news and information for children's health and well-being

An independent group of experts has been established to help develop a new strategy for improving care for children and young people.

The ‘Children’s and Young People’s outcomes strategy’ will focus the health service on improving health results for children, including those needing primary, hospital and urgent care, and children with long-term conditions.

It will identify health issues that matter most to children and young people, and how a modern NHS will meet their needs.

To inform the strategy, a group of independent experts from local government, the NHS and charities will hear views from children, parents, carers and wider families as well as health professionals.

The Children’s and Young People’s Forum will be jointly chaired by Professor Ian Lewis, Medical Director at the Alder Hey Children’s NHS Foundation Trust, and Christine Lenehan, Director at the Council for Disabled Children.

Professor Ian Lewis said:

‘This is a welcome opportunity to focus on children and young people in order to ensure that the modernisation of health services work well for them.

‘It’s a genuine chance to make a difference to improve the availability and quality of healthcare provided to them by the NHS. We look forward to working alongside other experts as part of the Children’s and Young People’s Forum.’

Health Secretary Andrew Lansley said:

‘Our ambition for the Children’s and Young People’s Health Outcomes Strategy is a simple one – to improve outcomes for children and young people’s health.

‘We will bring together people and resources from across the NHS, social care and wider children’s services to develop a clear set of goals to give all children the right start in life.

‘By intervening early we will be to able to influence patterns of behaviour and can ensure that children and young people get the quality of care, services and support that they deserve.’

The Children’s and Young People’s Forum, which is designed on the NHS Future Forum model, will carry out a three-month period of engagement with appropriate stakeholders before submitting its recommendations to the Government later in the year.

The Forum will build on work already planned through the Health and Wellbeing Board learning network and the SEN and Disability Pathfinder programme.

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Article source: http://www.dh.gov.uk/health/2012/01/children-forum/

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By Juliana Bunim on January 25, 2012

The UCSF Benioff Children’s Hospital has the best overall survival rates in the nation for bone marrow transplants, according to a recent independent review of 156 programs nationwide.

Morton Cowan, MD

The Pediatric Blood and Marrow Transplant Program, led by Morton Cowan, MD, was ranked number one for survival performance by the federally mandated review program of the Center for International Blood and Marrow Transplant Research (CIBMTR).

The 156 transplant centers were reviewed based on the number of transplants done annually, adjusted for risk, and estimated the chance for survival one year post transplant. Overall, the estimated chance of survival after one year was 63.4 percent. Of the 156 centers reviewed, only 14 (9 percent) were considered over performers, with the UCSF Pediatric Bone Marrow Transplant Program ranked number one with a survival rate of 87.6 percent.

Additionally, the Adult Hematology and Blood and Marrow Transplant (BMT) at UCSF Medical Center was again named an “over performer” by the CIBMTR. This is the second consecutive year the service has been recognized as an over performer. The adult program is also one of 14 nationwide recognized for exceeding U.S. expectations in patient survival rates for those undergoing a blood or marrow transplant from either a relative or an unrelated donor. At UCSF, 75 percent of adult patients receiving a BMT survive at least a year, compared to the national average of 63.4 percent. 

Christopher Dvorak, MD, a pediatric blood and bone marrow transplant specialist at the UCSF Benioff Children’s Hospital, wasn’t surprised by the results knowing firsthand the level of commitment to success that exists within and well beyond the pediatric BMT team.

“We work incredibly hard and have an attention to detail and dedication to our policies attempting to limit transplant-associated mortality,” said Dvorak, who is also head of the national Pediatric Blood and Marrow Transplant Consortium’s Supportive Care Strategy Sroup.

The UCSF pediatric BMT program has expanded in recent years by adding two physicians and two nurse practitioners, ultimately increasing the number of transplants performed. UCSF’s interdisciplinary collaboration among health care professionals also adds a nuanced level of support. “Some of the credit for our success must go to the pediatric intensive care unit which helps patients survive when then get critically ill,” Dvorak said.

The pediatric BMT unit also gives more individualized attention to the dosing of chemotherapy medications through increased interactions with the UCSF School of Pharmacy.  “We have a great School of Pharmacy and now have a doctor of pharmacy on our team, helping us with tailoring the chemo regimens. We have great nurses and nurse practitioners through the School of Nursing as well, and all of that plays into our success.”

While adult bone marrow transplants are usually performed to treat blood-related cancers, pediatric transplants are necessary for a host of other reasons. Immunodeficiency syndromes, defects in red blood cells, inborn errors of metabolism, and several types of cancer account for many of the BMT transplants performed in children at UCSF.

Since the UCSF Pediatric Bone Marrow Transplant Program was started by Cowan in 1982, nearly 1,000 transplants have been performed at UCSF Benioff Children’s Hospital. In 1982, UCSF performed the first partially matched bone marrow transplant on the West Coast, using bone marrow from a parent for a child with a severe immunodeficiency disease.

Today, UCSF is a leader in special treatment options for children with primary immunodeficiency diseases, marrow failure syndromes, genetic diseases, cancers and other life-threatening illnesses.

Photo by Kaz Tsuruta

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/JwUbXEz71dM/survival-rates-pediatric-bone-marrow-transplants-top-nation

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Parental Smoking and Childhood Ear Infections: A Dangerous Combination

Ear infections are very common in children; these infections are often called middle ear disease and include:

Megan A. Moreno, MD, MSEd, MPH;
Fred Furtner, Illustrator;
Frederick P. Rivara, MD, MPH, Editor

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/104?rss=1

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COMMENTS


Exposure to Magnetic Fields During Pregnancy and Asthma in Offspring

Paul J. Villeneuve, PhD

Arch Pediatr Adolesc Med. 2012;166(1):97. doi:10.1001/archpedi.166.1.97-a

Li et al¹ reported associations between prenatal exposure to magnetic fields and childhood asthma. They measured exposure to magnetic fields in pregnant women using personal monitoring and then examined their associations with newly diagnosed asthma among offspring. Each 1-mG increase in maternal magnetic field levels was associated with a 15% increased risk of asthma.

While I agree with their assertion that the search for environmental factors of childhood asthma remains elusive, their article does not address the relevance of other environmental exposures. Air quality is widely recognized as a risk factor involved in the development and exacerbation of childhood asthma. Exposure to ambient air pollution during pregnancy has been associated with allergies, wheeze, and asthma in offspring.^2-3 With respect to indoor air quality, house-dust mite allergens can produce new-onset cases of asthma; cat, cockroach, and house-dust mite allergens can exacerbate asthmatic episodes in sensitized individuals; and . . . [Full Text of this Article]

Author Affiliations: Population Studies Division, Health Canada, Ottawa, and Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/97?rss=1

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Cochlear Implants in Children and Adolescents

Annelle V. Hodges, PhD;
Thomas J. Balkany, MD

Arch Pediatr Adolesc Med. 2012;166(1):93-94. doi:10.1001/archpediatrics.2011.1104

Early human records from the third century BC indicate that primitive cultures recognized and treated hearing loss using plant extracts and minerals with empirical or magical intent.¹ However, only recently have physicians been able to treat adequately the most severe disorder of hearing, profound sensorineural hearing loss (nerve deafness). Beginning in the 1960s, the concurrent evolution of auditory science, including implantable microprocessors, microsurgery techniques, and antibiotics, opened the door to cochlear implantation, which has only become widely available for children in the past 2 decades.

Childhood deafness is common in the United States, with approximately 4000 infants per year born with bilateral severe to profound sensorineural hearing loss.^2-3 Before the advent of cochlear implantation, children born with these levels of impairment were often educated in state residential schools and communicated through manual language, most commonly American Sign Language (ASL). American Sign Language . . . [Full Text of this Article]

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/93?rss=1

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Pediatric Polypharmacy

Time to Lock the Medicine Cabinet?

Nancy E. Morden, MD, MPH;
David Goodman, MD, MS

Arch Pediatr Adolesc Med. 2012;166(1):91-92. doi:10.1001/archpediatrics.2011.162

The use of therapeutic agents represents a trade-off between the benefits of symptom relief or disease modification that increase quality or length of life and the risk of short- and long-term adverse effects. While evidence suggests that complex medication combinations greatly increase the odds of incurring an adverse drug event,^1-3 US Food and Drug Administration approval generally only requires testing of agents in isolation. As a consequence, we often do not know the net health outcomes associated with diverse and intense medication combinations. This uncertainty is magnified in the care of children for whom efficacy and safety studies are often lacking. Despite this therapeutic uncertainty, pediatric drug use is growing.⁴ A study in this issue of the Archives⁵ provides a critical examination of the drug exposure of pediatric inpatients. Polypharmacy is the norm for hospitalized infants and children. Should we be . . . [Full Text of this Article]

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/91?rss=1

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Adolescent Perceptions of Risk and Need for Safer Sexual Behaviors After First Human Papillomavirus Vaccination

Tanya L. Kowalczyk Mullins, MD, MS;
Gregory D. Zimet, PhD;
Susan L. Rosenthal, PhD;
Charlene Morrow, RN;
Lili Ding, PhD;
Marcia Shew, MD, MPH;
J. Dennis Fortenberry, MD, MS;
David I. Bernstein, MD, MA;
Jessica A. Kahn, MD, MPH

Arch Pediatr Adolesc Med. 2012;166(1):82-88. doi:10.1001/archpediatrics.2011.186

Objectives  To (1) examine perceptions of risk of human papillomavirus (HPV) and other sexually transmitted infections (STIs), (2) examine perceived need for safer sexual behaviors, and (3) determine factors associated with less perceived need for safer sexual behaviors, all in the context of receiving the first HPV vaccination.

Design  Cross-sectional baseline analysis from an ongoing longitudinal cohort study.

Author Affiliations: Divisions of Adolescent Medicine (Drs Mullins and Kahn and Ms Morrow), Biostatistics and Epidemiology (Dr Ding), and Infectious Diseases (Dr Bernstein) and Department of Pediatrics (Drs Mullins, Bernstein, and Kahn and Ms Morrow), Cincinnati Children’s Hospital Medical Center, and University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Mullins, Bernstein, and Kahn); Department of Pediatrics, Indiana University School of Medicine, Indianapolis (Drs Zimet, Shew, and Fortenberry); and Department of Pediatrics, Columbia University Medical Center, New York, New York (Dr Rosenthal).

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/82?rss=1

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Health-Related Quality of Life in Pediatric Minor Injury

Reliability, Validity, and Responsiveness of the Pediatric Quality of Life Inventory in the Emergency Department

Martha W. Stevens, MD, MSCE;
Keri R. Hainsworth, PhD;
Steven J. Weisman, MD;
Peter M. Layde, MD, MSc

Arch Pediatr Adolesc Med. 2012;166(1):74-81. doi:10.1001/archpediatrics.2011.694

Objective  To evaluate the feasibility, reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) in the first 2 weeks after pediatric emergency department care of minor injury.

Design  Prospective cohort study.

Author Affiliations: Section of Emergency Medicine (Dr Stevens), Injury Research Center (Drs Stevens and Layde), Department of Pediatrics, Children’s Research Institute (Drs Stevens, Hainsworth, and Weisman), and Departments of Anesthesia (Drs Hainsworth and Weisman) and Emergency Medicine (Dr Layde), Medical College of Wisconsin, Milwaukee.

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/74?rss=1

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The Interplay of Outpatient Services and Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders

David S. Mandell, ScD;
Ming Xie, MS;
Knashawn H. Morales, ScD;
Lindsay Lawer, MA;
Megan McCarthy, MA;
Steven C. Marcus, PhD

Arch Pediatr Adolesc Med. 2012;166(1):68-73. doi:10.1001/archpediatrics.2011.714

Objective  To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

Design  Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

Author Affiliations: Center for Mental Health Policy and Services Research (Drs Mandell and Morales and Mss Xie, Lawer, and McCarthy) and Department of Clinical Epidemiology and Biostatistics (Dr Morales), Perelman School of Medicine, and School of Social Policy and Practice (Dr Marcus), University of Pennsylvania, and Center for Autism Research, The Children’s Hospital of Philadelphia (Dr Mandell), Philadelphia, Pennsylvania.

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/68?rss=1

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Child Health Providers’ Precautionary Discussion of Emotions During Communication About Results of Newborn Genetic Screening

Michael H. Farrell, MD;
Jodi Speiser, MD;
Lindsay Deuster, MD;
Stephanie Christopher, MA

Arch Pediatr Adolesc Med. 2012;166(1):62-67. doi:10.1001/archpediatrics.2011.696

Objective  To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians’ communication about hidden emotions after newborn genetic screening.

Design  Communication quality indicator analysis.

Author Affiliations: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee (Dr Farrell and Ms Christopher); Department of Pathology, Loyola University Medical Center, Chicago, Illinois (Dr Speiser); and Department of Pediatrics, University of Minnesota, Minneapolis (Dr Deuster).

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/62?rss=1

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Association of Exclusive Breastfeeding Duration and Fibrinogen Levels in Childhood and Adolescence

The European Youth Heart Study

Idoia Labayen, PhD;
Francisco B. Ortega, PhD;
Jonatan R. Ruiz, PhD;
Helle M. Loit, PhD;
Jaanus Harro, PhD;
Inga Villa, PhD;
Toomas Veidebaum, PhD;
Michael Sjöström, PhD

Arch Pediatr Adolesc Med. 2012;166(1):56-61. doi:10.1001/archpediatrics.2011.769

Objective  To examine the association of exclusive breastfeeding (BF) duration on serum fibrinogen levels of children and adolescents from Estonia and Sweden, controlling for other potential confounding factors that could mediate in this relationship.

Design  Cross-sectional study.

Author Affiliations: Department of Nutrition and Food Science, University of the Basque Country, Vitoria, Spain (Dr Labayen); Unit for Preventive Nutrition, Department of Biosciences and Nutrition at Novum, Karolinska Institutet, Huddinge, Sweden (Drs Labayen, Ortega, Ruiz, and Sjöström); Department of Medical Physiology, School of Medicine (Dr Ortega), and Department of Physical Education and Sport, School of Physical Activity and Sport Sciences (Dr Ruiz), University of Granada, Granada, Spain; Department of Chronic Diseases, Estonian Centre of Behavioral and Health Sciences, National Institute for Health Development (Dr Loit), and Department of Psychology (Dr Harro) and Institute of Public Health (Dr Villa), University of Tartu, Estonian Centre of Behavioral and Health Sciences, Tartu, Estonia; and National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia (Dr Veidebaum).

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/56?rss=1

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Effect of Pediatric Bilateral Cochlear Implantation on Language Development

Tinne Boons, MA;
Jan P. L. Brokx, PhD;
Johan H. M. Frijns, MD, PhD;
Louis Peeraer, PhD;
Birgit Philips, MA;
Anneke Vermeulen, PhD;
Jan Wouters, PhD;
Astrid van Wieringen, PhD

Arch Pediatr Adolesc Med. 2012;166(1):28-34. doi:10.1001/archpediatrics.2011.748

Objective  To examine spoken language outcomes in children undergoing bilateral cochlear implantation compared with matched peers undergoing unilateral implantation.

Design  Case-control, frequency-matched, retrospective cross-sectional multicenter study.

Author Affiliations: Division of Experimental Otorhinolaryngology, Department of Neurosciences (Ms Boons and Drs Wouters and van Wieringen), and Faculty of Kinesiology and Rehabilitation Sciences (Dr Peeraer), Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Allied Health Sciences, Fontys University of Applied Sciences, Eindhoven, the Netherlands (Ms Boons and Dr Peeraer); and Ear, Nose and Throat Departments, Maastricht University Medical Centre, Maastricht, the Netherlands (Dr Brokx), Leiden University Medical Centre, Leiden, the Netherlands (Dr Frijns), Ghent University, Ghent, Belgium (Ms Philips), and Radboud University, Nijmegen, the Netherlands (Dr Vermeulen).

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/28?rss=1

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Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States

Chris Feudtner, MD, PhD, MPH;
Dingwei Dai, PhD;
Kari R. Hexem, MPH;
Xianqun Luan, MS;
Talene A. Metjian, PharmD

Arch Pediatr Adolesc Med. 2012;166(1):9-16. doi:10.1001/archpediatrics.2011.161

Objective  To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.

Design  Retrospective cohort study.

Author Affiliations: Center for Pediatric Clinical Effectiveness (Drs Feudtner and Dai, Ms Hexem, and Mr Luan) and Antimicrobial Stewardship Program (Dr Metjian), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia (Dr Feudtner).

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/9?rss=1

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This Month in Archives of Pediatrics Adolescent Medicine

Arch Pediatr Adolesc Med. 2012;166(1):6-7. doi:10.1001/archpediatrics.2011.509

Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States

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Article source: http://archpedi.ama-assn.org/cgi/content/short/166/1/6?rss=1

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Effects of a Family Intervention in Reducing HIV Risk Behaviors Among High-Risk Hispanic Adolescents

A Randomized Controlled Trial

Guillermo Prado, PhD;
Hilda Pantin, PhD;
Shi Huang, PhD;
David Cordova, PhD;
Maria I. Tapia, MSW;
Maria-Rosa Velazquez, MPA;
Meghan Calfee, MS;
Shandey Malcolm, MPH;
Margaret Arzon, BS;
Juan Villamar, MS;
Giselle Leon Jimenez, MFT;
Nicole Cano, BS;
C. Hendricks Brown, PhD;
Yannine Estrada, MSEd

Arch Pediatr Adolesc Med. Published online October 3, 2011. doi:10.1001/archpediatrics.2011.189

Objective  To determine the efficacy of a family intervention in reducing human immunodeficiency virus (HIV) risk behaviors among Hispanic delinquent adolescents.

Design  Randomized controlled trial.

Author Affiliations: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida.

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Article source: http://archpedi.ama-assn.org/cgi/content/short/archpediatrics.2011.189v1?rss=1

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A Randomized Trial of Single Home Nursing Visits vs Office-Based Care After Nursery/Maternity Discharge

The Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study

Ian M. Paul, MD, MSc;
Jessica S. Beiler, MPH;
Eric W. Schaefer, MS;
Christopher S. Hollenbeak, PhD;
Nancy Alleman, CRNP;
Sarah A. Sturgis, CRNP;
Stella M. Yu, ScD, MPH;
Fabian T. Camacho, MS, MA;
Carol S. Weisman, PhD

Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.198

Objective  To compare office-based care (OBC) with a care model using a home nursing visit (HNV) as the initial postdischarge encounter for “well” breastfeeding newborns and mothers.

Design  Randomized controlled trial.

Author Affiliations: Departments of Pediatrics (Dr Paul and Hollenbeak and Mss Beiler and Sturgis), Public Health Sciences (Drs Paul and Weisman and Messrs Schaefer and Camacho), and Obstetrics and Gynecology (Dr Weisman), Penn State College of Medicine, Hershey, Pennsylvania (Dr Weisman); Visiting Nurse Association of Central Pennsylvania, Harrisburg (Ms Alleman); and Health Resources and Services Administration–Maternal and Child Health Bureau, Rockville, Maryland (Dr Yu).

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Doctor-Office Collaborative Care for Pediatric Behavioral Problems

A Preliminary Clinical Trial

David J. Kolko, PhD, ABPP;
John V. Campo, MD;
Amy M. Kilbourne, PhD, MPH;
Kelly Kelleher, MD, MPH

Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.201

Objectives  To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems.

Design  Cases were assigned to DOCC and EUC using a 2:1 randomization schedule that resulted in 55 DOCC and 23 EUC cases.

Author Affiliations: Special Services Unit, Western Psychiatric Institute and Clinic and Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Kolko); College of Medicine (Dr Campo) and Center for Innovation in Pediatric Practice, The Research Institute (Dr Kelleher), Nationwide Children’s Hospital (Dr Campo), The Ohio State University, Columbus; and VA Ann Arbor Center for Clinical Management Research and Department of Psychiatry, University of Michigan (Dr Kilbourne).

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By Juliana Bunim on December 29, 2011

WHAT: The first San Francisco baby born in 2012 is always an exciting story to kick off the new year. If that baby is born at UCSF Benioff Children’s Hospital, we will be coordinating with media in an effort to offer access to the family for interviews and photography.

WHEN: Sunday, Jan. 1, 2012, Time TBA

WHERE: UCSF Benioff Children’s Hospital, 505 Parnassus Ave.

CONTACT: To find out if the first baby was born at UCSF Benioff Children’s Hospital, please contact Elizabeth Fernandez at (415) 298-4320 or elizabeth.fernandez@ucsf.edu on Sunday morning.

BACKGROUND INFORMATION: UCSF Benioff Children’s Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

For more information, visit http://www.ucsfbenioffchildrens.org/.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/2fiRyTGzzoY/media-advisory-coverage-opportunities-first-baby-born-2012

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The Challenge of Mental Health Care in Pediatrics

Ellen C. Perrin, MD;
R. Christopher Sheldrick, PhD

Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.202

Rising rates of identification of attention-deficit/hyperactivity disorder¹ and other mental health disorders,² and increasing recognition of their long-term morbidity,^3-5 have underscored the importance of creating efficient and effective mechanisms of providing access to high-quality mental health care for all children. The primary care setting should be an appropriate setting for recognition of and early intervention in these issues because virtually all children see a primary care pediatrician frequently in their first 3 years of life and at least once per year thereafter.⁶ Unfortunately, this potential is rarely met due to inconsistencies in pediatricians’ training and skills; the enormous requirements for identification, care, prevention, and documentation of the myriad child health problems that pediatricians are called on to manage⁷; and a fiscal environment that demands ever-shorter visits and ever-more documentation. For many physicians, identifying appropriate mental health referrals is a difficult and . . . [Full Text of this Article]

AUTHOR INFORMATION

Author Affiliations: Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts.

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Evaluation of the Web-Based Computer-Tailored FATaintPHAT Intervention to Promote Energy Balance Among Adolescents

Results From a School Cluster Randomized Trial

Nicole P. M. Ezendam, PhD;
Johannes Brug, PhD;
Anke Oenema, PhD

Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.204

Objective  To evaluate the short- and long-term results of FATaintPHAT, a Web-based computer-tailored intervention aiming to increase physical activity, decrease sedentary behavior, and promote healthy eating to contribute to the prevention of excessive weight gain among adolescents.

Design  Cluster randomized trial with an intervention group and a no-intervention control group.

Author Affiliations: Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands (Drs Ezendam and Oenema); Eindhoven Cancer Registry, Comprehensive Cancer Center South, Eindhoven, the Netherlands (Dr Ezendam); EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands (Dr Brug). Dr Ezendam is now with the Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, the Netherlands.

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Prevalence of Clinically Important Traumatic Brain Injuries in Children With Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms

Lise E. Nigrovic, MD, MPH;
Lois K. Lee, MD, MPH;
John Hoyle, MD;
Rachel M. Stanley, MD;
Marc H. Gorelick, MD;
Michelle Miskin, MS;
Shireen M. Atabaki, MD;
Peter S. Dayan, MD, MSc;
James F. Holmes, MD, MPH;
Nathan Kuppermann, MD, MPH; for the Traumatic Brain Injury (TBI) Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)

Arch Pediatr Adolesc Med. Published online December 5, 2011. doi:10.1001/archpediatrics.2011.1156

Objective  To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms).

Design  Secondary analysis of a large prospective observational cohort study.

Author Affiliations: Division of Emergency Medicine, Children’s Hospital–Boston, Harvard Medical School, Boston, Massachusetts (Drs Nigrovic and Lee); Division of Emergency Medicine, Helen DeVos Children’s Hospital, Michigan State University School of Medicine, Grand Rapids (Dr Hoyle); Department of Emergency Medicine, University of Michigan Health System, University of Michigan, Ann Arbor (Dr Stanley); Division of Emergency Medicine, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee (Dr Gorelick); University of Utah School of Medicine, Salt Lake City (Ms Miskin); Departments of Pediatrics and Emergency Medicine, Children’s National Medical Center, George Washington University School of Medicine, Washington, DC (Dr Atabaki); Department of Pediatrics, Morgan Stanley Children’s Hospital of New York–Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York (Dr Dayan); and Departments of Emergency Medicine (Drs Holmes and Kuppermann) and Pediatrics (Dr Kuppermann), School of Medicine, University of California–Davis Medical Center, Davis.

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Academic Medical Centers and Equity in Specialty Care Access for Children

Joanna Bisgaier, MSW, PhD;
Daniel Polsky, PhD;
Karin V. Rhodes, MD, MS

Arch Pediatr Adolesc Med. Published online December 5, 2011. doi:10.1001/archpediatrics.2011.1158

Objective  To test whether specialty clinics’ academic medical center (AMC) affiliation was associated with equity in scheduling appointments for children with public vs private insurance. Academic medical centers are safety-net providers of specialty medical care and it is unknown whether equitable access is afforded by AMCs across insurance conditions.

Design  Audit study data were linked to data describing audited clinics.

Author Affiliations: School of Social Policy Practice (Drs Bisgaier and Rhodes), Department of Medicine, School of Medicine (Dr Polsky), Leonard Davis Institute of Health Economics (Polsky and Rhodes), and Department of Emergency Medicine, School of Medicine (Dr Rhodes), University of Pennsylvania, Philadelphia.

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Can We Ensure That Children With Public Insurance Have Access to Necessary, High-quality Pediatric Specialty Care?

Stephen Berman, MD

Arch Pediatr Adolesc Med. Published online December 5, 2011. doi:10.1001/archpediatrics.2011.1164

The article entitled “Academic Medical Centers and Equity in Specialty Care Access for Children” by Bisgaier et al¹ has special relevance for 2 current important health policy issues. The first is the need for the Department of Health and Human Services and its Centers for Medicare Medicaid Services to issue detailed compliance standards related to ensuring equal access to health care for children with public insurance. The second is the need to continue adequate federal funding for the freestanding Children’s Hospitals Graduate Medical Education (CHGME) program.

When Congress passed the enabling Medicaid legislation in 1966, legislators were concerned that children enrolled in Medicaid would not receive needed care if the payment levels determined by states were too low. Therefore, the Medicaid legislation included federal oversight of provider payments for pediatric services. The Medicaid expansion enacted in the Omnibus Budget Reconciliation Act of 1989 codified the issue . . . [Full Text of this Article]

Author Affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora.

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When Will Routine Testing for Human Immunodeficiency Virus Infection Be the Routine for Adolescents?

Lawrence J. D’Angelo, MD, MPH

Arch Pediatr Adolesc Med. Published online January 2, 2012. doi:10.1001/archpediatrics.2011.1555

Best estimates place the number of individuals 13 to 24 years of age who are newly diagnosed with human immunodeficiency virus (HIV) infection each year at more than 10 000.¹ This represents approximately 20% of all newly diagnosed cases of HIV annually. While this number is large, the most troubling statistic concerning HIV infection among youth is that more than 48% of those youth who are infected are unaware of their status as opposed to 25% of infected individuals in all other age groups.²

In this issue of the Archives, Balaji et al³ report the results of their analysis of data on HIV testing from the 2009 Youth Risk Behavior Survey. While the data do support the fact that some groups of adolescents who appear to be at greater risk for HIV infection are more likely to be tested, the fact that only 17.9% of . . . [Full Text of this Article]

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Recent Progress in Understanding Pediatric Bipolar Disorder

Benjamin I. Goldstein, MD, PhD, FRCPC

Arch Pediatr Adolesc Med. Published online January 2, 2012. doi:10.1001/archpediatrics.2011.832

Bipolar disorder is one of the most severe psychiatric illnesses, particularly when onset occurs during childhood or adolescence. With recent empirical evidence, questions regarding the existence of bipolar disorder among children and adolescents have given way to questions regarding prevalence. There are substantial risks inherent in misapplying diagnoses and treatments of bipolar disorder when not warranted and in withholding these diagnoses and treatments when they are warranted. As with adults, the course of bipolar disorder among children and adolescents diagnosed using unmodified diagnostic criteria is characterized by recovery and recurrence, functional impairment, suicidality, and high rates of comorbid psychiatric and medical problems. Discrepancies between increasing billing diagnoses and a stable epidemiologic prevalence of bipolar disorder suggest the possibility that diagnostic criteria are not being systematically applied in some clinical settings. Introducing new diagnoses may exacerbate rather than mitigate concerns regarding misdiagnosis and excessive use of mood-stabilizing medications. Several medications, particularly second-generation antipsychotics, are efficacious for treating acute manic episodes of bipolar I disorder. However, less is known regarding the treatment of other mood states and subtypes of bipolar disorder. Psychosocial treatments provide a forum in which to educate children and families regarding bipolar disorder and its treatment, and may be especially beneficial for reducing depressive symptoms. Offspring of parents with bipolar disorder are at increased risk of developing the illness, as are youth with major depressive disorder and certain psychiatric comorbidities. Preliminary findings regarding biomarkers offer hope that, in the future, these biomarkers may inform diagnostic and treatment decisions.

Author Affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

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Patricia Yollin on December 7, 2011

A recent study of 904 adolescents who were told about ways to prevent injuries and illness by their primary care provider was most effective in curbing risky behavior in the area of helmet use when riding bicycles, skateboarding or rollerblading. 

A new study has found that providing preventive services to adolescents in a primary care setting can lessen certain kinds of risky behavior.

The research, published in the November 2011 issue of the Journal of Adolescent Health, was led by Elizabeth Ozer, PhD, a UCSF associate professor of pediatrics in the Division of Adolescent Medicine, and was conducted in three Kaiser Permanente clinics in Northern California.

The study examined the effect of screening and brief counseling for risky behaviors by a primary care provider during a teenager’s annual wellness checkup, followed immediately afterward by a discussion with a health educator.

The 904 adolescents in the study were 14 years old when the first risk assessment occurred at the time of their visit with their primary care provider; a second risk assessment and visit took place a year later when they were 15.

The strategy was most effective in the area of helmet use when riding bicycles, skateboarding or rollerblading. It was promising in terms of increasing seat-belt use and decreasing smoking among males. And it pointed to a trend, not statistically significant, of delaying the beginning of sexual activity. It appeared to have no effect, however, on experimenting with drugs and alcohol.

“There were concrete things people did,” Ozer said. “In addition to discussions with their provider, health educators would make sure kids would have a helmet. Our rates of screening for helmet use were where we had some of the biggest bang for our buck. It may be because helmet use is a relatively simple topic to discuss and to do something about. And we might see change in other areas as the teens get older and are engaging in more risky behavior.”

She said the research builds on her team’s previous publications that have shown that it is possible to dramatically increase the screening and counseling of adolescents in primary care, and is the first study to integrate a broad range of clinical services into primary care practice and then follow adolescent patients longitudinally to assess whether these discussions change their behavior.

“This is really a good first step” Ozer said. “Certainly, we need more work and more focus because this is such an important area.”

Integrating Prevention Strategies in Primary Care

The study was titled “Does Delivering Preventive Services in Primary Care Reduce Adolescent Risky Behavior?” It said that “most adolescents visit a health provider at least yearly, providing the opportunity to integrate prevention into clinical encounters.” It also pointed out that the majority of health problems and deaths during adolescence are preventable and related to behaviors such as risky sexual activity, substance use and vehicle-related injuries.

Elizabeth Ozer, PhD

The article was accompanied by an editorial from a researcher in Australia, who wrote: “Despite the rationale and support for clinical preventive services for adolescents, there is little evidence available on the benefits and costs of preventive programs.”

The editorial said the study by Ozer’s team had “significant strengths” and “bravely tackled design and measurement issues to provide encouraging evidence on the effectiveness of clinical preventive primary care services for adolescents.”

The visit with the health care provider, usually a pediatrician but occasionally a nurse practitioner, lasted 24 to 30 minutes. The follow-up talk with a health educator ranged from 15 to 30 minutes, depending on the adolescent’s level of risk.

“The idea was to pick up on what the provider had talked about and reinforce the same messages, as well as facilitate referrals and set goals that are manageable and doable,” Ozer said. “But we weren’t scripting anyone.”

For example, teenagers who said they always used a helmet received brief but positive reinforcement. If they said they used one only on long trips rather than when they were going around the corner, the health provider might point out that most accidents happen within a few blocks of the home, which means it’s really important to wear a helmet during every outing.

“There has to be something that connects — like the fact that smoking might make their acne worse or make them smell bad,” Ozer said. “Just giving them statistics doesn’t connect with them. Long-term consequences are not that salient.”

She said doctors and nurse practitioners avoided lecturing. Instead, they offered concrete suggestions and tried to make it clear that their frame of reference was health rather than a moral issue.

“I’m a psychologist and my area is behavior change — and it’s not very easy to change behavior in general,” Ozer said. “It’s even more difficult when you try to do multiple behaviors at a time.”

She said one of the reasons her team’s study is the first to track behavioral outcomes is that most research hones in on a specific area, such as a substance use intervention or a sexual activity intervention.

“But providers are being told they’re supposed to be doing all these things at once,” Ozer said. “So, we really need to be measuring and assessing and evaluating if this is even possible in a real-life busy, clinical setting. And if they do it, does it make any difference?”

The editorial in the Journal of Adolescent Health concluded: “The time has come to grow the evidence base supporting preventive interventions by building on what Ozer et al have done to tackle the challenges of scientifically assessing health outcomes, potential harms and cost-effectiveness. Only then will we make further progress in proving that an ounce of prevention really is worth a pound of cure.”

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/7aFFGskOxx8/study-aims-understand-adolescent-risky-behavior

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By Juliana Bunim on January 3, 2012

Children with a rare, life-threatening disease that is the most common cause of neonatal liver failure – biliary atresia – better tolerate liver transplants from their mothers than from their fathers, according to a UCSF-led study.

Tippi MacKenzie, MD

In the study, researchers reviewed all pediatric liver transplants nationwide from 1996 to 2010, and compared the outcomes for patients who received liver grafts from their mothers with those for patients who received livers from their fathers. 

Researchers believe the improved outcomes for children receiving a maternal liver graft may be due to higher levels of maternal cells in the patients’ livers. The presence of these cells may establish tolerance to maternal antigens – substances that induce an immune response – and therefore greater acceptance of maternal organs in these biliary atresia patients.

“This result is exciting because it supports the concept that trafficking of cells between the mother and the fetus has functional significance long after the pregnancy is over,” said senior author Tippi MacKenzie, MD, assistant professor of pediatric surgery at UCSF and a fetal surgeon at UCSF Benioff Children’s Hospital. “This is a topic we are actively studying both in animal models and in patients who have fetal surgery. Practically speaking, this study may allow us to counsel families in which both the mother and father are willing and able to be a donor.”

The researchers found that patients with biliary atresia who received a transplanted maternal portion of liver had a failure rate of 3.7 percent, compared to the failure rate of 10.5 percent observed in recipients of paternal livers.  In children who had liver transplantation for other diseases, there were no differences in the transplant outcome between maternal or paternal grafts.

The results will be published in the January issue of the American Journal of Transplantation and can be found online.

Biliary atresia, which affects one in 10,000 newborn infants, occurs when the common bile duct between the liver and the small intestine is blocked or absent. While early surgical intervention to treat biliary atresia is critical to prevent irreversible liver damage, once the liver fails, a liver transplant is required.

“We were testing the idea that if cells from the mother travel into the fetus during pregnancy and are involved in maternal-fetal tolerance, this phenomenon may have a long-lasting effect for transplantation tolerance when the mother donates an organ to the child,” MacKenzie said.

Co-authors of the study are Amar Nijagal, MD, Shannon Fleck, BS, Nancy Hills, PhD, Sandy Feng, Md, PhD, Qizhi Tang, PhD, Sang-Mo Kang, MD, and Phil Rosenthal, MD, all of UCSF.  It was funded by the Irene Perstein Award and a grant from the California Institute for Regenerative Medicine.

About UCSF Benioff Children’s Hospital

UCSF Benioff Children’s Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the UCSF Medical Center. For more information, go here.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/U8L_iWqaQrk/maternal-liver-grafts-more-tolerable-children-rare-disease

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By Juliana Bunim on December 29, 2011

WHAT: The first San Francisco baby born in 2012 is always an exciting story to kick off the new year. If that baby is born at UCSF Benioff Children’s Hospital, we will be coordinating with media in an effort to offer access to the family for interviews and photography.

WHEN: Sunday, Jan. 1, 2012, Time TBA

WHERE: UCSF Benioff Children’s Hospital, 505 Parnassus Ave.

CONTACT: To find out if the first baby was born at UCSF Benioff Children’s Hospital, please contact Elizabeth Fernandez at (415) 298-4320 or elizabeth.fernandez@ucsf.edu on Sunday morning.

BACKGROUND INFORMATION: UCSF Benioff Children’s Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

For more information, visit http://www.ucsfbenioffchildrens.org/.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/2fiRyTGzzoY/media-advisory-coverage-opportunities-first-baby-born-2012

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• FDA: HIV and AIDS Activities
• FDA: Antiretroviral drugs used in the treatment of HIV infection
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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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Article source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm284473.htm

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By Jason Bardi on December 16, 2011

A large, international team of researchers led by scientists at the University of California, San Francisco (UCSF) has identified the gene that causes a rare childhood neurological disorder called PKD/IC, or “paroxysmal kinesigenic dyskinesia with infantile convulsions,” a cause of epilepsy in babies and movement disorders in older children.

The study involved clinics in cities as far flung as Tokyo, New York, London and Istanbul and may improve the ability of doctors to diagnose PKD/IC, and it may shed light on other movement disorders, like Parkinson’s disease.

The culprit behind the disease turns out to be a mysterious gene found in the brain called PRRT2. Nobody knows what this gene does, and it bears little resemblance to anything else in the human genome.

Louis Ptacek, MD

“This is both exciting and a little bit scary,” said Louis Ptacek, MD, who led the research. The John C. Coleman Distinguished Professor of Neurology at UCSF and a Howard Hughes Medical Institute Investigator, Ptacek is a professor in the Department of Neurology, which seeks to discover the causes of human nervous system disorders and improve treatment options for patients by applying state-of-the-art translational research methods and engaging in collaborations with colleagues around the globe.

Discovering the gene that causes PKD/IC will help researchers understand how the disease works. It gives doctors a potential new way of definitively diagnosing the disease by looking for genetic mutations in the gene. The work may also shed light on other conditions that are characterized by movement disorders, including possibly Parkinson’s disease.

“Understanding the underlying biology of this disease is absolutely going to help us understand movement disorders in general,” said Ptacek.

Disease Strikes Infants with Epileptic Seizures

PKD/IC strikes infants with epileptic seizures that generally disappear within a year or two. However, the disease often reemerges later in childhood as a movement disorder in which children suffer sudden, startling, involuntary jerks when they start to move. Even thinking about moving is enough to cause some of these children to jerk involuntarily.

The disease is rare, and Ptacek estimates strikes about one out of every 100,000 people in the United States. At the same time, the disease is classified as “idiopathic” — which is just another way of saying we don’t really understand it, Ptacek said.

If you take an image of the brain by MRI, patients with the disease all look completely normal. There are no injuries, tumors or other obvious signs that account for the movements—as is often the case with movement disorders. Work with patients in the clinic had suggested a genetic cause, however.

“Sometimes we trace the family tree, and lo and behold, there is a history of it,” said Ptacek. In the last several years, he and his colleagues have developed a large cohort of patients whose families have a history of the disease.

The new research was based on a cohort of 103 such families that included one or more members with the disease. Genetic testing of these families led to the researchers to mutations in the PRRT2 gene, which cause the proteins the gene encodes to shorten or disappear entirely in the brain and spinal cord, where they normally reside.

One possible explanation for the resulting neurological symptoms, the researchers found, relates to a loss of neuronal regulation. When the genetic mutations cause the gene products to go missing, the nerve cells where they normally appear may become overly excited, firing too frequently or strongly and leading to the involuntary movements.

The article, “Mutations in the Gene PRRT2 Cause Paroxysmal Kinesigenic Dyskinesia with Infantile Convulsions” by Hsien-Yang Lee, Yong Huang, Nadine Bruneau, Patrice Roll, Elisha D.O. Roberson, Mark Hermann, Emily Quinn, James Maas, Robert Edwards, Tetsuo Ashizawa, Betul Baykan, Kailash Bhatia, Susan Bressman, Michiko K. Bruno, Ewout R. Brunt, Roberto Caraballo, Bernard Echenne, Natalio Fejerman, Steve Frucht, Christina A. Gurnett, Edouard Hirsch, Henry Houlden, Joseph Jankovic, Wei-Ling Lee, David R. Lynch, Shehla Mohammed, Ulrich Meuller, Mark P. Nespeca, David Renner, Jacques Rochette, Gabrielle Rudolf, Shinji Saiki, Bing-Wen Soong, Kathryn J. Swoboda, Sam Tucker, Nicholas Wood, Michael Hanna, Anne M. Bowcock, Pierre Szepetowski, Ying-Hui Fu and Louis J. Ptacek appears in the January 26, 2012 issue of Cell Reports.

In addition to UCSF, authors on this study are affiliated with the Universitéde la Méditerranée in Marseille, France; Washington University School of Medicine in Saint Louis, MO; the University of Florida in Gainesville, FL; Istanbul University in Turkey; University College London; Beth Israel Medical Center in New York; the Queen’s Medical Center in Honolulu, HI; the University of Groningen in the Netherlands; Juan P. Garrahan Pediatric Hospital in Buenos Aires, Argentina; Hôpital Gui de Chauliac in Montpellier, France; Mount Sinai Medical Center in New York; Hôpitaux Universitaires de Strasbourg in France; Baylor College of Medicine in Houston; the National Neuroscience Institute in Singapore; Children’s Hospital of Philadelphia; Guy’s Hospital in London; Justus-Liebig-Universität in Giessen, Germany; Rady Children’s Hospital in San Diego; the university of California, San Diego; the University of Utah in Salt Lake City; the Universitéde Picardie Jules Verne in Amiens, France; Kanazawa Medical University in Ishikawa, Japan; the National Yang-Ming University School of Medicine in Taipei, Taiwan; Taipei Veterans General Hospital in Taiwan; the International Paroxysmal Kinesigenic Dyskinesia/Infantile Convulsions Collaborative Working Group; and the Juntendo University School of Medicine in Tokyo.

This work was funded by the Dystonia Medical Research Foundation, the Bachmann-Strauss Dystonia Parkinson Foundation, the National Institutes of Health, the Sandler Neurogenetics Fund, ANR, INSERM and the Howard Hughes Medical Institute.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/LxbBdvI-rzw/ucsf-led-team-discovers-cause-rare-disease

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Article source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm283956.htm

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Doctors in California are preparing to send home one of the smallest premature babies ever to survive anywhere in the world.

When she was born in August, at 24 weeks, Melinda Star Guido was so tiny she could fit into the palm of her doctor’s hand.

Peter Bowes reports.

Article source: http://www.bbc.co.uk/go/rss/int/news/-/news/world-us-canada-16212408

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15 December 2011
Last updated at 20:19 ET

By Caroline Parkinson
Health editor, BBC News website

Amoxicillin, one of the range of penicillin drugs available

Penicillin doses for children – which have stayed the same for 50 years – need to be reviewed because youngsters are getting heavier, experts have said.

Dosages are based on age but an average weight is assumed and average weights have risen, the London-based team warn.

In the British Medical Journal, they say a review is needed to ensure children are getting enough medication.

But one pharmacist said using weight could mean more room for error.

Oral penicillins, such as amoxicillin, account for nearly 4.5 million of the total six million annual prescriptions for antibiotics given to treat childhood bacterial infections each year in the UK.

The current dosing guidelines are set out in the British National Formulary for Children.

Experts from King’s College London and St George’s, University of London, say basing doses on a child’s age was first suggested in the 1950s, and the guidelines medics still use were published in the BMJ in 1963.

Continue reading the main story

“Start Quote

What may have been adequate doses of penicillin 50 years ago are potentially not enough today”

End Quote
Dr Paul Long,
King’s College London

These estimated that a baby aged up to one weighed 10kg (22lbs), a two-year-old weighed 13kg (28.6lbs), a five-year-old 18kg (39.6lbs) and a 10-year-old 30kg (66.1lbs).

However, according to the Health Survey for England 2009, the average weight of a five-year-old has risen to 21kg (46.2lbs) and a 10-year-old is 37kg (81.5lbs), suggesting average weights are up to 20% higher than in 1963.

Dr Paul Long, a medicines expert at King’s College London who was part of the review team, said: ‘We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug.

“Children’s average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.”

He added: “These days new medicines go through very rigorous testing processes, but we seem to forget about the old ones.

“For adults, penicillin dosages have been reviewed twice in the same period.”

‘No evidence of harm’

Dr Long added: ‘It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and we want to reassure parents of that.

“But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose.”

‘In the long-term we are concerned that under-dosing could lead to penicillin-resistance in both individuals and wider communities.

But Steve Tomlin, Royal Pharmaceutical Society spokesman on children’s medicines, said – although the age bands were problematic – switching to weight-based dosing was not a simple matter.

“It could be much riskier. Who would be measuring the children and where? You’d have to make sure they were being measured in kilograms and not in pounds – and you could end up with a calculation of say 4.73ml, when they’d now be given five.”

And he said a “good proportion” of children would be getting enough medication under the current guidelines but added: “There’s a reasonable proportion that don’t.”

Mr Tomlin added that a lot of penicillins were licenced at particular doses – and so any changes would have to be agreed by them and the relevant agency.

“If that didn’t happen, dose changes would not be licensed – so it would be the licensing rules versus the BNF, so it would be the luck of the draw what people got.”

Article source: http://www.bbc.co.uk/go/rss/int/news/-/news/health-16202593

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17 December 2011
Last updated at 19:03 ET

Most children use the internet at home

Unhealthy food is being “shamelessly” promoted to children online to get around bans on television adverts, campaigners have claimed.

The British Heart Foundation cited websites by Cadbury’s and Nestle as examples of “cynical marketing”.

Sites used childish language, games and free gifts to appeal to children, according to the report.

But an Advertising Association spokesman insisted online promotion to children was strictly controlled.

The vast majority of UK children now use the internet at home, often in preference to television viewing.

The Advertising Standards Authority’s broadcasting code prohibits adverts for unhealthy food within children’s television programmes, or any programme which appeals to under-16s.

However, this code does not extend to material on websites aimed at children, although a separate regulation forbids any advert which might encourage “poor nutritional habits” or an “unhealthy lifestyle” in children.

Despite this, the BHF, alongside the Children’s Food Campaign, says that this different approach gives firms more scope to promote unhealthy foods.

With a significant proportion of children overweight or obese, even at primary school age, they want the blanket ban on marketing extended to cover the web.

‘Preying on children’

Examples of websites cited by the campaign was a site promoting Nesquik – a milkshake powder high in sugar.

Titled the “Imagination Station”, the site is hosted by an animated rabbit character and including a quiz game and a guide to making a spacesuit.

Another site, for Cadbury’s Buttons, which contain 6.2g of saturated fat per packet, was called “Buttons Furry Tales”, and also involved animated characters, games and puzzles, although an “adult” year of birth had to be provided to gain entry.

A third, for Cheestrings, manufactured by Kerry Foods, involves a personal greeting from another cartoon character, and a list describing 101 things they can do before they are 11.5 years old.

Nobody wants a marketing free-for-all but demands for bans based on hyperbole threaten people’s jobs, affordable media and a choice of foods we all enjoy”

Advertising Association spokesman

Cheestrings fall foul of the children’s television ban because each portion contains a third more salt than an average pack of ready salted crisps.

Mubeen Bhutta, from the BHF, said: “Junk food manufacturers are preying on children and targeting them with fun and games they know will hold their attention.

“Regulation protects our children from these cynical marketing tactics while they’re watching their favourite television programmes but there is no protection when they are online.”

Charlie Powell, from the Children’s Food Campaign, said that the government was “demonstrating complacency” when it should be providing “robust regulation”.

‘Responsible marketing’

However, a government spokesman said that it did not have direct responsibility for setting advertising codes.

A spokesman for the Advertising Standards Authority, an independent body which regulates the advertising industry, said that if campaigners felt that a specific website breached the online code, it should complain.

“We rigorously administer strict advertising food rules that apply across media, including online, in the interests of the public.

“The rules are very clear: ads must not condone or encourage poor nutritional habits or an unhealthy lifestyle in children.”

A spokesman for Nestle, which makes Nesquik, said it did not market products directly to under-sixes, and would only market products to under-12s which met a “strict nutritional profile”.

The “Imagination Station” site was aimed at parents, not children, she said.

A spokesman for Cadburys also said that the “Furry Tales” site was aimed at parents, but added that it did not meet the marketing policies of parent company Kraft Foods and was scheduled to be closed within weeks.

A spokesman for Kerry Foods, which makes Cheestrings, said that the product contained a similar amount of salt to cheddar cheese.

He said: “We are firm believers in responsible marketing and we ensure that everything we do is within the regulations set by the various governing bodies.”

And the Advertising Association, an industry body, attacked the BHF’s campaign, accusing it of “manipulating the facts” and ignoring those which did not support its case.

A spokesman said: “Nobody wants a marketing free-for-all but demands for bans based on hyperbole threaten people’s jobs, affordable media and a choice of foods we all enjoy.”

Article source: http://www.bbc.co.uk/go/rss/int/news/-/news/health-16217306

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The CFM bulletin has over 4,000 subscribers from Children’s Leads for Primary Care Trusts in England and other directors of children’s services, to individuals and healthcare workers all with an interest in the policy area of children and maternity healthcare.  The content is relevant to our audience and about new policy or new developments, or an update of policy or publication.

This month’s edition features information about Healthwatch Pathfinders,  Munro Review of Child Protection – Safeguarding Children in the Reformed NHS, Fathers’ Guide and Launch of phase one of the children and young peoples IAPT programme.

Download CFM bulletin, December 2011 (PDF 151K)

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Article source: http://www.dh.gov.uk/health/2011/12/children-families-and-maternity-cfm-bulletin/

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December 14, 2011

The proportion of children in England who are
obese in their final year of primary school is rising, new NHS
Information Centre figures show.

In 2010/11 19.0 per cent of Year 6 children measured as part of
the National Child Measurement Programme (NCMP)
were obese, compared to 18.7 per cent in 2009/10 and 17.5 per cent
in 2006/7.

Obese children are more likely to become obese adults

Tracy Parker, our Heart
Health Dietitian, said:

“This is a really sad statistic. It is a shame
that even more of our children are finishing primary school
obese.

“It has been shown obese children are more
likely to become obese adults. And obesity in adults is associated
with an increased risk of type 2 diabetes and heart disease.  We’ve got to
realise that children’s food and lifestyle choices today could have
long term consequences on their future health.

“That’s why our Food4Thought
campaign is encouraging parents, kids, teachers and
politicians to all think carefully about the food the next
generation are eating, and the amount of exercise they’re getting
each day.”

As part of the Food4Thought campaign, the BHF ran a survey into
children’s eating habits which had some alarming
findings. The survey found kids are turning their back on fruit and
veg in favour of snacks laden with fat, salt and sugar, as a
regular part of their daily diet.

We are now working with 30 schools
across the UK to set up healthy vending
machines. We aim to encourage school
pupils to eat healthier snacks and meals during the school day as
part of our plan to tackle childhood obesity.

The NCMP report was published online by the
NHS.

Article source: http://www.bhf.org.uk/media/news-from-the-bhf/rise-in-child-obesity-levels.aspx

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