding. The study examined data for youth and adolescents 5-19 years of age who were treated in U.S. emergency departments (EDs) for skateboarding-related injuries from 1990-2008. It found that nationally, over the 19-year period, there was an average of 64,572 children and adolescents treated each year for skateboarding-related injuries – about 176 a day. Most patients were male (89 percent), and were injured either at home (38 percent) or in the street and/or highway (30 percent). The most commonly injured body regions were the upper (45 percent) and lower (32 percent) extremities. The most common diagnoses were fractures or dislocations (33 percent), sprains and strains (25 percent) and bruises (20 percent). Children and adolescents 11-14 years of age were hospitalized more often than younger or older children/adolescents. Lower extremity injuries increased with age, while face and head or neck injuries decreased with age.
Accidents & Violence, Author Interviews, CDC, Pediatrics, Sleep Disorders / 07.04.2016

MedicalResearch.com Interview with: Anne G. Wheaton, Ph.D. Epidemiologist Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Population Health Epidemiology and Surveillance Branch Atlanta, GA  30341-3717  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Wheaton: Unintentional injury, mostly from motor vehicle crashes, is the leading cause of death for adolescents. Adolescents who do not get enough sleep are at an increased risk for motor vehicle crashes and other unintentional injury, such as sports injuries and occupational injuries. We evaluated the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among more than 50 thousand US high school students. The likelihood of each of five injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) was significantly higher for students sleeping ≤7 hours on an average school night compared with 9 hours. Infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students sleeping ≥10 hours compared to 9 hours on an average school night. Although short and long sleep may simply be associated with other adolescent risk behaviors, insufficient sleep may cause individuals to take more risks and disregard the possibility of negative consequences. However, the study was cross-sectional, meaning the students were asked questions at one time point, so it is not possible to determine if there is a cause and effect association between sleep and these risk behaviors. Insufficient sleep may contribute to injury risk directly by slowing reaction time, impairing ability to pay attention, or causing a driver to fall asleep, but these results provide evidence that some of the increased risk associated with insufficient sleep might be due to engaging in injury-related risk behaviors.
Author Interviews, CDC, HPV, Pediatrics, Vaccine Studies / 07.04.2016

MedicalResearch.com Interview with: Natalie L. McCarthy, MPH Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recently, deaths immediately following 4vHPV vaccination have garnered intense media attention.  Often, these media stories do not take into account the background rates of death in older children and young adults or disclose the potential for non-vaccine related causes of death.  The publicity surrounding deaths temporally associated with HPV and the paucity of studies examining deaths in adolescents following vaccination, was the basis for our evaluation of deaths following vaccines administered to individuals 9 through 26 years of age in the Vaccine Safety Datalink (VSD). The VSD is a collaborative project between the Centers for Disease Control and Prevention and several integrated healthcare systems, which monitors the safety of vaccines in the U.S. This study assessed the risk of death in the first 30 days following vaccination, described the causes of death, and included an evaluation of the potential association of vaccination and death among older children and young adults. The risk of death was not increased during the 30 days following vaccination, and no deaths were found to be causally associated with vaccination. The causes of death were consistent with what would be expected for this age group.
Author Interviews, JAMA, Pediatrics, Social Issues / 05.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23158" align="alignleft" width="154"]Paula Braitstein, PhD Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya 7Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis Regenstrief Institute Inc, Indianapolis, Indiana Dr. Paula Braitstein[/caption] Paula Braitstein, PhD Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis Regenstrief Institute Inc, Indianapolis, Indiana MedicalResearch.com: What is the background for this study? Dr. Braitstein: There are vast numbers of children and youth in the world who find themselves in street circumstances. Yet, there is an absence of consensus among academics, policymakers, stakeholders, and international organizations regarding the causes of child and youth street-involvement around the world. Without data concerning these reasons, policies are developed or implemented to mitigate street-involvement without taking these causes into account. Often, the prevailing paradigm assumes that children and youth on the street are juvenile delinquents and the government response is often characterized by social exclusion, criminalization, and oppression by police and civic authorities. Therefore we wanted to find out what reasons do children and youth self-report for their street-involvement globally. MedicalResearch.com: What are the main findings?  Dr. Braitstein: We systematically reviewed the literature and compiled data from 49 studies representing 24 countries globally. Street-connected children and youth most frequently reported poverty, family conflict, and abuse as their reasons for street-involvement. They infrequently identified delinquent behaviours for their circumstances. There were no significant differences between males and females reported reasons, with the exception of females in developed regions who were more likely to report abuse.
Author Interviews, Pediatrics, Respiratory, Vaccine Studies / 28.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22955" align="alignleft" width="100"]Tasnee Chonmaitree, M.D. Professor, Pediatrics and Pathology Division of Pediatric Infectious Diseases Department of Pediatrics University of Texas Medical Branch Galveston, TX 77555-0371 Dr. Tasnee Chonmaitree[/caption] Tasnee Chonmaitree, M.D. Professor, Pediatrics and Pathology Division of Pediatric Infectious Diseases Department of Pediatrics University of Texas Medical Branch Galveston, TX 77555-0371 MedicalResearch.com: What is the background for this study? Dr. Chonmaitree: Respiratory infections are common in infants and young children; they are caused by viruses and/or bacteria. Viral upper respiratory tract infection or the common cold is exceedingly common and leads to bacterial complications such as ear infection, which the leading cause of antibiotic prescription in the US and the most common reason children undergo surgery (ear tube placement). In the past few decades, some bacterial and viral vaccines have become available aiming to reduce respiratory infections in children. MedicalResearch.com: What are the main findings? Dr. Chonmaitree: Our study looked to update information on how often infants in the first year of life acquired the common cold, and ear infection in the new vaccine era. The study was performed between 2009 and 2014 and included 367 infants followed closely from near birth up to one year of age. We found that on average, an infant had about 3 colds in the first year of life, and almost half of infants had ear infection by age 1 year. This was less than what happened in the past few decades. The reduction of ear infection may have been the result of many factors from bacterial and viral vaccine use, to increased breastfeeding rate and reduction in household smoking. Risk factors for ear infection included carriage of bacteria in the nose, frequencies of common cold and lack of breastfeeding.
Author Interviews, Education, NYU/NYMC, Pediatrics, PNAS, Weight Research / 15.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22656" align="alignleft" width="200"]Michele Leardo Assistant Director Institute for Education & Social Policy New York University New York, NY 10012 Michele Leardo[/caption] Michele Leardo Assistant Director Institute for Education & Social Policy New York University New York, NY 10012 MedicalResearch.com: What is the background for this study? What are the main findings? Response: US school districts increasingly distribute annual fitness and body mass index (BMI) “report cards” to students and parents. Such personalized informational interventions have appeal in economics because they can inform parents about their children's obesity status at relatively low costs. Awareness of the weight status can lead to behavioral responses that can improve health. New York City public schools adopted Fitnessgram in 2007-2008, reporting each student’s BMI alongside categorical BMI designations. We examined how being classified as “overweight” for the previous academic year affected the students’ subsequent BMI and weight. Specifically, we compared female students whose BMI was close to their age-specific cutoff for being considered overweight with those whose BMI narrowly put them in the “healthy” category. We find that being labeled overweight had no beneficial effects on students’ subsequent BMI and weight.
Author Interviews, BMJ, Pediatrics / 14.03.2016

MedicalResearch.com Interview with: Ashley Bryce, NIHR PhD student Centre for Academic Primary Care, University of Bristol (first author) Dr Céire Costelloe NIHR Health Protection Research Unit in Healthcare associated infections and AMR, Imperial College London (senior author)  MedicalResearch.com: What is the background for this study? Response: Antimicrobial resistance is an internationally recognised threat to health. Previous antibiotic use has been shown to be a risk factor for antimicrobial resistance in adults. The contribution of primary healthcare is particularly important as this is where almost 80% of all antibiotics used within the health service are prescribed. Children receive a lot of primary healthcare services and, as such, receive a disproportionately high number of antibiotics compared with middle aged populations. Despite this, little research has been published describing the prevalence of bacterial resistance in children or the risk factors of importance in this group. MedicalResearch.com: What are the main findings? Response: Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment.
Addiction, Author Interviews, Pediatrics / 11.03.2016

MedicalResearch.com Interview with: Yanning Wang, MS Statistical Research Coordinator Department of Pathology, Immunology and Laboratory Medicine Department of Health Outcomes and Policy University of Florida College of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A number of new stimulant medications have been approved for attention deficit/hyperactivity disorder (ADHD) treatment in the past decade. The expansion of this market, along with the increase in ADHD diagnosis, provides greater availability of these drugs. This has raised public health concerns about potential non-medical use of prescription stimulants. Our study analyzed data from the National Monitoring of Adolescent Prescription Stimulants Study, which recruited and surveyed youth aged 10 to 18 years from entertainment venues in 10 US cities. We found that 6.8% of youth (750 out of 11,048) used prescription stimulants in the past 30 days. Among those 750 youth, more than half reported some type of non-medical use, and using someone else’s medication was the most common form (88.4 %). We investigated the difference between two subgroups of non-medical users: youth who only used stimulants non-medically, and those who had a prescription and reported non-medical use in the past 30 days. We found youth who only used stimulants non-medically at higher rate of using other substances and more likely to have close friends who have tried other drugs.
Author Interviews, Brain Injury, Pediatrics / 10.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22413" align="alignleft" width="137"]Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON Dr. Roger Zemek[/caption] Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON MedicalResearch.com: What is the background for this study? Dr. Zemek: The number of concussions have dramatically increased over the past decade.  Not only are children and adolescents are at highest risk for getting concussions, they also take longer to recover.  As part of our background work, our team performed a systematic review (published in JAMA Pediatrics) confirming that validated, easy-to-use prognosticators did not exist for clinicians to identify children with concussion who are at the highest risk for persistent post-concussive symptoms (PPCS) and sequelae. MedicalResearch.com: What are the main findings? Dr. Zemek: In this, the largest concussion study in the world to-date, we derived and validated in a large, diverse cohort of children a clinical risk score that is significantly superior to clinicians’ ability to predict future PPCS at the time of ED presentation. Multivariate analysis revealed that age group, female sex, past history of migraine, prior concussion with symptom duration of >1 week, ED presentation with “answering questions slowly”, 4 or more errors on BESS Tandem stance, and the initial symptoms of headache, noise sensitivity and fatigue were all clinically significant and strongly associated with PCS at 1-month. We assigned points based on the adjusted multivariate odds ratio, and the rule incorporating patient demographic factors, past history, early cognitive deficits, balance (an physical exam finding), and early symptoms.  The rule has a maximum of 12 points.  We selected two cut-off points in order to yield three clinically relevant (low, intermediate and high risk) categories for the development of PPCS at one month.
Author Interviews, Gastrointestinal Disease, Lancet, Microbiome, Pediatrics / 09.03.2016

MedicalResearch.com Interview with: Phillip I. Tarr, MD Melvin E. Carnahan MD Professor of Pediatrics Director, Pediatric Division of Gastroenterolgy and Nutrition Washington University in St Louis School of Medicine St Louis, MO 63110, USA MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Tarr: There is a longstanding belief that gut bacteria are relevant to the developing necrotising enterocolitis (NEC). We have established dysbiosis in the gut before NEC occurs, suggesting this ecological perturbation might be causal.

Author Interviews, Lifestyle & Health, Pediatrics, Weight Research / 08.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22478" align="alignleft" width="133"]Dr. Chance York PhD School of Journalism and Mass Communication Kent State University Dr. Chance York[/caption] Dr. Chance York PhD School of Journalism and Mass Communication Kent State University MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. York: A number of studies have examined the effects of heavy television viewing during childhood on childhood levels of Body Mass Index (BMI), but my study added a new element to this literature: it explores the long-term effects of TV viewing on adult-era BMI. The major takeaway is that heavy television viewing during childhood results in an individual propensity to watch TV much later in life, and this propensity to watch television results in increased BMI. In other words, kids who watch a lot of television tend to remain heavy TV users as adults, and the fact that they're heavy TV viewers as adults has a separate, unique effect on their adult BMI.
Accidents & Violence, Author Interviews, BMJ, Brain Injury, CDC, Pediatrics / 29.02.2016

MedicalResearch.com Interview with: [caption id="attachment_16316" align="alignleft" width="200"]Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia Dr. Joanne Klevens[/caption] Dr. Joanne Klevens, MD, PhD, MPH Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.
Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory / 29.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22065" align="alignleft" width="150"]Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto Dr. Suzanne Schuh[/caption] Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto Medical Research: What is the background for this study? Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home. The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.
Author Interviews, OBGYNE, Pediatrics, Pulmonary Disease, Tobacco Research / 24.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21974" align="alignleft" width="135"]Dr. med. Julia Dratva, MD MPH Medical Specialist Prevention and Public Health - FMH Scientific project leader MAS Versicherungsmedizin/Studienkoordinationleitung Dr. Julia Dratva[/caption] Dr. med. Julia Dratva, MD MPH          Medical Specialist Prevention and Public Health FMH  Scientific project leader MAS Versicherungsmedizin/Studienkoordinationleitung Dept. Epidemiology and Public Health Swiss Tropical and Public Health Institute Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Dratva: Early childhood is a critical time window for subsequent health. Early life environment is known to be important for lung development and respiratory health. Little is known on the potential impact on lung ageing and the potential mechanisms responsible for the long-term impact. We investigated early childhood factors and their association with lung function decline, a common marker of lung aging, in two long-standing adult cohorts, SAPALDIA and ECRHS. As recently published in scientific journal PlosONE, maternal smoking, early respiratory infections or season of birth are associated with a faster decline in lung function decline, while less rapid decline was found in persons who had attended daycare. The early exposures may not only have an independent adverse effect on lung aging but also increase the respiratory vulnerability to other adult risk factors. Stronger effects were observed in in smokers exposed to the aforementioned adverse factors.
Author Interviews, Depression, Eating Disorders, Mental Health Research, Nutrition, OBGYNE, Pediatrics / 23.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21832" align="alignleft" width="200"]Lisanne de Barse Department of Epidemiology Erasmus Medical Center Rotterdam Dr. Lisanne De Barse[/caption] Lisanne de Barse PhD Department of Epidemiology Erasmus Medical Center Rotterdam MedicalResearch: What is the background for this study? Dr. de Barse: Fussy (or “picky”) eating behaviour, which is characterised by consistent rejection of particular foods, is common in childhood and a source of concern for parents. It is not well understood what affects fussy eating. It is, however, well known that internalizing psychiatric problems of parents (i.e. anxiety and depression) have an impact on children’s health and development. Studies have also shown that mothers’ internalizing problems during the child’s preschool period was linked to child fussy eating. It was not clear whether the child’s eating problems causes stress and psychiatric symptoms in mothers or whether mothers’ symptoms predict child eating behaviour. Nor was it known what potential impact the dads’ state of mind have. The purpose of this study was to examine whether mothers’ and fathers’ internalizing problems during pregnancy and during the child’s life predicts child fussy eating. MedicalResearch: What are the main findings? Dr. de Barse: Our main findings indicate that mothers’ anxiety and depressive symptoms during pregnancy could have an influence on children’s fussy eating. This was irrespective of mothers’ internalizing symptoms at the child’s preschool period. We also found indications that fathers’ anxiety and depressive symptoms might influence children’s fussy eating behaviour. This was studied in Generation R, a study that has been tracking the health and wellbeing of children from conception onwards, conducted by the Erasmus Medical Centre, in Rotterdam, the Netherlands.
Author Interviews, Cost of Health Care, Pediatrics / 22.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21916" align="alignleft" width="200"]Joanna Thomson MD MPH Assistant Professor Division of Hospital Medicine Cincinnati Children’s Hospital Medical Center Dr. Joanna Thomson[/caption] Joanna Thomson MD MPH Assistant Professor Division of Hospital Medicine Cincinnati Children’s Hospital Medical Center Medical Research: What is the background for this study? What are the main findings? Response: Children with medical complexity have lifelong and complex illnesses. These children account for a disproportionate amount of pediatric health care use.  The lives of families are affected – both financially and socially.  We sought to characterize the challenges these families face through examination of financial and social hardships. In a cohort of families with children who receive care at Cincinnati Children’s Complex Care Center, four out of five families reported experiencing at least one hardship. The striking frequencies observed, despite relatively high measures of household socioeconomic status, suggest that these families face great challenges.  For example, families frequently experienced the need to borrow money and expected little to no help from family or friends. In order to benchmark the hardships experienced by families of children with medical complexity, we compared the hardships they experienced to those faced by the families of children with asthma in the Greater Cincinnati Asthma Risks Study. After accounting for key demographic and socio-economic differences between the two groups, families of children with medical complexity experienced similar to higher levels of financial and social hardship.  For instance, families of children with medical complexity were over two times as likely to report the inability to pay their rent or mortgage than families of children with asthma.
Author Interviews, Autism, JAMA, Pediatrics / 18.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21766" align="alignleft" width="142"]Dr. David Grossman MD MPH Vice chair of the U.S. Preventive Services Task Force Professor at the University of Washington Schools of Public Health and Medicine Dr. David Grossman[/caption] Dr. David Grossman MD MPH Vice chair of the U.S. Preventive Services Task Force Professor at the University of Washington Schools of Public Health and Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Grossman: The Task Force cares deeply about the challenges that children affected by autism and their families face in getting the care and support they need. This was the first time that we assessed the evidence around screening young children for autism, and our recommendation was informed by a review of the most up-to-date science, which included randomized trials, observational studies, and research from a number of Federal health agencies. We concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder in children for whom no concerns of autism have been raised by their parents or a clinician. This is an I statement, which is not a recommendation against screening, but a call for more research on screening and treatment in young children who don’t have obvious symptoms. It is important to note that this recommendation will not affect insurance coverage for autism screening, which is currently covered under the Affordable Care Act as a result of the American Academy of Pediatrics’ Bright Futures Guidelines.
Author Interviews, Hospital Readmissions, JAMA, Pediatrics / 16.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21532" align="alignleft" width="145"]Marion R. Sills, MD, MPH Associate Professor, Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine Dr. Marion Sills[/caption] Marion R. Sills, MD, MPH Associate Professor, Departments of Pediatrics and Emergency Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? Dr. Sills: My co-authors and I know that studies show that patients who are poorer or are minorities are readmitted at higher rates than other patients, and that readmissions penalties, which are far more commonly applied in relation to readmissions of adult patients, have been shown to punish hospitals for the type of patients that they serve, rather than purely for the quality of care they provide.  Currently, these penalties impact hospitals treating Medicare patients in all 50 states but only impact readmissions of children in 4 states, although other states are considering implementing these penalties.  This was our rationale for exploring the impact of patients’ social determinants of health (factors like race, ethnicity, health insurance and income) on how likely it was that a hospital would be penalized for readmissions under a typical state-level pay-for-performance measure based on hospital readmissions. Readmissions penalties are designed to penalize hospitals that provide lower quality care. However, without adjusting for social determinants of health factors, these pay-for-performance measures may unfairly penalize hospitals based on the type of patient they treat as well as the quality of care they provide. Medical Research: What are the main findings? Dr. Sills: We found that risk adjustment for social determinants of health factors changed hospitals’ penalty status on a readmissions-based pay-for-performance measure. Without adjusting the pay-for-performance measures for social determinants of health, hospitals may receive penalties partially related to patient factors beyond the quality of hospital care.
Asthma, Author Interviews, OBGYNE, Pediatrics / 12.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21542" align="alignleft" width="133"]Maria C. Magnus Norwegian Institute of Public Health Oslo Norway Maria C. Magnus[/caption] Maria C. Magnus Norwegian Institute of Public Health Oslo Norway  Medical Research: What is the background for this study? What are the main findings? Response:  Researchers have found that developing asthma can be linked to pregnant women and infants being exposed to paracetamol, (acetaminophen) by testing that the association was not simply linked to the complaint for which the person is taking paracetamol. The findings were published in the International Journal of Epidemiology Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway compared associations between several conditions during pregnancy (with and without the use of paracetamol) and asthma developing in the 114,500 children in the study. They examined asthma outcomes at ages three and seven and evaluated the likelihood of the association being as a result of the three most common uses of paracetamol in pregnancy: pain, fever, and influenza. The results showed that 5.7 per cent of the children had current asthma at age three, and 5.1 per cent had asthma at age seven. The research found that there was a strong link between children who had asthma at age three who had been exposed to paracetamol as during pregnancy or infancy. The strongest association was seen if the mother used paracetamol during pregnancy for more than one complaint with a child having asthma at three years old.
Author Interviews, Microbiome, Nutrition, Pediatrics, Weight Research / 12.02.2016

MedicalResearch.com Interview with [caption id="attachment_21538" align="alignleft" width="103"]Tine Rask Licht, Professor Head of Research Group on Gut Microbiology and Immunology Technical University of Denmark National Food Institute Søborg Prof. Tine Rask Licht[/caption] Tine Rask Licht, Professor Head of Research Group on Gut Microbiology and Immunology Technical University of Denmark National Food Institute Søborg Medical Research: What is the background for this study? What are the main findings? Response:  During childhood, the intestinal microbiota is under establishment. This period thus represents a ’window’, where the microbiota is likely to be more susceptible to be affected by external factors such as diet. Currently, it is well known that breast feeding has a major impact on the microbiota of young infants, but only very few studies have addressed the effect of the ‘next step’ in diet exposure, represented by complementary feeding. We studied two cohorts of children, born to normal-weight and obese mothers, respectively, and mapped the composition of bacteria in their fecal microbiota at age 9 months and 18 months.  We found that at 9 months, the microbiota was clearly affected by the composition of the complementary diet, but not by maternal obesity.
Allergies, Asthma, Author Interviews, JAMA, Pediatrics, Pulmonary Disease / 09.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21421" align="alignleft" width="180"]Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD Dr. Meghan Azad[/caption] Dr. Meghan B. Azad PhD Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and Children’s Hospital Research Institute of Manitoba Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study Medical Research: What is the background for this study? Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure.  Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.   Medical Research: What are the main findings? Dr. Azad: Wheezing is common in babies and young children.  Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS). We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15. By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers.
Author Interviews, Diabetes, Exercise - Fitness, JAMA, Lifestyle & Health, Pediatrics / 08.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21397" align="alignleft" width="160"]Mélanie Henderson, MD, FRCPC, PhD Mélanie Henderson[/caption] Mélanie Henderson, MD, FRCPC, PhD Pediatric Endocrinologist and Assistant Clinical Professor Division of Endocrinology and Diabetes University of Montreal/Centre Hospitalier Universitaire Ste-Justine Montréal, Québec Medical Research: What is the background for this study? What are the main findings? Dr. Henderson: Dysregulation in insulin sensitivity and insulin secretion are the basic elements in the pathophysiology of type 2 diabetes. There is extensive data suggesting that better lifestyle habits are associated with the prevention or the delay in onset of type 2 diabetes in adults, with improved lifestyle habits having been more effective than pharmacologic agents at diabetes prevention in one study. Little work however has been done to determine whether this holds true in children. Cross-sectional studies in youth have found conflicting results and no study has considered the combined effect of physical activity, fitness and sedentary behavior on insulin dynamics in children. Understanding the impact of lifestyle habits on insulin dynamics in childhood has become paramount, given that less than 7% of Canadian children are currently meeting physical activity guidelines and that 1/3 of school-aged Canadian children and 2/3 of Canadian teenagers are exceeding the current guidelines in terms of screen time, which advocate for a maximum of 2 hours daily. Our study shows that adiposity is the central predictor of insulin dynamics in children, and that physical activity and screen time play an important role, in part through their effect on adiposity. Thus, establishing and maintaining a highly physically active lifestyle early on in life, while minimizing sedentary behaviour (specifically screen time) appear to be important strategies to consider to prevent type 2 diabetes in youth.
Author Interviews, Education, NYU/NYMC, Pediatrics, Pediatrics, Social Issues / 05.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21333" align="alignleft" width="112"]Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Dr. Alan Mendelsohn[/caption] Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Adriana Weisleder, PhD [caption id="attachment_21334" align="alignleft" width="100"]Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center Dr. Adriana Weislander[/caption] Research scientist, Department of Pediatrics NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise. The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals. The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school.
Author Interviews, Genetic Research, JAMA, Pediatrics, Surgical Research / 03.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21247" align="alignleft" width="144"]Silje Steinsbekk PhD Associate Professor Dept. of Pschology Norwegian University of Science and Technology Dr.Steinsbekk[/caption] Silje Steinsbekk PhD Associate Professor Dept. of Pschology Norwegian University of Science and Technology  Medical Research: What is the background for this study? Dr. Steinsbekk:  More than every third American child is overweight or obese. Childhood obesity is associated with multiple negative health outcomes such as metabolic syndrome and hypertension, as well as mental health problems, reduced self-esteem and impaired quality of life. Further, overweight and obesity tend to persist from childhood into adulthood, and the risk of adult overweight increases the longer a child has been overweight. Identifying modifiable factors contributing to the development and continuity of unhealthy weight is therefore needed. Genome-wide association studies (GWAS) have identified genetic risks for obesity and these genetic risks have shown to influence development of obesity partly by accelerating weight gain in childhood. Identification of mechanisms through which genetic risks for obesity accelerate weight gain in childhood can therefore provide insight into the developmental pathogenesis of obesity and thus inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Appetite traits may therefore be targets of intervention to protect children against the effect of genetic predispositions to develop obesity. However, such a preventive approach presupposes that appetite traits indeed transmit the genetic effect upon later development of obesity. Notably, cross-sectional studies cannot establish whether appetite traits precede the development of obesity or are caused by it—a critical piece of information for clinicians seeking treatment targets to prevent childhood obesity. We therefore aimed to test whether genetic risk for obesity was associated with rapid childhood BMI growth and if this genetic effect was mediated by appetite traits, following a representative sample of Norwegian children from age 4 to 8.
Author Interviews, Genetic Research, JAMA, Pediatrics, Weight Research / 02.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21225" align="alignleft" width="180"]Profa. Patrícia Pelufo Silveira, MD, PhD Universidade Federal do Rio Grande do Sul Brazil Profa. Silveira[/caption] Profa. Patrícia Pelufo Silveira, MD, PhD Universidade Federal do Rio Grande do Sul Brazil Medical Research: What is the background for this study? What are the main findings? Response: Previous studies have shown that women who carry a certain gene variant (namely the 7-repeat allele of the dopamine type 4 receptor) have increased risk for obesity, especially if they also suffer from eating disorders. We have also demonstrated that girls who have this gene variant prefer to eat more fat when allowed to choose. However, for some neuropsychiatric conditions, this gene was shown to function as a “plasticity gene”. That is to say that being a carrier makes the individual more or less vulnerable to the disease, depending if the environment in which the person lives is bad (more risk) or good (less risk for the disease). This is called the “differential susceptibility” model. Therefore, in this paper, we wondered if the above described higher fat intake already reported in 7-repeat girls could be modified by the social environment in which they are raised. We saw that if a girl has the gene variant and is raised in a poorer environment, she is more likely to prefer to eat fat in her diet as we knew. However, if she has the gene variant but is raised in a better socioeconomic environment, she actually eats less fat in her regular diet compared to her counterparts who do not carry the gene variant. This is important because we change the focus from the gene (previously "blamed" for increasing fat preference and obesity as the years pass by) to the environment, as the genetic association will increase or decrease the risk according to the conditions in which the child is raised.
Author Interviews, Pediatrics, Weight Research / 27.01.2016

[caption id="attachment_20783" align="alignleft" width="150"]Lauren Fiechtner MD MPH Director of Nutrition Division of Pediatric Gastroenterology and Nutrition Massachusetts General Hospital for Children Dr. Lauren Fiechtner[/caption] MedicalResearch.com Interview with: Lauren Fiechtner MD MPH Director of Nutrition Division of Pediatric Gastroenterology and Nutrition Massachusetts General Hospital for Children MedicalResearch: What is the background for this study? What are the main findings? Dr. Fiechtner: In previous studies, we investigated if distance to a supermarket was associated with a child’s BMI or weight status. These were cross-sectional studies measuring only one point in time. We wondered if distance to a supermarket modified how much children in a behavioral intervention improved their weight or dietary intake. In particular we examined 498 children participating in the Study of Technology to Accelerate Research, which was a randomized controlled trial to treat childhood obesity in Eastern Massachusetts. The intervention included computerized clinician decision support plus a family self-guided behavior change intervention or a health coach intervention, which included text messages to the family to promote behavior change. We found that children living closer to supermarkets were able to increase their fruit and vegetable intake and decrease their BMI z-score more during the intervention period than children living farther from supermarkets.
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