Author Interviews, CDC, NEJM, Pediatrics, Respiratory / 27.02.2015

Seema Jain, MD Medical Epidemiologist Epidemiology and Prevention Branch, Influenza Division Centers for Disease Control and Prevention Atlanta, GA 30329MedicalResearch.com Interview with: Seema Jain, MD Medical Epidemiologist Epidemiology and Prevention Branch, Influenza Division Centers for Disease Control and Prevention Atlanta, GA 30329 MedicalResearch: What is the background for this study? What are the main findings? Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009.  The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children.  Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection. During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died.  Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%).  One or more viruses were detected in 1,472 (66%) of these children.  Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%).  The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period.  The highest incidence was among children younger than 2 years old (62.2/10,000).  Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia.  Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia.  Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%).  The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests. (more…)
Author Interviews, Nutrition, NYU, Pediatrics, Weight Research / 26.02.2015

Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of MedicineMedicalResearch.com Interview with: Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children.  No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating.  We did not find, at least one year after the store opened, any appreciable change in shopping or eating. (more…)
Author Interviews, Pediatrics, Toxin Research / 24.02.2015

Professor Kathy Cottingham PhD Departmental of Biological Sciences Dartmouth University Hanover, NHMedicalResearch.com Interview with: Professor Kathy Cottingham PhD Departmental of Biological Sciences Dartmouth University Hanover, NH Medical Research: What is the background for this study? What are the main findings? Professor Cottingham: Arsenic is a naturally occurring element that occurs in high concentrations in groundwater in certain parts of the world, including here in New Hampshire.  Exposure to high concentrations of arsenic in water has a number of potential health consequences, including cancer, cardiovascular disease, diabetes, obesity, adverse birth outcomes, and altered immune systems.  Effects of lower-dose exposures are still under investigation, but emerging evidence suggests similar effects as higher doses. In the U.S., public drinking water sources are regulated to have arsenic below a maximum contaminant level of 10 micrograms of arsenic per liter of water.  However, private wells are not regulated, and there is no requirement to test water in private wells to ensure that the water is safe to drink. The New Hampshire Birth Cohort, led by Dr. Margaret Karagas, is an ongoing longitudinal study of pregnant women who drink water from private wells.  This study quantified arsenic exposure in 72 infants born to women in the cohort, using urine samples and exposure modeling. Our results show that in general, exposure to arsenic during early infancy is quite low, regardless of how the infants were fed (breast milk vs. formula). However, a few formula-fed infants were highly exposed to arsenic, likely due to high concentrations of arsenic in the drinking water used to mix their powdered formula. Arsenic concentrations in breast milk - and in the urine of infants fed only with breast milk - were very low. (more…)
Allergies, Author Interviews, Microbiome, Pediatrics / 24.02.2015

Dr. Bill Hesselmar University of Gothenburg SwedenMedicalResearch.com Interview with: Dr. Bill Hesselmar University of Gothenburg Sweden MedicalResearch: What is the background for this study? What are the main findings? Dr. Hesselmar: The hygiene hypothesis is the background for this study, and the hypothesis states that children’s immune system need to be stimulated by bacteria and microbes to mature in a proper way prevent the children from developing immune mediated diseases such as allergies. There are increasing support for the hygiene hypothesis, with less allergies found in children from milieus with a rich microbial exposure such as: growing up on a farm or in a developing country, in children with many siblings, and after vaginal delivery as compared to caesarean section. Even though these findings are interesting from a theoretical point of view, they can’t be use in primary prevention since you can’t recommend anyone to live by a farm. We are investigating if there are harmless “microbial sources” in different daily life-situations that are good enough to stimulate children’s immune system. So far we have observed two such possible sources, the sharing of children’s pacifier (Pediatrics 2013) and hand dishwashing (this study). These are, however, only observational data – we have only found an association between hand dishwashing and a lower risk of allergy, we don’t know for sure that the lower risk of allergy was just because of the hand dishwashing. So far we regard it as an “interesting observation”, which need to be confirmed in new studies before any general conclusions could be made. The main findings was a lower risk of allergy (Odds Ratio 0,57) in children from hand dishwashing families as compared to children from families who use machine dishwashing.        (more…)
Allergies, Microbiome / 23.02.2015

Christine Cole Johnson, PhD, MPH Senior Staff Epidemiologist & Henry Ford Distinguished Scientist Department Chair Department of Public Health Sciences Henry Ford Hospital and Health System Detroit MichiganMedicalResearch.com Interview with: Christine Cole Johnson, PhD, MPH Senior Staff Epidemiologist & Henry Ford Distinguished Scientist Department Chair Department of Public Health Sciences Henry Ford Hospital and Health System Detroit Michigan   Medical Research: What is the background for this study? What are the main findings? Dr. Johnson: Our research group is focused on the environmental and infant gut microbiomes. We are interested in studying what environmental, lifestyle and behavioral factors affect the microbial community of the baby's gastrointestinal tract, and how that microbial community composition affects the development of allergic disorders. We have been following a birth cohort called WHEALS in Detroit and its suburbs since 2003, collecting data on potential risk and preventive factors as well as environmental samples and stool samples from the babies. We have used sequencing of the v4 region of the 16s rRNA gene, common and unique to all bacteria, to develop a fingerprint of the bacterial community in the stool samples. We have found that many variables shown in the past by ourselves and others to allergic disorders are associated with different types of bacterial communities, such as breastfeeding, mode of delivery, first born status, socioeconomic status, pets in the home, levels of endotoxin in the home, and environmental tobacco smoke. Current breastfeeding is the most important variable at both 1 and 6 months, and at one month, mode of delivery is next most important. Endotoxin levels in house dust samples, a crude marker of bacteria levels, are important at 1 month but even more important at 6 months. We also found that certain bacterial community patterns in the baby's gut impact whether or not they have parental-reported allergic symptoms when exposed to cats and dogs when the children are about 4 years of age. (more…)
Author Interviews, BMJ, NIH, Pediatrics, Weight Research / 21.02.2015

Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIHMedicalResearch.com Interview with: Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH MedicalResearch: What is the background for this study? What are the main findings? Dr. Zhu: Currently in the US, nearly two thirds of reproductive-aged women are overweight or obese. Moreover, the amount of weight gained during pregnancy can have immediate and long-lasting impacts on health of a woman and her infant. Previous evidence implicates that excessive gestational weight gain above the Institute of Medicine guidelines is related to high birthweight (>4000 g), a marker of intrauterine over-nutrition which may impose a greater risk of offspring’s obesity and metabolic diseases in later life. Given that more than one third of children and adolescents are overweight or obese in the US, it is of great public health significance to improve our understanding of determinants and mediators of childhood obesity. The length of breast feeding and age at introduction of solid foods are infant feeding practices that are potentially modifiable in early life. We therefore examined whether birthweight and infant feeding practices, specifically length of breast feeding, mediate the relationship between maternal gestational weight gain and childhood growth in the National Children’s Study Formative Research in Anthropometry, a cross-sectional multi-ethnic study of 1387 mothers and their children aged 0-5.9 years in the US (2011-2012). We illustrated that the intergenerational relationship between maternal gestational weight gain and early childhood growth (i.e., z scores for weight-for-age, weight-for-height, and body mass index-for-age) largely acts through birthweight rather than directly on childhood growth. Further, given the negative association of breastfeeding duration with childhood anthropometrics, longer length of breastfeeding suppressed the positive associations of gestational weight gain and birthweight with childhood growth. In addition, analysis by ethnicity revealed that these associations were only significant in non-Hispanic White and non-Hispanic Black participants as opposed to Hispanics and other ethnicities. (more…)
Author Interviews, Pediatrics, Pediatrics / 20.02.2015

Katherine M. Keyes, Ph.D. Assistant Professor of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032MedicalResearch.com Interview with: Katherine M. Keyes, Ph.D. Assistant Professor of Epidemiology Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Keyes: The Monitoring the Future study is an annually conducted survey of 8th, 10th, and 12th grade high school students in the United States, covering a wide range of adolescent health behaviors. The same questions on adolescent sleep were queried every year since 1991, allowing us to examine historical trends in the amount of sleep adolescents report. We found that there have been substantial decreases in the proportion of adolescents who report 7 or more hours of sleep on a regular basis, across all age groups and across all demographic groups. In the most recent years, after age 15, less than half of adolescents report regularly getting 7 or more hours of sleep every night. Given the importance of sleep in both the short and the long term for adolescent health, these findings suggest substantial public health concern. (more…)
Author Interviews, Heart Disease, JCEM, Pediatrics, Vitamin D / 12.02.2015

MedicalResearch.com Interview with: Markus Juonala, MD, PhD University of Turku Finland Medical Research: What is the background for this study? What are the main findings? Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness. (more…)
Accidents & Violence, Author Interviews, BMJ, Pediatrics / 11.02.2015

MedicalResearch.com Interview with: Joke Kieboom, paediatric intensivist Beatrix Children’s Hospital Medical Center Groningen University of Groningen The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The aim of the study was to evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. From 1993 to 2012 in the Netherlands, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes, of whom none had good outcome: 87 (89%) died and 11 (11%) survived for with severe disability or in a vegetative state (at one year after the drowning incident). (more…)
Author Interviews, Hospital Readmissions, Pediatrics, Pediatrics / 05.02.2015

Mark Brittan MD MPH Assistant Professor, Pediatric Hospital Medicine Children's Hospital Colorado University of Colorado School of MedicineMedicalResearch.com Interview with: Mark Brittan MD MPH Assistant Professor, Pediatric Hospital Medicine Children's Hospital Colorado University of Colorado School of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Brittan: As hospitals face reimbursement penalties for excess readmissions, clinicians are increasingly focused on improving care transitions in order to reduce readmissions. We are interested in learning about feasible ways to reduce pediatric readmissions so that we can improve the quality of care and experience of children and families who are being discharged from the hospital. The purpose of this study was to assess whether outpatient follow-up visits after hospital discharge can help to prevent readmissions. We chose to examine this question in a population of medically complex children enrolled in Medicaid. Children with medical complexity account for a growing proportion of pediatric hospitalizations and inpatient costs. These children are often dependent on technology (for example, ventilator machines, feeding tubes, and chronic indwelling catheters), and can have very complex care plans and medication regimens. Publically insured children are also vulnerable to increased hospital utilization and may not always have optimal or easy access to outpatient services. Showing a relationship between post-discharge outpatient visits and fewer readmissions would suggest that improvements in coordination of care or access to outpatient follow-up care may help to reduce readmissions in these children. To assess this relationship, we retrospectively analyzed 2006-2008 Colorado Medicaid claims data from which we were able to gather demographic, clinical, and visit information for all enrollees. In our study, we excluded children who were readmitted within 3 days of hospital discharge so that we could evaluate children who had a chance to follow-up. The study cohort included 2415 medically complex children aged 6 months to 18 years who were hospitalized at least once. Of these children, 6.3% were readmitted on days 4 – 30 after hospital discharge. Almost 22% of the children had an outpatient follow-up visit within 3 days of discharge, and 40% had a visit on days 4-29 after discharge. In the final analysis, we found expected associations between readmission and previously described risk factors, including number of patient comorbidities and longer initial hospital length of stay. Examining the relationship between outpatient follow-up and readmission, we found that children with later outpatient follow-up visits (days 4-29) were significantly less likely to be readmitted than those who did not have an outpatient visit on days 4-29 after discharge. (more…)
Author Interviews, Cancer Research, Pediatrics / 02.02.2015

MedicalResearch.com Interview with: Kate A O’Neill Department of Paediatrics University of Oxford Children’s Hospital John Radcliffe Hospital Oxford UK MedicalResearch.com: What is the background for this study? Dr. O'Neill: Cancer affects around 1 in 500 children under the age of 15. Although the diagnosis and treatment of these diseases have seen major advances over the past few decades, survivors often experience health complications later in life, and cancer remains the main cause of disease related death in children in the developed world. The identification of risk factors for a number of adult cancers has allowed awareness and screening campaigns aimed at preventing disease. For the majority of childhood cancers, however, we still do not know what causes them, and so similar preventative measures are at present not possible. Incidence rates for many childhood cancers peak within the first few years of life, suggesting that the causative events occur early. For childhood leukaemia, it has even been shown that pre-malignant cells are already present at birth, indicating the disease may originate in utero. Studies exploring potential prenatal risk factors for childhood leukaemia have consistently found that children with the disease have higher birthweights than children who do not, and it is now widely accepted that the faster a foetus grows, the higher the risk of developing leukaemia in childhood. Leukaemia is the most common childhood cancer, accounting for approximately one third of all cases. Other childhood cancers are rarer, and it is consequently harder to perform similar risk association studies. The aim of this study was to compile information on large enough numbers of cases and controls to allow the analysis of risk associations between birthweight and all types of childhood cancer. Furthermore, we compiled data in different countries (USA and UK) to allow the comparison of results from two independent populations. MedicalResearch.com: What are the main findings? Dr. O'Neill: We found that with each 0.5kg (1.1lb) increase in birthweight, the risk of childhood cancer increased by 6%. Compared to babies with average birthweights (3-3.49kg, or 6.6lb -7.7lb), babies with clinically high birthweights (4kg, or 8.8lb, and above) had an increased risk of between 16% and 20%. These increased risks were strongest for certain cancers:
  • Leukaemias
  • Tumours of the central nervous system
  • Renal tumours
  • Soft tissue sarcoma
  • Neuroblastoma
  • Lymphoma
  • Germ cell tumours
  • Malignant melanomas
Hepatic tumours showed the reverse association, with risk increasing as birthweight decreased. Retinoblastoma, an embryonal tumour, and malignant bone tumours, which occur predominantly in adolescents, did not associate with birthweight. Our results were strikingly similar between USA and UK populations. Furthermore, birthweight appeared act independently of other factors that are known or suspected to associate with birthweight and/or childhood cancer (gestational age, birth order, plurality, maternal age and race/ethnicity). In summary, we found that approximately half of all childhood cancers are associated with birthweight. The association with a diversity of otherwise unrelated cancers indicates that in utero tissue growth and development has an underlying and potentially key role in the development of malignancy in childhood. (more…)
Author Interviews, Lancet, Neurological Disorders, Pediatrics, Respiratory / 31.01.2015

Samuel Dominguez MD Departments of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, COMedicalResearch.com Interview with: Samuel Dominguez MD Departments of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, CO Medical Research: What is the background for this study? What are the main findings? Dr. Dominguez: Due to global poliovirus eradication efforts, clusters of acute flaccid paralysis (AFP) and/or cranial nerve dysfunction in children are rare and associated with few pathogens, primarily enteroviruses and flaviviruses.  Our study reports the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of EV-D68 respiratory illness, strengthening the potential link between EV-D68 and neurologic disease in children. (more…)
Author Interviews, BMJ, Pediatrics, Weight Research / 30.01.2015

Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford, Department of Primary Care and Public Health Sciences King’s College London, London, UKMedicalResearch.com Interview with: Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford Department of Primary Care and Public Health Sciences King’s College London, London, UK Medical Research: What is the background for this study? What are the main findings? Response: Overweight and obesity in children have increased dramatically since the 1960s with important clinical and economic impacts, especially among those who become obese adults. Consequently, understanding trends in obesity is of increasing importance for monitoring population health and informing policy initiatives. Current trends suggest that a majority of the world’s population will be either overweight or obese by 2030. However, recent reports suggest that the increasing trend in overweight and obesity in children may have leveled off since 2000. But, in many countries data are based on a limited number of time points and relatively small surveys, limiting definitive conclusions and not allowing examining trends in subgroups by sex and age. Moreover, only a few countries have data on younger children (aged under 6 years). Our study aimed to use primary care electronic health records to examine prevalence of overweight and obesity in 2 to 15 year old children in England and to compare trends over two decades, from 1994 to 2003 and from 2004 to 2013. Medical Research: What are the main findings? Response: We found that currently about a third of children in the UK are overweight or obese. We also found that overweight and obesity prevalence increased during decade 1 (1994-2003) but stabilized in decade 2 (2004-2013). This was observed in both sexes and the in younger age groups (2-5 year and 6-10 year). However, rates continued to increase in older children (11-15 year), albeit at a slower speed than in decade 1 (1994-2003). (more…)
Author Interviews, Cognitive Issues, HIV / 27.01.2015

Sophie Cohen MD, PhD Student Department of Pediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands Cairns Base Hospital Australia MedicalResearch.com Interview with: Sophie Cohen MD, PhD Student Department of Pediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands Cairns Base Hospital Australia Medical Research: What is the background for this study? What are the main findings? Response: Since combination antiretroviral therapy (cART) has become widely available for HIV-infected children, the incidence of severe neurological complications has decreased drastically from 30-50% to less than 2%. Unfortunately, even in cART-treated HIV-infected children a range of cognitive problems have been found, such as a lower intelligence quotient (IQ) and poorer visual-motor integration. Importantly, while most HIV-infected children in industrialized countries are immigrants with a relatively low socioeconomic status (SES), cognitive studies comparing HIV-infected children to SES-matched controls are very scarce.  Understanding the prevalence and etiology of cognitive deficits in HIV-infected children is essential because they may result in more pronounced problems, and influence future intellectual performance, job opportunities and community participation. Also, early detection of cognitive impairment might trigger the development of early intervention strategies. In this study we aimed to compare the neuropsychological profile of HIV-infected children to that of healthy controls, matched for age, gender, ethnicity and SES. Also, we aimed to determine the prevalence of cognitive impairment in the HIV-infected group and detect associations between HIV/cART parameters and cognitive performance. We found that the HIV-infected group had a poorer cognitive performance compared with the healthy children on all tested domains (including intelligence, information processing speed, attention, memory, executive- and visual-motor functioning). Using a novel statistical method called Multivariate normative comparison (MNC), we detected a prevalence of 17% with cognitive impairment in the HIV-infected group. Lastly, we found that the center for disease control (CDC) clinical category at HIV diagnosis was inversely associated with verbal IQ (CDC C: coefficient -22.98, P=0.010). (more…)
Author Interviews, BMJ, Gastrointestinal Disease, Pediatrics / 25.01.2015

Dr Laila J Tata PhD Associate Professor in Epidemiology Faculty of Medicine & Health Sciences University of NottinghamMedicalResearch.com Interview with: Dr Laila J Tata PhD Associate Professor in Epidemiology Faculty of Medicine & Health Sciences University of Nottingham Medical Research: What is the background for this study? What are the main findings? Response: Over the last decades there has been increased clinical awareness of coeliac disease (CD) partially because of improvements in the accuracy and availability of diagnostic tests, however, we do not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary socioeconomic group. Funded by CORE/Coeliac UK and conducted at the University of Nottingham, this study analysed 2,063,421 children aged less than 18 years who were registered with general practices (primary care doctors) across the United Kingdom contributing to their routine electronic health records to The Health Improvement Network (THIN) database  between 1993 and 2012. The study found 1,247 children were diagnosed with coeliac disease, corresponding to about 1 new case in every 10,000 children each year. Girls consistently had more diagnoses than boys and whilst the incidence of new celiac disease cases among children up to age 2 years remained stable over time, diagnoses in older children almost tripled over the past 20 years. Moreover, the study found a socioeconomic gradient in celiac disease diagnoses, such that children living in less socioeconomically deprived areas were about twice as likely to be diagnosed as those from more deprived areas. This pattern held for boys and girls and for all ages. (more…)
Author Interviews, Neurological Disorders, Neurology, Pediatrics, Sleep Disorders / 23.01.2015

James Tao, MD, Ph.D Assistant Professor Director, EEG Lab Department of Neurology, The University of Chicago, IL.MedicalResearch.com Interview with: James Tao, MD, Ph.D Assistant Professor Director, EEG Lab Department of Neurology, The University of Chicago, IL. Medical Research: What is the background for this study? What are the main findings? Dr. Tao: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with chronic uncontrolled epilepsy. Patients often died in sleep, in bed, and unwitnessed. They were often found in prone position. These circumstances of SUDEP are remarkably similar to those of sudden infant death syndrome (SIDS). In our study, we found that 73% of 253 SUDEP patients were died in prone position. These findings suggest that sudden unexpected death in epilepsy may share the mechanisms similar to SIDS. (more…)
Author Interviews, Mental Health Research, Pediatrics, Social Issues / 20.01.2015

Ji Su Hong, MD Department of Psychiatry Washington University School of Medicine St. Louis, MOMedicalResearch.com Interview with: Ji Su Hong, MD  Department of Psychiatry Washington University School of Medicine St. Louis, MO   Medical Research: What is the background for this study? What are the main findings? Dr. Ji Su Hong: The estimated prevalence of preschool conduct disorder is 3.9%-6.6%. Approximately 1 out of 20 preschoolers has conduct disorder. Disruptive behaviors are common in the preschool period of development. However, to date we have not had scientific data to help guide clinicians to distinguish  between normal disruptive behaviors in preschoolers and behaviors that are markers of later Conduct disorder at school age. There were common misbehaviors which were found in preschoolers with mental health problems as well as healthy preschoolers. Those were losing temper, low intensity destruction of property and deceitfulness/stealing. Preschoolers who exhibited high-intensity defiant behavior, aggression toward people or animals, high-intensity destruction of property, peer problems and deceitfulness, including stealing, were more likely to have preschool conduct disorder and they were more likely to be diagnosed with a conduct disorder at school-age. (more…)
Author Interviews, CDC, Infections, JAMA, Pediatrics / 16.01.2015

MedicalResearch.com Interview with: Dr. Stefan Goldberg MD Medical Officer in CDC’s Division of Tuberculosis Elimination Clinical Research Branch Medical Research: What is the background for this study? What are the main findings? Dr. Goldberg: A shorter, simpler treatment regimen for children with latent TB infection can help prevent TB disease and reduce future transmission. The results from our study, a multinational, clinical trial, found that a once-weekly regimen of the anti-TB drugs rifapentine and isoniazid taken as directly observed therapy over a period of three months was safe and as effective for children (age 2-17) in preventing TB disease as the standard self-administered nine-month daily regimen of isoniazid alone. The study also showed that children are more likely to complete the shorter course of treatment, which is important given that treatment completion can be difficult. Specifically, we found that 88 percent of the trial participants on the combination regimen completed therapy while 81 percent completed the standard regimen. The CDC’s Tuberculosis Trials Consortium (TBTC), which conducted this study, works to include children in research when their inclusion is scientifically supportable and when children also might benefit from important new tools, such as alternative treatment regimens. This study is an extension of a large, international trial among persons age 12 and older, published by TBTC in 2011, which showed the shorter, simpler regimen to be as safe and effective as standard treatment. (more…)
Author Interviews, Autism, Pediatrics, Pediatrics / 13.01.2015

Terisa P. Gabrielsen, PhD, NCSP Assistant Professor, School Psychology Dept. of Counseling Psychology and Special Education Brigham Young University, Provo, UT 84602MedicalResearch.com Interview with: Terisa P. Gabrielsen, PhD, NCSP Assistant Professor, School Psychology Dept. of Counseling Psychology and Special Education Brigham Young University, Provo, UT 84602 Medical Research: What is the background for this study? What are the main findings? Dr. Gabrielsen: One of the keys to improving outcomes for individuals with outcomes is to begin intervention as early as possible, which means we need to identify autism symptoms as early as possible, preferably during the early toddler years.  The current study grew out of a screening feasibility study to see what would happen if pediatricians followed the AAP guidelines for screening every child for autism at ages 18 and 24 months as part of their regular pediatric care appointments.  That study  was conducted in a large, independent community pediatrics practice.  We found that universal screening of 796 patients helped to identify 10 toddlers with autism who had not previously been referred for evaluations.  Physicians had previously identified 3 others with autism in the group, and toddlers with other delays, such as language delays, were also identified through the screening process.  We wondered what some possible causes were for the low rate of autism referrals and designed the current study to look for what information was available to a pediatrician during the timespan of a typical pediatric exam.  We found that even in toddlers with autism, a brief (10-minute) sample contains an overwhelming ratio of typical behaviors (averaging 89%) compared to infrequent atypical behaviors (11%)  that would indicate the presence of autism.  We had autism experts identifying the behaviors from videos of the evaluations of children in the previous study, so they had many luxuries that a clinician doesn't have during an exam (i.e., ability to focus on one aspect of development, ability to rewind and re-view behaviors).  After watching the 10-minute video observations, we asked our experts, "Would you refer this child for an autism evaluation?"  We found that even the experts missed referring a child for an autism evaluation 39% of the time when the only data available were the brief observations. (more…)
Author Interviews, Pediatrics / 12.01.2015

MedicalResearch.com Interview with: Tomi  Ajetunmobi MSc and Bruce Whyte MSc Bespoke Specialist Services Information Services Division NHS National Services Scotland Edinburgh Medical Research: What is the background for this study? What are the main findings? Response: In developing countries, breast milk is considered the best source of nutrition for human infants, vital for child health and development. In developed counties, however, the message that ‘breast is best’ though widely accepted, is not practiced, particularly in the UK; debate continues on the role played by infant feeding in ensuring child health. The benefits of breastfeeding in terms of child health have been difficult to prove methodologically for ethical reasons. Moreover, most studies that have shown an association are often limited by the sample size, scope of the data and adjustment for a wide range of confounders particularly socioeconomic factors, which influence both infant feeding and child health outcomes. Using a range of linked administrative records comprising 502,948 singletons born in Scotland between 1997 and 2013 (representing approximately 70% of all Scottish births) , the study aimed to quantify the association between infant feeding patterns reported at a routine check-up 6 to 8 weeks after birth and hospital admission for childhood common illnesses. These included gastrointestinal, respiratory and urinary tract infections, otitis media, fever, asthma, eczema, diabetes and dental caries. The linkage made it possible to adjust for a wide range of confounders. Our findings were consistent with other studies and showed a greater risk of hospital admission amongst infants who were not breastfed particularly within six months of birth, even after adjustment for parental, delivery and infant health factors and features of the health care system. At least one in five hospitalisations for gastrointestinal and lower respiratory tract infections within six months of birth may have been averted (all other factors remaining constant) had all children in the cohort been exclusively breastfed 6 to 8 weeks after birth. The association was also evident beyond six months of birth. (more…)
Author Interviews, Pediatrics, Pharmacology / 07.01.2015

Prof. H. Szajewska The Medical University of Warsaw Department of Paediatrics Warsaw, PolandMedicalResearch.com Interview with: Prof. H. Szajewska The Medical University of Warsaw Department of Paediatrics Warsaw, Poland   Medical Research: What is the background for this study? Dr. Szajewska: Proton pump inhibitors (PPIs) are increasingly being used in the management of irritability and excessive crying in young infants. For example, a 7-fold increase in PPI prescriptions for infants was demonstrated in one US-based study. While differences among countries may occur, over-prescription of PPIs for infants remains a problem. The use of PPIs is mainly based on the assumption that these symptoms are attributable to gastroesophageal reflux or gastroesophageal reflux disease. Indeed, in infants, common symptoms of both conditions include regurgitation or vomiting associated with irritability or crying. However, there is still uncertainty with regard to the role of proton pump inhibitors for the management of excessive crying and irritability. Dr. Szajewska: What are the main findings? We aimed to examine whether proton pump inhibitors are effective in the management of excessive crying and irritability in infants. Only 5 randomized controlled trials fulfilled the inclusion criteria, so the evidence remains limited. There was variability in how crying/irritability outcomes were reported, but all trials used reliable methods. Some trials showed a decrease in crying/irritability from baseline to the end of the intervention; a similar effect was observed in the control group. However, no significant differences between the treatment groups were observed. (more…)
Author Interviews, JAMA, Pediatrics, UCSF / 06.01.2015

Yvonne Wu MD Professor of Clinical Neurology and Pediatrics UCSF School of MedicineMedicalResearch.com Interview with: Yvonne Wu MD Professor of Clinical Neurology and Pediatrics UCSF School of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Wu: Newborn infants commonly have elevated bilirubin levels, manifested as jaundice, because the body's mechanisms for breaking down bilirubin have not yet fully matured.  Although high bilirubin levels are almost always well tolerated, extremely high bilirubin levels may lead to brain injury, or kernicterus, which in turn can cause a very severe form of cerebral palsy.  When bilirubin levels are extremely high, or when bilirubin levels remain high despite phototherapy, it is recommended that an exchange transfusion be performed to prevent brain injury and cerebral palsy.  The American Academy of Pediatrics (AAP) has published recommendations on when an exchange transfusion should be performed, based on bilirubin level, age of infant and other clinical factors.  However, no previous study had examined the actual risk of cerebral palsy in infants whose bilirubin levels exceeded the exchange transfusion thresholds. Among 500,000 newborns born at Kaiser Permanente Northern California over a 17-year period, we found 1833 who had at least one bilirubin level above the AAP exchange transfusion level.  There were only 3 cases of cerebral palsy due to kernicterus in this group, even though only 42 (2.3%) of them had received exchange transfusions.  All 3 infants had bilirubin levels at least 5 mg/dL above the AAP exchange transfusion threshold and all 3 infants had 2 or more other risk factors for brain damage, including prematurity, sepsis, hypoxia and the hereditary blood disorder G6PD deficiency.  We did not identify any cases of kernicterus among otherwise well term babies, even at bilirubin levels that exceeded the AAP exchange transfusion threshold. (more…)
Author Interviews, Inflammation, Pediatrics, Pediatrics / 06.01.2015

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? What are the main findings? Prof. Bisgaard: The purpose of this study was to look for a shared risk factor for immunological diseases which make its debut in childhood. During the recent decades a parallel increase in prevalence of immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have been observed in westernized countries. The rate of cesarean delivery has increased in the same period and has previously been associated with the development of some of these diseases. This study takes advantage of the unique and valuable nationwide registry data in Denmark to establish a large population based cohort (2 million term children) with 35 years of follow up (in the period 1977-2012). We found cesarean delivery to be a common risk factor for a range of childhood immunological diseases: asthma, juvenile arthritis, inflammatory bowel diseases, connective tissue disorders, immune deficiencies and leukemia, but with no association to psoriasis, celiac disease, and diabetes type 1. (more…)
Author Interviews, Dermatology, Infections, Pediatrics / 06.01.2015

Jonathan Olsen Institute of Primary Care and Public Health Cardiff University Heath Park CardiffMedicalResearch.com Interview with: Jonathan Olsen Institute of Primary Care and Public Health Cardiff University Heath Park Cardiff MedicalResearch: What is the background for this study? What are the main findings? Response: Molluscum Contagiosum is a common skin condition in children which has a prevalence of between 5.1% to 8% in children aged 14 years and under. Strikingly however, there is little epidemiological evidence describing the natural history, transmission between family members and impact upon quality of life of molluscum contagiosum. Our research aimed to address this gap in evidence by conducting a prospective cohort study of UK children recruited by clinical and self-referral using the validated Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP). We recruited 306 children during 2013 and showed that on average lesions will last for 12 months, however 30% still had lesions at 18 months and 13% still had lesions at 24 months. Most children experienced only a small effect on their quality of life from the condition, however 1 in 10 experienced a large or very large impact on their quality of life. The condition was shown to be highly contagious with further transmission between children living in the same household as an index case shown in 40%. (more…)
Author Interviews, Gastrointestinal Disease, Pediatrics / 06.01.2015

Miranda van Tilburg, PhD Associate Professor of Medicine University of North CarolinaMedicalResearch.com Interview with: Miranda van Tilburg, PhD Associate Professor of Medicine University of North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. van Tilburg: Functional gastrointestinal disorders are common in children, adolescents and adults but little is known about the prevalence in infants and toddlers.  Functional gastrointestinal disorders in infancy include disorders such as regurgitation, colic, and dyschezia, while functional gastrointestinal disorders in toddlers include functional constipation, functional diarrhea, functional dyspepsia, cyclic vomiting, and rumination. Of these disorders only colic and regurgitation have received much research attention. Prevalence, cause and consequences of most functional gastrointestinal disorders in infants and toddlers are largely unknown. We set out to determine the prevalence in the US by asking a representative sample of mothers to report on their child’s symptoms. Our study found that 27% of infants and toddlers may suffer from a functional gastrointestinal disorder. Among infants, regurgitation was the most common disorder and among toddlers constipation. Despite functional gastrointestinal disorders generally being more prevalent in older girls and adult women, no sex differences were found in this age group. Toddlers who suffer from a functional gastrointestinal disorders had lower quality of life and made more health care visits. (more…)
Author Interviews, Compliance, Flu - Influenza, Pediatrics, Pediatrics, Vaccine Studies / 31.12.2014

Melissa Stockwell, MD, MPH, FAAP Florence Irving Assistant Professor of Pediatrics and Population and Family Health Columbia University - College of Physicians & Surgeons and Mailman School of Public Health Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac) Co-Director, Primary Care Clinician Research Fellowship in Community Health New York, NY 10032MedicalResearch.com Interview with: Melissa Stockwell, MD, MPH, FAAP Florence Irving Assistant Professor of Pediatrics and Population and Family Health, Columbia University - College of Physicians & Surgeons and Mailman School of Public Health Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac); Co-Director, Primary Care Clinician Research Fellowship in Community Health Medical Research: What is the background for this study? What are the main findings? Response:  Influenza can be a very serious disease and is more than just a bad cold.  Some children who are 6 months through 8 years need two doses of the influenza vaccine in a season depending on if and when they received previous influenza vaccine doses. We know that only about half of these families who want to vaccinate their children against the flu and get the first dose, come back to get the second dose. (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Pediatrics, University Texas, UT Southwestern / 26.12.2014

Ron B. Mitchell, MD Professor of Otolaryngology and Pediatrics William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas ENT Clinic Dallas, TX 75207MedicalResearch.com Interview with: Ron B. Mitchell, MD Professor of Otolaryngology and Pediatrics William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas ENT Clinic Dallas, TX 75207 Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: The “gold standard” for the diagnosis of and quantification of obstructive sleep apnea (OSA) is polysomnography (PSG or a ‘sleep study’). However, the majorities of T&A procedures are done without PSG and are based on a clinical diagnosis. This is because PSG is expensive, requires overnight observation and is often unavailable. It is important to diagnose and quantify OSA as it allows for surgical planning and predicts the need and type of treatment after surgery. We used data from the Childhood Adenotonsillectomy (CHAT) study; a large multicenter trial (RCT), to look at the ability of clinical parameters to predict the severity of obstructive sleep apnea in children scheduled for a T&A. The main findings of the study are that certain clinical parameters such as obesity and African American race as well as high scores on certain validated questionnaires (such as the pediatric sleep questionnaire- PSQ) are associated, but cannot predict OSA severity. PSG remains the only way to measure objectively the severity of OSA. (more…)
Author Interviews, Infections, Pediatrics / 23.12.2014

MedicalResearch.com Interview with: Femi Oshin Consultant in Communicable Disease Control Devon, Cornwall & Somerset PHE Centre and Dan Murphy Cornwall & Isles of Scilly Health Protection Team, Cornwall, UK Medical Research: What is the background for this study? What are the main findings? Response: Salmonella disease are significant infections, particularly so in children. Ownership of reptiles kept as pets has risen sharply in recent years, as has Salmonella infections in children. Our study found children living in homes with a reptile as a pet are more likely to require hospitalisation from Salmonella infection, and the risk appears to increase with decreasing age of the child. (more…)
Author Interviews, Pediatrics, Toxin Research, University Texas / 21.12.2014

Ying Xu Assistant Professor, Ph.D. Department of Civil, Architectural and Environmental Engineering University of Texas, AustinMedicalResearch.com Interview with: Ying Xu Assistant Professor, Ph.D. Department of Civil, Architectural and Environmental Engineering University of Texas, Austin Medical Research: What is the background for this study? What are the main findings? Response: Phthalates have been widely used as plasticizers to enhance the flexibility of polyvinyl chloride (PVC) products.  They are ubiquitous and persistent indoor pollutants and may result in profound and irreversible changes in the development of human reproductive tract. In this study, we found that the emissions of phthalates and phthalate alternatives increase significantly with increasing temperature.  We developed an emission model and validated the model via chamber experiments.  Further analysis showed that, in infant sleep microenvironments, an increase in the temperature of mattress can cause a significant increase in emission of phthalates from the mattress cover and make the concentration in breathing zone about four times higher than that in the room, resulting in potentially high exposure.  In residential homes, an increase in the temperature from 25 to 35 ºC can elevate the gas-phase concentration of phthalates by more than a factor of 10, but the total airborne concentration may not increase that much for less volatile compounds. (more…)
Author Interviews, CMAJ, Pharmacology / 19.12.2014

MedicalResearch.com Interview with: Naveen Poonai MSc MD FAAP FRCPC Paediatric Emergency Physician Children's Hospital, London Health Sciences Center Assistant Professor Paediatrics and Internal Medicine Schulich School of Medicine and Dentistry London, Ontario, Medical Research: What is the background for this study? What are the main findings? Dr. Poonai: We found that in children discharged home with a fracture, both ibuprofen and oral morphine were effective at relieving pain. However, there were no significant differences in efficacy between the two agents and oral morphine was associated with more side effects. MedicalResearch.com: What was most surprising about the results? Dr. Poonai: The most surprising findings for us were that over 70% of children experienced pain significant enough to require analgesia once they were discharged home.  Furthermore, we were surprised to find that the anecdotally more potent agent morphine, was equivalent to ibuprofen for post-fracture pain relief in children. (more…)