Author Interviews, JAMA, NYU, Pediatrics, Weight Research / 20.01.2016

More on Obesity from MedicalResearch.com MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Endocrinology, OBGYNE, Pediatrics / 19.01.2016

More on Obgyne on MedicalResearch.com MedicalResearch.com Interview with: Sandra Schulte (candidate Medicine) University Hospital Bonn Dept. Ped. Endocrinology and Diabetology MedicalResearch: What is the background for this study? What are the main  findings? Response: Low birth weight, unfavourable intrauterine conditions and post-natal catch-up-growth are associated with impaired growth, accelerated pubertal maturation and metabolic disturbances later in life. However, normally, study designs cannot rule out the influence of different genetic backgrounds and familiar environments between their subjects and control groups. Therefore, we recruited a very special study cohort, solely composed of monozygotic twins. These twins had significant differences in birthweight, due to twin-to-twin-transfusion-syndrome (TTTS). Because of irregular placental anastomoses, one twin, the recipient, receives more blood becoming hypertensive and polyuric, leading to polyhydramnios and ultimately congestive heart failure and hydrops fetalis. In contrast, the donor twin becomes hypovolemic, hypotensive and oliguric, leading to oligohydramnios and growth restriction. We followed 30 pairs of these twins regularly from birth up to this current follow-up at a mean age of 14.6 years, to examine the impact of a lower birthweight on auxologic development and pubertal maturation later in life. (more…)
Alcohol, Author Interviews, BMJ, Pediatrics, Tobacco Research / 16.01.2016

More on Alcohol on MedicalResearch.com MedicalResearch.com Interview with: Dr Joanne Cranwell PhD, CPsychol The UK Centre for Tobacco and Alcohol Studies  School of Medicine Division of Epidemiology & Public Health Clinical Sciences Building University of Nottingham MedicalResearch: What is the background for this study? Dr. Cranwell: We conducted this particular study because it is well established that adolescent exposure to alcohol and tobacco in the media, such as film, television, and paid for advertising are determinants of subsequent alcohol and tobacco use in young people. The extent of potential exposure has been transformed over the past decade by the emergence of social media, in which exposure to pro-tobacco content has also been linked to favourable attitudes towards tobacco, including intention to smoke, in young non-smokers. Our previous published research highlighted that popular YouTube music videos contain tobacco and substantial alcohol content, including branding. Alcohol advertising is largely self-regulated by the alcohol industry and the Portman Group who speaks on behalf of the UK drinks industry.   The Advertising Standards Authority also provides guidance on marketing of alcohol products in the UK. Broadly speaking the guidelines from these three regulators state that “Marketing communications for alcoholic drinks should not be targeted at people under 18 and should not imply, condone or encourage immoderate, irresponsible or anti-social drinking”. However the extent to which adults and adolescents are exposed to tobacco or alcohol content from YouTube at a population level has not been quantified. In this new study we have therefore estimated population exposure to tobacco and alcohol impressions, defined as appearances in 10-second intervals in a sample of popular videos, in the British adolescent and adult population. (more…)
Author Interviews, Cancer Research, Heart Disease, Pediatrics / 07.01.2016

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).
  • Cardiomyopathy was present in 7.4% of survivors and newly identified by screening in 4.7%.
  • Coronary artery disease was present in 3.8% of survivors and newly identified by screening in 2.2%.
  • Valvular disease (regurgitation or stenosis) was present in 28% of survivors and newly identified by screening in 24.8%.
  • Conduction or rhythm abnormalities were present in 4.4% of survivors and newly identified by screening in 1.4%.
The prevalence of these cardiac findings might be expected in an older population but not necessarily in this young adult (median age at time of study 31 years, range: 18-60) population.    (more…)
Author Interviews, Exercise - Fitness, Pediatrics, Weight Research / 28.12.2015

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. (more…)
Author Interviews, Pediatrics, Technology / 27.12.2015

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.  (more…)
Author Interviews, Pediatrics, Weight Research / 23.12.2015

MedicalResearch.com Interview with: S. Bryn Austin, ScD, Professor Dept. of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Director, Strategic Training Initiative for the Prevention of Eating Disorders and Katherine L. Record JD, MPH Massachusetts Health Policy Commission Boston  Medical Research: What is the background for this editorial? What are the main concerns regarding thinness in 'Paris' models? Response: The fashion industry has long been criticized for promoting unrealistic and patently unhealthy standards of thinness for girls and women. Furthermore, decades of psychological research have documented the pervasive and pernicious harm caused to body image and sense of self especially for adolescent girls during a most vulnerable time of development. What is often left out of the discussion, though, is the immediate and sometimes deadly harm caused to the girls and young women working as professional models as a result of what amounts to coerced starvation as a condition of employment. Most models begin working in the industry in their early or mid teens -- in other words, as children. We must ask ourselves, what other industry or employer in the United States would ever be allowed by our government to foster practices of coerced starvation of American child labor? (more…)
Author Interviews, CDC, Pediatrics, Race/Ethnic Diversity / 22.12.2015

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 birth prevalence of cerebral palsy has not decreased from the mid-1980’s to early 2000’s. The study also looked at whether the birth prevalence over time differed for children with cerebral palsy who were in certain racial and ethnic groups, had certain birth characteristics, or had other developmental disabilities and found that:
  • The birth prevalence of children with cerebral palsy with moderate to severe intellectual disability decreased about 2.6% each year from 1985 to 2002.
  • Birth prevalence of cerebral palsy among black children was higher than among white and Hispanic children, and this higher prevalence continued over the 17-year period.
  • Overall, there was no change over time in cerebral palsy birth prevalence among children born at certain birthweights or gestational age, but there were some differences when looking at these factors in different racial/ethnic groups.
(more…)
Author Interviews, Pediatrics, UCSD, Weight Research / 17.12.2015

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:
  • quench the thirst at the beginning of a meal with water,
  • use a portable 30 second hourglass sand timer,
  • take a bite only when the sand timer was turned, and
  • stop eating when they were no longer hungry (as compared to feeling of fullness), and
  • limit food consumption after the point of satiety.
Over a one-year period, children not using the hourglass excessively increased their body-mass index, while in contrast children using the hourglass grew normally their body-mass index. Body surface area and waist hip ratio followed the same trend. The study shows feasibility of regulating food intake by education that is directed at developing slow eating habits and cessation of eating at satiety. A combination of behavioral training and focused eating monitoring may constitute a weight control method that may serve a life-time and can be promoted for children and adolescents at moderate costs, on a national basis. (more…)
Author Interviews, JAMA, Pediatrics, Surgical Research / 16.12.2015

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 Negligence Claimline to get back what they deserve. You go to doctors as they are the ones who can help you get your health back in order, but when something like this happens, it is understandable as to why some people lose faith in this system. (more…)
Author Interviews, Dermatology, Pediatrics / 16.12.2015

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. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, Pediatrics / 14.12.2015

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 ACO, where attribution length can be thought of as a proxy for consistent primary care from ACO providers. Specifically, attribution length of 2 or more years was associated with a 40.6% decrease in inpatient days. This decrease was partially offset by increases in outpatient visits (as one would expect with a primary care focus), emergency department visits, and use of pharmaceuticals. Combined these utilization changes resulted in a cost reduction 15.7% for those attributed 2 or more years. These changes were achieved while meeting quality benchmarks. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 10.12.2015

MedicalResearch.com Interview with: Maria C. Magnus PhD Norwegian Institute of Public Health Department of Chronic Diseases Nydalen Norway Medical Research: What is the background for this study? What are the main findings? Dr. Magnus: Type 1 diabetes mellitus is one of the most common chronic diseases with onset in childhood, but environmental risk factors have not been convincingly established. A few previous studies report that childhood weight increase might influence the development of type 1 diabetes. This study combined information from two Scandinavian birth cohorts, including more than 99,000 children. The results showed that a higher weight increase during the first year of life increased the risk of type 1 diabetes. The same was not seen for height increase during the first year of life. (more…)
Addiction, Alcohol, Author Interviews, Cannabis, OBGYNE, Ophthalmology, Pediatrics / 28.11.2015

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. (more…)
Author Interviews, Genetic Research, Pediatrics / 25.11.2015

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. (more…)
Abuse and Neglect, Accidents & Violence, Author Interviews, Pediatrics / 25.11.2015

Dr. Ffion C Davies Consultant in Emergency Medicine & Paediatric Lead University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UKMedicalResearch.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. (more…)
Accidents & Violence, Author Interviews, Pediatrics / 24.11.2015

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. (more…)
Author Interviews, Pediatrics, Tobacco Research / 24.11.2015

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. (more…)
Author Interviews, Blood Pressure - Hypertension, CDC, Pediatrics, Weight Research / 20.11.2015

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. (more…)
Allergies, Author Interviews, Pediatrics / 18.11.2015

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 multiple sclerosis, have an underlying immune-mediated pathology, we hypothesized that this association might be mediated by differential changes in neonatal immune phenotype and function with birth season. We therefore sought to investigate the influence of season of birth on neonatal immunity by a combined analysis of immune cells subsets from cord blood and inflammatory mediators in the airways of neonates from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) 2010 birth cohort. Medical Research: What are the main findings? Prof. Bisgaard: We found a birth season–related fluctuation in neonatal immune cell subsets and in early-life airway mucosal immune function. The seasonal airway immune pattern was associated with the number of activated and regulatory T cells in cord blood whereas it was independent of concomitant presence of pathogenic airway microbes. Specifically, summer newborns presented with the lowest levels of all cell types and mediators and thereby seem to display the most quiescent immune status. Fall births presented mainly with an enhanced type 2 profile (eosinophils and IL-13), along with high TNF-a, IL-12p70, IL-10, and IL-2 levels, suggesting recent immune activation; whereas winter newborns had the highest levels of most cell types and mediators, including an anti-bacteria/ fungi–associated type 17 response (neutrophils, IL-17, and IL-1b), an antiviral response (pDCs and NK cells), increased eosinophil counts and an IL-5–mediated type 2 response. These season-linked immune profiles were similar to the known immune pathology of type 2 immune-mediated diseases associated with the fall and winter birth seasons, suggesting that immune function in early life might be biased toward the trajectory to later disease development. (more…)
Author Interviews, JAMA, Pediatrics, Respiratory / 17.11.2015

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. (more…)
Author Interviews, Gender Differences, Pediatrics, Sleep Disorders / 17.11.2015

MedicalResearch.com Interview with: Sabine Plancoulaine, MD, PhD Senior Researcher NSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), early Origin of the Child's Health And Development (ORCHAD) Team, Villejuif, France; and Paris Descartes University, Paris, France Medical Research: What is the background for this study? Dr. Plancoulaine: A decrease in children’s total sleep duration has been reported in the last decades, suggesting that more and more children are now in chronic sleep debt. There is now accumulating evidence that insufficient quantity and/or quality of sleep have a negative impact on children’s physical and mental health development, cognitive function, behaviour and academic success. Sleep disorders and short sleep duration in childhood have also been suggested as predictors of sleep disorders and short sleep duration in adolescence and adulthood. An increased risk of obesity has been shown among shorter sleeper children, especially boys.  Medical Research: What are the main findings? Dr. Plancoulaine: In our study we aimed at describing sleep duration in 3 years old children from a French pre-birth cohort (546 boys and 482 girls) and at investigating gender-specific factors associated with shorter sleep duration defined as <12h/24h. In our study, children aged 3 years slept on average 12hrs35 and 91% of them were napping. Parental presence when falling asleep (e.g. holding hands) was the only factor associated with shorter sleep duration in both gender and increased the risk by around 3 and 4 in boys and girls respectively. The other associated risk factors were more gender-specific. Among boys, each hour of TV viewing duration increased by 72% the risk of being a short sleeper and each additional standard deviation of BMI increased the risk by 31%. Among girls, adherence to a fruit and vegetables dietary pattern divided the risk of being short sleeper by 2 while being cared at home increased it by 2.5 folds. Other investigated factors were not associated (i.e. familial incomes, parental educational level, maternal age at birth, maternal pre-pregnancy BMI, maternal depression status (at birth and at 3y), gestational age, child’s birth rank, birth weight and physical activities at 3y, existence of night awakenings at 3y). (more…)
Author Interviews, CDC, Infections, OBGYNE, STD / 13.11.2015

MedicalResearch.com Interview with: Dr. Virginia Bowen PhD Epidemic Intelligence Service Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,CDC  Medical Research: What is the background for this study? What are the main findings? Dr. Bowen: Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during the course of pregnancy. Our study looked at recent trends in CS between 2008 and 2014. After four years of decline, Congenital syphilis rates increased by 38% from 2012 to 2014. The findings from this report show we are missing opportunities to screen and treat pregnant women for STDs. Syphilis in pregnant women can cause miscarriages, premature births, stillbirths, or death of newborn babies. We have effective tests and treatment for syphilis – there’s no excuse for allowing it to resurge. Every case of CS is one too many. (more…)
Author Interviews, Bone Density, Mineral Metabolism, Nutrition, Pediatrics / 13.11.2015

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. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics, Probiotics / 10.11.2015

Dr. Ulla Uusitalo PhD University of South Florida, TampaMedicalResearch.com Interview with: Dr. Ulla Uusitalo PhD University of South Florida, Tampa Medical Research: What is the background for this study? What are the main findings? Dr. Uusitalo: The TEDDY Study is an international prospective cohort study with the primary goal to identify environmental causes of Type 1 Diabetes (T1D). It is carried out in six clinical research centers, in four countries: University of Colorado Health Science Center (US), Georgia Regents University (US), Pacific Northwest Diabetes Research Institute (US), Turku University Hospital (Finland), Institute of Diabetes Research (Germany), and Lund University (Sweden), since 2004. One possible environmental factor related to Type 1 Diabetes etiology is diet. Dietary supplements including probiotics as well as various types of infant formulas including probiotic fortified infant formula are studied. The microbial composition of gut has been shown to be associated with the development of  Type 1 Diabetes. Colonization of the infant gut starts already in utero and early microbial exposures have been found to be important in defining the trajectory of colonization. Probiotics have been demonstrated to induce favorable immunomodulation and it has been suggested that probiotic treatment could prevent T1D. Therefore we wanted to study the early exposures of probiotic and risk of islet autoimmunity, a condition often preceding Type 1 Diabetes. This study produced very interesting results. The main finding was that we found 60% decrease in the risk of islet autoimmunity among children with HLA genotype of DR3/4 (high risk), who were exposed to probiotics during the first 27 days of life. (more…)
Allergies, Asthma, Author Interviews, Emergency Care, Pediatrics / 07.11.2015

MedicalResearch.com Interview with: Jill Hanson, MD Children’s Mercy Hospital Kansas City MO  Background from the American College of Allergy, Asthma & Immunology “Asthma is the most common chronic disease in children, and one of the most difficult to manage, which is one of the reasons there are so many emergency department visits for asthma sufferers in the US.” Medical Research: What are the main findings of this study? Dr. Hanson: Our study of asthmatic children found that the number of historical asthma-related acute care visits (i.e. urgent care, emergency department and inpatient admissions) was predictive of future asthma-related acute care visits.  (more…)
Author Interviews, Infections, Pediatrics, Respiratory / 06.11.2015

MedicalResearch.com Interview with: Dominik Mertz, MD, MSc, FMH (CH) Assistant Professor, McMaster University Department of Medicine, Division of Infectious Diseases Associate Membership Department of Clinical Epidemiology and Biostatistics / Pathology and Molecular Medicine Medical Director Infection Prevention & Control, Hamilton Health Sciences Juravinski Hospital and Cancer Center Hamilton, ON, Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Mertz: There was a perception that there was an increase in ICU admissions and deaths, initially in Kansas City and Chicago, which was found to be related to the enterovirus strain EV-D68, which had previously not resulted in any major outbreaks in North America. We have one of the first laboratories that was able to provide a specific EV-D68 PCR routine testing allowing us identify EV-D68 cases and to compare the outcomes in patients infected with this strain to children infected by other rhino/enteroviruses. We found a substantial overlap in how the patients presented between patients with EV-D68 and non-EV-D68 infection. It seems that children infected with EV-D68 were in deed at higher risk for having respiratory distress and needing hospital admission, with children with allergies being at a higher risk. We did not find an increase in more severe outcomes, though, i.e. no higher risk for ICU admission (23 vs 15%) and 0 deaths in the EV-D68 group. We also did not find any evidence of in-hospital transmission of EV-D68. (more…)
Accidents & Violence, Author Interviews, Pediatrics, Race/Ethnic Diversity / 04.11.2015

Bindu Kalesan PhD MPH Director Evan’s Center for Translational Epidemiology and Comparative Effectiveness Research Assistant Professor of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118MedicalResearch.com Interview with: Bindu Kalesan PhD MPH Director Evan’s Center for Translational Epidemiology and Comparative Effectiveness Research Assistant Professor of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118  Medical Research: What is the background for this study? What are the main findings? Dr. Kalesan: Firearm injuries are one of the 3 major causes of death in children in the US. for every 7 pediatric firearm deaths there are 8 children non-fatally injured by a gun. Those that survive will live with disability and severe morbidity. From our earlier studies, we found that this burden of survivorship and injury is different according to race/ethnicity. There is also evidence that Injury related hospitalizations are also associated low-income households and neighborhoods. In the background of gun (violence) control, frequently comparisons are drawn between firearm injuries and motor vehicle accidents. In this study we use nationally representative hospitalization data and compared pediatric firearm-related hospitalization and pedestrian motor vehicle accident hospitalizations to assess whether the risk of firearm related hospitalizations among minorities varies depending on the neighborhood they live. We found that black children were at substantially greater risk of firearm hospitalization as compared to pedestrian motor vehicle hospitalization. This greater risk of firearm hospitalization among black children persisted across neighborhoods. Simply put, the risk of firearm hospitalization versus pedestrian motor vehicle hospitalization among black children was high, regardless of whether they lived in low income or high income neighborhoods.We also found that all minority race children (black, Hispanic and other race) as compared to white children were at a greater likelihood of homicide-firearm hospitalization than of pedestrian motor vehicle hospitalization and all minority race children were significantly less likely to be hospitalized for unintentional firearm than pedestrian injuries in comparison to white children. Therefore, overall we found a minority race disadvantage regardless of whether they lived in high and low-income neighborhoods. (more…)
Author Interviews, Columbia, Compliance, HIV, JAMA, Pediatrics / 04.11.2015

MedicalResearch.com Interview with: Dr. Louise Kuhn PhD Professor, Epidemiology Sergievsky Center Columbia University  Medical Research: What is the background for this study? What are the main findings? Dr. Kuhn: Ritonavir-boosted lopinavir-based antiretroviral therapy is recommended as first-line treatment for HIV-infected infants and young children while efavirenz is recommended for adults and older children. There are several advantages of transitioning HIV-infected children to efavirenz-based treatment as they get older.  These advantages include the possibility of once-daily dosing, simplification of co-treatment for tuberculosis, avoidance of some metabolic toxicities, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. However, there have been concerns about possible reduced viral efficacy of efavirenz-based treatment in children exposed to nevirapine for prevention of mother-to-child transmission.  This is because efavirenz and nevirapine are in the same drug class and the majority of children who become infected despite exposure to nevirapine used for prevention have mutations in their virus that usually predict resistance to this drug class. In this study, we randomized HIV-infected children to two different treatment strategies: In the control strategy they remained on their initial ritonavir-boosted lopinavir regimen; in the alternative strategy they transitioned to an efavirenz-based regimen.  All children had been exposed to nevirapine used (unsuccessfully) to prevent mother to child HIV transmission and were virologically-suppressed (HIV in blood < 50 copies/ml) at the time of enrollment into the study.  We observed excellent virological control in both groups with fewer than 3% of children having levels of HIV in their blood greater than 1000 copies/ml.  Sustained suppression of virus in blood below 50 copies/ml throughout follow-up was achieved in 82% of the children transitioned to efavirenz-based treatment compared to 72% of children remaining on the control treatment. (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 03.11.2015

MedicalResearch.com Interview with: Dr. Tove Fall, PhD Associate Professor in Epidemiology Ingelsson Group Upssala University Medical Research: What is the background for this study? What are the main findings? Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies. (more…)