Author Interviews, JAMA, NYU/NYMC, Pediatrics, Weight Research / 20.01.2016
Water Jets In Schools Provide One Key To Reducing Childhood Obesity
More on Obesity from MedicalResearch.com
MedicalResearch.com Interview with:
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Dr. Brian Elbel[/caption]
Brian Elbel, PhD, MPH, Associate Professor, Department of Population Health, NYU Langone Medical Center
Amy Schwartz, PhD, Director, New York University Institute for Education and Social Policy, and the Daniel Patrick Moynihan Chair in Public Affairs, Syracuse University
Michele Leardo, MA, Assistant Director
New York University Institute for Education and Social Policy
Medical Research: What is the background for this study? What are the main findings?
Response: New York City, as well as other school districts, is making tap water available to students during lunch by placing water dispensers, called water jets, in schools. Surprisingly, drinking water was not always readily available in the lunchroom. Water jets are part of a larger effort to combat child obesity.
We find small, but statistically significant, decreases in weight for students in schools with water jets compared to students in schools without water jets. We see a .025 reduction in standardized body mass index for boys and .022 for girls. We also see a .9 percentage point reduction in the likelihood of being overweight for boys and a .6 percentage point reduction for girls. In other words, the intervention is working.
Dr. Brian Elbel[/caption]
Brian Elbel, PhD, MPH, Associate Professor, Department of Population Health, NYU Langone Medical Center
Amy Schwartz, PhD, Director, New York University Institute for Education and Social Policy, and the Daniel Patrick Moynihan Chair in Public Affairs, Syracuse University
Michele Leardo, MA, Assistant Director
New York University Institute for Education and Social Policy
Medical Research: What is the background for this study? What are the main findings?
Response: New York City, as well as other school districts, is making tap water available to students during lunch by placing water dispensers, called water jets, in schools. Surprisingly, drinking water was not always readily available in the lunchroom. Water jets are part of a larger effort to combat child obesity.
We find small, but statistically significant, decreases in weight for students in schools with water jets compared to students in schools without water jets. We see a .025 reduction in standardized body mass index for boys and .022 for girls. We also see a .9 percentage point reduction in the likelihood of being overweight for boys and a .6 percentage point reduction for girls. In other words, the intervention is working.
Dr. Joanne Cranwell[/caption]
Dr. Daniel Mulrooney[/caption]
MedicalResearch.com Interview with:
Daniel A. Mulrooney, MD, MS
Cancer Survivorship
Jude Children's Research Hospital
TN 38105-3678
Medical Research: What is the background for this study? What are the main findings?
Dr. Mulrooney: This is a cross-sectional analysis performed in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study designed to facilitate longitudinal evaluation of health outcomes among adults previously treated for childhood cancer. Following patients over the life spectrum can be challenging making it difficult to understand the long-term health effects of childhood cancer therapy. Previous studies have relied on self-report, registry, or death certificate data. Our study is novel because we clinically evaluated cancer survivors on the St. Jude campus and identified substantial, asymptomatic cardiac disease (cardiomyopathy, coronary artery disease, valvular disease, and conduction/rhythm disorders).
Dr. Rebold[/caption]
MedicalResearch.com Interview with:
Michael Rebold, PhD, CSCS
Assistant Professor
Department of Exercise Science
Bloomsburg University
Bloomsburg, PA 17815
Medical Research: What is the background for this study?
Dr. Rebold: The obesity epidemic seen in children. If we can make children at a young age physically active then maybe they will be more likely to be physically active into their adult years. Since parents are the primary role models for younger children we must find ways to get the parents involved in physical activity as well, because children will model their parent's behaviors.
Medical Research: What are the main findings?
Dr. Rebold: The main findings from this study are that when parents are actively participating in activities with their children, their children spend more time in physical activities and less time in sedentary activities. When parents are not present and children are alone, then they spend more time engaging in sedentary activities and less time in physical activities. When parents are actively watching their children, children still engaged in a significant more amount of time in physical activities than sedentary activities when compared to the alone condition but still not as great as with parents participating.
Children also liked and were motivated to engage in additional physical activity time when parents were participating with them.
Dr. Deirdre Murray[/caption]
MedicalResearch.com Interview with:
Dr. Deirdre Murray
Senior Lecturer/Consultant Paediatrician
Dept of Paediatrics and Child Health
University College Cork
Clinical Investigations Unit Cork University Hospital
Principal Investigator
Irish Centre for Fetal and Neonatal Translational Research
Medical Research: What is the background for this study? What are the main findings?
Dr. Murray: Everyday in clinic, and in waiting rooms and in restaurants we see parents are handing over their smart phones and iPads to occupy young children. The nature of childhood play is changing rapidly. The exact frequency and the effect of this change in unknown. We wanted to first measure how young children 12-36 months are using touchscreen devices. We asked parents who attended our paediatric unit, both outpatients and short stay inpatients to answer a study specific questionnaire.
We found that of the 82 parents surveyed, 82% of parents owned a touchscreen device, and of these 87% gave their device to their toddler to play with. Thus 71% of toddlers had access to a touchscreen device. This rate was similar across the age range studied (12-36 months). By parental report, 24 months was the median age of ability to swipe (IQR: 19.5–30.5), unlock (IQR: 20.5–31.5) and active looking for touch-screen features (IQR: 22–30.5), while 25 months (IQR: 21–31.25) was the median age of ability to identify and use specific touch-screen features. Overall, 32.8% of toddlers could perform all four skills.
Touchscreen usage was common at a very young age and from 2 years of age toddlers have the ability to interact purposefully with touch-screen technology. 
Dr. Van Naarden Braun[/caption]
MedicalResearch.com Interview with:
Kim Van Naarden Braun, Ph.D.
Epidemiologist
Developmental Disabilities Branch
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
Atlanta, GA 30341
Medical Research: What is the background for this study? What are the main findings?
Dr. Van Naarden Braun: Over the past five decades, remarkable improvements have been made in obstetric and neonatal care resulting in significant declines in infant mortality both in the US and abroad, particularly for infants born premature and very low birthweight. Successes in neonatal survival have been met by concerns that the occurrence of developmental disabilities, most notably cerebral palsy, would increase. By monitoring changes over time in the prevalence of cerebral palsy, we can try to understand the impact of these advances further. Our recently published study reported that the 
Prof. Schmid-Schonbein[/caption]
MedicalResearch.com Interview with:
Geert W. Schmid-Schonbein, Ph.D.
Distinguished Professor and Chairman
Department of Bioengineering
Adjunct Professor in Medicine
University of California San Diego
Medical Research: What is the background for this study? What are the main findings?
Dr. Schmid-Schonbein: Most approaches to control/reduce body weight focus on reducing food quantity, improving quality and promoting daily activity. These approaches, effective in the short term, only yield modest weight control. Weight management strategies recommended in the past have not significantly diminished the current trend towards childhood and adolescence obesity.
We developed and tested an alternative approach to control weight gain in healthy individuals to reduce the risk for development of obesity and diabetes complications. The essence is to:
“Eat deliberately slow AND stop eating when you feel no longer hungry”.
The approach avoids any form of special diet, uses no drugs, can be adopted for a lifetime and used in any ethnic environment. Children in a Mexican School in Durango were instructed by a pediatrician to learn to eat deliberately slow and to stop eating when the satiety reflex sets in, i.e. the moment when the feeling of hunger has disappeared.
They were instructed to:
Dr. Minneci[/caption]
MedicalResearch.com Interview with:
Dr. Peter C. Minneci, M.D., MHSc
Center for Innovation in Pediatric Practice
Assistant Professor, Pediatric Surgery
The Ohio State's Wexner Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Minneci: Non-operative management of uncomplicated appendicitis has been shown to safe and effective studied in several international adult trials. To be a reasonable treatment alternative to urgent appendectomy, non-operative management of appendicitis in children must have a clinically acceptable success rate with minimal harm in patients that fail and subsequently undergo appendectomy. We performed a prospective single-institution patient choice trial allowing the families of children with acute uncomplicated appendicitis to choose between urgent appendectomy or non-operative management with antibiotics alone. We enrolled 102 patients, with 65 choosing surgery and 37 choosing non-operative management with antibiotics alone. Non-operative management had an in-hospital success rate of 94%, a 30-day success rate of 89%, and a 1-year success rate of 76%. Compared to the surgery group, patients managed non-operatively reported higher quality of life scores at 30 days and had significantly fewer disability days and lower costs, with no differences in the rates of complicated appendicitis or treatment-related complications at 1 year of follow-up. With this being said, there are some cases that I have read about where doctors have failed to diagnose patients for Appendicitis even after they have complained about having a number of the symptoms associated with it. Following this, some patients have even contacted companies like 
Dr. Alison Cooke[/caption]
MedicalResearch.com Interview with:
Dr Alison Cooke PhD, MRes, BMidwif (Hons), RM
Lecturer in Midwifery (Teaching and Research)
School of Nursing, Midwifery & Social Work
The University of Manchester
Oxford Road Manchester
Medical Research: What is the background for this study? What are the main findings?
Dr. Cooke: The use of topical oils for the management of newborn dry skin or for massage is a common practice across the globe. In the UK, olive oil and sunflower oil are commonly recommended by maternity service health professionals for baby dry skin, yet there is no evidence to support this practice. The OBSeRvE study was conducted to investigate the effect of these two oils on healthy term newborn baby skin barrier function. The study found that both oils impeded the development of the skin barrier function from birth.
Dr. Eric Christensen[/caption]
MedicalResearch.com Interview with:
Dr. Eric W. Christensen, PhD
Health Economist
Children’s Hospitals and Clinics of Minnesota
Minneapolis, MN
Medical Research: What is the background for this study?
Dr. Christensen: National healthcare expenditures are up from 5.0% of gross domestic product in 1960 to 17.4% in 2013. We must find ways to control cost while maintaining quality. Accountable care organizations (ACOs) were designed to control a population’s health care cost while maintaining or improving quality. This study was an examination of one ACO exclusively covering a pediatric Medicaid population.
Medical Research: What are the main findings?
Dr. Christensen: We found that health care utilization and cost patterns were associated with the length of time patients were attributed to this 
Dr. Thompson[/caption]
MedicalResearch.com Interview with:
Professor Benjamin Thompson PhD
School of Optometry and Vision Science
Faculty of Science, University of Waterloo
Waterloo, Ontario
Canada
Medical Research: What is the background for this study?
Dr. Thompson: Our investigation was part of the longitudinal Infant Development and Environment and Lifestyle (IDEAL) study that was designed to investigate the effect of prenatal methamphetamine exposure on neurodevelopment. Although the negative impact of prenatal drug exposure on a wide range of neurodevelopmental outcomes such cognitive and motor function is established, the effect on vision is not well understood. To address this issue, vision testing was conducted when children in the New Zealand arm of the IDEAL study turned four and half years of age.
Although the primary focus of the IDEAL study was the impact of methamphetamine on neurodevelopment, the majority of children enrolled in the study were exposed to a range of different drugs prenatally including marijuana, nicotine and alcohol. Many children were exposed to multiple drugs. This allowed us to investigate the impact of individual drugs and their combination on the children’s visual development.
Alongside standard clinical vision tests such as visual acuity (the ‘sharpness’ of vision) and stereopsis (3D vision), we also tested the children’s ability to process complex moving patterns. This test, known as global motion perception, targets a specific network of higher-level visual areas in the brain that are thought to be particularly vulnerable to neurodevelopmental risk factors.
Dr. Schulert[/caption]
MedicalResearch.com Interview
Grant S Schulert MD, PhD
Clinical Fellow, Division of Rheumatology
Cincinnati Childrens Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Schulert: Influenza infection causes millions of illnesses annually, but most of those are relatively mild. In a subset of cases, patients can become critically ill, even if they are relatively young and healthy. Several previous reports had observed in these critically ill patients features of a hyperinflammatory syndrome known as HLH (hemophagocytic lymphohistiocytosis) or MAS (macrophage activation syndrome). This hyperinflammation can be triggered by other infections as well as in a subtype of juvenile arthritis, but there is also a familial form occurring in early childhood with known genetic causes. Our questions with this study were
1) how often are features consistent with HLH/MAS seen in fatal H1N1 influenza infections and
2) do patients with fatal H1N1 infection have genetic mutations associated with HLH/MAS?
Our collaborator Paul Harms, MD, and his team at the Michigan Center for Translational Pathology, University of Michigan Medical School identified 16 cases of fatal H1N1 influenza infection. Based on their clinical features, between 41-88% of these patients could be categorized as having a hyperinflammatory HLH/MAS. We then used processed tissue samples from the patients for whole exome genetic sequencing, which reads the entire genetic code of every gene in a person. Five patients carried mutations in genes which cause HLH, and several others carried mutations in genes linked to MAS. This suggests that there may be genetic risk factors for developing fatal hyperinflammatory syndromes in H1N1 infection.
MedicalResearch.com Interview with:
Dr. Ffion C Davies
Consultant in Emergency Medicine & Paediatric Lead
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Leicester UK
Medical Research: What is the background for this study?
Dr. Davies: This study is from the Trauma Audit Research Network data, which is a major trauma database receiving data from nearly all hospitals in England and Wales. A 2012 TARN report on major trauma in children showed a peak of injuries resulting from child abuse in the younger age group. In this study we analysed the database in more detail, in order to profile this peak of injuries from non-accidental injury (NAI).
Medical Research: What are the main findings?
Dr. Davies: The main findings are that severe injury and death resulting from non-accidental injury occurs nearly always in the under 5 year old age group, and 75% of cases are under 1 year old. This contrasts with reports in the media, whereby high profile deaths in children from non-accidental injury are often older children. This probably reflects reporting bias, because those children experienced a prolonged period of abuse, despite involvement of health and social services. Our study shows that very small infants are the most likely to die, or to sustain severe head injuries.
Dr. NJ Scheers[/caption]
MedicalResearch.com Interview with:
N.J. Scheers, PhD
Former manager of CPSC's Infant Suffocation Project
BDS Data Analytics, Alexandria, VA
Medical Research: What is the background for this study? What are the main findings?
Dr. Scheers: There are no federal regulations for crib bumpers. The American Academy of Pediatrics, the Canadian Pediatric Society, the National Institutes of Health, and others have long recommended against crib bumper use. Crib bumper manufacturers have a long-standing voluntary safety standard aimed at making crib bumpers safe. Neither of these approaches has worked to prevent deaths from bumpers.
Medical Research: What are the main findings?
Dr. Scheers: Using data from the Consumer Product Safety Commission (CPSC), the research identified 48 deaths from crib bumpers from 1985-2012. Reports of the deaths increased significantly and were three times higher from 2006 through 2012 than in previous years.
In most of the deaths, the crib bumpers were the only source of suffocation, rebutting beliefs that other items in the cribs (comforters, pillows, blankets) caused the deaths. In other deaths, wedging occurred between the bumper and other objects such as pillows and infant recliners. All of these deaths would have been preventable if crib bumpers had not been in the cribs.
The study linked more deaths to crib bumpers than the 48 indicated in the CPSC data. A review of data from the National Center for the Review and Prevention of Child Deaths reveals reports of 32 bumper-related deaths from 37 states from 2008-2011. That puts the number of fatalities tied to crib bumpers at 77 and suggests the actual number is much higher.
The study identified 146 injuries from 1990-2012. Eleven were “near-misses” in which the babies were rescued before they died. These were near-suffocations, chokings, strangulations, and falls from infants using bumpers to climb out of the cribs. There were reports of poor bumper design, such as a lack of bottom bumper ties, or construction problems, such as bumper ties and decoration that detached.
Parents often buy bumpers to prevent slat entrapments or to prevent infants bumping their heads in the cribs. This is the first study to show that these events occurred even with a bumper present.
Dr. Shadel[/caption]
MedicalResearch.com Interview with:
William G. Shadel, PhD
Associate Director, Population Health Program
Senior Behavioral Scientist
RAND Corporation
Pittsburgh, PA 15213
Medical Research: What is the background for this study? What are the main findings?
Dr. Shadel: The tobacco industry spends almost all of its multi-billion dollar advertising budget at retail point-of-sale locations. A key feature of their advertising strategy includes the tobacco power wall, a prominent behind the cashier display of hundreds of cigarette and tobacco product brands. The power wall also displays posters for those tobacco products as well as pricing information. As such, it conveys a lot of positive messages about tobacco products to consumers.
The purpose of this experiment was to evaluate whether hiding or moving the tobacco power wall from its highly conspicuous location reduced teens’ smoking risk when they shop at convenience stores. The study took place in the RAND StoreLab (RSL), a life-sized replica of a convenience store that was constructed to explore a range of options for regulating tobacco products at point-of-sale retail locations. A sample of 271 teens (ages 11-17) was randomized to one of three experimental conditions: cashier (the tobacco power wall was located in its usual location, behind the cashier); side wall (the tobacco power wall was moved from behind the cashier to an out of the way location in the RSL); and hidden (the tobacco power wall was located behind the cashier, but was hidden behind an opaque wall). After teens finished shopping in the RSL, they completed questionnaires that measured their susceptibility to future smoking.
Teens assigned to the condition where the power wall was hidden were significantly less likely to report that they would smoke in the future, compared with those that were assigned to the cashier condition. Locating the power wall to a sidewall had no effect on smoking susceptibility.
Dr. Yang[/caption]
MedicalResearch.com Interview with:
Quanhe Yang, PhD
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention
Atlanta, GA 30341
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Yang: Body mass index (BMI) is an important risk factor for high blood pressure among adolescents. Despite a recent leveling off in the numbers of overweight and obese youths, weight-associated health outcomes remain a problem in the U.S. Some researchers have suggested that the increased prevalence of high blood pressure among adolescents is associated with the epidemic of overweight and obesity in the U.S.
As a result, we analyzed trends in pre-high blood pressure and high blood pressure among U.S. youth using data from a series of National Health and Nutrition Examination Surveys. Nearly 15,000 adolescents between the ages of 12 and 19 were included in the surveys, which were conducted between 1988 and 2012.
During that 24-year timeframe, the prevalence of high blood pressure actually decreased overall, while pre-high blood pressure remained largely unchanged. However, those rates differed based on body weight category. For example, pre-high blood pressure was consistently higher among overweight/obese adolescents (18 to 22 percent) than those of normal weight (11 to 12 percent). The observed changes in both pre-high blood pressure and high blood pressure prevalence were consistent across age group, sex and race/ethnicity.
Prof. Bisgaard[/caption]
MedicalResearch.com Interview with:
Professor of Pediatrics Hans Bisgaard, MD, DMSc
Copenhagen Prospective Studies on Asthma in Childhood
Herlev and Gentofte Hospital,
University of Copenhagen, Denmark
Medical Research: What is the background for this study?
Prof. Bisgaard: Birth season has been reported to be a risk factor for several immune-mediated diseases, although the critical season varies depending on the disease. Autoimmune diseases are generally associated with spring births, whereas asthma and allergies are more common among subjects born in fall and winter. Because many of these diseases, such as asthma, rheumatoid arthritis, and 
Dr. Bacharier[/caption]
MedicalResearch.com Interview with:
Leonard B. Bacharier, MD
Professor of pediatrics
Clinical Director, Division of Allergy, Immunology and Pulmonary Medicine
St Louis School of Medicine
Washington University
St Louis, Missouri
Medical Research: What is the background for this study? What are the main findings?
Dr. Bacharier: Oral corticosteroids such as prednisone have become the standard of care for children whose colds tend to progress and lead to severe wheezing and difficulty breathing.
“But there are some studies that suggest these treatments don’t consistently work for young children. That’s why we want to find ways to prevent upper respiratory infections from progressing to lower respiratory tract illnesses. Once the episode gets going, standard interventions are less effective than would be desired”, reported Dr. Bacharier.
Dr. Garcia[/caption]
MedicalResearch.com Interview with:
Audry H. Garcia PhD
Scientist Department of Epidemiology
Erasmus MC, University Medical Center Rotterdam
Rotterdam, The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Garcia: Mild and chronic metabolic acidosis as a result of a diet rich in acid-forming nutrients, such as cheese, fish, meat and grain products, may interfere with optimal bone mineralization and indirectly increase the risk of osteoporosis later in life. Previous observational studies in adults have reported inverse associations between dietary acid load and bone mass. However, the evidence in younger populations is scarce; only a few studies have been performed in healthy children and adolescents with inconsistent results, and not much is known on the effects of dietary acid load on bone mass in younger children or in children with a non-European background.
In a prospective multiethnic population-based cohort study of 2,850 children from the city of Rotterdam, the Netherlands, we found that dietary acid load estimated as dietary potential renal acid load (dPRAL), and as protein intake to potassium intake ratio (Pro:K) at 1 year of age, was not consistently associated with childhood bone health. Furthermore, associations did not differ by sex, ethnicity, weight status, or vitamin D supplementation.
