health-e-kids.org

UCSF School of Dentistry to Offer Free Dental Care for Children

admin — Sat, 18 Feb 2012 05:25:55 +0000

By Leland Kim on February 17, 2012

Brent Lin, DMD, examines patient Moses Peralta at the UCSF School of Dentistry Dental Clinic at Parnassus.

Stephanie Peralta brings her four children to the UCSF School of Dentistry Clinic at Parnassus all the way from Livermore, California.

The family makes the 45-mile journey across the bridge to get free dental care provided by UCSF dental students and clinical faculty members. This year, the trek to San Francisco will take longer since the Bay Bridge will be closed until Tuesday morning for construction work.

“I constantly tell them their teeth are going to fall out if they don’t brush their teeth,” she said. “It’s hard to get them to get in good habits of brushing their teeth and continue doing it every day.”

This Saturday, the UCSF School of Dentistry is hosting its annual “Give Kids A Smile” program from 9 a.m. to 3 p.m., offering free dental care to kids ages 4-17 – the same age range as Peralta’s children.

Brent Lin, DMD

“The older ones are definitely role models for my youngest daughter,” Peralta said. “So if my older ones are brushing their teeth, the little one will want to get in the bathroom and do it herself.”

The goal of the community outreach program is to not only to provide dental services, but also to educate children and their parents about proper brushing and flossing techniques.

“Some common misconceptions of dental health include that tooth decay is a natural part of getting older,” said Brent Lin, DMD, clinical professor at the UCSF School of Dentistry. “That’s not true. Tooth decay is not inevitable.”

Impact of Dental-Related Illnesses

Approximately 45 million people, or more than a quarter of all Americans, have no dental health care coverage. Dental decay is one of the most common chronic illnesses among children. Although most dental diseases are preventable, many children unnecessarily suffer from dental disease because of inadequate home care, and lack of access to dental services, according to the U.S. Centers for Disease Control and Prevention (CDC).

“Good oral health starts when the patient is very young,” Lin said. “We suggest that expectant mothers get their teeth checked because their oral health could impact their child’s health while he or she is still in the womb.”

Brent Lin, DMD, cleans a patient’s teeth at the UCSF School of Dentistry Dental Clinic as two dental students observe.

An estimated 51 million school hours per year are lost in the U.S. because of dental-related illness. Poor oral health has been related to decreased school performance, poor social relationships and less success later in life, according to the CDC.

“Children miss a lot of school because of toothache or dental appointments and they have a hard time focusing on their work because of discomfort from dental pain. It can greatly impact one’s quality of life,” Lin said. “We take this opportunity to make the public aware of the importance of good oral health and how we can prevent teeth-related diseases.”

And this opportunity can make a world of a difference for many Bay Area families.

“Especially being a low income parent I think it’s important there are programs like this out there that can offer free services,” Peralta said. “We’re grateful to UCSF.”

Photos by Leland Kim

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/fp_KvLfeKkQ/ucsf-school-dentistry-offer-free-dental-care-children

Children, Families and Maternity e-bulletin February 2012

admin — Wed, 15 Feb 2012 19:50:42 +0000

This is a bi-monthly e-bulletin for internal and external stakeholder groups designed to provide them with regular updates on activities that are supporting the delivery of the Be Healthy outcome for children, young people and families through the Every Child Matters: Change for Children agenda.

This month’s edition features information about the Launch of New Children and Young People’s Health Outcomes Strategy

Download CFM bulletin, February 2012 (PDF 169K)

Article source: http://www.dh.gov.uk/health/2012/02/cfm-2/

Tenofovir, Leading HIV Medication, Linked with Risk of Kidney Damage

admin — Sat, 11 Feb 2012 07:40:12 +0000

By Steve Tokar on February 10, 2012

Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco (UCSF).

Michael G. Shlipak, MD, MPH

The researchers call for increased screening for kidney damage in patients taking the drug, especially those with other risk factors for kidney disease.

In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine – a marker of kidney damage – rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease (CKD) rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors.

For individual patients, the differences in risk between users and non-users of tenofovir for each year of use were 13 percent vs. 8 percent for protein in urine, 9 percent vs. 5 percent for rapidly declining kidney function and 2 percent vs. 1 percent for CKD. “However, these numbers are based on the average risks in our study population, and patients with more risk factors for kidney disease would be put at proportionately higher risk,” said principal investigator Michael G. Shlipak, MD, MPH, chief of general internal medicine at SFVAMC and professor of medicine and epidemiology and biostatistics at UCSF.

Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible, said Shlipak. “We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease,” he cautioned.

Q A

Tenofovir, for Patients and Providers

The implications for patients already on or starting antiretroviral therapy are “mixed,” said Shlipak. “The best strategy right now is to work with your health care provider to continually monitor for kidney damage. Early detection is the best way to determine when the risks of tenofovir begin to outweigh the benefits.”

Shlipak noted that HIV, itself, increases the risk of kidney damage, while modern antiretroviral treatments clearly reduce that overall risk. “Patients need to be aware of their kidney disease risks before they start therapy, and this should influence the medications that they choose in consultation with their doctor,” he said. “For an otherwise healthy patient, the benefits of tenofovir are likely to exceed the risks, but for a patient with a combination of risk factors for kidney disease, tenofovir may not be the right medication.”

Tenofovir is used to decrease viral load and increase immune cell count in people infected with the virus. It is currently considered the preferred first line treatment for HIV because of its potency, overall low toxicity, and convenience of dosing. It is sold under a variety of names, by itself and in combination with other medications.

The study examined the medical records of 10,841 HIV-positive veterans in the national VA health care system who were new users of antiretroviral therapy from 1997 to 2007. It was published electronically in the journal AIDS on January 9.

Lead author Rebecca Scherzer, PhD, a researcher and statistician at SFVAMC and UCSF, said that the observational study was the largest and most conclusive indication so far of tenofovir’s association with kidney damage. “There have been a number of previous, smaller studies suggesting that this drug might be associated with kidney disease, but the results were mixed,” she said. “Those studies may have missed this association because they were too small, lacked appropriate lab data or excluded subjects with pre-existing renal impairment or risk factors for kidney disease.”

To be sure that tenofovir was the culprit, Scherzer and her colleagues looked for associations between 18 other antiretroviral medications and the same three measures of kidney disease: protein in urine, rapid decline in function and progression to CKD. None were associated with higher risk.

Shlipak noted that the study results are particularly strong because two of the risk factors – decline in function and CKD – indicate kidney function, while protein in urine indicates physical damage to the kidney. “These are independent markers,” he said. “To see the same drug cause both types of kidney disease gives you a very objective signal that something real is happening here.”

Shlipak emphasized that, despite tenofovir’s association with progressive kidney disease, it is an important component of effective antiretroviral therapy that may be required in many patients to control viral load.

The VA is the largest provider of HIV care in the United States, said Shlipak. “We could not have done this work without access to the VA’s system of electronic medical records,” he said. “In particular, the data kept by the VA Clinical Care Registry, located at the VA Palo Alto Health Care System, were essential to this study.”

Co-authors of the study are Michelle Estrella, MD, of Johns Hopkins School of Medicine; the late Andy I. Choi, MD, MAS, of SFVAMC and UCSF; Steven G. Deeks, MD, of San Francisco General Hospital; and Carl Grunfeld, MD, PhD, of SFVAMC and UCSF.

The study was supported by funds from the National Institutes of Health, the National Center for Research Resources, the American Heart Association and the Department of Veterans Affairs, some of which were administered by the Northern California Institute for Research and Education.

NCIRE – The Veterans Health Research Institute – is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

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/s42XAd_1P_c/tenofovir-leading-hiv-medication-linked-risk-kidney-damage

Pediatric Dentist Applies Science to Prevent Cavities

admin — Fri, 10 Feb 2012 22:18:36 +0000

Kate Rauch on February 10, 2012

Pediatric dentist Ling Zhan, DDS, is also a dental scientist who wants to apply basic science to prevent cavities.

Pediatric dentist Ling Zhan, DDS, PhD, an assistant professor in the UCSF School of Dentistry, is building a path to something children and parents the world over welcome: fewer cavities.

Cavities are the number one infectious disease in children in the U.S. Every year, nearly $4.5 billion is spent to treat them and about 1.6 million school days are missed annually related to dental decay. The prevalence of this disease is five times higher than asthma.

Zhan is an emerging leader in the use of xylitol, a naturally occurring sugar alcohol, to prevent tooth decay in children. Research shows that the sweet-tasting substance, which is extracted from the fibers of fruits, vegetables and other vegetation, have the potential to prevent cavities. Xylitol, commercially used as a sugar substitute, is lower in calories than sucrose and appears to diminish the negative dental effects of oral bacteria.

Many of the children Zhan sees in her research and clinic are suffering from significant tooth decay.

“In the traditional dental clinic, we’re normally only fixing the cavities, but not treating the cause,” Zhan said. “I’m a dentist, but also a dental scientist. Cavities can be readily prevented, and I want to see if there’s anything I can apply from basic science to fix this.”

In a recent study, Zhan and her team found that xylitol can prevent cavities in infants. In the findings, which Zhan presented in the 2nd International Conference on Novel Anticaries and Remineralizing Agents, infants whose gums were wiped daily with xylitol by their parents had nearly eight times fewer dental carries after one year than those who used wipes without xylitol. The study will be published in the Journal of Dental Research later this year.

Read the entire story on the Clinical and Translational Science Institute’s website.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/mRVLrQ_XzVs/pediatric-dentist-applies-science-prevent-cavities

UCSF Issues Joint Statement From Kidney Transplant Candidate, Chief Medical Officer

admin — Thu, 09 Feb 2012 21:44:14 +0000

February 9, 2012

Recent media reports about one of UCSF’s kidney transplant candidates have contained confusing and incorrect information about the University’s policy for evaluating kidney transplant candidates, in particular for undocumented individuals.

Protecting patient privacy is paramount at UCSF, but today Jesus Navarro has authorized release of a joint statement with UCSF Chief Medical Officer Josh Adler, MD.

UCSF is dedicated to providing the highest quality, safest treatment for all of its patients. The University has tremendous compassion for patients, and their families, who face the very difficult issues related to kidney failure. While for some of these patients transplants can be lifesaving, transplant surgery is the starting point of a lifetime of medical care and treatment, including daily use of costly anti-rejection drugs.

UCSF does not reject transplant candidates based on their immigration status and has performed transplants on undocumented individuals. These patients are not refused treatment. Rather, UCSF refers them to community-based and other external services that can help them address issues related to specific access-to-care hurdles faced by non-citizens. Of particular concern is their lack of easy access to the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.

While the patients resolve those problems, they remain on the transplant waiting list.

Joint Statement from Jesus Navarro and Josh Adler, MD, chief medical officer, UCSF Medical Center

Joshua Adler, MD

February 8, 2012

UCSF is committed to helping Jesus Navarro and all kidney transplant candidates achieve their goal of a transplant. On Tuesday, we jointly developed a plan that we hope will secure for Mr. Navarro the health coverage he needs for his care during transplant surgery and beyond, including costly anti-rejection medications. While that plan is pursued, he will remain on the transplant list, as was always the case, and will continue to accrue time toward a transplant.

Last May, Mr. Navarro met with UCSF medical, social work and financial staff in preparation for a potential kidney transplant. Like many others, he had been on the UNOS (United Network for Organ Sharing) waiting list for a long time, in his case more than six years. Mr. Navarro still had one year or more until he would reach the top of the UNOS list and UCSF’s standard procedure calls for reviewing patients at that time to ensure they are still good candidates for a future transplant.

As of today, he still is not at the top of the list, but is expected to reach the top in three to six months.

During the May visit to UCSF, Mr. Navarro met with UCSF financial counselors who asked about his immigration status. Mr. Navarro responded that, in fact, he was undocumented. Due to the complexities of the current health insurance industry, this was a concern for UCSF because it increases the risk that Mr. Navarro will not be able to continue to be insured and therefore not receive the follow-up care and medication needed to stay healthy after a transplant.

Per UCSF practice, Mr. Navarro’s status on the waiting list was changed to “inactive” as a result, which means that he would maintain his place on the waiting list, but would not receive a transplant even if he reached the top unless he had a reasonable coverage plan in place. The counselors also referred Mr. Navarro to two community assistance organizations that specialize in resolving immigration issues, as part of our effort to increase the likelihood of transplanted patients maintaining their health coverage for the surgery and critical post-transplant care.

Mr. Navarro has told UCSF that, to him, this meant he would not get a transplant until he resolved his immigration status; this was not what UCSF was trying to convey. Instead, UCSF was following its policy to make sure Mr. Navarro would continue to have the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.

UCSF regrets the misunderstanding and is committed to reviewing its processes to make sure that communication is consistent and clear with all patients, including Mr. Navarro. UCSF does not and will not discriminate on the basis of immigration status.

The road to a kidney transplant is long, and it may still take Mr. Navarro months to continue through the process. In the meantime, he continues to maintain his health through dialysis, as he has for the past 6 1/2 years.

This situation underscores the many obstacles all transplant candidates face securing the long-term coverage they need because of the patchwork nature of the health care system. These obstacles can be more difficult for undocumented individuals to overcome.

UCSF Medical Center operates one of the world’s largest kidney transplant programs, with more than 5,240 patients on the list waiting to receive a kidney. Sadly, only 350 of those patients will receive a kidney transplant this year, mainly because of a shortage of organs, either from deceased patients or living-related donors.

We encourage everyone to become an organ donor. For more information, contact Donate Life California, or, to become a living donor, contact UCSF.

Article source: http://feedproxy.google.com/~r/UCSF_News/~3/vo_F2nCaTg8/ucsf-issues-joint-statement-kidney-transplant-candidate-and-chief-medical-officer

Local Sevenoaks Woman writes a children’s book and donates money to Macmillan.

admin — Thu, 09 Feb 2012 15:30:53 +0000

Pat MacVicar from Underriver in Sevenoaks has finally seen her dream become reality when her first children’s book Newvolution has gone on sale to the general public.

Pat, 53 and a mother of three came up with the story as a result of a dream about rabbits with horns hopping around her garden and decided to put pen to paper during her twice-daily train journeys to Chelsfield Hospital to undergo chemotherapy for stage three breast cancer.

The book which is now on sale at Sevenoaks Bookshop and online at Amazon and on the Newvolution website |took two years to write, during which Pat tragically discovered that her cancer had spread to her brain and liver. Despite being given only six months to live, Pat has been treated with experimental drugs and still continues today to fight hard. The book which has been a huge achievement for Pat will not only serve as a legacy for her children but, Pat has decided to give something back to Macmillan by donating a £1 from each book sale as they were there to help and support her during her moment of need.

As Helene Poursain Fundraising Manager for West Kent explains: ‘It is so nice to hear that Pat recieved such great support from Macmillan during her time of need and we are so grateful that as a result she wishes to donate money to Macmillan. Her story is truly inspirational and one I am sure her family are incredibly proud of. We wish her all the best and hope that her book is a success.’

The story of Newvolution is specifically written for children and is centred around a young girl Lucy who sees her world turn upside down when she learns that everyday animals have evolved into far more special creatures than she thought possible. The book draws inspiration from Pat’s own family of two girls and a boy and has even been brought to life by her daughter Helen who illustrated the story.

To support Pat copies of the book can be brought from Sevenoaks Bookshop or online at Amazon and on the Newvolution website|. Paperbacks are £7.99 or hardbacks for £11.9

Article source: http://www.macmillan.org.uk/Fundraising/Inyourarea/England/Latest_news/LocalSevenoaksWomanwritesachildrensbookanddonatesmoneytoMacmillan.aspx

Goals for Blood Pressure in Kidney Disease Patients May Be Unrealistic, Suggests Study

admin — Thu, 02 Feb 2012 07:12:23 +0000

By Steve Tokar on February 1, 2012

An upward revision of the blood pressure numbers used to identify risk of end-stage renal disease (ESRD) might actually help doctors provide better care for their patients, said the authors of a study in patients with chronic kidney disease (CKD).

Carmen A. Peralta, MD

The researchers found that systolic blood pressure – the “upper number” in a blood pressure reading – was the key variable. Current guidelines call for CKD patients to maintain a systolic pressure of 130/80 or lower in order to prevent ESRD, which is complete or almost complete kidney failure, leading to dialysis, kidney transplant, or death.

In the study, however, the team determined that systolic pressure had to be 140 or higher in order to be associated with an increased risk of ESRD. A level of 150 or higher was associated with highest risk.

Given that attaining a systolic blood pressure of 130/80 is “very hard to achieve among patients in clinical practice,” it would be worth considering revising the guidelines to make them “a bit more lenient and easier to achieve,” said lead author Carmen A. Peralta, MD, a physician at the San Francisco VA Medical Center (SFVAMC) and an assistant professor of medicine at the University of California, San Francisco (UCSF).

“A revision might allow physicians to not only prescribe fewer blood pressure medications for their patients, but focus more clearly on other aspects of their care, such as blood glucose levels in diabetics,” said Peralta.

The researchers also found, to their surprise, that more than one third of patients in the study had uncontrolled hypertension – defined as a blood pressure of 150/90 or higher – which greatly increases the risk of cardiovascular disease as well as ESRD. The greatest risk factors were being age 60 or older and having high levels of protein in urine.

“The prevalence of hypertension indicates a serious public health concern in the United States,” said Peralta, “and tells us that we need to do a lot more education on the importance of blood pressure control. It also tells us that perhaps our efforts should be focused on reducing blood pressure among people at highest risk, rather than chasing lower numbers in individuals already at 140/90.”

Peralta said that the study, published in the January 9 issue of Archives of General Internal Medicine, is particularly important because it examined the link between blood pressure and risk of ESRD under “real world” conditions in a “contemporary, representative sample” of patients with kidney disease.

She and her fellow researchers studied 16,129 participants in the Kidney Early Evaluation Program (KEEP), a nationwide kidney health screening program offered by the National Kidney Foundation. “The KEEP cohort is a realistic representation of regular people in the United States walking around with CKD,” said Peralta. “In the past, the question of what targets we should establish for preventing ESRD has mostly been studied in randomized control trials, where participants actually tend to be healthier than the general population.”

All study participants had stage 3 CKD, defined as an estimated glomerular filtration rate (eGFR) of lower than 60. GFR is the flow rate of blood filtered by the kidney.

Co-authors of the study are Keith C. Norris, MD, of Charles Drew University of Medicine and Science, Los Angeles, CA; Suying Li, PhD, of Minneapolis Medical Research Foundation, MN; Tara I. Chang, MD and Manjula K. Tamura, MD, of Stanford University School of Medicine; Stacy E. Jolly, MD, of Cleveland Clinic Medicine Institution, OH; George Bakris, MD, of University of Chicago; Peter A. McCullough, MD, of Providence Park Heart Institute, Novi, MI; and Michael Shlipak, MD, of SFVAMC and UCSF.

The study was supported by funds from the National Institute of Diabetes and Digestive and Kidney Diseases, a Robert Wood Johnson Harold Amos award, and the National Institutes of Health. Some of the funds were administered by the Northern California Institute for Research and Education. KEEP is supported by Amgen, Abbot, Novartis, Siemens, Genentech, Genzyme, Nephroceuticals, Pfizer, Lifescan and Suplena.

NCIRE – The Veterans Health Research Institute – is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

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/vr6NjB77Tbo/goals-blood-pressure-kidney-disease-patients-may-be-unrealistic-suggests-study

FDA approves Inlyta to treat patients with a type of advanced kidney cancer

admin — Fri, 27 Jan 2012 19:03:55 +0000

FDA NEWS RELEASE

For Immediate Release: Jan. 27, 2012
Media Inquiries: Stephanie Yao, 301-796-0394, stephanie.yao@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA approves Inlyta to treat patients with a type of advanced kidney cancer
Drug helps keep cancer from progressing

The U.S. Food and Drug Administration today approved Inlyta (axitinib) to treat patients with advanced kidney cancer (renal cell carcinoma) who have not responded to another drug for this type of cancer.

Renal cell carcinoma is a type of kidney cancer that starts in the lining of very small tubes in the kidney. Inlyta works by blocking certain proteins called kinases that play a role in tumor growth and cancer progression. Inlyta is a pill that patients take twice a day.

“This is the seventh drug that has been approved for the treatment of metastatic or advanced kidney cell cancer since 2005,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “Collectively, this unprecedented level of drug development within this time period has significantly altered the treatment paradigm of metastatic kidney cancer, and offers patients multiple treatment options.”

Recently approved drugs for the treatment of kidney cancer include sorafenib (2005), sunitinib (2006), temsirolimus (2007), everolimus (2009), bevacizumab (2009) and pazopanib (2009).

The safety and effectiveness of Inlyta were evaluated in a single randomized, open-label, multi-center clinical study of 723 patients whose disease had progressed on or after treatment with one prior systemic therapy. The study was designed to measure progression-free survival, the time a patient lived without the cancer progressing. Results showed a median progression-free survival of 6.7 months compared to 4.7 months with a standard treatment (sorafenib).

The most common side effects observed in greater than 20 percent of patients in the clinical study were diarrhea, high blood pressure (hypertension), fatigue, decreased appetite, nausea, loss of voice (dysphonia), hand-foot syndrome (palmar-plantar erythrodysesthesia), weight loss, vomiting, weakness (asthenia) and constipation.

Patients with high blood pressure should have it well-controlled before taking Inlyta. Some patients who took Inlyta experienced bleeding problems, which in some cases were fatal. Patients with untreated brain tumors or gastrointestinal bleeding should not take Inlyta.

Inlyta is marketed by New York City-based Pfizer Inc.

For more information:

FDA: Office of Hematology and Oncology Products

FDA: Approved Drugs: Questions and Answers

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/ucm289423.htm

Independent experts to help improve health results for children

admin — Thu, 26 Jan 2012 12:17:36 +0000

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.

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

Survival Rates for Pediatric Bone Marrow Transplants Top in Nation

admin — Wed, 25 Jan 2012 22:45:41 +0000

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

Viagra Saves Baby

admin — Fri, 20 Jan 2012 16:19:54 +0000

Viagra, the impotence drug, has kept alive a baby born with a huge hole in her diaphragm.

Baby Sharice Dunnon nearly died after sucking her stomach into her lungs after taking her first breath.

Parents William Dunnon, 31, and Annmarie Massey, 22, of Kilmarnock were told that baby Sharice had only a 50% chance of survival.

That was eight months ago, but now after life saving surgery Sharice is enjoying a normal lifestyle thanks to the use of erectile dysfunction drug Viagra, which is regulating her heart.

Viagra’s current use to treat male impotence was discovered as a side effect, as the drug was originally designed to treat angina.

Commenting on toddler Sharice, mum Annmarie said:

“Looking at her now you wouldn’t know there is anything wrong. She’s constantly smiling.”

And William added: “I was told when I was 16 I’d never have children, so Sharice was a miracle for us. Now she’s a double miracle.”

However parents Annmarie and William are unhappy at the fact that the potential problems weren’t spotted sooner at Crosshouse Hospital, where baby Sharice was born.

They claim that doctors at the hospital had told them that the pregnancy was normal and there were no problems.

A spokeswoman for NHS Ayrshire and Arran declined to comment specifically on the case, adding ” If anyone is unhappy with the care they or a relative has received we would urge them to contact us.”

Viagra Cialis and Levitra are prescription medications used to treat Erectile Dysfunction

Article source: http://www.uk-med.co.uk/Health/Viagra-Saves-Baby

Healthy kids

admin — Mon, 16 Jan 2012 01:26:34 +0000

January 16, 2012

New national guidelines to help
nurseries and childminders provide healthy meals for young children
have been unveiled by the School Food Trust.

The charity’s ‘Voluntary Food and Drink
Guidelines for Early Years Settings in England’ is aimed at
helping ensure healthy food in childcare
venues for the under-fives to help reduce
diet-related problems like childhood
obesity. It provides childcare providers with a
nationally-recognised source of information about food they should
offer children, portion sizes and sample menus.

The School Food Trust is a
specialist advisor to the Government and its new
guidelines have been supported by the National Day Nurseries
Association, National Childminding Association and Pre-School
Learning Alliance.

Victoria Taylor, our Senior Dietitian, said:
“More than a fifth of children turn up to their first day at school
overweight or obese and that has to
change. These guidelines look to be a positive
step towards teaching children about healthy eating from
an early age.

“These are only voluntary guidelines though
and so it’s important that food and drink provision is
closely monitored to ensure young children are enjoying
balanced and nutritious food. If
standards are slipping then a mandatory approach could be a better
option.”

Article source: http://www.bhf.org.uk/media/news-from-the-bhf/early-years-diet.aspx

Parental Smoking and Childhood Ear Infections: A Dangerous Combination [Advice for Patients]

admin — Sat, 07 Jan 2012 11:15:36 +0000

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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:

Acute otitis media: Children with acute otitis media have signs and symptoms of infection, such as ear pain and fever. Acute otitis media is very common in children; more than 5 million cases occur each year in the United States.
Otitis media with effusion: Children with otitis media with effusion have extra fluid in the middle ear, so symptoms may include feeling like the ear is plugged or difficulty hearing. Children often get otitis media with effusion after having a cold or viral infection. About 90% of children have otitis media with effusion before starting school, most often between ages 6 months and 4 years.

Even though these infections are common, they can have serious consequences. Children who have repeated ear infections sometimes need surgery, which has risks. Children who have middle ear . . . [Full Text of this Article]

IF I SMOKE, HOW CAN I PREVENT EAR INFECTIONS IN MY CHILD?

MY CHILD HAS ALREADY HAD SOME EAR INFECTIONS; IS IT TOO LATE FOR ME TO QUIT SMOKING?

IVE TRIED TO QUIT AND IT DIDN’T WORK; WHAT ELSE CAN I DO?

FOR MORE INFORMATION

INFORM YOURSELF

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

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Parental Smoking and the Risk of Middle Ear Disease in Children: A Systematic Review and Meta-analysis

Laura L. Jones, Amal Hassanien, Derek G. Cook, John Britton, and Jo Leonardi-Bee

Arch Pediatr Adolesc Med. 2012;166(1):18-27.

ABSTRACT
| FULL TEXT

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

Exposure to Magnetic Fields During Pregnancy and Asthma in Offspring [The Pediatric Forum]

admin — Sat, 07 Jan 2012 05:15:36 +0000

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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 INFORMATION

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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Cochlear Implants in Children and Adolescents [Editorial]

admin — Sat, 07 Jan 2012 05:15:22 +0000

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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]

AUTHOR INFORMATION

REFERENCES
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Effect of Pediatric Bilateral Cochlear Implantation on Language Development

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

Arch Pediatr Adolesc Med. 2012;166(1):28-34.

ABSTRACT
| FULL TEXT

Cochlear Implantation in Prelingually Deafened Adolescents

Daniel M. Zeitler, Abbas Anwar, Janet E. Green, James S. Babb, David R. Friedmann, J. Thomas Roland, Jr, and Susan B. Waltzman

Arch Pediatr Adolesc Med. 2012;166(1):35-41.

ABSTRACT
| FULL TEXT

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

Pediatric Polypharmacy: Time to Lock the Medicine Cabinet? [Editorial]

admin — Fri, 06 Jan 2012 23:07:53 +0000

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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]

AUTHOR INFORMATION

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Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States

Chris Feudtner, Dingwei Dai, Kari R. Hexem, Xianqun Luan, and Talene A. Metjian

Arch Pediatr Adolesc Med. 2012;166(1):9-16.

ABSTRACT
| FULL TEXT

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

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

admin — Fri, 06 Jan 2012 23:07:40 +0000

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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.

Setting An urban hospital-based adolescent primary care clinic.

Participants Girls 13 to 21 years (for this article girls are defined as being aged 13 to 21 years) (n = 339) receiving their first HPV vaccination and their mothers (n = 235).

Main Outcome Measures (1) Girls’ perceived risk of HPV after HPV vaccination, (2) girls’ perceived risk of other STIs after vaccination, (3) girls’ perceived need for continued safer sexual behaviors after vaccination, and (4) factors associated with girls’ perception of less need for safer sexual behaviors.

Results Mean age of girls was 16.8 years. Most participants (76.4%) were black, and 57.5% were sexually experienced. Girls perceived themselves to be at less risk for HPV than for other STIs after HPV vaccination (P .001). Although most girls reported continued need for safer sexual behaviors, factors independently associated with perception of less need for safer sexual behaviors included adolescent factors (lower HPV and HPV vaccine knowledge and less concern about HPV) and maternal factors (lower HPV and HPV vaccine knowledge, physician as a source of HPV vaccine information, and lack of maternal communication about the HPV vaccine).

Conclusions Few adolescents perceived less need for safer sexual behaviors after the first HPV vaccination. Education about HPV vaccines and encouraging communication between girls and their mothers may prevent misperceptions among these adolescents.

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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Health-Related Quality of Life in Pediatric Minor Injury: Reliability, Validity, and Responsiveness of the Pediatric Quality of Life Inventory in the Emergency Department [Article]

admin — Fri, 06 Jan 2012 23:07:30 +0000

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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.

Setting Pediatric hospital emergency department.

Participants Children and adolescents with minor injury (n = 334).

Main Outcome Measures Child- and parent-reported clinical outcomes and PedsQL scale scores.

Results The PedsQL had good to excellent internal consistency reliability (α range, 0.73-0.93). For each day that the clinical symptoms persisted, there were consistent decreases in mean health-related quality of life (HRQOL) scores (validity testing). There were significantly greater negative changes in mean HRQOL scores for fractures vs soft-tissue injuries and for lower vs upper extremity injuries. Clinical outcomes categorized as poor had large negative changes in HRQOL not seen in good outcome groups. Distribution-based indicators of change supported good responsiveness (effect sizes for the physical summary score, 0.01-2.44; group differences at follow-up exceeded estimates of the minimal importance difference).

Conclusions The PedsQL is feasible, reliable, and demonstrates good construct and discriminant validity and responsiveness in measuring short-term outcome after minor injury care in the pediatric emergency department. Assessing short-term outcome from the patient perspective with HRQOL measures may greatly enhance our ability to evaluate the effectiveness of emergency department care.

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

admin — Fri, 06 Jan 2012 16:59:13 +0000

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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.

Setting The Medicaid-reimbursed health care system in the continental United States.

Participants Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428).

Main Exposures Use of respite care and therapeutic services, based on procedure codes.

Main Outcome Measures Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9).

Results Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization.

Conclusions Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.

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

admin — Fri, 06 Jan 2012 16:59:03 +0000

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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.

Setting Standardized parent encounters performed in practicing physicians’ clinics or during educational workshops for residents.

Participants Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians.

Intervention Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions.

Outcome Measures Four groups of “precautionary empathy” behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both “definite” and “partial” instances.

Results Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the “instruction about emotion” behavior (eg, “don’t be worried”), which may sometimes be leading or premature.

Conclusions Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening.

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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Communicating With Parents About Newborn Screening: The Skill of Eliciting Unspoken Emotions

Beth A. Tarini

Arch Pediatr Adolesc Med. 2012;166(1):95-96.

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Association of Exclusive Breastfeeding Duration and Fibrinogen Levels in Childhood and Adolescence: The European Youth Heart Study [Article]

admin — Fri, 06 Jan 2012 16:58:53 +0000

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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.

Setting Estonia and Sweden.

Participants A total of 704 children (mean [SD] age, 9.5 [0.4] years) and 665 adolescents (15.5 [0.5] years).

Main Exposure Exclusive BF duration was reported by the mother and categorized in the following 5 categories: never, less than 1 month, 1 to 3 months, more than 3 to 6 months, and more than 6 months.

Main Outcome Measures Fasting fibrinogen level. Age, sex, pubertal status, country, adiposity (sum of 5 skin-fold thicknesses), total cholesterol and triglyceride levels, blood pressure, physical activity (accelerometry), birth weight, maternal education, body mass index, and age were considered confounders in the analyses.

Results Longer duration of exclusive BF was associated with lower fibrinogen levels regardless of confounders (P .001). Mean (SD) fibrinogen levels were lower in youth who were breastfed for more than 3 months (after adjusting for all confounders, P .01) in children (2.55 [0.04] vs 2.77 [0.03] g/L), adolescents (2.59 [0.06] vs 2.72 [0.03] g/L), boys (2.47 [0.04] vs 2.73 [0.04] g/L), and girls (2.60 [0.03] vs 2.75 [0.02] g/L), compared with groups who were not breastfed. The results did not change substantially after further adjustment for birth weight and maternal educational level.

Conclusions Exclusive BF is associated with less low-grade inflammation, as estimated by serum fibrinogen levels, in healthy children and adolescents. These findings give further support to the notion that early feeding patterns could program cardiovascular disease risk factors later in life.

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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Effect of Pediatric Bilateral Cochlear Implantation on Language Development [Article]

admin — Fri, 06 Jan 2012 10:57:51 +0000

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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.

Setting Two Belgian and 3 Dutch cochlear implantation centers.

Participants Twenty-five children with 1 cochlear implant matched with 25 children with 2 cochlear implants selected from a retrospective sample of 288 children who underwent cochlear implantation before 5 years of age.

Intervention Cochlear implantation.

Main Outcome Measures Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales and Schlichting Expressive Language Test).

Results On the receptive language tests (mean difference [95% CI], 9.4 [0.3-18.6]) and expressive language tests (15.7 [5.9-25.4] and 9.7 [1.5-17.9]), children undergoing bilateral implantation performed significantly better than those undergoing unilateral implantation. Because the 2 groups were matched with great care on 10 auditory, child, and environmental factors, the difference in performance can be mainly attributed to the bilateral implantation. A shorter interval between both implantations was related to higher standard scores. Children undergoing 2 simultaneous cochlear implantations performed better on the expressive Word Development Test than did children undergoing 2 sequential cochlear implantations.

Conclusions The use of bilateral cochlear implants is associated with better spoken language learning. The interval between the first and second implantation correlates negatively with language scores. On expressive language development, we find an advantage for simultaneous compared with sequential implantation.

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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Cochlear Implants in Children and Adolescents

Annelle V. Hodges and Thomas J. Balkany

Arch Pediatr Adolesc Med. 2012;166(1):93-94.

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Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States [Article]

admin — Fri, 06 Jan 2012 04:32:22 +0000

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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.

Setting A total of 411 general hospitals and 52 children’s hospitals throughout the United States.

Patients A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.

Main Outcome Measures Daily and cumulative exposure to drugs and therapeutic agents.

Results The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children’s hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children’s hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).

Conclusion A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.

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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Pediatric Polypharmacy: Time to Lock the Medicine Cabinet?

Nancy E. Morden and David Goodman

Arch Pediatr Adolesc Med. 2012;166(1):91-92.

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This Month in Archives of Pediatrics & Adolescent Medicine [This Month in Archives of Pediatrics & Adolescent Medicine]

admin — Fri, 06 Jan 2012 04:32:10 +0000

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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

In this study by Feudtner et al (SEE ARTICLE) of nearly one-fifth of all pediatric hospitalizations across the United States, a typical patient admitted to a children’s hospital is exposed to a dozen drug and therapeutic agents. For those in the hospital at least 1 week, 10% are exposed to 35 different drugs.

Parental Smoking and the Risk of Middle Ear Disease in Children: A Systematic Review and Meta-analysis

Jones et al (SEE ARTICLE) found that living with a mother who smokes increases the chance of middle ear disease by 62% and increases the chance of needing surgery for middle ear disease by 86%. Each year, secondhand tobacco smoke results in nearly 300 000 children in the United States developing middle ear disease.

Effect of Pediatric Bilateral Cochlear Implantation on Language Development

Boons et al (SEE ARTICLE) report that children with bilateral cochlear implants performed better on both expressive and receptive language tests than children with unilateral implants 3 years after the first cochlear implantation. Bilateral implantation done simultaneously resulted in better expressive language outcomes than those done sequentially.

Cochlear Implantation in Prelingually Deafened Adolescents

Zeitler et al (SEE ARTICLE) found that adolescents with prelingual deafness undergoing unilateral cochlear implantation showed significant improvement in objective hearing outcome measures. Patients with shorter durations of deafness and earlier age at cochlear implantation tend to outperform their peers.

Excess Body Mass Index–Years, a Measure of Degree and Duration of Excess Weight, and Risk for Incident Diabetes

Lee et al (SEE ARTICLE) report that a higher level of excess body mass index–years (a measure of time spent with body mass index [calculated as weight in kilograms divided by height in meters squared]85th percentile or 25.0) is associated with an increased risk of diabetes. This relationship is stronger for younger individuals than for older individuals, and it is stronger for Hispanic and black individuals compared with white individuals.

Physical Activity and Performance at School: A Systematic Review of the Literature Including a Methodological Quality Assessment

This study by Singh et al (SEE ARTICLE) found strong evidence for a significant positive relationship between physical activity and academic performance in children. Increased physical activity is associated with positive effects on language skills and reading.

Association of Exclusive Breastfeeding Duration and Fibrinogen Levels in Childhood and Adolescence: The European Youth Heart Study

Previous studies showed that low-grade inflammation could be implicated in the development of cardiovascular disease from the early stages of life. The study by Labayen et al (SEE ARTICLE) shows that longer exclusive breastfeeding in infancy is associated with lower serum fibrinogen levels in children and adolescents, independent of potential confounders such as adiposity and physical activity. Differences in fibrinogen concentrations became significant when children and adolescents were breastfed for at least 3 months.

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

The results of the study by Farrell et al (SEE ARTICLE) raise concern about an apparent problem with physician-parent communication after “nondisease” carrier newborn screening results because many physicians fail to recognize parents’ emotional problems after newborn screening. Such problems may need to be addressed if population-scale newborn screening is to result in more good than harm.

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

According to the study by Mandell et al (SEE ARTICLE), although respite care is not universally available through Medicaid for children with autism spectrum disorders, each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.

Health-Related Quality of Life in Pediatric Minor Injury: Reliability, Validity, and Responsiveness of the Pediatric Quality of Life Inventory in the Emergency Department

Stevens et al (SEE ARTICLE) found that the Pediatric Quality of Life Inventory 4.0 Generic Core Scales instrument is feasible, is reliable, and demonstrates good construct and discriminant validity and responsiveness in measuring short-term outcome after minor injury care in the pediatric emergency department. Outcome assessment in the pediatric emergency department may be improved by including measures of health-related quality of life to evaluate short-term effects of emergency department care.

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

In this survey by Mullins et al (SEE ARTICLE) of 235 girls aged 13 to 21 years and their mothers, few adolescents perceived less need for safer sexual behaviors after the first human papillomavirus vaccination. The vast majority of adolescent girls continue to perceive the importance of safer sexual behaviors after receiving their first human papillomavirus vaccination.

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Effects of a Family Intervention in Reducing HIV Risk Behaviors Among High-Risk Hispanic Adolescents: A Randomized Controlled Trial [Article]

admin — Fri, 06 Jan 2012 04:31:57 +0000

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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.

Setting Miami–Dade County Public School System and Miami–Dade County’s Department of Juvenile Services, Florida.

Participants A total of 242 Hispanic delinquent youth aged 12 to 17 years and their primary caregivers completed outcome assessments at baseline and 3 months after intervention.

Intervention Participants were randomized to either Familias Unidas (120 participants), a Hispanic-specific, family intervention designed to reduce HIV risk behaviors among Hispanic youth, or a community practice control condition (122 participants).

Main Outcome Measures Self-reported measures included unprotected sexual behavior, engaging in sex while under the influence of alcohol and/or drugs, number of sexual partners, and incidence of sexually transmitted diseases. Family functioning (eg, parent-adolescent communication, positive parenting, and parental monitoring) was also assessed via self-report measures.

Results Compared with community practice, Familias Unidas was efficacious in increasing condom use during vaginal and anal sex during the past 90 days, reducing the number of days adolescents were under the influence of drugs or alcohol and had sex without a condom, reducing sexual partners, and preventing unprotected anal sex at the last sexual intercourse. Familias Unidas was also efficacious, relative to community practice, in increasing family functioning and most notably in increasing parent-adolescent communication and positive parenting.

Conclusion These results suggest that culturally tailored, family-centered prevention interventions may be appropriate and efficacious in reducing HIV risk behaviors among Hispanic delinquent adolescents.

Trial Registration clinicaltrials.gov Identifier: NCT01257022

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

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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 [Article]

admin — Thu, 05 Jan 2012 22:18:13 +0000

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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.

Setting A single academic hospital.

Participants A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks’ gestation.

Interventions Home nursing visits were scheduled no later than 2 days after discharge; OBC timing was physician determined.

Outcome Measures Mothers completed telephone surveys at 2 weeks, 2 months, and 6 months. The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery. Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration. Maternal mental health, parenting competence, and satisfaction with care outcomes were assessed. Analyses followed an intent-to-treat paradigm.

Results At 2 weeks, hospital readmissions and emergency department visits were uncommon, and there were no study group differences in these outcomes or with unplanned outpatient visit frequency. Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group (85.9% vs 78.8%) (P = .002) and were more likely to be breastfeeding at 2 weeks (92.3% vs 88.6%) (P = .04) and 2 months (72.1% vs 66.4%) (P = .05) but not 6 months. No group differences were detected for maternal mental health or satisfaction with care, but HNV group mothers had a greater parenting sense of competence (P .01 at 2 weeks and 2 months).

Conclusions Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits.

Trial Registration clinicaltrials.gov Identifier: NCT00360204

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 [Article]

admin — Thu, 05 Jan 2012 22:18:02 +0000

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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.

Setting Preassessment was conducted in 4 pediatric primary care practices. Postassessment was conducted in the pediatric or research office. Doctor-office collaborative care was provided in the practice; EUC was initiated in the office but involved a facilitated referral to a local mental health specialist.

Participants Of 125 referrals (age range, 5-12 years), 78 children participated.

Interventions Children and their parents were assigned to receive DOCC or EUC.

Main Outcome Measures Preassessment diagnostic status was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Preassessment and 6-month postassessment ratings of behavioral and emotional problems were collected from parents using the Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Parent Rating Scale, as well as individualized goal achievement ratings forms. At discharge, care managers and a diagnostic evaluator completed the Clinical Global Impression Scale, and pediatricians and parents completed satisfaction and study feedback measures.

Results Group comparisons found significant improvements for DOCC over EUC in service use and completion, behavioral and emotional problems, individualized behavioral goals, and overall clinical response. Pediatricians and parents were highly satisfied with DOCC.

Conclusion The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care.

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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The Challenge of Mental Health Care in Pediatrics

Ellen C. Perrin and R. Christopher Sheldrick

Arch Pediatr Adolesc Med. 2011;0(2011):20112021-2.

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The Challenge of Mental Health Care in Pediatrics

Perrin and Sheldrick
Arch Pediatr Adolesc Med 2011;0:archpediatrics.2011.202v1-2.
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Media Advisory: Coverage Opportunities for First Baby Born in 2012

admin — Thu, 05 Jan 2012 22:17:52 +0000

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

The Challenge of Mental Health Care in Pediatrics [Editorial]

admin — Thu, 05 Jan 2012 16:16:35 +0000

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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.

REFERENCES
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Doctor-Office Collaborative Care for Pediatric Behavioral Problems: A Preliminary Clinical Trial

David J. Kolko, John V. Campo, Amy M. Kilbourne, and Kelly Kelleher

Arch Pediatr Adolesc Med. 2011;0(2011):20112011-8.

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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 [Article]

admin — Thu, 05 Jan 2012 16:16:23 +0000

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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.

Setting Twenty schools in the Netherlands.

Participants A total of 883 students (aged 12-13 years).

Intervention The FATaintPHAT (VETisnietVET in Dutch) Web-based computer-tailored intervention.

Outcome Measures Self-reported behaviors (diet, physical activity, sedentary behavior) and pedometer counts were measured at baseline and at 4-month and 2-year follow-up; body mass index (BMI), waist circumference, and fitness were measured at baseline and at 2-year follow-up. Descriptive and multilevel regression analyses were conducted among the total study population and among students not meeting behavioral recommendations at baseline (students at risk).

Results The complete case analyses showed that FATaintPHAT had no effect on BMI and waist circumference. However, the intervention was associated with lower odds (0.54) of drinking more than 400 mL of sugar-sweetened beverages per day and with lower snack intake (β = –0.81 snacks/d) and higher vegetable intake (β = 19.3 g/d) but also with a lower step count (β = –10 856 steps/wk) at 4-month follow-up. In addition, among students at risk, FATaintPHAT had a positive effect on fruit consumption (β = 0.39 g/d) at 4-month follow-up and on step count (β = 14 228 steps/wk) at 2-year follow-up but an inverse effect on the odds of sports participation (odds ratio, 0.45) at 4-month follow-up. No effects were found for sedentary behavior.

Conclusion The FATaintPHAT intervention was associated with positive short-term effects on diet but with no effects or unfavorable effects on physical activity and sedentary behavior.

Trial Registration Netherlands Trial Registry: ISRCTN15743786

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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Medical Home Access and Health Care Use and Expenditures Among Children With Special Health Care Needs [Article]

admin — Thu, 05 Jan 2012 16:16:12 +0000

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Medical Home Access and Health Care Use and Expenditures Among Children With Special Health Care Needs

Melissa A. Romaire, PhD, MPH;
Janice F. Bell, PhD, MPH, MN;
David C. Grossman, MD, MPH

Arch Pediatr Adolesc Med. Published online December 5, 2011. doi:10.1001/archpediatrics.2011.1154

Objective To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN).

Design Cross-sectional analysis.

Setting The 2003-2008 Medical Expenditure Panel Surveys.

Participants A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation.

Main Exposure Parent or caregiver report of CSHCN having a medical home.

Main Outcome Measures We examined CSHCN’s annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures.

Results CSHCN with a medical home had 14% more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, –$968; 95% CI, –$121 to –$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95% CI, $22-$153).

Conclusions There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.

Author Affiliations: Department of Health Services, School of Public Health (Drs Romaire, Bell, and Grossman), and Department of Pediatrics (Dr Grossman), University of Washington, and Group Health Research Institute (Dr Grossman), Seattle.

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

admin — Thu, 05 Jan 2012 10:01:53 +0000

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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.

Setting Twenty-five emergency departments participating in the PECARN.

Patients Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14.

Intervention Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori).

Main Outcome Measures Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms.

Results Of the 42 412 patients enrolled in the overall study, 42 099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%).

Conclusion Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

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 [Article]

admin — Thu, 05 Jan 2012 10:01:43 +0000

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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.

Setting Specialty clinics serving children residing in Cook County, Illinois.

Participants From January-May 2010, 273 clinics were each called twice.

Main Outcome Measures Logistic regression was used to examine associations between AMC affiliation and discriminatory denials of Medicaid–Children’s Health Insurance Program (CHIP) (ie, nonacceptance of Medicaid-CHIP when accepting commercial insurance), controlling for clinics’ specialty type, practice size, neighborhood poverty level, and physicians’ credentials. Among clinics that accepted both insurances, linear regression was used to examine the association between wait times (days) for appointments and insurance status, adjusting for covariates. Tests for interaction terms were performed to identify changes in wait time for academic clinics across insurance status.

Results Of the 273 paired calls to clinics, 155 (57%) resulted in discriminatory denials of Medicaid-CHIP. The odds of a discriminatory denial were 45% lower if a clinic was AMC affiliated (odds ratio, 0.55; 95% CI, 0.31-0.99). On average, academic clinics scheduled Medicaid-CHIP appointments with wait times 40 days longer than private insurance (β, 40.73; 95% CI, 5.06-76.41).

Conclusions Affiliation with an AMC was associated with fewer discriminatory denials of children with Medicaid-CHIP. However, children with Medicaid-CHIP had significantly longer wait times at AMC-affiliated clinics compared with privately insured children. Academic medical centers’ propensity toward serving publicly insured patients makes them candidates for targeted resource allocation, perhaps with incentives contingent on equitable appointment acceptance and wait times.

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

Arch Pediatr Adolesc Med. 2011;0(2011):201111641-3.

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

Berman
Arch Pediatr Adolesc Med 2011;0:archpediatrics.2011.1164v-3.
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Can We Ensure That Children With Public Insurance Have Access to Necessary, High-quality Pediatric Specialty Care? [Editorial]

admin — Thu, 05 Jan 2012 10:01:31 +0000

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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 INFORMATION

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

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Academic Medical Centers and Equity in Specialty Care Access for Children

Joanna Bisgaier, Daniel Polsky, and Karin V. Rhodes

Arch Pediatr Adolesc Med. 2011;0(2011):201111581-7.

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

admin — Wed, 04 Jan 2012 21:24:59 +0000

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

Lawrence J. DAngelo, 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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Association Between HIV-Related Risk Behaviors and HIV Testing Among High School Students in the United States, 2009

Alexandra B. Balaji, Danice K. Eaton, Andrew C. Voetsch, Ryan E. Wiegand, Kim S. Miller, and Sonal R. Doshi

Arch Pediatr Adolesc Med. 2012;0(2012):201111311-6.

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Recent Progress in Understanding Pediatric Bipolar Disorder [Review Article]

admin — Wed, 04 Jan 2012 21:24:49 +0000

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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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Study Aims to Understand Adolescent Risky Behavior

admin — Wed, 04 Jan 2012 21:24:38 +0000

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

Maternal Liver Grafts More Tolerable for Children with Rare Disease

admin — Tue, 03 Jan 2012 22:41:57 +0000

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

Media Advisory: Coverage Opportunities for First Baby Born In 2012

admin — Fri, 30 Dec 2011 04:08:55 +0000

By Juliana Bunim on December 29, 2011

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.

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

Children and Young People’s Mental Health – recent developments

admin — Thu, 22 Dec 2011 22:33:28 +0000

This letter issued jointly by Prof Dame Sally Davies (Chief Medical Officer); Dame Christine Beasley (Chief Nursing Officer); Dr Keith Ridge (Chief Pharmaceutical Officer) and Prof Sir Bruce Keogh (NHS Medical Director) highlights the publication of documents by the National Institute for Health and Clinical Excellence relating to improving mental health outcomes for children and young people.

Read the letter PL/CMO/2011/02, PL/CNO/2011/02, PL/CPHO/2011/02: Children and Young People’s Mental Health – recent developments

Article source: http://www.dh.gov.uk/health/2011/12/mental-health-recent-developments/

FDA expands use of HIV drug Isentress to children and adolescents

admin — Wed, 21 Dec 2011 19:05:22 +0000

FDA NEWS RELEASE

For Immediate Release: Dec. 21, 2011
Media Inquiries: Erica Jefferson, 301-796-4988, erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA expands use of HIV drug Isentress to children and adolescents

Isentress (raltegravir) was approved today by the U.S. Food and Drug Administration for use with other antiretroviral drugs for the treatment of HIV-1 infection for children and adolescents ages 2-18.

The drug is part of a class of medications called HIV integrase strand transfer inhibitors that works by slowing the spread of HIV in the body. It was first approved for use in adult patients in October 2007, under FDA’s accelerated approval program, which allows the agency to approve a drug to treat a serious disease based on clinical data showing that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients.

The program is designed to provide patients with earlier access to promising new drugs, but the company will be required to submit additional clinical information after approval to confirm the drug’s clinical benefit.

“Many young children and adolescents are living with HIV and this approval provides an important additional option for their treatment,” said Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research.

Isentress is a pill that can be taken twice daily, with or without food. The pill is also available in a chewable form. Because the two tablet formulations are not interchangeable, the chewable form is only approved for use in children ages 2 to 11.

A single, multi-center clinical trial of 96 children and adolescents ages 2-18 years with HIV-1 infection evaluated the safety and effectiveness of Isentress. These patients previously received treatment for HIV-1 infection. After 24 weeks of treatment with Isentress, 53 percent of these patients had an undetectable amount of HIV in their blood.

The most commonly reported severe, treatment-related side effects in patients taking Isentress include trouble sleeping (insomnia) and headache. The frequency of these side effects is similar for children and adults. One pediatric patient reported severe treatment-related insomnia, while another pediatric patient experienced a drug-related skin rash. The drug should be discontinued if this occurs.

Isentress does not cure HIV infection. Patients must stay on continuous HIV therapy to control HIV infection and decrease HIV-related illnesses.

Isentress is made by Whitehouse Station, N.J.-based Merck Co., Inc.

For more information:

FDA: HIV and AIDS Activities
FDA: Antiretroviral drugs used in the treatment of HIV infection
CDC: HIV/AIDS
HHS: AIDS News and Resources
AIDS Information

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

UCSF-Led Team Discovers Cause of Rare Disease

admin — Tue, 20 Dec 2011 10:16:23 +0000

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.

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

FDA approves mechanical cardiac assist device for children with heart failure

admin — Mon, 19 Dec 2011 21:13:41 +0000

FDA NEWS RELEASE

For Immediate Release: Dec. 16, 2011
Media Inquiries: Sandy Walsh, 301-796-4669, sandy.walsh@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA approves mechanical cardiac assist device for children with heart failure

The U.S. Food and Drug Administration today approved a medical device that supports the weakened heart of children with heart failure to help keep them alive until a donor for a heart transplant can be found.

The mechanical pulsatile cardiac assist device is called the EXCOR Pediatric System, made by a German company, Berlin Heart. The device comes in graduated sizes to fit children from newborns to teens.

“This is a step forward, it is the first FDA-approved pulsatile mechanical circulatory support device specifically designed for children,” said Susan Cummins, M.D., M.P.H, chief pediatric medical officer in the FDA’s Center for Devices and Radiological Health. “Previous adult heart assist devices were too large to be used in critically ill children to keep them alive while they wait to get a new heart.”

The device consists of one or two external pneumatic (driven by air) blood pumps, multiple tubes to connect the blood pumps to heart chambers and the great arteries, and the driving unit.

Heart failure in children is much less common than in adults. Heart transplantation offers effective relief from symptoms. However, far fewer pediatric sized donor hearts are available for transplantation than for adults, limiting the use of heart transplantation in children and prolonging the waiting period until transplant can occur. In infants, the median waiting time for a donor heart is 119 days. Overall a reported 12-17 percent of children and 23 percent of infants die while on the wait list for a heart transplant.

In the primary U.S. study group of 48 patients, the use of the device was found to improve survival to transplant in patients when compared with the use of extracorporeal membrane oxygenation (ECMO) which is the current standard of care, although not FDA approved. Stroke, which can cause serious brain deficits, is a risk of the EXCOR Pediatric System.

The EXCOR was designated as a Humanitarian Use Device (HUD) by the Office of Orphan Products Development at the FDA. This designation is for medical devices intended to benefit patients in the treatment or diagnosis of a disease or condition that affects fewer than 4,000 individuals in the United States annually. The device was approved under a Humanitarian Device Exemption (HDE), a type of marketing application that is similar to a premarket approval application in that the level of safety required for approval is the same. Rather than having to show a reasonable assurance of effectiveness, devices submitted under the HDE marketing route need to prove that the probable benefit from use of the device outweighs the probable risk of illness or injury from its use to obtain the FDA’s approval.

The FDA approval of an HDE authorizes an applicant to market the device subject to certain use restrictions. After the passing of the Pediatric Medical Device Safety and Improvement Act of 2007, HUDs intended and labeled for use in a pediatric population are permitted to be marketed for profit.

The FDA’s Orphan Products Grant Program supported the U.S. clinical trials for the EXCOR Pediatric System with grants of $400,000 per year for three years.

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

VIDEO: ‘Miracle baby’ to be sent home

admin — Mon, 19 Dec 2011 21:13:41 +0000

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

Child penicillin dose review call

admin — Mon, 19 Dec 2011 21:13:39 +0000

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

Food firms ‘target web children’

admin — Mon, 19 Dec 2011 11:53:15 +0000

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

Children, Families and Maternity (CFM) bulletin

admin — Mon, 19 Dec 2011 11:53:14 +0000

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)

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

Childhood obesity levels

admin — Mon, 19 Dec 2011 11:53:13 +0000

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