RxPG News : Paediatrics

AAP President provides update on agenda for children

Sat, 15 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) BOSTON -- O. Marion Burton, MD, FAAP, president of the American Academy of Pediatrics (AAP) will address attendees at 10:30 a.m. ET on Saturday,Oct. 15, 2011, at the AAP National Conference and Exhibition in Boston.

Dr. Burton will outline AAP efforts to advance its agenda for children and reflect on his year as AAP president. In his talk, Dr. Burton will focus on maintaining the advances made, while not losing ground as budget cuts threaten to dismantle prior successes.

Hard-won victories related to environmental and medical product protections for children are being challenged. Work remains to ensure inappropriate gag laws do not interfere with pediatricians discussing health and safety issues with families. Gains such as new immunization administration codes that enable pediatricians to recover the costs of delivering multi-component vaccines could be endangered as budgets are slashed and Medicaid reimbursements are challenged. The Affordable Care Act, which the AAP supported, is under scrutiny as more beneficiaries are added and costs shifted to state governments low on funds.

Physicians and government agencies must continue to work together to ensure the improvements made in the infrastructure of children's health care and safety remain intact, Dr. Burton said.

Dr. Burton will also discuss AAP international efforts, and particularly the Helping Babies Breathe initiative, which is saving newborns in resource-limited countries and helping move toward the Millennium goal of reducing deaths of children under age 5 by two-thirds by 2015.

Dr. Burton will also address AAP's leading role in the evolving science of well child care and health supervision. The AAP has created strategic priorities around early brain and child development and epigenetics, and is leading the efforts of the Head Start National Center on Health cooperative agreement from the U.S. Department of Health and Human Services Office of Head Start. The AAP continues to validate and improve its Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, which will further strengthen pediatricians as the physicians most appropriate to oversee the health care of the world's children.

Dr. Burton is the 2010-2011 president of the AAP. He is a community pediatrician and associate dean for clinical affairs and director of community pediatrics at the University of South Carolina School of Medicine. A graduate of Clemson University and Medical University of South Carolina (MUSC), he trained at MUSC and at Medical College of Georgia. Dr. Burton and his wife, Debbie, live in Columbia, S.C., and have six children and seven grandchildren.

SUNY receives $4.3 million for research in neuroscience, pediatric pharmacology and vision

Fri, 14 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The State University of New York has received two grants totaling more than $4.3 million from the National Institutes of Health (NIH) to support neuroscience and pediatric pharmacology and vision research as part of SUNY REACH, a collaborative research network of SUNY's four academic health centers and the College of Optometry. The lead researchers on both grants will be headquartered at SUNY Downstate Medical Center in Brooklyn, New York.

SUNY REACH (Research Excellence in Academic Health) is comprised of SUNY Downstate, University at Buffalo, College of Optometry, Stony Brook University School of Medicine, and Upstate Medical University.

The first grant, $3.7 million from the Eunice Kennedy Shriver National Institute of Child Health and Human Development will support research into Retinopathy of Prematurity (ROP), a condition that contributes to vision loss (and in the most serious cases, blindness) in premature infants. Jacob V. Aranda, MD, PhD, professor or pediatrics and director of neonatalogy at SUNY Downstate Medical Center, and principal investigator on the grant, notes that the condition affects 50 to 80 percent of preterm babies born weighing less than 1250 grams.

Dr. Aranda's research will help define the molecular events that lead to ROP and develop drug strategies to prevent it. Dr. Aranda and Kay Beharry, director of the Perinatal-Neonatal Pharmacology Translational Lab at SUNY Downstate, along with Dr. William Jusko at Buffalo, will provide overall administration of the complex project, with two pre-clinical science protocols and one clinical protocol. These two protocols will focus on the hypothesis that caffeine and ibuprofen, used together, can be used to regulate the overgrowth of vessels that lead to ROP in animal models.

Once studies on the safety, efficacy, and timing of intervention are completed, randomized clinical testing will begin at multiple clinical sites. In addition to Downstate, these will include the University at Buffalo, Stony Brook University, Columbia University, Kings County Hospital Center, Maimonides Medical Center, New York Hospital Queens and Wyckoff Heights Medical Center.

Collectively, these centers form the New York Pediatric Developmental Pharmacology Research Consortium, which will study and develop novel drug therapies in newborn babies, focusing on those that will prevent blindness in preterm newborns. This is the only center focused on pediatric ocular pharmacology in the country, and one of only four pediatric pharmacology centers funded by the National Institutes of Health.

Regarding the retinopathy grant, Dr. Aranda said, Retinopathy of prematurity occurs in two out of three small babies born prematurely and treated with oxygen, and can lead to blindness. In fact, it is the most common cause of blindness in children. Understanding the molecular events leading to retinopathy of prematurity and providing novel, effective and safe drug interventions will avert a lifetime of blindness, disability, and darkness.

The second grant, $650,000 from the National Institute of Neurological Disorders and Stroke (NINDS), positions SUNY's academic health centers to participate in the NIH NINDS Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) project, which aims to speed up early phase clinical trials on new therapies. Steven R. Levine, MD, professor of neurology and associate dean for clinical research and faculty development at SUNY Downstate Medical Center, is the principal investigator on this project.

Dr. Levine's project will be one of 25 across the U.S. designed to create the infrastructure necessary to develop and implement research protocols in neurological disorders. It uses the SUNY REACH template for developing a statewide network of patients and research infrastructure to expand the SUNY Clinical Trials Network. Dr. Levine's initial focus will be a multi-center approach to identify biomarkers and predictors of stroke across New York State.

By combining four SUNY campuses into one application, we have created an innovative and very large network of patients with extremely diverse ethnic and racial backgrounds that will facilitate a sustained and powerful influence on neurological clinical trial performance, says Dr. Levine. It shifts the paradigm for collaborative structuring of clinical trials and will lead to a faster pipeline to Phase 3 trials.

NeuroNEXT will expand the capability to test the most promising new therapies for a wide range of neurological disorders affecting children and adults, said Elizabeth McNeil, MD, the NIH/ NINDS program director who will oversee the nationwide program. Through 25 clinical sites across the US, as well as a clinical and a data coordinating center, the NIH will provide the expertise and infrastructure needed to rapidly assess treatment options as they become available from both academic and industry investigators.

SUNY REACH aims to make SUNY a competitive leader in biomedical research that significantly affects the health of New Yorkers. The consortium provides a unique research opportunity by involving campuses that are geographically spread across New York State, and capitalizing on their collective access to urban and rural populations that are racially, ethnically, and culturally diverse. As these latest grants demonstrate, SUNY REACH also leverages the power of the individual SUNY academic health centers to obtain grant funding.

Member campuses of SUNY REACH each contributed approximately $180,000 to fund the consortium. Federal research dollars from the National Science Foundation and NIH at these campuses account for 60 percent of all federal research dollars awarded to SUNY.

Wayne State University to study effects of risky family environments on childhood asthma

Wed, 05 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) DETROIT -- According to the Asthma and Allergy Foundation of America, asthma is the third ranking cause of hospitalization of children younger than 15 in the United States. It is the leading cause of school absences from a chronic illness in 5- to 17-year-olds, accounting for an annual loss of more than 14 million school days per year. A Wayne State University researcher is now investigating the impact of risky family environments on asthma morbidity in children.

The five-year, $3 million grant, Risky Family Environments and Childhood Asthma, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health, will be led by Richard Slatcher, Ph.D., assistant professor of psychology in Wayne State University's College of Liberal Arts and Sciences, and resident of Beverly Hills, Mich.

The project will study 180 children between the ages of 10 and 15 in Detroit, using an innovative home-based naturalistic assessment tool called the Electronically Activated Recorder (EAR). The EAR will measure whether identified risky family behaviors are associated with greater asthma morbidity -- such as symptom severity, emergency room visits and pulmonary function -- in three waves of data collection over two years. In addition, the research will try to determine if asthma morbidity increases because of avoidant coping behaviors and poor management of asthma treatment, such as noncompliance with treatment plans or poor asthma management behaviors.

According to Slatcher, little is known about how risky family environments -- those characterized by conflict, neglect, and lack of emotional warmth and support -- affect health. A key limitation of previous research is that our knowledge of family life of children with asthma has been based entirely on self-reports and interviews of family members, said Slatcher. It is well known that those traditional types of assessment tools can give biased -- even inaccurate -- pictures of families. In order to develop clinical interventions and treatments that really work to combat asthma, it is essential that we get a clear view of the family risk factors. The EAR gives us a 'fly-on-the-wall' perspective of real families going about their daily lives, one that we believe is a big methodological step in the right direction.

This project will foster future bench to bedside translation of its key findings into novel interventions to reduce asthma in children. It also will allow physicians to include family interventions based on family assessments, which ultimately will improve adherence to treatment plans as well as avoidance of asthma triggers that can lead to severe asthma attacks or even death, said Slatcher.

This is an important study for children in Detroit, an area that has troubling high incidences of asthma morbidity and mortality, said Hilary Ratner, Ph.D., vice president for research and interim dean of the Graduate School at Wayne State University. There is an urgent need to address this issue, and Dr. Slatcher's work aims to have a great impact on children who otherwise are helpless in getting the appropriate treatment plan and parent care they need to prevent or treat their asthma.

Newly identified DNA repair defect linked to increased risk of leukemia relapse

Mon, 26 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A newly identified defect in a DNA repair system might leave some young leukemia patients less likely to benefit from a key chemotherapy drug, possibly putting them at greater risk of relapse. The problem was identified in a study led by St. Jude Children's Research Hospital scientists.

The study's findings offer a potential new marker to help identify acute lymphoblastic leukemia (ALL) patients who are at higher risk of having their cancer return and thus are candidates for more tailored therapies. The research was published in the September 25 online edition of the scientific journal Nature Medicine.

The work focused on a protein named MSH2, which is involved in DNA repair. DNA is the molecule that carries instructions for building and sustaining life. Cell division requires DNA synthesis. The DNA repair system helps correct errors in DNA production. The DNA repair proteins are also involved in how some chemotherapy agents kill leukemia cells.

In this study, investigators discovered a new mechanism responsible for low MSH2 levels in about 11 percent of pediatric ALL and in several adult cancers. Researchers also found low MSH2 levels were associated with leukemia resistance to the thiopurine medications, including mercaptopurine, a drug all children with ALL receive.

If confirmed, this work suggests a patient's MSH2 status might someday be used to guide treatment, said Barthelemy Diouf, Ph.D., the first author. He is a postdoctoral fellow in the laboratory of William Evans, Pharm.D., the paper's senior author. Evans is chief executive officer and director of St. Jude.

In the U.S., ALL is diagnosed in about 3,000 children annually, making it the nation's most common childhood cancer. It is also one of modern medicine's success stories. At St. Jude, 90 percent of young ALL patients are now cured. This study reflects ongoing efforts to understand why treatment sometimes fails.

The research built on earlier work from the laboratory of Evans and others that linked a deficit of MSH2 with an increased risk of certain cancers and resistance to mercaptopurine, a drug that is the backbone of leukemia treatment.

In this study, scientists found that 11 percent of 90 newly diagnosed pediatric ALL patients had low or undetectable levels of the MSH2 protein.

Ten years after an ALL diagnosis, children with low MSH2 protein levels were less likely to be alive and four times more likely to have suffered relapses. The comparison included 97 patients treated in a St. Jude study called Total XV, which ended in 2007. Sixteen patients had leukemia with low MSH2 levels. The analysis took other factors into account, including a patient's age and early treatment response, which are associated with high-risk ALL. The results suggest MSH2 protein levels might help identify a new group of high-risk patients.

Further work revealed no evidence of problems in the MSH2 gene itself, so scientists expanded their search for why some patients had low MSH2 levels in their leukemia cells. Researchers looked for changes in the makeup of eight genes known or suspected of playing a role in the breakdown of MSH2. To do that, they screened DNA from 69 of the 90 newly diagnosed ALL patients at nearly 1 million spots in the genome.

The research showed each patient was missing at least one of the four genes that regulate MSH2 degradation. MSH2 was still made, but the system to protect it from destruction had been impaired or eliminated, leading to more rapid breakdown of MSH2 and a crippled system for fixing DNA, Evans said. The missing genes were FRAP1, HERC1, PRKCZ and PIK3C2B.

A check of leukemia cells from another group of St. Jude ALL patients found that about 12 percent, or 21 of the 170 children, were missing at least one of the same genes. A search of public databases found one or more of the same genes deleted in 13.5 percent of sporadic colorectal cancer patients and 16 percent of adults with ALL.

Evans noted that low MSH2 levels did not increase resistance to other drugs used to treat ALL. In the future, we may want to intensify use of other therapies, he said.

Chemotherapy during pregnancy does not seem to cause developmental problems in children

Mon, 26 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Stockholm, Sweden: Children born after their mothers were treated with chemotherapy during pregnancy appear to be unaffected by the experience in terms of the development of their mental processes and the normal functioning of their hearts, according to new research presented at the 2011 European Multidisciplinary Cancer Congress [1].

Professor Frederic Amant will tell the congress: To the best of our knowledge this is the first time that children of 18 months and older have been examined after chemotherapy during pregnancy, and the news is reassuring in respect of the effects of chemotherapy on cognitive and cardiac outcomes.

However, he will say that a significant number (47) of the 70 children born from 68 pregnancies were delivered preterm and the researchers found that prematurity, but not chemotherapy, did affect these children's cognitive development significantly.

Prof Amant, a gynaecological oncologist at the University Hospitals Leuven (Leuven, Belgium), and colleagues in two other European countries (The Netherlands and the Czech Republic) started to recruit children to the study in 2005. They included children who had been born before that time (between 1991-2004) as well as those born between 2005-2010, so that they ranged in age from 18 months to 18 years. The children were examined at birth and at the ages of 18 months, 5-6, 8-9, 11-12, 15-16 and 18 years. The children's health was monitored for an average of nearly two years, with some of them being followed for as long as 18 years.

While the 68 mothers were pregnant, they were being treated with chemotherapy, either on its own or in combination with radiotherapy or surgery or both, for a range of different cancers. The most common cancer was breast (35 women), followed by haematological cancers such as leukaemias and lymphomas (18), ovarian cancer (6), cervical cancer (4); other cancers included brain, skin, colorectal, nasopharyngeal, and Ewing's Sarcoma.

The researchers collected data on the mothers' treatment and medical history, and then assessed the children's general health, school performance, any sporting activity and the family's social situation by means of questionnaire completed by the parents at each assessment visit. They looked at the development of the children's mental processes by evaluating intelligence, verbal and non-verbal memory, attention, working memory and executive functions (the ability to control and regulate other abilities and behaviours). Parents also completed a questionnaire on behavioural and emotional problems. Cardiac function was assessed by electrocardiography (ECG) and echocardiography.

The average gestational age at which the children were born was 35.7 weeks; seven children were born very early (28-32 weeks), nine were born early (32-34 weeks), 31 were born preterm (34-37 weeks) and 23 were born at term (37 weeks or more). There were two twin pregnancies.

Prof Amant and his colleagues found that the incidence and type of congenital malformations were similar to the general population, as was growth, general health and development; no heart abnormalities were detected. Cognitive development was in the normal range for the majority of the children, but those that fell below the normal IQ range were mainly those that had been born early. One set of twins, who were born at 32.5 weeks, had significant neurodevelopmental delay, and for these twins the researchers said they could not rule out prenatal exposure to chemotherapy as being the possible causal factor.

Prof Amant says: Our results so far suggest that children who were prenatally exposed to chemotherapy seem to do as well as children in the general population, and, that the treatment does not influence the development of mental processes or the functioning of the heart in the children we have followed for an average of 22 months. Therefore, although the role played by chemotherapy in the poor outcome of one of the twin pregnancies cannot be excluded, we believe these results do allow us to make a recommendation about chemotherapy in pregnancy: pregnant women with cancer do not need to delay their cancer treatment or terminate their pregnancy. The benefits of chemotherapy to the mothers outweigh any potential long-term harm to the children.

However, it is important to prevent preterm birth if possible and continue pregnancy until at least 37 weeks, as the data suggest the children suffer more from prematurity than from prenatal chemotherapy. Pregnant women who are receiving chemotherapy often have delivery induced from the moment the foetus is viable although not mature. Our results suggest this should be avoided.

He says that that it is not clear whether chemotherapy itself could be a possible cause for premature delivery, but that in many cases preterm delivery is induced and is itself the cause of the cognitive developmental problems seen in this group of children.

Prof Amant will conclude: At this stage we do not know the full, long-term consequences of prenatal chemotherapy, including its effect on the children's fertility and likelihood of developing cancers when they are older. For this reason, we are continuing this international collaboration to follow-up more children for longer periods of time.

Micronutrient powders reduce anemia and iron deficiency in infants in low-income countries

Tue, 06 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Adding a powder that contains several vitamins and minerals, including iron, zinc and vitamin A, to the semi-solid foods taken by infants and children between six months and two years of age, can reduce their risk of anaemia and iron deficiency. This is the conclusion of a new Cochrane Systematic Review.

Vitamin and mineral deficiencies, particularly those of iron, vitamin A and zinc, affect more than two billion people worldwide. Infants and young children are highly vulnerable because they grow rapidly and often have diets low in these nutrients. Micronutrient powders are single-dose packets containing multiple vitamins and minerals in powder form that can be sprinkled onto any semi-solid food immediately before eating at home or at any other place. Thus, this intervention is known as home or point of use fortification.

Led by Luz Maria De-Regil, a team of researchers set out to see whether using micronutrient powders could improve the health of young children. They found eight relevant trials that together involved 3748 children living in Asia, Africa and the Caribbean, where anaemia is a public health problem. The studies lasted between two and 12 months and the powder formulations contained between five and 15 nutrients.

Overall, home fortification with the micronutrient powders reduced the risk of having anaemia by 31% and iron deficiency by 51% when compared with no intervention or placebo. The team found, however, that there was little or no evidence that this intervention has an effect on growth, survival or overall developmental outcomes. We still need to know more about possible positive and adverse side effects as only a few trials reported on this, says De-Regil, who is an Epidemiologist at the Department of Nutrition for Health and Development of the World Health Organization in Geneva, Switzerland.

The researchers also found that these powders had a very similar effect to daily iron supplements. However, as they report, We need to treat this result with caution, however, because there was much less data for this comparison.

It seems that micronutrient powders can be helpful for infants and young children aged six to 23 months and living in places that have different amounts of anaemia and malaria, regardless of whether the intervention lasts two, six or 12 months or whether recipients are girls or boys.. Nonetheless, the authors add a word of caution: This intervention involves mixing the powders with homemade food as a vehicle, so it is important to assure that basic sanitation is available and food hygiene and handling is done properly with safe water.

The team believes that we now need more information about the best combination of vitamins and minerals to include in the mix, whether to give it daily or intermittently and for how long to give it to ensure that children receive the maximum benefits.

Pharmacists need to provide better information to teenagers on risks and benefits of medicines

Sun, 04 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Hyderabad, India: A large proportion of teenagers regularly and frequently take some form of medication without receiving targeted information about the risks and benefits, according to a review of current research, to be presented at the annual congress of the International Pharmaceutical Federation (FIP) tomorrow (Tuesday).

Dr Priya Bahri will tell delegates that 35% of boys and 45% of girls in Europe and the USA take painkillers for headaches every month. In addition, they take a variety of other medicines for things like stomach aches, sleeping disorders, nervousness, asthma, infectious diseases and for pregnancy prevention. Most teenagers take their medicines appropriately, but there is evidence of accidental or intentional inappropriate use or misuse, she says.

At a time when young people want to be independent of their parents and make their own decisions about their bodies and medications, they feel misunderstood by healthcare professionals, have concerns over side effects and may be confused by information coming from a variety of sources such as their friends, their family, the internet, the news, and the healthcare professionals they encounter, says Dr Bahri, who is the pharmacovigilance lead for guidelines and risk communication at the European Medicines Agency (London, UK), but who was speaking in a personal capacity. [1]

Part of teenage life is starting to make your own health choices. The medicines that teenagers use most frequently and largely autonomously include those for asthma, and painkillers such as paracetamol and ibuprofen. Every month in Europe and the USA, about 35% of boys and 45% of girls use painkillers for headaches. Teenagers also use other medicines: every month 32% use them for stomach aches, 6% for sleeping disorders and 6% for nervousness. The prevalence of asthma, one of the most frequent chronic disorders worldwide, is around 10% in teenagers, so most of those with this condition will be taking medication for it, and it is estimated from worldwide data that around a quarter of teenage girls will be taking some form of contraceptive, including hormonal ones. In addition, girls may be invited to receive the human papilloma virus (HPV) vaccine to protect them against cervical cancer. However, public discussions in the media over the usefulness and safety of these measures make some feel anxious and confused, she says.

Dr Bahri is investigating how well information about medications are communicated to teenagers, and has found that not only is there very little research into this area, but what there is indicates that healthcare professionals, including pharmacists, need to improve the way they talk to young people and communicate the risks and benefits of medicines.

The HPV vaccination programme is a good example of where healthcare professionals could be better prepared for communication with teenagers, she says. There were several incidents in Europe of HPV vaccination-related anxiety attacks among girls receiving the vaccine. In addition, in many countries in the world, older children and adolescents, rather than young children receive various vaccinations, and may develop concerns over them.

Research has found that although pharmacists know about the importance of talking to teenagers about their medications, they tend not to. This was shown in The Netherlands with the example of isotretinoin, which is sometimes prescribed for teenage acne. Isotretinoin causes birth defects and so can only be taken in conjunction with effective contraception, requiring the physician and pharmacist to initiate a conversation with teenage girls. The study showed that the pharmacists knew they should talk to the girls, but it didn't reveal why the majority of them did not comply fully with their role in the country's pregnancy prevention programme when dispensing isotretinoin. Obstacles to communication is an area where much more research needs to be done, says Dr Bahri.

As a pharmacist myself, I know how difficult these conversations can be, but I would advocate that pharmacists should be looking into their communication behaviour and identifying opportunities and successful methods for initiating caring and non-judgemental dialogue. It is vital that pharmacists overcome our own hesitation to talk; we should start the dialogue and listen to questions and concerns. It is important to help teenagers to care for their health, while being aware of their vulnerabilities as well as their capabilities.

She will tell the congress that pharmacists also need to be aware that increasingly medicines are being advertised on the internet to improve school performance, and they need to monitor this and inform teenagers about the risks.

Good communications with teenagers could also be vital for the well-being of the whole family in some circumstances. This can be the case in developing countries and among disadvantaged groups in the developed world, such as those who have migrated and have poor language skills.

Sometimes, in places where teenagers are the only literate person in the family, they may even bear the responsibility of the health of their siblings and the older members of their families, she says.

Dr Bahri concludes: Effective communications with teenagers at the individual and population level is vital, and pharmacists should consider investigating the use of text messages, social media and other web-based forms of communication with this age group, in addition to more traditional methods. We need to bear in mind that some research in different regions of the world has shown that teenagers still expect most information to come directly from their healthcare providers, but not necessarily from pharmacists.

As pharmacists, we should be prepared to handle the needs and feelings of young people in a sensitive manner, taking into account the fact that they are in a vulnerable phase where a bad experience could influence their current and future health behaviour.

Faster progress through puberty linked to behavior problems

Thu, 01 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Children who go through puberty at a faster rate are more likely to act out and to suffer from anxiety and depression, according to a study by researchers at Penn State, Duke University and the University of California, Davis. The results suggest that primary care providers, teachers and parents should look not only at the timing of puberty in relation to kids' behaviour problems, but also at the tempo of puberty -- how fast or slow kids go through puberty.

Past work has examined the timing of puberty and shown the negative consequences of entering puberty at an early age, but there has been little work done to investigate the effects of tempo, said Kristine Marceau, a Penn State graduate student and the study's primary author. By using a novel statistical tool to simultaneously model the timing and tempo of puberty in children, we present a much more comprehensive picture of what happens during adolescence and why behaviour problems may ensue as a result of going through these changes.

The team -- led by Elizabeth Susman, the Jean Phillips Shibley Professor of Biobehavioral Health at Penn State -- created a unique nonlinear mixed-effects model that incorporated data from 364 white boys and 373 white girls that had been collected as part of the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development, which had an initial goal of determining how variations in the environment are related to children's development. The data included information about breast and pubic hair development in girls and genital and pubic hair development in boys as assessed by nurses, as well as weight and height for both boys and girls. The data also included information on internalizing and externalizing behaviour problems as reported by boys' and girls' parents or other caregivers, and risky sexual behaviours as reported by the kids themselves.

We found that earlier timing for girls was related to a slew of behaviour problems, and we also found that a faster tempo of development independently predicted those same sorts of problem behaviours, said Marceau. Although timing and tempo both predicted behaviour problems in girls, timing and tempo weren't related to each other. For boys, though, we found a strong relationship between timing and tempo. For example, we found that boys who have later timing combined with slower tempo exhibited the least amount of acting out and externalizing problems.

The team's results will appear in the September issue of the journal Developmental Psychology.

Why does going through puberty at a faster rate relate to external behavior problems and internal anxiety and depression?

"The thought is that when the major changes of puberty are compressed into a shorter amount of time, adolescents don't have enough time to acclimate, so they're not emotionally or socially ready for all the changes that happen," said Marceau. "This is the explanation that originally was attributed solely to early timing, but we suggest that the same thing also is happening if the rate of puberty is compressed."

According to Susman, timing and tempo of puberty vary dramatically across kids. "Children are extremely sensitive to how fast or slow other kids are going through puberty, and that may contribute to both the internalizing depression-type problems or the externalizing problems of acting out," she said.

In the future, Susman plans to examine the effects of tempo of puberty on later women's health problems. "One of the things that has concerned me over the years is the relationship between early puberty and later women's health problems," she said. "Specifically, there is some indication that early timing of puberty relates to more reproductive cancers, with the speculated mechanism being estradiol. If you're an early maturer, you have a longer exposure to this hormone. The question is whether the tempo of puberty has similar implications for women's health."

Fathers benefit from seeking help as parents

Wed, 15 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Men are sometimes criticized for being unwilling to ask for directions when they travel, but they can benefit from looking for help as they begin their journeys as fathers, according to a researcher on fatherhood at the University of Chicago.

Along the way, they should not shy from asserting their roles, said Jennifer Bellamy, an Assistant Professor at the University of Chicago School of Social Service Administration.

Sometimes dads feel like they don't get the same level of support that moms do when they become parents, but I think dads should seek opportunities from the beginning to be involved with their children, said Bellamy, who worked on a research project in Texas on fatherhood and has published on the subject.

Fathers should, for instance, try to go to visits with the pediatrician and ask questions about their child's development, she suggested. She also said fathers should seek out groups in their communities that provide support and encouragement for fatherhood and visit websites devoted to fathering for tips on their role. Such resources can help fathers develop their distinctive strengths as parents.

We know that fathers play with children in a different way than mothers do, they are more physical, and that benefits the children. That physical activity actually helps the children's development, she said.

The 2010 U.S. Census showed that were 70.1 million fathers across the country and 25.3 million of those are in married couple families with children under age 18.

The Census also showed some dramatic changes for fathers; 1.8 million fathers head a single-parent household. The 2010 Census showed that men headed 15 percent of single-parent families, three times the percentage reported in 2000. In contrast, the 1970 Census showed that men headed only 1 percent of the single-parent households.

The School of Social Service Administration is a leading research center for the study of fatherhood. It provides field placements for its students in social service agencies serving young fathers, and the school's faculty is among the nation's leading scholars in family and fatherhood issues, particularly among fathers who need help from social workers.

Some of Bellamy's fieldwork, for instance, has been done with low-income never married parents and their children. In her work with the Texas Fragile Families Initiative program, Bellamy and her colleagues have been able to show how effectively interventions help young fathers.

Birth was often a 'magic moment' for the young fathers, many of whom reported becoming more responsible individuals in response to the feeling of attachment they had for their children, she said.

Successful programs were able to help connect young fathers with training and employment programs. The study found that school-focused programs, team-parenting programs, and community- based fatherhood programs were most useful in helping young dads develop.

Young fathers in effective programs were less likely to face criminal or substance abuse problems and were more willing to ask for parenting help. An evaluation of successful programs also showed they seemed to reduce repeat teenage births.

Working in the Texas program was something of an eye-opener for Bellamy. I had never really thought about fatherhood issues. The literature I was exposed to as a master's student in social work did not really discuss fathering, but working in the program made me realize what an important field it is, she said.

Teens with type 2 diabetes already show possible signs of impaired heart function

Tue, 07 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Heart function may be affected in people with Type 2 diabetes as early as adolescence, according to a new study that will be presented Sunday at The Endocrine Society's 93rd Annual Meeting in Boston.

Past studies in adults with Type 2 diabetes show that their heart and blood vessels' ability to adapt to exercise may be impaired. Our study shows that these changes in heart function may begin to happen very early after Type 2 diabetes occurs, said the study's lead author, Teresa Pinto, MD, a pediatric endocrinologist at the Dalhousie University IWK Health Centre in Halifax, Nova Scotia, Canada.

Pinto performed the research while at the University of Auckland in New Zealand. The researchers studied how the heart and blood vessels of 13 teenagers with Type 2 diabetes adapted to exercise, compared with 27 overweight or obese subjects who did not have diabetes and 19 nondiabetic and nonobese control subjects. The subjects were ages 12 to 20 and from New Zealand. Their body composition, including percentage of body fat, was determined using dual-energy x-ray absorptiometry (DEXA) scans.

All subjects performed an exercise test on a stationary bicycle designed for use in a magnetic resonance imaging (MRI) machine. With MRI, images were taken of each subject's heart and femoral artery, a large blood vessel in the leg that supplies the leg with blood. MRI took place while the subjects were at rest and during or immediately after exercise on the cycle.

The images of the heart showed that the hearts of subjects with Type 2 diabetes did not expand and fill up with blood between heart beats as well as the hearts of subjects in the other two groups. This occurred during exercise only, the authors found. With exercise, the amount of blood pumped out with each heart beat (the cardiac output) was normal in all three groups, although still lower in the diabetic group.

We showed that the heart's pumping function is strong, but it is not filling as well as normal between heart beats. This is known as diastolic dysfunction, Pinto said. Although this study did not determine the reason for this, we know that with diabetes, the heart can become stiffer, limiting its ability to stretch and expand.

In addition, images of the femoral artery showed that the flow of blood through the artery was significantly less in the diabetic group during exercise compared with the other two groups.

It appears that irrespective of weight, Type 2 diabetes seems to have a negative effect on the heart and blood vessels in adolescents, Pinto said. This impaired exercise capacity may be reversible with exercise training however, as some literature in adults suggests, but further studies are required to determine this.

Desserts with a low glycemic index may benefit weight-loss efforts for obese children

Mon, 06 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Overweight girls lose more weight and can better stay on a healthy diet if they eat sugar-free, low-fat desserts several times weekly, as opposed to any dessert once a week, a new study finds. The results will be reported Monday at The Endocrine Society's 93rd Annual Meeting in Boston.

Dieters commonly splurge on dessert once a week, usually choosing fattening items, said lead investigator Antonia Dastamani, MD, PhD, a pediatrician and research fellow at Athens University School of Medicine in Athens, Greece. However, we found a positive effect of more frequent consumption of desserts that have a low glycemic index and low glycemic load.

Carbohydrates have a low glycemic index (GI) if they raise glucose, or blood sugar, levels more slowly than other carbohydrates do. The glycemic load (GL), which depends on serving size, is the food's total effect on blood sugar.

Studies suggest that low GI/GL diets have a positive effect on weight control and improving insulin resistance, Dastamani said.

Obesity can cause insulin resistance, in which the body does not properly use the hormone insulin. This results in high blood sugar levels and sets the stage for development of diabetes.

Dastamani and her colleagues tested the effects of incorporating into a balanced diet certain low-calorie, low-GI/GL desserts containing sugar substitutes such as sucralose. The products are made by the Giotis Company, a food production company in Athens, which donated the desserts and helped fund the study.

The investigators studied the effects of two diets in 29 girls, ages 10 to 14 years, who had a body mass index (BMI) in the 85th percentile or above, considered overweight or obese. A group of 15 girls ate a diet consisting of 45 percent carbohydrates, 35 percent fats and 20 percent proteins, including the low-GI/GL desserts four times a week. The other group of 14 girls followed the same diet except, instead of the low-GI/GL desserts, they ate desserts of their choice once a week.

After three months on the diet, both groups improved their BMI (body composition). Compared with the second group, however, the group that ate the low-GI/GL desserts lost significantly more weight and had better average BMI and systolic blood pressure (the first number in a blood pressure reading), the authors reported.

Girls who ate the low-GI/GL desserts also had significantly improved levels of the appetite-suppressing hormone leptin, the researchers found. They also had better improvements in biochemical markers of insulin resistance (fasting insulin levels in the blood and the homeostatic model assessment, or HOMA, index).

Childhood obesity is pandemic, and dietary changes among overweight and obese children must be a priority, Dastamani said. Desserts with a low glycemic index and glycemic load, when eaten in moderation, are valuable tools in the treatment of pediatric obesity.

Athletic girls more likely to have impaired bone structure if menstrual cycle stops

Sun, 05 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Young female athletes who have stopped menstruating have a weakening in the quality of their bone structure that may predispose them to breaking a bone, despite getting plenty of weight-bearing exercise, a new study finds. The results will be presented Sunday at The Endocrine Society's 93rd Annual Meeting in Boston.

Given the high number of young women and girls involved in athletic activities and the fact that up to 24% of young female athletes may lose their periods, this finding represents a significant public health concern, said Madhusmita Misra, MD, the study's principal investigator.

Misra, a pediatric endocrinologist at Massachusetts General Hospital in Boston, said amenorrhea, or absence of menstruation, can result from intense physical activity, either alone or combined with inadequate intake of calories. In a previous study, Misra found that athletes who lose their periods have low bone density, a risk factor for fracture and premature osteoporosis. Because abnormal bone structure (microarchitecture) is a known independent risk factor for fractures among older women, she assessed it in the current study.

Misra and her colleagues studied 34 endurance athletes, ages 15 to 21, all of whom were involved in running or other weight-bearing activities. Sixteen athletes had no periods, and 18 had normal menstruation. The investigators studied the athletes' bone density and bone microarchitecture, and compared these measures with those from 16 nonathletic controls. To assess bone structure, they used a form of CT scanning called high-resolution peripheral quantitative computed tomography.

They found that nonmenstruating athletes have a bone structure that is abnormal compared with menstruating athletes and nonathletes. Differences were seen in cortical bone (the outer rim of compact bone) and in trabecular (spongy) bone at both sites studied: the tibia, or shinbone, and even a non-weight-bearing site, one of the long forearm bones near the wrist. Athletes who still got their menstrual periods did not have impaired bone structure, the researchers reported.

Our results are of particular concern to teenagers and young women, who are at a time in their lives when they should be actively accumulating bone and optimizing peak bone mass, she said.

Peak bone mass, the amount of bone present at the end of skeletal maturity, is usually achieved by the mid-20s and is an important factor in determining future bone health.

The study, which was funded by the National Institute of Child Health Development, also found that later age at starting menstruation was associated with a greater chance of bone structure impairments.

Bone microarchitecture may provide information regarding bone health independent of bone mineral density, Misra said. Your bone density score may not reveal the full risk of poor bone strength.

Anorexic girls have increased bone density after physiological estrogen treatment

Sat, 04 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Estrogen therapy improves low bone density due to anorexia nervosa in teenage girls with the disease when given as a patch or as a low oral dose that is physiological (close to the form or amount of estrogen the body makes naturally). These results of a new study are being presented Monday at The Endocrine Society's 93rd Annual Meeting in Boston.

A large proportion of adolescents with this eating disorder have low bone density and therefore are at an increased risk of fractures, said Madhusmita Misra, MD, the study's lead author and an associate professor of pediatrics at Harvard Medical School and Massachusetts General Hospital in Boston. An important cause of this low bone density is low levels of estrogen, a hormone in the body that prevents bone loss.

Previous studies have shown that giving oral estrogen combined with progesterone as birth control pills is not effective in increasing bone density in girls with anorexia nervosa, Misra said. However, the impact of giving estrogen in a more natural, or physiological, form has not been previously studied in girls with anorexia nervosa.

This National Institutes of Health-funded study explored, over an 18-month period, the effect of physiological estrogen replacement on bone accrual rates in 110 female patients with anorexia nervosa. These patients and 40 healthy-weight girls as controls were between ages 12 to 18 years, a common time for anorexia nervosa to start and also an important time for building optimal bone mass, Misra said.

Girls with anorexia nervosa were randomly assigned to receive either a placebo (an inactive substance) or one of two types of estrogen based on their bone maturity. The researchers estimated bone maturity (whether growth plates had closed) based on wrist and hand X-rays. Those girls with mature bone received either placebo or a full adult dose of estrogen (100 micrograms of estradiol) given via a skin patch. This transdermal form is a natural form of estrogen, Misra said. Girls receiving estrogen also received cyclic progesterone pills to reduce the risk of endometrial cancer.

Girls with anorexia nervosa whose bones were immature received incremental low doses of oral estrogen, ranging from 3.75 to 11.25 micrograms of estradiol. These low, natural levels mimic estrogen levels seen in early puberty and avoid accelerating fusion of the growth plates, which would otherwise limit height potential, Misra said. Healthy-weight controls received no treatment other than calcium and vitamin D supplements, which all subjects received.

Using dual-energy X-ray absorptiometry (DEXA) bone density scans, the researchers assessed bone mineral density at the lumbar spine (lower back), hip and whole body. Physiological estrogen administration caused a significant increase in bone density at the spine and hip, compared with placebo, as found on DEXA Z-scores, the authors reported. However, Misra said that estrogen did not result in a complete catch-up to normal bone density measures. Girls with anorexia nervosa still had lower bone density than healthy-weight controls did.

In addition to weight gain, physiological estrogen could be a potential therapeutic option for optimizing bone mass in girls with anorexia nervosa, Misra said. The decision to treat would depend on the individual patient and her fracture risks.

BUSM names Deborah Frank, M.D., inaugural professors in child health and well-being

Wed, 01 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Boston University School of Medicine (BUSM) announces the establishment of an endowed Professorship in Child Health and Well-Being in the department of Pediatrics. This anonymously donated endowment reinforces the importance of supporting clinical practice focusing on public policies related to ending hunger and hardship in young children.

The inaugural incumbent of this professorship is Deborah A. Frank, MD. Frank serves as BUSM professor of Pediatrics; director, Grow Clinic for Children at Boston Medical Center (BMC); and founder and principal investigator of Children's HealthWatch, a network of pediatric and public health researchers working to improve child health. A highly respected national authority, she has testified before both the United States and Massachusetts legislatures on the growing national problem of hunger and its effects on children. Frank also leads research funded by the National Institute on Drug Abuse on the effects of intrauterine exposure to cocaine and other substances on children's long term development. She advocates at hearings and in the media against criminalizing addicted mothers or stigmatizing their children.

Frank has served on numerous committees and advisory boards including the Mayor's Hunger Commission, the Massachusetts Child Hunger Initiative and the Physicians Task Force on Childhood Hunger in Massachusetts. She has received awards in recognition for her work including the 2004 Standing Ovation Award, Massachusetts Human Services Coalition; 2007 Woman of Valor Award, Jewish Funds for Justice; 2008 Woman of Justice Award, Boston Lawyer's Weekly, and more recently in 2010 Dr. Frank received the Massachusetts Health Council Outstanding Leadership Award and the Physician Advocacy Merit Award from the Institute on Medicine as a Profession at Columbia University. Frank is the author of more than 50 papers and articles.

An endowed professorship is one of the most significant means by which BUSM can honor its highly esteemed teachers and researchers. They are important to the mission of BUSM because they offer our school the opportunity to attract highly distinguished faculty, said BUSM Dean Karen H. Antman, MD. Dr. Frank's long-standing commitment to caring for and training others to care for children and to understanding and preventing child hunger makes her a deserving candidate to be the first to hold this professorship. By selecting Dr. Frank for this important honor we show continued commitment to serving the most basic needs of the youngest and most vulnerable members of our society.

A summa cum laude graduate of Radcliffe College and Harvard Medical School, Frank did her residency at Children's Orthopedic Hospital in Seattle and completed a fellowship in Child Development with T. Berry Brazelton at Children's Hospital in Boston. She joined BUSM as a clinical assistant professor of Pediatrics in 1981 when she also established the Failure to Thrive Program at Boston City Hospital, now known as the Grow Clinic for Children at Boston Medical Center (BMC). Frank was named BUSM professor of Pediatrics in 2001.

First controlled clinical trial for Juvenile Batten disease to start

Tue, 31 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) After years of building hope for a treatment, Rochester researchers and clinicians will begin the first controlled clinical trial for Juvenile Batten disease this summer, thanks to $1 million in grants from the Food and Drug Administration (FDA) and the Batten Disease Support and Research Association (BDRSA). The trial will examine whether mycophenolate mofetil, a drug FDA-approved to suppress the immune system and prevent organ rejection in children, is safe for these children and whether it can slow or halt the progression of the fatal neurodegenerative disease.

Families have been anxiously awaiting word on when we could launch this clinical trial, said Frederick Marshall, M.D., principal investigator of the trial and Associate Professor of Neurology. Juvenile Batten Disease is very rare, but the families are very close and well-informed about potential treatments. They have been watching the progress of this research and hoping for the day when we could launch the trial.

Juvenile Batten disease is a lysosomal-storage disease that strikes seemingly healthy children and progressively robs them of their abilities to see, reason and move. It ultimately kills them in late adolescence or young adulthood. Batten disease is in the same family of diseases as Krabbe disease to which former Buffalo Bills quarterback Jim Kelly lost his son, Hunter, in 2005.

Juvenile Batten disease is a very rare recessively inherited genetic condition. That means both parents must pass on the abnormal gene in order for a child to develop the disease, but it also means there is a 1 in 4 chance another child in a family has it. Because the onset of symptoms usually occurs sometime between 4- and 8-years-old, parents often have more children before they know they are carriers and before they can obtain genetic counseling.

The trial will enroll 30 patients who are already showing symptoms of the disease. Each child will be their own control during the study, taking the medication for eight weeks, and a placebo for eight weeks. The children will take a break in the middle of the trial to clear the body of medication. Because it is a double-blind study, the researcher-clinicians and the families will not know when the child is taking a placebo or the active medication. Patients will have to travel to Rochester four times over the 22 weeks they are in the trial, which is no small feat, considering the difficulties of traveling with children who may be blind and/or seizure-prone.

Rigorous study confirms video game playing increases food intake in teens

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The US Centers for Disease Control and Prevention estimates that almost 18% of US teens are obese. Although most experts agree that our growing obesity epidemic is driven by both inadequate physical activity and excessive caloric intake, implementing solutions is extraordinarily difficult. One area that has caught the attention of health researchers is the observation that trends in video game playing parallel obesity rates on a population basis. Furthermore, several studies have documented a positive association between how much time a child plays video games and his or her chance of being obese. However, correlation does not necessarily imply causality, and controlled intervention studies are required to test whether playing video games causes children to increase their food intake and/or decrease their energy expenditure. In the first such study of this kind, Canadian and Danish researchers tested their hypothesis that video game playing is accompanied by increased spontaneous food intake.

This study is an especially important piece of the scientific puzzle in this arena because it went beyond simply simultaneously documenting the relationship between video game playing and food intake in kids, said Shelley McGuire, PhD, American Society for Nutrition spokesperson. Instead, it actually studied the same group of children during two separate, experimentally-administered periods of rest and video-game play, and then used gold-standard methods to measure important outcomes such as food intake, energy expenditure, and feelings of hunger and appetite. Consequently, the results can be used with a high degree of confidence to suggest that playing virtual soccer can affect food intake. Very interesting! Given our current obesity crisis in kids, I will be curious to follow the results of follow-up studies. For instance, do violent games or educational games have the same effect as sports-related games?

Healthy, normal-weight male teens (mean age: ~17 y) were studied in this crossover intervention trial consisting of two 1-h periods. In one period, subjects rested (control period); in the other, they played video games. For both study periods (which occurred at 10:30 AM), the youth reported to a research laboratory after an overnight fast and were provided with a standardized breakfast (8:00 AM). During the intervention periods, blood samples were collected every 10 min, and energy expenditure was assessed by using indirect calorimetry. Immediately thereafter, each participant was offered full access to a spaghetti lunch. Food intake and measurements of hunger, satiety, fullness, and appetite were assessed.

Blood glucose concentrations increased more when playing video games than during the control period, but there was no differential effect on insulin or ghrelin (a hormone thought to signal the sensation of hunger to the brain). Energy expenditure was 21 kcal/h higher during video game play than during the resting condition. However, subjects ate 80 more kilocalories after playing the video games than they did after the control period. This resulted in a net positive energy of 163 kcal during the entire day when video games were played compared with when subjects rested, despite the fact that the subjects reported similar appetite ratings during these periods.

The authors concluded that their results provide preliminary evidence that male teens playing video games for 1 h consume more calories in the short-term than they do after 1 h of rest. Moreover, overconsumption of food after playing video games occurs without changes in perceived hunger and appetite. Additional studies are needed to determine the long-term effects on weight gain and health.

Researchers join forces to cure deadly childhood disease

Tue, 03 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) ST. LOUIS -- The Center for World Health and Medicine at Saint Louis University and the Institute for OneWorld Health have established a joint research agreement to develop new drugs to combat diarrhea, which is the second leading cause of death worldwide in children under age 5.

Each year more than two million children in developing countries die from diarrheal diseases, which are caused by a wide range of bacterial, parasitic and viral pathogens. These organisms can be particularly virulent in the developing world, which is plagued by poor sanitation, unclean water, malnutrition and a lack of knowledge about how to prevent the illnesses.

Diarrhea is frequently a symptom of another disease, such as cholera and rotavirus, and turns deadly in children who rapidly lose body fluids, become severely dehydrated and go into shock.

When children in St. Louis, Mo., develop severe diarrhea and become lethargic, their parents take them to the emergency room, where they are given IV fluids, said Peter Ruminski, executive director of the Center for World Health and Medicine.

Places like rural Sub-Saharan Africa or Haiti lack adequate sanitation and access to clean water and don't have the same infrastructure that we have. Families there are not as readily able to hop in their vehicles, drive to the hospital and get hooked up to an IV to replenish vital body fluids. So if we can come up with a therapy to reduce fluid loss and get children through the acute attack phase of their diarrheal illness, we'll have an immediate effect on the number of children who die. Our goal is to save lives.

The collaboration between the Center for World Health and Medicine and the Institute for OneWorld Health (iOWH) aims to develop safe and effective anti-secretory drugs, which inhibit the loss of fluid in the intestine regardless of the root cause of the problem. These drugs are intended to be used as an adjunct to oral rehydration therapy.

The Institute for OneWorld Health is committed to finding treatments for cholera and other diarrheal diseases that claim the lives of so many infants and children around the world, said Richard Chin, M.D., iOWH CEO. This partnership will bring us closer to saving millions of children who would otherwise die from treatable diseases.

Under the agreement, the Center for World Health and Medicine will provide expertise in medicinal chemistry and pharmacology to identify potential anti-secretory drug candidates for future development.

Jon Jacobsen, Ph.D., director of chemistry at SLU's Center for World Health and Medicine, is leading the effort along with Brian Bond, Ph.D., the Center's director of pharmacology, and will closely collaborate with the medicinal chemistry group at the University of Missouri-St. Louis, led by John Walker, Ph.D.

Possible new approach to treating deadly leukemia in babies

Tue, 12 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) MAYWOOD, Ill. -- A Loyola University Health System study points to a promising new approach to treating an aggressive and usually fatal leukemia in babies.

The study involved a type of leukemia called mixed lineage leukemia, or MLL. Only 25 to 50 percent of babies diagnosed with MLL leukemia survive the disease.

The study demonstrated how it may be possible to kill cancerous MLL cells by targeting a protein called DOT1. Researchers showed that, without the DOT1 protein, cancerous MLL cells died, said Charles Hemenway, MD, PhD, senior author of the study.

We are focusing on the unique biology of MLL leukemia, Hemenway said.

The study was presented at the 2011 meeting of the American Association for Cancer Research.

Between 5 and 10 percent of all leukemias are MLL positive. In children older than 1 who have MLL leukemia, the survival rate is about 75 percent. By comparison, the survival rate for most other childhood leukemias is about 90 percent. Adults who have MLL leukemia also have lower survival rates than adults with other types of leukemia.

MLL is a subtype of leukemia caused by a mutation in a gene called MLL. The mutated gene codes for an abnormal MLL protein, which turns a blood cell into a cancer cell. For reasons researchers don't understand, MLL leukemia is more resistant to chemotherapy than other forms of leukemia.

In previous studies, Loyola researchers developed a small molecule, called PFWT, that binds to the MLL protein. This binding effectively disables the MLL protein, leading to the death of the cancer cell. Later this year, Hemenway plans to begin testing PFWT molecules on mice that have MLL leukemia.

The new study points to a second possible way to attack MLL cells, by targeting the DOT1 protein. DOT1 works in conjunction with the MLL protein. The study demonstrated that DOT1 is critical for keeping cancer MLL cancer cells alive.

Researchers cultured MLL cells from mice. From these cells, researchers removed the gene that codes for the DOT1 protein. Without the gene, the cell no longer produced the DOT1 protein, and without the DOT1 protein, the cancerous cells died.

Loyola researchers are collaborating with researchers from Nemours/Alfred I. duPont Hospital for Children to identify molecules that could disable DOT1.

Hemenway said a double-barrel approach -- targeting both the DOT1 and MLL proteins --potentially could be a more effective treatment than current chemotherapy, with fewer side effects. But it will take years of additional research and testing before such a treatment would be available for patients.

Hemenway said several other Loyola researchers are studying MLL leukemia. There are a lot of opportunities for collaboration, he said.

Childhood psychological problems have long-term economic and social impact, study finds

Mon, 28 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Psychological problems experienced during childhood can have a long-lasting impact on an individual's life course, reducing people's earnings and decreasing the chances of establishing long-lasting relationships, according to a new study.

Analyzing information about large group of British residents followed for five decades from the week of their birth, researchers found that family income was about one-fourth lower on average by age 50 among those who experienced serious psychological problems during childhood than among those who did not experience such problems.

In addition, childhood psychological problems were associated later in life with being less conscientious, having a lower likelihood of being married and having less-stable personal relationships, according to findings being published in the Proceedings of the National Academies of Sciences.

These findings demonstrate that childhood psychological problems can have significant negative impacts over the course of an individual's life, much more so than childhood physical health problems, said James P. Smith, one of the study's authors and a senior economist at the RAND Corporation, a nonprofit research organization. The findings suggest that increasing efforts to address these problems early in children may have large economic payoffs later in life.

The other two authors of the study are Alissa Goodman and Robert Joyce of the Institute for Fiscal Studies in London.

Researchers found that the impacts of psychological disorders during childhood are far more important individually and collectively over a lifetime than childhood physical health problems. To illustrate, while family income at age 50 is reduced by 25 percent or more due to childhood mental problems, the reduction in family income on average is 9 percent due to major childhood physical health problems and only 3 percent due to minor childhood physical health problems. A central reason for the larger impact of childhood mental health problems is their effects take place much earlier in childhood and persist, researchers say.

The study is the latest in a growing body of evidence that shows psychological troubles early in life can have a long-term negative impact on earnings and social relationships. An earlier study co-authored by Smith showed that childhood psychological problems had a major impact on adult socioeconomic standing, costing $2.1 trillion over the lifetimes of all affected Americans. The results found for the American sample closely parallel those found for the British sample. Another source of concern is that in both America and Britain childhood mental problems appear to be increasing over time.

The latest study was conducted by analyzing information collected as part of the National Child Development Study, which has followed the lives of a single group of 17,634 children who were born in Britain during the first week of March in 1958.

Information has been collected from the group periodically, including surveys about childhood physical and psychological health through physician-led examinations, extensive parental questionnaires and teacher reports. The study includes detailed information about participants' parents, including socio-economic details and family circumstances such as whether there was instability in the home.

Researchers found that the negative economic impact of childhood psychological problems were apparent early in adulthood, with household income 19 percent lower among 23-year-olds who had psychological problems as a child as compared to those who did not.

Some of the smaller family income is caused by a lower likelihood that those who had childhood psychological problems will live with a partner as an adult. By age 50, people who had childhood psychological problems had a 6 percent lower probability of being married or cohabitating and an 11 percent lower chance of working.

The National Child Development Study includes assessments of participants' cognitive functioning and personality traits at age 50, allowing researchers to estimate the impact of childhood psychological problems in those areas.

Children with mental health issues showed reduced cognitive abilities as adults, possibly because their psychological problems make it difficult for them to concentrate and remember, researchers say. Childhood mental health problems also had a negative impact at age 50 on agreeableness and conscientiousness, two key measures of personality.

Researchers found childhood mental health problems also had significant effects on inhibiting social mobility across and within generations and reduced the number of distinct continuous jobs a person held as an adult. This is important because one way people increase their income is by changing jobs by moving on to better opportunities.

Critical thinking: How do children learn who to trust?

Mon, 21 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A UT Dallas researcher is examining how children evaluate information to solve problems and learn how to think critically, with the aim of combating misleading advertising aimed at young people.

Children's lack of cynicism is refreshing to adults. But to navigate through life successfully, individuals must develop an ability to differentiate between reliable and doubtful sources of information. Dr. Candice Mills, assistant professor in the School of Behavioral and Brain Sciences and a researcher in the Center for Children and Families, is currently working with preschool and elementary-age children in two separate studies.

The first study, sponsored by a grant from the National Institute of Child Health and Human Development, is examining ways to help preschool-age children determine which source will be most helpful in answering their questions for problem solving. Mills and her team also are looking at other aspects of problem solving, such as the ability to ask good questions and use new information.

A group of 4- and 5-year-olds are being asked to solve simple problems with the help of outside sources with different levels of knowledge: a knowledgeable source, an ignorant source (who admits to not knowing the answers) and an inaccurate source (who provides wrong answers). The experiment manipulates how children learn about the knowledge status of each source: through experience, explicit labeling, observation or the combination of explicit labeling and observation.

Given the difficulty that children and adults often have in problem solving, it is important to better understand the rudimentary development of problem-solving skills, Mills said. The results from this research will inform scientists and practitioners in education and child development regarding early developments in children's problem-solving abilities. Determining some of the factors that may help children recognize that a source should be discounted should be useful in developing programs to combat misleading ads.

Another study looks at 7-to 9-year-old children and how they develop the ability to critically evaluate the information they encounter. Children are participating in several short tasks designed to measure how they consider information.

The study also involves observing how parents and children interact when discussing questionable sources because parent-child interaction is considered vital to learning. Parent-child conversations are being monitored to see how they discuss different kinds of misinformation presented in storybooks.

Most young children can recognize some sources are untrustworthy because of inaccuracy or deception, but they may have a hard time spotting biased information or exaggerated claims. Developing this ability to discern will arm young people against misleading information and could help them develop into better decision-makers as adults, Mills said.

This project is supported by a grant from the Timberlawn Psychiatric Research Foundation.

By examining these issues, we can gain important insight into how to nurture the development of critical-thinking skills as children grow into adults, Mills said.

Vital funding for children's brain tumor research

Fri, 04 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) New research into drugs which could prevent the return of persistent brain tumours in children has won vital funding from two major brain tumour charities.

The pioneering work in this historically underfunded area is being carried out at the Children's Brain Tumour Research Centre at The University of Nottingham, one of the centres of excellence in Europe.

The new research has been jointly funded by the Samantha Dickson Brain Tumour Trust and the Joseph Foote Charitable Trust, both charities set up by families who have lost children to the disease.

The scientists will be investigating 'ependymoma', a tumour type from which less than half of the children diagnosed will survive. It's a type that usually affects children, and develops from the cells lining the fluid-filled spaces in the brain called ventricles. Even after surgical removal combined with chemotherapy and radiotherapy, this type of cancer tends to return in a therapy-resistant form in up to half of the cases.

Normal, healthy cells use 'tumour suppressor genes' to help control their growth. But in certain ependymoma cells, some of these genes are de-activated by proteins called 'histone deacetylases', allowing the cells to grow and multiply in an uncontrolled way.

The team is investigating a group of drugs called 'histone deacetylase inhibitors' (HDACi) which are designed to re-activate the body's natural defence mechanisms against brain cancer. Previous work by the group in the lab shows that the HDACi 'Trichostatin A' causes most ependymoma cells to grow more slowly and eventually die. One HDACi is currently being trialled in the treatment of adult patients with another type of brain tumour, 'glioblastoma multiforme'.

Leading the research, Professor Richard Grundy, said: This is vital funding which will make a real difference to our work. It is hoped that this research will lead to a better understanding of the biology of the cancer cells that return following initial treatment, and of the factors responsible for their resistance to therapy. This could lead to new ways to predict how these tumours will behave, and how ependymoma cells can be targeted and destroyed by new cancer drugs.

Paul Carbury, CEO of the Samantha Dickson Brain Tumour Trust, said: We are proud to be working with the Joseph Foote Charitable Trust to offer funding that will facilitate this vital research. The fact that this new project was selected through our accredited competitive peer review process shows that it is especially deserving of our support. We're optimistic that it will directly lead to the development of a new and effective treatment that will improve patients' outlooks and could save lives.

Andy Foote of the Joseph Foote Charitable Trust added: Our organisation was set up to fund research just like this, as it was an ependymoma that led to the tragic loss of our son, Joseph. Both the SDBTT and the JFCT have a strong track record of funding research, including previous work at The University of Nottingham, and it is our constant hope that partnerships such as this will produce results which will give cause for optimism for anyone whose lives are affected by brain cancer.

6-month drug regimen cuts HIV risk for breastfeeding infants, NIH study finds

Wed, 02 Mar 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Giving breastfeeding infants of HIV-infected mothers a daily dose of the antiretroviral drug nevirapine for six months halved the risk of HIV transmission to the infants at age 6 months compared with giving infants the drug daily for six weeks, according to preliminary clinical trial data presented today.

The longer nevirapine regimen achieved a 75 percent reduction in HIV transmission risk through breast milk for the infants of HIV-infected mothers with higher T-cell counts who had not yet begun treatment for HIV.

The study was presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

Extended breastfeeding reduces infant mortality in places that lack safe, clean water by protecting babies from common childhood diseases because breast milk contains protective antibodies from the mother that formula feeding does not provide, says Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, which funds the trial. These findings show that giving the infants of HIV-infected mothers an antiretroviral drug daily for the full duration of breastfeeding safely minimizes the threat of HIV transmission through breast milk while preserving the health benefits of extended breastfeeding.

The new findings apply to mothers and infants in developing nations, where infectious diseases such as gastroenteritis and pneumonia often pose a life-threatening risk to very young children. The U.S. Department of Health and Human Services recommends that HIV-infected mothers in the United States feed their babies with infant formula, not breast milk, because safe and affordable formula is available, infant deaths due to infections are low and only total avoidance of breastfeeding will completely protect these infants from HIV transmission through breast milk.

This advanced-stage clinical trial known as HPTN 046 is co-funded by NIAID, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute on Drug Abuse and the National Institute of Mental Health, all part of NIH. The HIV Prevention Trials Network and the International Maternal, Pediatric and Adolescent AIDS Clinical Trials Network are conducting the trial under the leadership of Hoosen Coovadia, M.D., M.B.B.S., of the University of the Witwatersrand in Durban, South Africa. Bonnie Maldonado, M.D., of Stanford University in Stanford, Calif., presented the study results for Dr. Coovadia on March 2, 2011, at CROI.

More than 1,500 mother-infant pairs in South Africa, Tanzania, Uganda and Zimbabwe are participating in HPTN 046, which began in February 2007 and will conclude in July 2011. The participating infants received daily nevirapine for the first six weeks after birth. Those infants who remained free of HIV then were assigned at random to receive either daily nevirapine or a placebo until six months after birth or the cessation of breastfeeding, whichever came first. Study investigators compared the rates of HIV infection in the two groups of infants, and evaluated and compared the safety and tolerance of nevirapine in the infants.

$1.9 million NIH grant supports research in the most common soft tissue tumor in children

Mon, 21 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A nearly $2 million grant from the National Institutes of Health (NIH) will help investigators at Nationwide Children's Hospital search for biomarkers that may be linked to the development and outcome of hemangiomas, the most common soft tissue tumor in children. Nationwide Children's is home to the only Hemangioma and Vascular Malformations Clinic in the United States with an NIH-sponsored clinical study.

A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. Hemangiomas appear as a red to reddish-purple, raised lesion or as a massive, raised tumor.

Hemangiomas can be extremely disfiguring and life-threatening, resulting in significant distress for the families of affected children, said the grant's principal investigator, Gayle Gordillo, MD, director of the Hemangioma and Vascular Malformations Clinic in Plastic and Reconstructive Surgery at Nationwide Children's Hospital. A critical barrier to improving the clinical outcomes for affected children is the lack of low-risk treatment options. The most effective treatment options all have life-threatening side effects.

Dr. Gordillo's laboratory research using a mouse-model has shown that the formation of these soft tissue tumors depends on nox-4. Nox-4 is an enzyme involved in the production of reactive oxygen species, a natural part of a healthy cellular environment. However, excessive production of reactive oxygen species can result in significant damage to the cell.

As part of the NIH-funded study, Dr. Gordillo and colleagues at both Nationwide Children's Hospital and The Ohio State University Medical Center, will examine urine and blood samples from patients with hemangioma beginning from the time they enroll in the study until they are 2 years of age. They will also perform ultrasound on each patient to measure the size of the hemangioma and velocity of the blood flowing to the tumor. Recruitment for study participants will take place at Nationwide Children's.

By comparing samples from these patients with samples from age-matched healthy children, Dr. Gordillo's team will be able to investigate how nox-4 regulates growth of endothelial cells that develop into tumors. They will also search to determine whether biological products caused by nox-4 function can be used as biomarkers to determine patient outcome.

This is the first prospective, longitudinal study aimed at identifying biomarkers in children with hemangiomas, said Dr. Gordillo, also a faculty member at The Ohio State University College of Medicine. Our goal is to further understand the role oxidant production has on hemangioma formation. Our findings could help identify potential new treatment targets and establish biomarkers that can be used to design clinical trials to test new therapeutics to treat these soft tissue tumors.

Study shows tobacco retail proximity to schools

Mon, 21 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- For years the tobacco industry has argued that efforts to ban tobacco advertising near schools would constitute a total ban on tobacco advertising in urban areas.

But public health researchers at the University at Buffalo and Roswell Park Cancer Institute have presented research that shows this is not the case in Buffalo and Niagara Falls, N.Y. The UB and RPCI researchers presented their study results in a poster session on Feb. 18 at the annual meeting of the Society for Research on Nicotine and Tobacco held in Toronto.

They found that tobacco outlets in Buffalo and Niagara Falls are more concentrated around elementary and secondary schools; the outlets (convenience stores, groceries, delis, etc.) also are more densely concentrated in lower-income areas, which may be exacerbating tobacco-use disparities between socioeconomic groups.

According to the tobacco industry's argument, the area around schools in urban areas comprises a significant percentage of land area and population that would be off-limits to tobacco advertisements if an advertising ban were in place.

The tobacco industry has stated that a tobacco advertising ban within a 1,000-foot buffer zone near schools in urban areas would be equivalent to a total ban on advertising and would, therefore, be unconstitutional on First Amendment grounds, explains Andrea Licht, a doctoral candidate in the Department of Social and Preventive Medicine in the UB School of Public Health and Health Professions. Licht is first author on the study.

However, based on our analyses, a law banning tobacco advertising within 1,000 feet of schools would affect fewer than half of their outlets, she says. We also found that only about one-third of the population potentially lives within this 1,000-foot buffer zone, so such an advertising ban would not act like a 'de facto' ban, as industry has claimed.

During 2009-10, the years covered by the study, there were 350 tobacco retail outlets and 104 schools located in the City of Buffalo.

The study found that 17.3 percent of schools in Buffalo have a tobacco retail outlet located within 500 feet, while 49.9 percent have a tobacco retail outlet located within 1,000 feet and 71.2 percent of schools have a tobacco retail outlet located within 1,500 feet.

In the City of Niagara Falls, there were 65 tobacco retail outlets and 15 schools. Of those 15 schools, 13.3 percent have a tobacco retail outlet located within 500 feet, 33.3 percent have a tobacco retail outlet within 1,000 feet and 46.7 percent of schools have a tobacco retail outlet within 1,500 feet.

The proximity to schools is significant because smoking patterns are almost exclusively developed during the adolescent and teen years, Licht explains.

These outlets near the schools and in lower-income areas may be more likely to be frequented by adolescents, young adults and other disadvantaged populations, says Licht. Since availability, accessibility and the perception that smoking is normal are all associated with higher youth smoking rates, it is likely that advertising bans near schools may serve to reduce youth smoking initiation.

Modell Chair in Pediatric Immunology established

Wed, 16 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) The Children's Hospital of Philadelphia has announced the establishment of the Jeffrey Modell Endowed Chair in Pediatric Immunology Research.

A ceremony on Feb. 15 at the Hospital's Ruth and Tristram Colket, Jr. Translational Research Building recognized the first holder of the chair, pediatric immunologist Jordan S. Orange, M.D., Ph.D. The chair's $2 million endowment will allow Dr. Orange to break new ground in his ongoing research. Dr. Orange is internationally prominent for studying and treating primary immunodeficiency disorders in children.

We appreciate the generosity of Fred and Vicki Modell for their continuing support of Dr. Orange's important work, said Steven M. Altschuler, M.D., chief executive officer of The Children's Hospital of Philadelphia. This gift will advance the efforts by Dr. Orange and the Jeffrey Modell Foundation to translate scientific knowledge into real improvements in children's lives.

Dr. Altschuler presented the endowed chair to Dr. Orange. Fred and Vicki Modell spoke at the ceremony, as did Alan R. Cohen, M.D., physician-in-chief of Children's Hospital.

Dr. Orange is already the director of the Jeffrey Modell Diagnostic Center at Children's Hospital, a premier program among dozens of centers worldwide that have been established by the Jeffrey Modell Foundation to provide expert diagnosis and treatment to patients with primary immunodeficiency diseases. Co-founded by Fred and Vicki Modell in 1986, the Foundation honors the memory of their son Jeffrey, who died at age 15 from complications of primary immunodeficiency.

Primary immunodeficiencies include over 150 genetic disorders in which the immune system's ability to produce specific antibodies to fight off infection is greatly impaired or absent. Early diagnosis and treatment are essential to preventing recurrent infections from doing permanent damage.

Dr. Orange's research focuses on the biology of natural killer cells and the innate immune system, with a clinical focus on primary immunodeficiency disease. He has received funding from the National Institute of Allergy and Infectious Diseases and the United States Immunodeficiency Network to support his laboratory work, and has authored over 100 scientific publications. In 2009 the American Philosophical Society awarded him the Judson Daland Prize for Clinical Investigation, which honors outstanding achievements in patient-oriented research.

Over the past decade, Dr. Orange has redefined the field of human natural killer cell deficiencies in various genetic disorders. He recently collaborated with European researchers who achieved marked clinical improvements in using gene therapy to treat young children with Wiskott-Aldrich syndrome, a rare but often severe immunodeficiency disorder. At Children's Hospital, he is currently conducting clinical trials testing the use of immunotherapy to boost immune function in children with Wiskott-Aldrich syndrome.

In addition to his duties at The Children's Hospital of Philadelphia, Dr. Orange is on the Pediatrics faculty of the University of Pennsylvania School of Medicine and is an elected member of the American Society for Clinical Investigation.

Johns Hopkins School of Medicine postdoctoral fellows win awards

Wed, 09 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Nine Johns Hopkins University School of Medicine postdoctoral fellows recently were awarded fellowships. Rita Strack, Ph.D., received one of 12 total Damon Runyon Cancer Research Foundation fellowships, and Bagrat Abazyan, M.D., Robert H. Cudmore, Ph.D., Mi-Hyeon Jang, Ph.D., Shinichi Kano, Sun-Hong Kim, Ph.D., M.D., Ph.D., Minae Niwa, Ph.D., Frederick Charles Nucifora Jr., Ph.D., D.O., M.H.S., and Emily G. Severance, Ph.D., were among the 214 recipients of the NARSAD: The Brain and Behavior Research Fund Young Investigator fellowship.

The Damon Runyon Cancer Research Foundation, a nonprofit organization focused on supporting innovative early career researchers, encourages the nation's most promising young scientists to pursue careers in cancer research by providing them with independent funding ($156,000 over three years) to work on innovative projects. Rita L. Strack, Ph.D., a postdoc in molecular biology and genetics, is studying how cells ensure quality control during protein synthesis. The quality control process, called nonsense-mediated decay, is essential for cells to function properly; synthesizing defective proteins can lead to many types of cancer. This process may be a novel target for cancer diagnosis or therapeutics.

Since 1987, NARSAD: The Brain and Behavior Research Fund has awarded more than $274 million in 4,046 grants to 3,319 scientists around the world. Receiving up to $60,000 over two years, the fellowship recipients pursue brain and behavior research related to schizophrenia, depression, bipolar disorder, autism, ADHD and anxiety disorders, such as OCD and PTSD.

Robert H. Cudmore, Ph.D., a postdoctoral fellow in neuroscience, is studying on the cellular level the effects of exercise as an alternative and complementary treatment for mood disorders. Minae Niwa, Ph.D., of of psychiatry and behavioral sciences, is studying how the immune system affects functioning of the dopamine neurotransmitter system to induce psychiatric disorders. Frederick Charles Nucifora Jr., Ph.D., D.O., M.H.S., an assistant professor of psychiatry, is exploring the role of a gene called neuronal PAS3 (NPAS3) in schizophrenia. Bagrat Abazyan, M.D., a fellow in psychiatry and behavioral sciences, is generating a mouse model of a gene that when functioning abnormally in brain cells may contribute to symptoms of schizophrenia. Mi-Hyeon Jang, Ph.D., a postdoctoral fellow in neurology, is exploring how new cells are born in the hippocampal region of the brain and how this is affected by the so-called disrupted-in-schizophrenia-1 (DISC1) gene. Shinichi Kano, M.D., Ph.D., of psychiatry and behavioral sciences, is investigating a mechanism through which altered glial cells and infection may work synergistically to contribute to schizophrenia. Sun-Hong Kim, Ph.D., a postdoctoral fellow in psychiatry and behavioral sciences, is studying a new mediator of nitric oxide-regulated behaviors in relation to brain development disturbances implicated in schizophrenia. Emily G. Severance, Ph.D., a research associate in pediatrics, is testing whether a breached gastrointestinal barrier contributes to symptoms of psychiatric disorders.

Study suggests why HIV-uninfected babies of mothers with HIV might be more prone to infections

Tue, 08 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Babies whose mothers have HIV, but who are not HIV-infected themselves, are born with lower levels of specific proteins in their blood called antibodies, which fight infection, compared with babies not exposed to HIV, a new study has found. The finding, published today in the Journal of the American Medical Association, might explain in part why uninfected babies born to women with HIV have a higher risk of illness and death early in life.

Major programmes using antiretroviral drugs have successfully reduced the rate of mother-to-child transmission of HIV from 20-30 per cent to around five per cent in some areas of South Africa and to less than one per cent in developed countries. However, HIV-uninfected infants born to HIV-infected mothers in Africa are more prone to infections such as pneumonia and meningitis, and up to four times more likely to die before their first birthday, compared with babies born to HIV-negative women. Socioeconomic factors are thought to account partially for this discrepancy but differences in the babies' immune systems might also be important.

The new study, by scientists from Imperial College London and Stellenbosch University in South Africa, found that babies born to HIV-infected mothers had significantly lower levels at birth of antibodies against a range of bacterial infections (Hib, pertussis, pneumococcus and tetanus).

Antibodies, which bind to specific pathogens and direct immune cells to attack them, are transferred from mother to child through the placenta late in pregnancy. The study found lower levels of some specific antibodies in mothers with HIV, but also that less antibody is transferred from mother to child across the placenta.

Despite their low antibody levels at birth, the babies in the study responded well to vaccination: they produced similar levels of antibody to some vaccines and higher levels to other vaccines.

It's likely that lower antibody levels in these babies contributes to lower protection against infection before the babies have received their vaccines, said Dr Christine Jones from the Department of Paediatrics at Imperial College London, the study's first author. Although they appear more vulnerable in the first few months of life, the good news is that these babies respond well to vaccination. We might be able to protect them even better against infections, either by vaccinating them earlier or by vaccinating the mother in pregnancy. More research will be needed to establish what the best way of protecting these babies might be.

The study involved 109 HIV-infected and uninfected mothers in a community health centre in Khayelitsha, a rapidly-growing township in Cape Town, South Africa. The researchers measured antibody levels in the mothers at delivery and the infants at birth. They also assessed how the babies responded to routine vaccination by measuring the babies' antibody levels at four months, after they had received their routine vaccines.

Amongst the HIV-negative women in the study, a third also had low antibody levels, showing that protection against infection in their babies might also not be optimal in some women, who are otherwise perfectly healthy.

Powerful 3-D X-rays for kids in braces should be the exception, not the rule

Fri, 28 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---Some orthodontists may be exposing young patients to unnecessary radiation when they order 3-D X-ray imaging for simple orthodontic cases before considering traditional 2-D imaging, suggests a paper published by University of Michigan faculty.

There is ongoing debate in the orthodontic community over if and when to use cone beam computed tomography (CBCT) for orthodontic diagnosis and treatment planning, said Dr. Sunil Kapila, lead author of the paper and chair of the Department of Orthodontics and Pediatric Dentistry at the U-M School of Dentistry.

A very small number of orthodontists utilize the 3-D imaging on a routine basis when developing a treatment plan, and this raises concerns of unnecessary radiation exposure. In contrast, the evidence summarized in Kapila's paper suggests that 2-D imaging would suffice in most routine orthodontic cases. One of the tradeoffs for the superb 3-D images is higher radiation exposure, Kapila said.

The amount of radiation produced by 3D CBCT imaging varies substantially depending on the machine used and the field of view exposed, and some clinicians may not realize how much higher that radiation is compared to conventional radiographs. One CBCT image can emit 87 to 200 microsieverts or more compared to 4 to 40 microsieverts for an entire series of 2-D X-rays required for orthodontic diagnosis, Kapila said. Considering that the average US population is exposed to approximately 8 microsieverts of background radiation a day, 200 microsieverts equates to about 25 days worth of cosmic and terrestrial radiation.

Most of the patients who need orthodontic treatment are young adults and pediatric patients,said Dr. Erika Benavides, clinical assistant professor in U-M's Department of Periodontics and Oral Medicine. Benavides is the board certified oral and maxillofacial radiologist who reads the CBCT scans taken at the U-M School of Dentistry. Keeping in mind that the radiation received has cumulative effects, adding unnecessary radiation exposure to the patient may result in a higher biological risks, particularly in the more susceptible young children. This is why selecting the patients that would benefit the most from this additional exposure needs to be done on a case-by-case basis.

Both Kapila and Benavides said when used judiciously, CBCT is an invaluable tool with a definite place in orthodontic treatment planning. The paper published by Kapila and his colleagues advocates a balanced approach to utilizing CBCT in our patients, Kapila said.

To that end, Kapila and colleagues reviewed the existing data on CBCT and found that this type of imaging is typically recommended in cases that include those with impacted teeth, temporomandibular joint disease, craniofacial abnormalities, and jaw deformities. While other patients could also benefit from 3D imaging, the decision to scan these patients should be made on a case-by-case basis after a clinical exam and evaluation of the specific patient needs, particularly when 2-D imaging has shown that addition 3-D information would result in a demonstrable benefit that would likely alter the treatment plan.

There is nothing published on current usage patterns, Kapila said. Most of the information is anecdotal. Some clinicians and orthodontists are using this technology routinely, but I believe that most of those that use 3-D imaging use it fairly judiciously, Kapila said.

The patients who are scanned at U-M Dental School are referred after clinical evaluation by dental specialists and the area to be scanned is carefully limited, Benavides said.

Making ADHD teens better drivers

Mon, 24 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- A University at Buffalo researcher's work with a state-of-the-art driving simulator is making better drivers among those considered to be the most risky motorists on the road: teens with ADHD (attention deficit hyperactivity disorder).

Gregory A. Fabiano, UB associate professor of counseling, school and educational psychology, has already established a therapeutic program that not only helps these teens become better drivers but also builds better relationship with their parents.

Now, thanks to a $2.8 million grant from the National Institute of Health's National Institute of Child Health and Human Development, Fabiano will extend his already successful program to other teens and their families, therapy that includes dramatic demonstrations of the unforgiving and often dramatic dangers of texting while driving.

Click here to see a video interview with Fabiano. (

We had worked with children with ADHD for a long time at the university, says Fabiano, a recipient of the Presidential Early Career Award for Scientists and Engineers, the nation's highest honor for professionals at the early stages of their independent scientific research careers. And as those kids grew up, we heard concerns from parents about the transition to independent driving.

So we did some research and found out results not surprising to anybody. Teen drivers are the worst on the road. And some recent research has shown that compared to that worst group of drivers, teen drivers with ADHD were significantly more at risk for everything.

Fabiano's grant-funded project -- a joint effort between a Graduate School of Education research team and UB's New York State Center for Engineering Design and Industrial Innovation -- also has found stark results when it comes to teens texting while driving: Texting while driving can make individuals as bad as drunk drivers or worse.

It's hard to turn on the TV or open a newspaper or magazine without seeing something about the risks of texting and driving, Fabiano says. Because cell phones only have been around for a while, this is a recent phenomenon. And only in the past five years have text messages and texting been something we all have on our phones and in our pocket, so it's really a new distracter that teens now entering the roadway are having.

In our research, we have yet to have somebody be a successful texter while driving, and that includes our internal staff and me, Fabiano explains. Texting while driving impairs driving to the extent where there are deviations in the lane, on the shoulder, people spinning out, they lose control, and it's not hard to extrapolate that if that sort of thing happened on a real road, you could have hit a pedestrian, another car, a bad accident.

Fabiano says the significant conclusion of this part of his research is how the teenagers who lose control of the simulated vehicle while texting often do not realize their ability to drive was severely compromised.

We have found teens with ADHD are like children with ADHD in that they have poor insight on the impact of their behavior on others, Fabiano says. So most of the teens we work with think they can easily text while driving without any poor consequences.

Fabiano's five-year NIH study began in April. It focuses on ADHD teenage drivers with learner's permits. The teens practice on the driving simulator and are given an onboard driving monitor to track driving behaviors, giving parents and teens the chance to review their driving performance and interactions.

The goal of the study is develop a driver education program targeted to ADHD teens and their parents.

Exclusive Breast feeding for six months questioned in UK

Thu, 13 Jan 2011 18:59:18 PST

( from http://www.rxpgnews.com ) Current guidance advising mothers in the UK to exclusively breast feed for the first six months of their baby's life is being questioned by child health experts on bmj.com.

The authors, led by Dr Mary Fewtrell, a consultant paediatrician at the UCL Institute of Child Health in London, have reviewed the evidence behind the current guidance and say the time is right to reappraise this recommendation.

The researchers stress that while they fully back exclusive breast feeding early in life, they are concerned that exclusively doing so for six months and not introducing other foods may not always be in the child's best interests.

In 2001 the World Health Organisation (WHO) made its global recommendation that infants should be exclusively breast fed for the first six months. Many western countries did not follow this recommendation but in 2003 the UK health minister announced that the UK would comply.

Fewtrell and colleagues support six months exclusive breast feeding in less developed countries where access to clean water and safe weaning foods is limited and there is a high risk of infant death and illness. However they have reservations about whether the WHO's guidance about when to introduce other foods is right for the UK.

The WHO's recommendation that mothers should breast feed exclusively for six months is largely based on a systematic review undertaken in 2000 that considered existing research in this area, say the authors. This review concluded that exclusively breast fed babies have fewer infections and that the babies experience no growth problems.

Dr Fewtrell argues that the evidence that breast milk alone provides sufficient nutrition for six months is questionable. She says there is a higher risk of iron deficiency anaemia if babies are exclusively breast fed and that there could also be a higher incidence of celiac disease and food allergies if children are not introduced to certain solid foods before six months.

The authors also fear that prolonged exclusive breast feeding may reduce the window for introducing new tastes, particularly bitter taste which may be important in the later acceptance of green leafy vegetables. This could encourage unhealthy eating in later life and lead to obesity, they say.

Fewtrell and colleagues conclude that it is time to review the UK's guidance in the light of the evidence that has built up on this issue over the last ten years.

Quick school cafeteria lines could lead to healthier food choices

Wed, 12 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Middle schools soon might add fast cafeteria lines to their menu of tools to help students eat healthier, according to Penn State researchers.

The U.S. Department of Agriculture recently awarded $40,000 from the Economic Research Service to Amit Sharma, assistant professor; Martha Conklin, associate professor, hospitality management; and Lisa Bailey-Davis, senior instructor of public health sciences, College of Medicine.

The project will use economic concepts to study the effect of fast cafeteria lines on healthy lunch choices for middle school students, Sharma said.

Students have only a little over 30 minutes to eat lunch, and that includes time spent in the lunch line, Sharma said. Our idea is to create a conducive environment where it is more convenient for students to make healthier food choices.

Sharma said convenience is the key. When students are pressed for time and face multiple food choices, they usually pick foods that are familiar and popular.

Those choices, as you can imagine, usually aren't the most healthy ones, Sharma said.

To limit the time spent in line, the researchers worked on designing a fast service lane option for school cafeterias with limited food choices, called meal deals. Students can select a main dish from limited options, for instance, but most of the side selections would be predetermined. Sharma expects that the strategy will reduce the time that students spend in the lunch lane and encourage them to chose fast lanes more often. The researchers will test the fast service lane at a local middle school.

The researchers will first collect information from students, parents, administrators and food service personnel about how students currently make food choices and which choices are the most popular. From that data, they will develop the food combinations for the fast service lane.

We have to strike the right balance when we create the meal deals, said Sharma. The food choices should be exciting enough for the students, but also healthy.

Once the food combinations are selected and the fast service lane is in place, the researchers will collect data on fast lane use and food combination sales for two or three weeks. The sales of the meal deals will continue for a week after the experiment to determine if students continue to make healthy food choices.

If we can counter those unhealthy choices, we can slowly have the students choose healthier foods rather than food that might be unhealthy, Sharma said.

Middle school students make ideal candidates for the experiment because previous research suggests they are beginning to develop the cognitive capacity to make choices, such as decisions on food and health, according to Sharma. Students also face more health and diet options at this age.

Sharma said it is important that the fast service lane concept fits the school district budget, as well.

Obviously, for the program to work, it has to be affordable, said Sharma. If the fast lane meals incur significant costs for the food service, we will have to go back to the drawing board and find the solutions that are more financially viable.

Nationwide Children's Hospital awarded $11.5 million contract extension for biospecimen banking

Tue, 11 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Nationwide Children's Hospital was awarded $11.5 million from the National Cancer Institute (NCI) late last year to continue its role as one of two Biospecimen Core Resources (BCR) for The Cancer Genome Atlas (TCGA). Contract awards to Nationwide Children's could total up to $49.2 million over six years.

TCGA is a signature program of the National Institutes of Health (NIH). The goal of the project is to perform cutting-edge genetic testing of tumors from more than 10,000 patients with one of 20 different cancers, thereby improving the ability to diagnose, treat and prevent the disease. Nationwide Children's was awarded an initial $7.7 million contract starting in November 2009 to begin operating in this role.

As a BCR for TCGA, The Research Institute at Nationwide Children's is central to the process of acquiring both tumor and normal tissue samples and their accompanying clinical information from contributing medical and research centers. BCR functions include analyzing all specimens to ensure they meet rigorous quality standards for each tumor type and ensuring that the clinical information for each sample is available. Once the optimal specimens are examined and processed, the BCR distributes the DNA and RNA extracted from the specimens to researchers throughout the national TCGA research network.

TCGA has already yielded scientific discoveries that are now being used in clinical trials. We are excited to contribute to future research into breast, endometrial, melanoma, and other cancers, said Dr. Julie Gastier-Foster, PhD, principal investigator of the BCR.

Maintaining a key leadership position within TCGA continues Nationwide Children's rising role in the cancer research community. This selection was in recognition of our more than 20 years of expertise in banking tumor specimens and genetic testing of pediatric cancers, explained John Barnard, MD, president, The Research Institute at Nationwide Children's Hospital. It is a clear example of the trust and satisfaction the NCI has placed in our capabilities.

The BCR contract extends the previous tissue processing and banking work performed at Nationwide Children's Hospital. Since 1989, pediatric tumor specimens from all pediatric institutions in the Children's Cancer Study Group (now part of the Children's Oncology Group, or COG) have been banked at Nationwide Children's Biopathology Center. Because of this expertise and experience, in 1993 Nationwide Children's began working with the Gynecologic Oncology Group (GOG) serving as a biorepository for gynecologic cancer specimens, thus housing two of the NIH's 11 national biospecimen banks.

Today, the Biopathology Center stores more than one million specimens with clinical annotations for use in cancer research, making the hospital one of the largest biorepositories in North America, with expertise in both pediatric and adult tissue specimens. In addition, the Biopathology Center serves as a national reference laboratory for several pediatric cancers, performing genetic testing used to assign patients to tailored therapy. Significant use of the banks by COG and GOG has led to numerous studies and peer-reviewed publications.

The additional funding from the NCI highlights our initial success as a BCR and expands our opportunity to have a significant national impact on cancer diagnosis and treatment, as well as an immediate impact on our local economy, stated Steve Allen, MD, CEO of Nationwide Children's Hospital.

Since establishing the BCR at Nationwide Children's, more than 40 full-time jobs have been created in areas such informatics, laboratory technology, and clinical trials development. An additional 15 jobs are expected to be added.

Vitamin D levels of newborn babies predicts their risk of respiratory infections during infancy

Mon, 27 Dec 2010 08:45:27 PST

( from http://www.rxpgnews.com ) The vitamin D levels of newborn babies appear to predict their risk of respiratory infections during infancy and the occurrence of wheezing during early childhood, but not the risk of developing asthma. Results of a study in the January 2011 issue of Pediatrics support the theory that widespread vitamin D deficiency contributes to risk of infections.

"Our data suggest that the association between vitamin D and wheezing, which can be a symptom of many respiratory diseases and not just asthma, is largely due to respiratory infections," says Carlos Camargo, MD, DrPH, of the Massachusetts General Hospital (MGH), who led the study. "Acute respiratory infections are a major health problem in children. For example, bronchiolitis – a viral illness that affects small airway passages in the lungs – is the leading cause of hospitalization in U.S. infants."

Although vitamin D is commonly associated with its role in developing and maintaining strong bones, recent evidence suggests that it is also critical to the immune system. Vitamin D is produced by the body in response to sunlight, and achieving adequate levels in winter can be challenging, especially in regions with significant seasonal variation in sunlight. Previous studies by Camargo's team found that children of women who took vitamin D supplements during pregnancy were less likely to develop wheezing during childhood. The current study was designed to examine the relationship between the actual blood levels of vitamin D of newborns and the risk of respiratory infection, wheezing and asthma.

The researchers analyzed data from the New Zealand Asthma and Allergy Cohort Study, which followed more than 1,000 children in the cities of Wellington and Christchurch. Midwives or study nurses gathered a range of measures, including samples of umbilical cord blood, from newborns whose mothers enrolled them in the study. The mothers subsequently answered questionnaires – which among other items asked about respiratory and other infectious diseases, the incidence of wheezing, and any diagnosis of asthma – 3 and 15 months later and then annually until the children were 5 years old. The cord blood samples were analyzed for levels of 25-hydroxyvitamin D (25OHD) – considered to be the best measure of vitamin D status.

Cord blood samples were available from 922 newborns in the study cohort, and more than 20 percent of them had 25OHD levels less than 25 nmol/L, which is considered very low. The average level of 44 nmol/L would still be considered deficient – some believe that the target level for most individuals should be as high as 100 nmol/L – and lower levels were more common among children born in winter, of lower socioeconomic status and with familial histories of asthma and smoking. By the age of 3 month, infants with 25OHD levels below 25 nmol/L were twice as like to have developed respiratory infections as those with levels of 75 nmol/L or higher.

Survey results covering the first five years of the participants' lives showed that, the lower the neonatal 25OHD level, the higher the cumulative risk of wheezing during that period. But no significant association was seen between 25OHD levels and a physician diagnosis of asthma at age 5 years. Some previous studies had suggested that particularly high levels of vitamin D might increase the risk for allergies, but no such association was seen among study participants with the highest 25OHD levels. Camargo notes that very few children in this study took supplements; their vitamin D status was determined primarily by exposure to sunlight.

An associate professor of Medicine at Harvard Medical School, Camargo notes that the study results do not mean that vitamin D levels are unimportant for people with asthma. "There's a likely difference here between what causes asthma and what causes existing asthma to get worse. Since respiratory infections are the most common cause of asthma exacerbations, vitamin D supplements may help to prevent those events, particularly during the fall and winter when vitamin D levels decline and exacerbations are more common. That idea needs to be tested in a randomized clinical trial, which we hope to do next year."

Children's cognitive performance influenced by mother's iron+folic acid status during pregnancy

Tue, 21 Dec 2010 23:31:28 PST

( from http://www.rxpgnews.com ) In developing countries where iron deficiency is prevalent, prenatal iron-folic acid supplementation increased offspring intellectual and motor functioning during school age, according to researchers from the Johns Hopkins Bloomberg School of Public Health. They examined the intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy and found that aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning were positively associated with prenatal iron and folic acid supplementation. The results are published in the December 22/29 issue of the Journal of the American Medical Association.

"Iron is essential for the development of the central nervous system," said Parul Christian, DrPH, MSc, lead author of the study and an associate professor with the Bloomberg School's Department of International Health. "Early iron deficiency can alter neuroanatomy, biochemistry, and metabolism, leading to changes in neurophysiologic processes that support cognitive and sensorimotor development."

Researchers conducted a cohort study in rural Nepal, following 676 children aged 7 to 9 years from June 2007 to April 2009 who were born to women in a community-based, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001. Child participants were randomly assigned to receive daily iron, folic acid and zinc, or multiple micronutrients containing these plus 11 other micronutrients. All received vitamin A, as did a control group of vitamin A alone from early pregnancy through 3 months postpartum. Researchers assessed intellectual functioning using the universal nonverbal intelligence test (UNIT) and motor function was assessed using the Movement Assessment Battery for Children (MABC). The study found evidence that maternal prenatal supplementation with iron and folic acid was positively associated with general intellectual ability, some aspects of executive function, and fine motor control compared to offspring of mothers in the control group.

"This innovative study shows that in very low-income settings, children's cognitive performance is influenced by their mother's iron+folic acid status during pregnancy, along with school attendance, illustrating the importance of both nutritional and environmental interventions," said Maureen Black, PhD, professor of pediatrics at the University of Maryland School of Medicine and an adjunct professor with the Bloomberg School's Department of International Health.

"Few studies have examined whether micronutrient supplementation during gestation, a critical period of central nervous system development, affects children's later functioning," adds Christian. "Considering the significant role of iron and folic acid in the development of both intellectual and motor skills, antenatal use per international guidelines should be expanded in many low and middle-income settings where program coverage continues to be poor."

Intensive chemotherapy can dramatically boost survival of older teenage leukemia patients

Mon, 20 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) More effective risk-adjusted chemotherapy and sophisticated patient monitoring helped push cure rates to nearly 88 percent for older adolescents enrolled in a St. Jude Children's Research Hospital acute lymphoblastic leukemia (ALL) treatment protocol and closed the survival gap between older and younger patients battling the most common childhood cancer.

A report online in the December 20 edition of the Journal of Clinical Oncology noted that overall survival jumped 30 percent in the most recent treatment era for ALL patients who were age 15 through 18 when their cancer was found.

The study compared long-term survival of patients treated between 2000 and 2007 in a protocol designed by St. Jude investigators with those enrolled in earlier St. Jude protocols. About 59 percent of older patients treated between 1991 and 1999 were cured, compared with more than 88 percent of children ages 1 through 14 treated during the same period. But overall survival for older patients rose to almost 88 percent between 2000 and 2007, when long-term survival of younger patients soared to about 94 percent. Nationally, about 61 percent of ALL patients age 15 to 19 treated between 2000 and 2004 were still alive five years later.

Not only did more patients in the recent treatment era survive, but Ching-Hon Pui, M.D., chair of the St. Jude Department of Oncology and the paper's lead author, said they are also less likely to suffer serious late treatment effects, including second cancers and infertility. That is because the regimen, known as Total XV, eliminated or dramatically reduced reliance on drugs associated with those side effects.

The protocol also replaced radiation of the brain with chemotherapy as a strategy for preventing relapse in the central nervous system and for reducing the risk of later neuro-cognitive problems. None of the adolescents suffered central nervous system relapses. Not only have we increased the cure rate, but we have also improved the long-term quality of life for our patients, Pui said.

Historically, individuals who develop ALL after age 14 were less likely to survive their disease than were younger patients. Older teenagers are more likely to have high-risk subtypes of the disease, their cancer cells are more likely to be resistant to current anti-cancer drugs and they tend to have more toxicity from therapy. The challenge is to get adolescents on the right amount of drug while avoiding toxicity. In Total XV we seem to have struck the right balance, said Mary Relling, Pharm.D., chair of St. Jude Pharmaceutical Sciences Department and co-author of the research.

The findings come amid growing evidence that adolescents and young adults with ALL do better when treated on pediatric rather than adult protocols. There are a lot of data to show that young adults with ALL treated on pediatric protocols have fewer relapses than similar patients treated on adult leukemia protocols, Relling said. She noted that these results suggest ALL patients in their 20s and 30s might benefit from adding high-dose methotrexate and asparaginase to treatment. Both drugs block proliferation of cancer cells. They are not widely used in adult cancer treatment, in part because increased age is associated with more complications. Pui said Total XV also demonstrated the vast majority of older adolescents can be cured without undergoing a bone marrow transplant. This lesson should be extended to young adults, he added.

Total XV incorporated several treatment innovations, including greater use of targeted intravenous high-dose methotrexate and asparaginase for older patients. The study included 45 older adolescents and 453 younger patients. Forty-four older and 403 younger patients treated in the earlier studies were also included in this report.

Pui said patient compliance was also closely monitored. Blood tests helped identify patients with very low or no detectable amount of the drug mercaptopurine, a sign the drug was not being taken as directed. Pui said levels of the chemotherapy agent rose after patients and families were reminded of the importance of strict treatment adherence.

For the first time, a patient's initial response to treatment was used to guide ongoing care. The technique was pioneered at St. Jude and involves measuring cancer cells or the minimal residual disease (MRD) that survived initial therapy. MRD screening allowed us to catch patients who would previously not have been identified as poor responders to therapy and to treat them more intensively, Pui said.

Research tackles drug use, HIV in South African youth

Mon, 13 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Drug use, risky sexual behavior and violence among South African youth may be reduced thanks to Penn State researchers, who will look at expanding a leisure education and life skills program to 56 South African high schools. The researchers, led by Linda Caldwell, professor of recreation, park, and tourism management, and Edward Smith, associate director of the Penn State Prevention Research Center for the Promotion of Human Development, received a $2.8-million grant from the National Institute on Drug Abuse.

Caldwell and her colleagues will implement HealthWise, a curriculum they developed that teaches youth how to best utilize their free time, said Caldwell. HealthWise teaches adolescents to examine personal motivations and other factors leading to their decision-making, and it also provides information on safe sexual practices and how to avoid risky situations. In better understanding why they make decisions, youth can successfully prevent poor outcomes that result from risky decisions.

Recent studies show that nearly one-quarter of HIV-infected individuals in South Africa are under the age of 25, and AIDS is responsible for 71 percent of all deaths in the 15 to 49 year age group. One in eight South African high school students begins drinking alcohol before the age of 13. In grades 8 through 11, more than 10 percent of children have tried marijuana ,and about 30 percent of children have smoked cigarettes.

Caldwell and Smith first implemented HealthWise in the Cape Town Metro South Education District (MSED) in 2001 as a pilot program and later as a randomized trial involving nine schools and over 7,000 youth. Results from the trial indicated HealthWise was effective in reducing both substance use and sexual risk. Cigarette and alcohol use, for example, were significantly lower among those in the HealthWise schools. In addition, fewer males initiated sexual behavior and were less likely to push girls into unwanted sex. Importantly, from the perspective of reducing HIV risk, both males and females reported less use of substances at sexual encounters and were less likely to report having sex with someone they had recently met. There was also increased perception of condom availability, condom skills and conversations with partners surrounding condom use.

Following the success of the first trial, MSED administrators approached Caldwell and Smith requesting that they help with a large-scale implementation.

We saw great success in HealthWise over the past decade, said Caldwell. We hear constantly from teachers and district administrators of how good HealthWise is. The kids like it, too, because it's so positive. Now we're looking at what factors of success are important for a large-scale rollout of the program.

2 studies provide insight into stroke risk and prevention in young sickle cell anemia patients

Mon, 06 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Monthly blood transfusions combined with daily medication to remove the resulting excess iron remains the best approach for reducing the risk of recurrent strokes in young patients with sickle cell anemia, according to a preliminary analysis of a multicenter trial that includes St. Jude Children's Research Hospital.

The study compared the efficacy of two treatments for the potentially life-threatening problem of iron overload caused by chronic transfusion therapy. The transfusions are used to guard against additional strokes in young sickle cell anemia patients. The trial, known as SWiTCH or Stroke with Transfusion Changing to Hydroxyurea, was halted in May after an interim safety review determined the alternative therapy was not significantly better than the standard treatment at reducing iron buildup and was associated with an increased stroke risk.

Russell Ware, M.D., Ph.D., chair of the St. Jude Children's Research Hospital Department of Hematology and principal investigator of SWiTCH, discussed the results at the 52nd Annual Meeting of the American Society of Hematology. The meeting is being held December 4 -7 in Orlando, Fla.

Jonathan Flanagan, Ph.D., a staff scientist at St. Jude, presented results of another study that provide the first independent validation of an association between five common genetic variations and stroke risk in young sickle cell patients.

Between 70,000 and 100,000 individuals in the U.S. have sickle cell anemia. They make an abnormal hemoglobin molecule that sometimes takes on a twisted or sickle shape, disrupting blood flow and oxygen delivery throughout the body. Patients are vulnerable to a variety of problems, including organ damage, episodes of acute pain and stroke. Five to 10 percent of patients will suffer strokes before their 20th birthday. Up to 90 percent of patients will experience a recurrence.

Flanagan and his colleagues tried to validate earlier reports linking 38 genetic polymorphisms to stroke risk in sickle cell disease. Researchers compared the genetic makeup of 130 young sickle cell anemia (SCA) patients enrolled in the SWiTCH trial with 103 SCA patients enrolled in another study. The SWiTCH participants had suffered documented strokes while patients in the other trial had not.

Investigators validated the association between stroke risk and five single nucleotide polymorphisms (SNPs) in four genes. SNPs are small inherited variations in the makeup of particular genes and are sometimes used as markers of disease risk. These findings reinforce earlier observations suggesting there is a genetic component to stroke risk in sickle cell anemia. We are now focusing on how these five SNPs might play a role in stroke development, said Flanagan, the poster's first author. Ware is the senior author.

Investigators also confirmed that the alpha-thalassemia trait is associated with a reduced stroke risk. Affected individuals carry two or three, rather than the usual four, genes for making one of the hemoglobin proteins needed to ferry oxygen throughout the body. Researchers reported no association between another inherited condition, G6PD deficiency, and strokes.

SWiTCH was a Phase III trial funded by the National Heart, Lung, and Blood Institute. Between October 2006 and April 2009, 133 children and adolescents ages 5 through 18 enrolled at one of 25 participating U.S. centers. All had a diagnosis of sickle cell anemia, had an average age of almost 13, had suffered at least one stroke and had undergone monthly blood transfusions for an average of seven years.

Sixty-six were randomly assigned to continue monthly transfusions and to take the drug deferasirox, or Exjade, daily to remove excess iron from their bodies. The remaining 67 patients were assigned to treatment with hydroxyurea daily for 30 months to reduce stroke risk and to undergo monthly blood removal to reduce iron buildup.

Monthly blood transfusions are 90 percent effective at preventing future strokes in sickle cell patients. But Ware said the resulting iron overload and other factors have fueled interest in alternative approaches to stroke prevention.

Hydroxyurea received U.S. Food and Drug Administration approval in 1998 for use in adults with SCA. The medication works by stimulating production of fetal hemoglobin, an alternative form of the molecule. A pilot study found the drug offered a possible alternative for managing stroke risk.

The SWiTCH study was halted after a review of data from 62 patients found no statistically significant difference in iron concentrations in the liver biopsies of the two treatment groups.

As expected, strokes were more common among patients receiving hydroxyurea than those who continued transfusion therapy. Seven of the 67 patients in the hydroxyurea group had another stroke. There were no additional strokes in the chronic transfusion patients.

Relationship-strengthening class improves life for new families

Thu, 02 Dec 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Expectant parents who completed a brief relationship-strengthening class around the time their child was born showed lasting effects on each family member's well being and on the family's overall relationships, according to a recent Penn State study.

The team, led by Mark Feinberg, senior research associate in Penn State's Prevention Research Center for the Promotion of Human Development, analyzed the effects of the Family Foundations program for three years after a child was born.

The Family Foundations program, offered in several Pennsylvania locations as part of the study, targets couples expecting their first child. Most research has shown that conflict increases while affection and support decrease among couples after a baby is born. The program's eight sessions -- four before birth and four after -- aim to foster attitudes and skills related to positive family relationships, such as emotion regulation, temperament and positive parenting. The program is effective, says Feinberg, in part because expectant, first-time parents tend to be open-minded.

At this point in their lives, parents are eager and excited, and looking for more information about parenting, said Feinberg. Because they quickly become experts on their child after he or she is born, this time before and just after birth is crucial. Parents are open and hungry to learn at this stage, and this allows us to give guidance to help improve their confidence and help them know what to expect.

Parents who were randomly assigned to enroll in the program reported lower levels of stress and depression symptoms and higher levels of confidence in their parenting abilities, compared to parents who were randomly assigned to a control group. Also, parents in the program supported each other more than parents not enrolled in the program. Enrolled parents showed more effective parenting styles -- they overreacted less and were less likely to spank, slap, grab or hit their children as discipline or punishment.

Feinberg said that helping parents support each other is a key aim of the program.

When we feel supported, we feel tend to feel more confident and less distressed -- we have a longer fuse, rather than a shorter fuse, he said. All this can lead to parents getting emotionally closer and more supportive of each other and their children.

Children of parents enrolled in Family Foundations showed higher levels of emotional adjustment compared to children of parents not enrolled in the program, as reported by mothers. At age three, boys of parents in the study showed lower levels of aggression and hyperactivity, but this finding did not apply to girls.

The attitudes parents gain, and the support they learn to provide to each other, create a protective layer that helps them weather the storm of stress that can erupt with the birth of a child.

By giving expecting parents the tools, skills and perspectives to support each other, the program results in enhanced co-parenting relations that help protect them from stressors, said Feinberg. Sleep-deprived new parents can feel distressed and irritated easily. But with positive co-parenting relations, disagreements tend not to escalate into conflict, and conflict tends not to blow up into violence.

Unlike some prevention programs, Family Foundations was designed for all parents, not only for those identified as at risk. According to Feinberg, research suggests that not only married parents can benefit from such a program, but divorced parents who still seek to raise a child together can benefit from learning these skills and perspectives, too.

Parents should not underestimate the importance of the types of support they provide for one another for their child's welfare, said Feinberg. The fact is that children's well-being is dependent on parents' interactions.

Doubled risk of anxiety for 18 month-old children with congenital heart defects

Wed, 17 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Research from the Norwegian Institute of Public Health (NIPH) shows that children with severe congenital heart defects have twice the risk of anxiety at 18 months of age compared to healthy children. Children with mild and moderate heart defects, on the other hand, did not show an increased risk of anxiety.

- These findings suggest that children with severe forms of congenital heart defects are prone to emotional problems at a very young age. The increased risk of anxiety could be related to the number of medical procedures and hospital admissions that characterise the first years of life for these children, said PhD student Kim Stene-Larsen at the NIPH.

Part of the HEARTKIDS project

The NIPH is collaborating with the Department of Paediatric Cardiology at Oslo University Hospital on a major research project, HEARTKIDS.

In this follow-up study the researchers examined whether children with congenital heart defects had an increased risk of internalising problems such as anxiety or sleep problems at 18 months of age.

Out of 198 eighteen month old children with a congenital heart defect who were studied, 58 had a severe heart defect. Analysis showed that the children with a severe heart defect had a doubled risk of anxiety compared to healthy children.

In addition to the severity of the heart defect, maternal anxiety and depression explained some of the anxiety in these children. Children with mild or moderate heart defects, however, showed no signs of anxiety or other internalising problems.

The HEARTKIDS project is a sub-study of the Norwegian Mother and Child Cohort Study (MoBa). The project is funded by the Norwegian Research Council. This longitudinal study aims to explore the psychological and developmental consequences of congenital heart defects in infants and toddlers. Through a merge of the MoBa and the Oslo University Hospital's nationwide register of congenital heart defects, which provides accurate diagnostic information about heart defects, it is possible to compare children with varying severity of heart defects with healthy children.

Previous findings from the HEARTKIDS project have shown that 6-month-old children with moderate or severe congenital heart defects show a higher risk of emotional reactivity (irritability, frequent and powerful crying).

Need for more knowledge about children with congenital heart defects

Approximately one percent of all newborn children have a congenital heart defect. The severity of the heart defects varies widely from minor defects to complex conditions that require a series of operations throughout the child's first year.

Several studies have shown that children with congenital heart defects down to 3 years of age are more prone to emotional problems like anxiety and depression. However, there is little knowledge about the emotional problems in infancy and early childhood, which is the phase of life where most of the medical treatment is carried out. The HEARTKIDS project is focusing on the phase from birth to child age 3 years of age.

New assessment tool helps shed light on lupus in kids worldwide

Tue, 09 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) A newly designed tool is helping researchers shed light on the quality of life (QoL) of children with lupus around the world, according to research presented at the American College of Rheumatology (ACR) annual meeting, held Nov. 7-11, in Atlanta.

Lupus is a significant disease with a major impact on QoL of children around the world. This is a chronic, unremitting disease that we need to get under better control, said Thomas J.A. Lehman, M.D., chief of Pediatric Rheumatology at Hospital for Special Surgery, who was involved with the study. We have done better at treating the disease and lessening the impact of the disease on children around the world, but we still lack a cure.

Lakshmi Nandini Moorthy, M.D., a pediatric rheumatologist in the ambulatory care center in the Department of Medicine at HSS who served as principal investigator of the study, said the study had a couple of take home points. Parents across multiple cultures seem to perceive that children with lupus have a lower quality of life than their children actually report. That could reflect a greater perception of their child's vulnerability or a parent's own quality of life or anxiety, said Dr. Moorthy, who is also chief of the Division of Pediatric Rheumatology at the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey. A second interesting point is that in this particular study, the children in an Asian country report a better quality of life than children in Europe or South America. We need to gather more data and more details to confirm this result.

The study was conducted using a 26 item health-related quality of life assessment tool developed by Dr. Moorthy several years ago while she was a pediatric rheumatology fellow at HSS. Before the SMILEY tool (Simple Measure of Impact of Lupus Erythematosus in Youngsters), there was no good way to measure quality of life in lupus patients. The only tools available were general surveys and those that were developed for juvenile arthritis. Lupus is a very chronic, fluctuating disease. In one person, it can affect their eyes, in another it can affect their kidney or brain, and in another person it can just be a rash that affects their appearance, Dr. Moorthy said. We needed a scale that was general enough to capture all that, but at the same time be specific enough to capture the effects of lupus.

So, Dr. Moorthy developed SMILEY, which includes 26 questions, all of which have five possible responses corresponding with facial expressions ranging from very sad to happy. It is easy to use and score. Questions include how does lupus make you feel about going to school, how does lupus make you feel about the way you look, how does lupus make you feel about your future, and how worried are you about the side effects of your medications.

For the study presented at ACR, 125 children and parents participated from South America (Brazil and Argentina), Europe (Italy, Spain, Netherlands), and Asia (China). Children and parents filled out SMILEY as well as generalized quality of life and physical function scales. Physicians also filled out surveys gauging severity of disease and impact of the disease.

By looking at the SMILEY scores, we can see that lupus has a major impact on the quality of life of children everywhere in the world, and while there are cultural differences in exactly how it impacts them, it has a major impact everywhere, Dr. Lehman explained. The quality of life scores appear to be higher in Asia than in Europe, which was second highest, and South America. We want to look further into why the quality of life scores are different in Asia and how cultural factors and family expectations may play a role in this. Are there differences in how families cope with an ill child that may have a major impact on the quality of life scores and what can we learn from this?

NC Children's Hospital part of $12 million grant to create first-of-kind registry for IBD

Wed, 13 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) CHAPEL HILL, N.C. -- Building on the success of previous efforts among researchers and caregivers to improve the care of chronically ill children, North Carolina Children's Hospital is one of 27 sites across the nation developing a disease registry for inflammatory bowel diseases (IBD). The research collaborative is part of a $12-million grant to Cincinnati Children's Hospital Medical Center, enabling the creation of this first-of-its-kind registry system providing real time information on thousands of IBD cases across the country and, eventually, around the world.

This extraordinary collaboration will make available electronic medical record data about symptoms, treatments and outcomes for patients at multiple locations throughout the United States. It will allow doctors and researchers to assess which treatment strategies are having the greatest positive impacts on patients.

Although patients with any chronic illness could eventually benefit from this work, the grant is focused on enhancing an already-successful collaborative network (ImproveCareNow) focused on inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, conditions that affects around 100,000 children in the United States. The University of North Carolina Chapel Hill is one of the founding centers in the ImproveCareNow collaborative.

I am particularly excited to be working with this national, multidisciplinary team of investigators on this innovative and ambitious project, said Michael Kappelman, MD, MPH, an assistant professor of pediatrics at the UNC School of Medicine. This grant has made possible the IT infrastructure necessary to pool electronic clinical data from multiple hospitals and practices in order to promote continuous quality improvement work and simultaneously learn more about the real world effectiveness of the multiple treatment options for patients with this condition.

Kappelman is a pediatric gastroenterologist, digestive disease epidemiologist, and health services researcher at UNC Chapel Hill with both clinical and research expertise in pediatric IBD. He has been the chair of the ImproveCareNow research committee for three years and has been newly named the collaborative's director of data management. Kappelman and Darren DeWalt, MD, MPH, from the division of general internal medicine, are co-investigators on this grant.

The grant was awarded by the federal Agency for Healthcare Research and Quality, which supports research that leads to more informed decisions and improves the quality of health care services. This grant builds on the research from last year's $8 million transformative research grant from the National Institutes of Health to create a network of patients, clinicians and researchers to improve management of chronic care.

Rather than waiting months or years for peer-reviewed papers to be published on outcomes involving a relatively small number of patients, the new registry will allow information to flow directly from patients' electronic medical records into the database, creating a real-time body of shared knowledge that can be accessed and reviewed immediately, making best practices and corresponding outcomes available to clinicians, researchers, hospitals, clinics, administrators, policymakers, and even patients themselves.

The principle investigator for the project, John Hutton, MD, director of Biomedical Informatics at Cincinnati Children's, expects the registry to come on-line in stages over the next three years.

IBD is a relatively uncommon condition so no center has enough patients to determine the best care practices, said Hutton. The registry will make the latest and most up-to-date information about treatment and outcomes available to everyone. Our hope is that this project will demonstrate this is a dynamic, effective way to identify the most successful treatment options and get them into broader practice much faster.

The registry is the next step in what has been a successful effort over the past four years among caregivers and researchers who have been sharing information on IBD through the ImproveCareNow network of physicians. By sharing information and comparing notes, doctors have been able to improve remission rates for patients with IBD by as much as 20 percentage points over just the past three years. As of June 30, 71 percent of the patients cared for by the collaborative were in remission.

In addition to the University of North Carolina Chapel Hill, the grant proposal was also prepared by investigators at the University of Vermont (where ImproveCareNow is based), Cincinnati Children's Hospital Medical Center, Children's Hospital of Philadelphia, The Children's Hospital in Denver, Nationwide Children's Hospital in Columbus, and Nemours Children's Clinics in Delaware. In all, nearly 30 different sites taking care of thousands of patients are part of the collaborative network. (A list of the sites is included at the end of the release.)

It is estimated that about 1 million people in the United States have Crohn's disease and ulcerative colitis, and 10 percent of them or 100,000 are children under the age of 18. Children with these diseases often suffer from abdominal pain, diarrhea, bloody stools, poor appetite, weight loss and poor growth, and must struggle to lead active lives. The diseases are due to a chronic inflammation of the intestinal tract.

Locations of GI practices included in this chronic care collaborative include:

Children's Hospital coordinates new network for developmental disabilities

Wed, 13 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Recognizing both medical progress and unmet needs in the field of developmental disabilities, The Children's Hospital of Philadelphia will house the Network Coordinating Center for a newly established collaborative organization, the Developmental-Behavioral Pediatrics Research Network.

Launched this year with a three-year, $200,000 per year grant from the federal government's Maternal Child Health Bureau, the Network brings together experts from 12 leading pediatric programs to focus on a broad range of neurodevelopmental disabilities, notably autism spectrum disorders, attention-deficit hyperactivity disorder (ADHD), and intellectual disability (formerly referred to as mental retardation, and affecting an estimated 2 to 3 percent of children).

These disabilities often involve problems in learning, attention, inappropriate behaviors, sleep and social skills.

These conditions are highly challenging to families, educational systems and caregivers, said Nathan J. Blum, M.D., chair of the Network's Executive Committee, and the director of the Leadership Education in Neurodevelopmental Disabilities (LEND) Program at The Children's Hospital of Philadelphia. Two of our largest challenges are how to best individualize treatments to our patients, and how to develop more effective interventions for these conditions.

Even for the most effective treatments, added Blum, such as using stimulant medication for ADHD, a significant number of patients do not respond well to existing treatments. For many other developmental disorders, treatments remain to be developed or adequately evaluated.

By fostering collaboration among leading clinical and research programs, said Blum, the Network will be able to sponsor multi-site studies in many patients to provide a large enough sample size to properly evaluate new treatments as they are developed.

The Network will also provide opportunities to make use of recent advances in genetics and neuroimaging, as applied to neurodevelopmental disorders. As those technologies may lead to better diagnostic tools, they offer the potential of earlier diagnosis and possibly earlier interventions. In particular, genetic studies such as those conducted at Children's Hospital's Center for Applied Genomics and other facilities are identifying biochemical pathways that are altered in neurodevelopmental conditions.

We expect that greater knowledge of these biological pathways will allow scientists to develop drugs to target specific disabilities and potentially reverse learning deficits, said Blum. Having a developmental-pediatrics research network will provide greater opportunities to investigate the effectiveness of new drug candidates, and more rapidly translate basic science findings into eventual clinical treatments.

In its initial stages, said Blum, the new Network will develop the infrastructure to build itself, will agree on a research agenda, will standardize data collection from its member sites, and will initiate smaller projects to share data. The Network Coordinating Center, based at The Children's Hospital of Philadelphia, will organize the Network's central administrative functions. The Network will then select and implement new research studies.

Unique gastroenterology procedure developed in adults shows promise in pediatrics

Mon, 27 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The use of device-assisted enteroscopy, a technique that allows complete examination of the small bowel, may be just as successful pediatrics as it has been in adult medicine, according to a study from Nationwide Children's Hospital.

One of these techniques known as Double-Balloon Enteroscopy (DBE), a procedure readily available in adults, allows doctors to reach parts of the small intestine that cannot be reached using standard endoscopic procedures. Due to access issues and size limitations, DBE is rarely considered an option in pediatrics. As a result, little is known about this technique in children.

Since the introduction of fiberoptic endoscopy in the 1950s, gastrointestinal endoscopy has undergone dramatic progress in how it can aid in the diagnosis and treatment of patients, said Steven H. Erdman, MD, gastroenterologist and at Nationwide Children's Hospital and one of the study authors.

Yet, even with this progress, endoscopic examination and treatment in the small intestine has remained a challenge, especially in children. Small intestinal enteroscopy in the pediatric population remains relatively unknown and underutilized, said Dr. Erdman, also a professor of Clinical Pediatrics at The Ohio State University College of Medicine.

To shed light on the indications and possible benefits of DBE in children, physicians from Nationwide Children's reviewed the outcomes of DBE cases performed at the hospital during a two-year period. The physicians performed a total of 13 DBE procedures on 11 pediatric and adolescent patients. Prior to the DBE, all patients underwent a detailed diagnostic evaluation including laboratory testing and diagnostic radiologic imaging along with upper endoscopy, colonoscopy and capsule endoscopy (CE) tests. Abnormal small intestinal CE findings or continued small bowel disease symptoms without diagnosis by conventional methods were used as indications for DBE.

Two of the patients underwent DBE for treatment of small intestinal polyps associated with Peutz-Jeghers Syndrome which dramatically improved their symptoms of abdominal pain and bleeding. Another patient's DBE was done to remove a bleeding small intestinal vascular malformation that had caused years of symptoms resolving chronic anemia. Two other patients had histories of bloody diarrhea, anorexia and weight loss; lower DBE provided evidence leading to the diagnosis of Crohn's disease when other medical techniques had been unsuccessful.

DBE can be associated with abdominal discomfort following the procedure due to gaseous distention as was seen in five of the 13 procedures. Utilizing carbon dioxide rather than regular air to fill the intestine during this procedure has eliminated this issue.

Noting the limitations of this study on a small number of patients from a single institution, Dr. Erdman says that DBE appears to hold promise for pediatrics. Our experience suggests that DBE shows great potential in the diagnosis and management of pediatric small intestinal disease without undue risk, he said. Since completion of the original report, eight additional DBE procedures have been completed with similar positive outcomes.

Although DBE shows great potential, Dr. Erdman warns that pediatric centers may not be able to devote the necessary resources and time needed to provide this type of service. DBE remains a resource-intensive procedure requiring multiple staff, general anesthesia and extended procedure time in addition to cost outlays for equipment, he said. These instruments were designed for use in adults and size is a limitation that remains to be address before DBE can become a more standardized tool in pediatric gastroenterology.

Psychotropic medication and youth in foster care report

Thu, 23 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Boston, MA -The Tufts Clinical and Translational Science Institute (CTSI) today issued a landmark report from a multi-state study on psychotropic medication oversight in foster care. Led by Laurel K. Leslie, MD, MPH at Tufts CTSI, Christopher Bellonci, MD at Tufts Medical Center and Justeen Hyde, PhD at Cambridge Health Alliance, the study examined state policies and practices in 47 states, including Massachusetts, and the District of Columbia regarding the use of medication for treating behavioral and mental health problems in foster care children and adolescents ages 2 to 21 years.

Over the past decade, psychotropic medication use in the general youth population has more than doubled. Estimated rates of psychotropic medication use in foster care youth, however, are much higher (ranging from 13-52%) than those in the general youth population (4%).

In 2008, President Bush signed into law the Fostering Connections to Success and Increasing Adoptions Act, which requires state child welfare agencies and Medicaid to provide ongoing oversight and coordination of medical and mental health services, including psychotropic medications, for youth in foster care. Since then, state child welfare agencies have been working to develop sound policies and practices for this population of kids.

The Tufts CTSI multi-state study, begun in 2009, concluded that while oversight of psychotropic medication is a high priority of the state child welfare agencies, there is also great variability among the state policies and practices governing such oversight. The Study Report calls for a national approach and resources for medication oversight for youth in foster care. A more detailed national look at which state policies and practices are the most effective for improving the mental health of these youth is also needed. Without a national approach, crossing a state border could mean the difference between a youth in foster care being appropriately treated with medications or not. The report also stresses the need for youth-serving organizations and state agencies to work together, and for more informed decision-making and appropriate medication monitoring for youth in foster care.

The majority of states in the multi-state study reported an increasing trend in the use of psychotropic medications among youth in foster care, specifically regarding: Increased use of antipsychotics, antidepressants, and attention-deficit hyperactivity disorder (ADHD) medications;

Increased polypharmacy (the use of more than one psychotropic medication at the same time); Increased medication use among young children; and Increased reliance on giving medications as needed and blanket authorizations for such drug use in residential facilities.

Officials in some states felt that this increase partially reflected demand by foster parents, schools, and other stakeholders. Others felt that reimbursement and time pressures in the healthcare system encouraged medication use. A few states, however, indicated a decrease in medication use in their states and thought that these changes reflected policy and practices implemented over the last several years.

Many child welfare officials understood that medication plays an important role in addressing mental health problems. However, officials were concerned that medications were being used to manage problems that might respond as well, or better, to psychosocial treatments.

Funded by the Charles H. Hood Foundation and the National Institute of Mental Health-funded Child and Adolescent Services Research Center in San Diego, the study involved interviews with state child welfare agency key staff as well as a review of existing policies and guidelines available on state public websites or provided by staff. The Study Report and specific tools developed by states are available online at http://www.tuftsctsi.org/About-Us/CTSI Components/Community-Engagement.aspx. The Study Report was funded by the William T. Grant Foundation and Tufts CTSI.

States that participated in the study include: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.

Researchers find faster, less-intrusive way to identify transplant recipients' organ rejection

Thu, 23 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) STANFORD, Calif. - A simple, inexpensive blood test could soon help doctors halt organ rejection before it impairs transplanted hearts and kidneys.

In the past, we couldn't spot rejection episodes until they harmed the organ, said Atul Butte, MD, PhD, who is co-senior author of the new research and an associate professor of medical informatics and of pediatrics at the Stanford University School of Medicine, in addition to director of the Center for Pediatric Bioinformatics at Lucile Packard Children's Hospital. Our goal is to develop blood tests that will keep transplanted organs functioning so that patients can avoid a second transplant.

Butte and his collaborators have made a big step toward that goal. The Stanford team found three easily measured proteins that rise in the blood during acute rejection, in which a patient's immune system attacks his or her transplanted organ. The research, which will be published online Sept. 23 in PLoS-Computational Biology, is the first-ever report of an immune-rejection signal that is shared by two kinds of transplanted organs. The protein signals are now being validated in liver- and lung-transplant recipients as well.

The new blood test circumvents the invasive, expensive, slow system now used to keep tabs on transplants. Currently, all organ recipients receive functional monitoring of their new body parts. Heart transplant patients get regular echocardiograms, for instance. If organ function drops, doctors cut a tiny sample from the transplanted tissue to check for rejection, and then adjust patients' immune-suppressing drugs accordingly. About 25 percent of kidney recipients and 40 percent of heart recipients experience an episode of acute rejection in the first year after transplant.

The new blood test will let doctors skip directly to drug dosing before a transplant is damaged. As well as treating rejection early, doctors could use the test to reduce doses of immune-suppressing drugs for patients whose bodies are handling their transplanted organs well, thus reducing unnecessary drug side effects. Butte predicts the test will be commercially available in three to five years.

The new technique makes use of an existing method to detect proteins in blood, called enzyme-linked immunosorbent assay, or ELISA, that is already used to diagnose diseases such as strep throat. The Stanford team found new proteins for diagnostic ELISA kits to target.

To identify the new protein markers, the researchers started from publicly available data documenting changes during transplant rejection in levels of messenger RNA, the molecule that tells cells to make new proteins from the instructions in the genetic code. These changes gave the team clues about which proteins might appear in the blood during rejection.

From 45 protein candidates identified via mRNA data, the team zeroed in on 10 for which ELISA-based laboratory test kits were already available. Using blood samples from 39 kidney and 63 heart transplant recipients, the kits found three proteins that reliably increased in the blood during acute rejection.

Because ELISA-based diagnostics are already used in clinical settings, it won't be hard to modify the technology for transplant patients, Butte said. Stanford University has filed patent applications for the new test.

The researchers also independently validated their method of using public RNA data to identify marker proteins by confirming that the computational method detected known biomarkers for several other diseases. The new discovery method is exciting, Butte said, because it could be applied to many diseases that lack good diagnostic tools.

For a disease like pancreatic cancer, where we find it late and patients die quickly, we have a huge medical need for identifying good diagnostic markers, he said. Why don't we use public data to help us with this process?

Spinal muscular atrophy research team receives Pepsi Refresh funds from Sophia's Cure Foundation

Wed, 08 Sep 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Brian Kaspar, PhD, principal investigator in the Center for Gene Therapy at The Research Institute at Nationwide Children's Hospital, along with a team of Spinal Muscular Atrophy (SMA) researchers and clinicians, recently received a $250,000 grant for SMA research and clinic development from Sophia's Cure Foundation via the Pepsi Refresh Project.

Spinal Muscular Atrophy (SMA) is a group of inherited debilitating neurological diseases that cause progressive muscle degeneration and weakness throughout the body. There is no treatment for the progressive weakness caused by the disease. It is estimated that SMA occurs between one-in-6,000 and one-in-20,000 births. One-in-40 to one-in-80 normal men and women carry the gene for SMA, and if both a man and woman carry the gene, there is a 25 percent chance that any of their children will manifest SMA.

Sophia's Cure Foundation, a not-for-profit organization created to assist in funding clinical research for SMA and to offer support to families affected by SMA by providing advocacy, awareness and education, received the $250,000 grant from the Pepsi Refresh Project and awarded it to Dr. Kaspar and his team. The Pepsi Refresh Project has committed to award more than $20 million in 2010 to projects and research that will move communities forward. Individuals can apply for these grants to benefit a variety of projects while web site visitors vote for the best ideas.

We are extremely honored to be able to fund such an incredibly promising program, said Vincent Gaynor of Sophia's Cure Foundation. Dr. Kaspar and his team are some of the most talented and devoted researchers in the field. It was our mission to educate the community on their promising work, and to bring together a united effort to see Dr. Kaspar's SMA research funded. There is a tremendous amount of work yet to be done, and we look forward to continuing our support of this research.

The Pepsi Refresh Project is an innovative funding mechanism that is clearly making a major impact for community projects, said Dr. Kaspar, also a faculty member at The Ohio State University College of Medicine. Spinal Muscular Atrophy research and therapeutic development stands to gain from this important and generous investment, and we all look forward to translating our research to advance human clinical trials.

Both Dr. Kaspar's team and Sophia's Cure Foundation are extremely thankful for everyone that voted for their application via the Pepsi Refresh program. It is clear that the SMA community worked together and united for a common goal to push this research and cause to first place.

This is a major win for the SMA community, said Dr. Kaspar. We are honored and extremely appreciative for the support from both of these organizations.

The grant of $250,000 will assist Dr. Kaspar and his team at Nationwide Children's in research and development, moving their gene therapy work toward scaleable production and purification methods to perform the pivotal safety studies and produce clinical grade material as they advance this program to the clinic.

Through his SMA research, Dr. Kaspar has worked closely with, and will continue to collaborate with a host of doctors and researchers in the field, all with the common goal to find a treatment for SMA.

Parent Project Muscular Dystrophy awards $600K to Nationwide Children's for gene therapy study

Tue, 10 Aug 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Parent Project Muscular Dystrophy (PPMD), the largest non-profit organization in the United States focused on finding a cure for Duchenne muscular dystrophy (Duchenne), announced that PPMD will award a $600,000 grant to Nationwide Children's Hospital in Columbus, Ohio to conduct clinical testing of a promising gene therapy technique for muscle disease.

Investigators, led by Jerry Mendell, M.D., director of the Center for Gene Therapy in The Research Institute at Nationwide Children's Hospital with co-investigator Brian Kaspar, Ph.D, will inject a modified virus (vector) carrying the gene for the muscle growth-stimulating protein follistatin into the quadriceps muscles of volunteers with Becker muscular dystrophy and sporadic inclusion body myositis. The goal of the study is to verify that the procedure is safe and to document any increase in quadriceps muscle size and function. People with these diseases have overall muscle weakness but with particular weakness of the quadriceps muscle, which is important for standing and sitting. Preliminary studies in mice with muscular dystrophy and in non-human primates demonstrated that follistatin delivered in this manner can cause significant increases in the size of injected muscles. Improvements in the strength of the mice and non-human primates were documented.

PPMD funding for the project will cover the costs of manufacturing the clinical grade viral vectors, and the costs associated with the clinical testing. If the initial study is successful, the investigators will expand the research to a phase II study and will also make plans to test it in Duchenne muscular dystrophy and other muscle diseases. The first clinical studies are planned to start in early 2011.

This is the first time a gene therapy approach has been used to supply genes that generically stimulate muscle growth rather than directly replacing missing muscle proteins, explains Sharon Hesterlee, Ph.D., PPMD Senior Director of Research and Advocacy, Other applications could include the treatment of muscles that have been injured directly through accidents or indirectly through disuse.

PPMD's CEO and President, Patricia Furlong believes the work being done at Nationwide Children's Hospital has huge potential. Part of PPMD's mission has always been to fund promising research in the fight to end Duchenne. Not only does the work Dr. Mendell is doing with follistatin show great promise, but if successful, it would help all patients living with Duchenne and Becker muscular dystrophy, as well as other muscular issues. It complements the other exciting therapeutic avenues that PPMD is funding as well.

Dr. Mendell is extremely grateful to PPMD for the grant and acknowledges, PPMD is dedicated to supporting research and researchers that are navigating new paths in the treatment of muscular dystrophy. Pat and the PPMD community have not just been supportive financially, but have been true partners in this project. It is refreshing to work with an organization that is willing to take risks on treatments like follistatin. We look forward to continuing this partnership and sharing our results with the community.

Developmental disabilities center established at Washington University

Tue, 20 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Improving the lives of infants and children with developmental disabilities will be the focus of Washington University's new Intellectual and Developmental Disabilities Research Center (WUIDDRC).

The center, established with a five-year, nearly $6 million grant from the National Institutes of Health (NIH), will focus on research to prevent and treat developmental disabilities in children. Special emphasis will be placed on clinical and translational research as well as on reaching out to families and the community with resources and services.

Developmental disabilities are very challenging for families, says Terrie E. Inder, MD, PhD, director of the WUIDDRC and professor of pediatrics, of radiology and of neurology and a neonatal specialist at St. Louis Children's Hospital. Our long-term goal is to provide better care to children in our area through research, advocacy and better clinical services.

Many families with children who have developmental disabilities receive services from the state in which they live, however, those services have been limited due to budget constraints, Inder says. The WUIDDRC will work closely with the State of Missouri, and a member of the center will assist state committees with recent research findings to guide future directions of services.

In addition, the WUIDDRC has reached out to community partners such as the Missouri Foundation for Health; Ranken-Jordan - A Specialty Pediatric Hospital; the Thompson Center for Autism and Neurodevelopmental Disorders at the University of Missouri; the Institute for Human Development in Kansas City, Mo.; and several other programs in Missouri to engage them in the center's services and develop more active collaborations. This will enhance communication of research needs to the WUIDDRC from these state providers and of research findings from the center to patients and families.

The establishment of WUIDDRC is a tribute to exceptional leadership, passion and dedication of Terrie Inder to this important area of pediatric disability, says Alan L. Schwartz, PhD, MD, the Harriet B. Spoehrer Professor and head of the Department of Pediatrics. Her optimistic vision for the future catalyzed by creative research is bright. We are proud to have her here and leading this effort.

The center's research focus will be on cerebral connectivity, genetics and environmental influences. Its sections are administrative, animal models, human clinical, imaging and biostatistics and informatics.

The WUIDDRC received additional startup funding from the McDonnell Centers for System Neuroscience and Cellular and Molecular Neurobiology and from the School of Medicine.

Inder also plans to collaborate with other IDDRCs in the Midwest to share knowledge and resources.

Collaboration will give us greater knowledge of opportunities for helping families and will move the science forward faster, she says.

More than 60 investigators from 12 university departments will be involved in the center's research. Serving as associate directors are John Constantino, MD, the Blanche F. Ittleson Professor of Psychiatry and professor of pediatrics; David Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of Neurology and professor of developmental biology; Jeffrey D. Milbrandt, MD, PhD, professor and head of the Department of Genetics and professor of medicine, of neurology and of pathology; Jeffrey J. Neil, MD, PhD, the Allen P. and Josephine B. Green Professor of Neurology and professor of radiology, of pediatrics and of neurobiology; and Schwartz.

The Intellectual and Developmental Disabilities Research Centers were established in 1963 as centers of excellence for research in mental retardation and developmental disabilities. Fourteen national centers are funded by the Eunice Kennedy Shriver National Institute for Child Health and Human Development.

Simple, accurate in-office tool predicts athletes at high-risk for ACL injury, study details

Sat, 17 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) PROVIDENCE, R.I. -- Previously, determining athletes at high-risk for ACL (anterior cruciate ligament) injuries required expensive and complex laboratory-based motion analysis systems, such as those used in creating video games. But a new study presented today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting, offers physicians a low-cost, in-office, tool to help identify athletes at increased risk.

ACL injuries are devastating to athletes, and the risk factor for female athletes is much higher, said Greg Myer, sports biomechanist at the Cincinnati Children's Hospital. In an earlier study, we used motion analysis systems to measure and calculate torques on ligaments which accurately predicted which athletes are high-risk, but this method was expensive, labor intensive and required sophisticated equipment. So in this study, we looked for a low-cost, in office, simpler method to predict which athletes are high-risk.

Unfortunately, women are two to eight times more likely to injure their ACL than men, according to recent studies. Researchers believe this may be due to differences in hormone levels on ligament strength and stiffness, neuromuscular control and fatigue, lower limb biomechanics, ligament strength, as well as a difference in neuromuscular control in women when landing jumps (women appear to have less hip and knee flexion or bending and land more knock kneed than men.)

The good news, according to Myer, is that those athletes who have the higher risk factors of increased knee torques or load are those who also benefit the most from the remedy of neuromuscular training in jumping, posture and building landing strength.

The simpler, lower-cost measure to predict high-risk athletes for ACL injury provides the next critical step to bridge the gap between expensive in-laboratory identification of injury and identification of these injuries in the doctor's office. The simplified method, which can be done in the doctor's office combines measuring the tibia or shin bone with a standard measuring tape and an athlete's weight in combination with motions of the knee during landing captured with standard camcorders. These simple factors can quickly identify young females who demonstrate a primary risk for ACL injury. The in-office method strongly correlated to the expensive laboratory method with variables that ranged from 0.87 to 0.98.

This method may be used as a training camp protocol in partnership with team clinicians or set up and run in the athletic training setting, said Myer. Current evidence indicates that athletes identified as high-risk for ACL injury using this approach are more responsive to neuromuscular training aimed at reducing this risk factor. This tool can also be used to get high-risk athletes into appropriate interventions to further reduce their potential of injury risk which may increase both the efficacy and efficiency of future interventions aimed to prevent ACL injury in female athletes.

New joint program for high-risk pregnant women and their babies

Fri, 16 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The Children's Hospital and the University of Colorado Hospital (UCH) have finalized an agreement to jointly establish a center for advanced maternal fetal medicine offering state-of-the-art care for high-risk pregnant women and their babies.

The two leading academic medical centers have individually provided such services for more than three decades, and by building on already existing adult and pediatric expertise, they together will be able to provide unparalleled care and treatment for the region's most at-risk moms and babies.

The rapid development of technology and clinical innovation now enables caregivers to not only diagnose but also provide intervention for certain medical conditions before a baby is born. The ability to provide such interventions can reduce, and in some cases eliminate, the adverse consequences of many chronic diseases.

The new center initially will focus on babies needing highly-specialized surgical care within 72 hours of birth, and both mother and baby will be cared for at The Children's Hospital. Under the unique program, mothers who are carrying high-risk babies may receive their outpatient care and ultimately deliver at The Children's Hospital starting in early 2011. UCH will continue treating other serious neonatal conditions and high-risk mothers while also offering its routine labor and delivery services to more than 3,000 families each year.

The unique collaboration of research, education and clinical care that exists on the Anschutz Medical Campus allows for rapid clinical intervention by some of the most renowned providers in the world. Our multidisciplinary approach ensures the best possible outcomes for mother and child, said Children's President and CEO Jim Shmerling. Often, when it comes to treating these tiny patients, timing is everything.

This center will offer personalized support services to families that are unique to this region, including a Perinatal Mental Health Program to support mothers with post partum depression and a Fetal Concerns Program to provide support and education to families who have learned their unborn baby has a medical condition.

The high-risk mother-baby program in particular provides unparalleled care and treatment for mothers and their babies while offering them access to more coordinated medical specialties than any other program in the Rocky Mountain region, said Bruce Schroffel, president and CEO of University of Colorado Hospital. Formalizing the program recognizes the superior care that comes with combining the talents of the medical teams at both hospitals and proves to be an example of the unique specialty programs found only at the Anschutz Medical Campus, a point of destination for excellence in patient care, education and research.

Could waiting 2 minutes improve how newborns recover from heart surgery?

Thu, 15 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A newly funded study is set to determine whether waiting two minutes to clamp a newborn's umbilical cord after delivery could improve how well he or she recovers from corrective heart surgery.

Most physicians typically clamp and cut the umbilical cord immediately following delivery. Some physicians advocate for delaying the clamping of the baby's umbilical cord, thereby increasing the flow of blood from the placenta to the child. The practice of delayed umbilical cord clamping has been shown to improve hematocrit levels, leading to an increased number of oxygen-carrying red blood cells throughout the body.

Hematocrit levels are an important factor during surgery and blood transfusions are often required to replace blood lost during complicated procedures. This is especially true in children with critical congenital heart disease.

Babies born with critical congenital heart disease often require multiple blood transfusions during corrective heart surgery due to the complexity of the surgery and the babies' small size, said Carl Backes, Jr., MD, Neonatology fellow at Nationwide Children's Hospital. However, data suggests that surgical outcomes are improved when fewer blood transfusions are performed.

A $125,000, two-year grant from the American Heart Association will allow Dr. Backes to examine whether delayed umbilical cord clamping could have a positive impact on surgical outcomes.

We suspect that delayed umbilical cord clamping following delivery will decrease the need for blood transfusions in this at-risk population, said Dr. Backes. Given the growing body of evidence suggesting that blood transfusions during or after cardiac surgery is associated with acute and delayed adverse effects, we hope to evaluate the potential role for adding delayed cord clamping to existing blood conservation programs at Nationwide Children's Hospital.

When a baby being cared for prenatally at Ohio State University Medical Center (OSUMC) is identified in the womb as having a prenatal heart lesion, Dr. Backes and Nationwide Children's cardiologist Timothy Hoffman, MD, will determine whether the baby has critical congenital heart disease likely to require surgery within the first month of life. If so, Dr. Backes works collaboratively with obstetricians at OSUMC to coordinate the timing of the umbilical cord clamping. This project serves as the first federally funded research collaboration between The Ohio State University Maternal Fetal Medicine Program, the section of Neonatology and Cardiology and Cardiothoracic Surgery at Nationwide Children's.

Hopefully this multidisciplinary pilot study will serve as the basis for future collaborations in both research and clinical arenas, said Dr. Backes.

Each baby's umbilical cord will either be clamped right away or the clamping will be delayed for 120 seconds post-delivery. The research team will then monitor the children's progress for two years, comparing differences between the groups.

Our group will examine whether potential differences in blood product exposure between the two groups, and most importantly, if those differences are associated with meaningful clinical outcomes, said Dr. Backes. We suspect that delayed clamping has additional benefits other than improving hematocrit levels, and we may discover something new about how the body helps heal itself.

Progress made in addressing food marketing to children, but challenges remain

Tue, 13 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) STOCKHOLM, Sweden: The last six years have seen significant progress in efforts to curb the marketing of unhealthy food to children, with an increasing number of governments taking on the issue, but considerable challenges remain, a leading expert on the topic said today (Tuesday).

At the International Congress on Obesity in Stockholm, Tim Lobstein presented an analysis of the European policy landscape, undertaken as part of the European Commission's effort to gather evidence to support policy making on the marketing of foods to children.

For many years, public health experts have argued that the marketing of calorie-packed food and drinks to children contributes to the global obesity problem, but the issue has gained more traction over the last few years as concern over the scale of childhood obesity and has grown and as efforts to combat it have progressed.

An increasing number of countries are trying to address this issue, with some introducing regulations addressing television advertising during children's programming or the use of familiar personalities or fictional characters to promote products during that television time slot. There is real progress, but the challenges are numerous, said Lobstein, director of policy at the International Association for the Study of Obesity, which coordinated the European Union PolMark study. Firstly, most countries do not address advertising to children by the calorie content or other nutrient quality of the food product and marketing channels beyond broadcast advertising have been largely ignored. Secondly, our research has shown that there's a certain amount of anarchy at the moment and concluded that the terms need to be set by government, not the industry itself, because although they appear to be willing, there's chaos within the details, with a lot of contradiction in what industry is offering.

Internationally, several countries are considering strong measures, Lobstein noted. Brazil is developing legislation on broadcast advertising, Thailand has legislation to limit the quantity of advertising to children, Korea and Malaysia have a ban on junk food marketing to children, while South Africa, Colombia and Chile have a draft law in waiting, he said.

In Europe, two-thirds of countries now have, or are proposing, statements on food marketing to children in their national health plans.

That is a big shift, Lobstein said. Six years ago, there were only about two or three countries out of the 50 or so in European region doing this, so this decade has seen a rapid increase in awareness by government policy makers, who are increasingly writing it into their strategies.

Also, the UK took a lead in 2006 by banning ads for specific types of food during children's viewing hours. This was considered a major step, Lobstein said, because it introduced a legal definition of junk food, using a formula based on the nutrient profile of food products.

In the United States, a federal interagency working group established last year is developing proposals for voluntary nutritional standards for food and drink marketed to children and adolescents under the age of 18. The final proposals are scheduled to be submitted in a report to the U.S. Congress by July. Lobstein also noted that U.S. First Lady Michelle Obama's childhood obesity initiative does not rule out the possibility of regulation if voluntary measures prove insufficient.

He said the passage of a resolution - without dissent - at the annual meeting of member states of the World Health Organization (WHO) in Geneva in May is another mark of progress. The resolution urged countries to implement recommendations contained in a report on restricting food and drink marketing to children and instructed WHO to provide technical support. A general resolution endorsing a set of recommendations doesn't look dramatic, but it consolidates the progress made so far. If they had tried to debate the recommendations one-by-one, they may have found countries unwilling to endorse them and that would have unravelled quite a lot of the work that has been done to get this far, Lobstein said.

One of the major challenges is that voluntary action has some impact, but not enough, Lobstein said. Food companies are making pledges and showing that they are sticking to those, but the pledges have loopholes. They don't all stick to the same criteria around the definition of marketing, what age group of children and what foods are covered. Companies have been pushing the boundaries into children's social marketing networks, school playgrounds, text messaging to mobile phones and so on, undermining any likely parental controls. We need a system that supports, rather than hinders, the efforts of parents to prevent obesity in their children. You cannot expect the industry to reform itself when so much money would be lost, he said.

In a separate presentation at the conference, Brazilian researcher Fabio Gomes reported an analysis of advances and setbacks in his country's effort to address food marketing. The Brazilian government is proposing statutory regulation that would require health warnings to be included in advertisements for food. Gomes said that challenges in Brazil include weak consumer criticism and the abandonment of early government proposals for a watershed for advertising to children. Also, while multinational companies have made pledges on the issue in the United States and in Europe, they have not made their pledges or self-regulation rules effective in Brazil, he said. We are in a deaf dialogue in Brazil, said Gomes, a nutritionist and senior analyst at the National Cancer Institute of Brazil.

Lobstein said it is less important whether measures are voluntary or statutory. What matters, he said, is that governments need to agree a clear set of targets that include cross-border marketing applied to products based nutrient profiling, a timeline and monitoring to ensure progress is being made.

Success of community interventions for childhood obesity varies depending on the target age group

Tue, 13 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Stockholm, Sweden: Community-based interventions designed to prevent obesity in children seem to work best in those under the age of five, while there is evidence of some success in primary school children, but very mixed effects in adolescents, a leading expert in the field said today (Tuesday).

In a presentation at the International Congress on Obesity in Stockholm, Professor Boyd Swinburn, chair of population health and director of the World Health Organization Collaborating Centre for Obesity Prevention at Deakin University in Australia, reported findings of an evaluation of the success of three community-based demonstration projects around the Australian city of Geelong. Each targeted a different age group for about three years and included a comparison population that got no intervention. One focused on children under the age of five, another intervened at the primary school age and the third targeted teenagers. The intervention program for teenagers also had similar sister projects in Fiji, Tonga and Auckland, New Zealand. The interventions included a range of strategies to increase healthy eating and physical activity and aimed to build the capacity of the community to continue with them once the project ended.

Comprehensive community-based interventions are in their infancy, Swinburn said. The first generation of demonstration projects included brief intervention periods with implementation limited to schools. Most of those showed relatively modest, or no, effects. However, more recent studies in the last five years have become increasingly sophisticated, broadening beyond schools to the whole community, to include parents, local government, sports clubs and other settings. Such second-generation studies have been undertaken in a variety of locations around the world, but most have focused on primary school aged children, with few in pre-schoolers or adolescents.

Our results, together with the evidence from other demonstration projects conducted elsewhere, suggest we should get moving to scale up efforts in the under-5s. There hasn't been that much research in this age group, but what has been done around the world indicates these children seem to be the most susceptible to change, Swinburn said. For primary school children, the effects seen in studies aren't as strong, but there's enough evidence to say we should roll out what we know. But for adolescents, programmes seem to have an effect for some groups but not others. For Pacific populations, in particular, we saw little impact on weight gain and for those groups, unfortunately, we need to go back to the drawing board.

In Swinburn's study, the best results were seen in the programme that targeted children under five. It involved 12,000 children targeted in multiple settings, such as pre-schools, day care, homes and maternal and child health services. After three years, the prevalence of overweight and obesity among the children in the intervention group was about 3 percentage points lower than that in the comparison group. This programme was also notable for its very small budget for the interventions (AUD100,000 in total) so most of the work was 'in-kind' from the existing personnel and budgets of community organizations.

The project targeting primary school aged children also had a significant impact, Swinburn said. The intervention wasn't sufficient to reduce the prevalence of overweight and obesity, but it did slow down the rate of unhealthy weight gain - after three years, the children gained about 1kg less than they otherwise would have. One kilogram over three years sounds very unimpressive on an individual level, but if you are influencing a whole population, including normal-weight children, then because it's an average it's actually quite meaningful. Small changes applied across a whole population can have a significant impact on disease outcomes, he said.

When it came to the studies in adolescents across the four countries, three years of intervention had a variable effect, depending on the population group. The adolescents in the Australian schools were mainly European Australians and the programme had a significant effect on reducing overweight and obesity. However, at the other three sites in Fiji, Tonga, and Auckland, students were from a variety of Pacific Islands and Indian backgrounds and effects were mixed, with some populations showing no differences between the intervention and comparison groups.

Once you get to high-school aged children, trying to implement an intervention at the whole community level becomes more difficult because high schools have a larger catchment area and parents and other organisations are less engaged, Swinburn said. The usual health promotion activities - such as those aimed at increasing consumption of fruit and vegetables, improving the healthiness of foods available at school, improving body image and reducing inappropriate dieting, promoting breakfast, decreasing consumption of high-sugar drinks while increasing water consumption, and increasing active transport - haven't been enough for many ethnic groups and we now need to go back and think about how best to intervene with them.

Hallmarks of success and failure have emerged from the various studies, Swinburn said. What the school principal says and does around what the rules are seems to be much more important than the programmes and activities that the teachers are running, he said. For instance, if the principal sets a policy that all children will participate in sports, or that the tuck shop will stock only healthy food, that does an enormous amount for change in cultural norms and expectations and the programmes tend to flow. Conversely, if the leaders are not on board and there are no policies or resources to support efforts, it is extremely hard to get meaningful changes.

One of the main challenges in establishing community-based intervention, Swinburn said, has been that the effort has been driven by professionals, rather than by a grass-roots movement demanding change.

U.S. First Lady Michelle Obama's campaign to tackle childhood obesity has provided a significant boost to the profile of community-based intervention, Swinburn said. However, he added that he and other experts in the field are watching the effort with guarded optimism.

Air pollution doesn't increase risk of preeclampsia, early delivery, study finds

Fri, 02 Jul 2010 04:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- While pregnant women may worry about the effects of air pollution on their health and that of their developing child, exposure to carbon monoxide and fine particles in the air during pregnancy does not appear to increase the risk of preterm delivery or preeclampsia -- a serious condition that arises only during pregnancy -- according to results of a study headed by a University at Buffalo epidemiologist.

The research was conducted in the region around Seattle, Wash., using data from 3,675 women who were enrolled in the Omega Study, an investigation of the effects of diet and environment on women's health and nutrition before and during pregnancy.

Carole Rudra, PhD, assistant professor of social and preventive medicine at UB and first author on the study, presented the results June 23 at the Society for Pediatric and Perinatal Epidemiology annual meeting held in Seattle June 22-23. Rudra studies the ways in which the human-made environment and maternal behaviors affect health during pregnancy.

There is strong evidence that air pollutants may increase risk of cardiovascular disease, says Rudra. This led me to examine air pollutants in relation to preeclampsia, which is similar to cardiovascular disease and a risk factor for the condition. Pollutants may interfere with delivery of oxygen to the placenta and increase maternal oxidative stress and inflammation. These pathways could lead to both preeclampsia and preterm delivery.

Rudra noted that carbon monoxide levels were fairly high in the Seattle area in comparison with other U.S. cities when she began this research, but have declined significantly in recent years.

Rudra and colleagues collected data from regional air-pollutant-monitoring reports on concentrations of carbon monoxide (CO) and minute airborne particles (such as dust, fumes, mist, smog and smoke) during specific exposure windows at residences of study participants.

The exposure windows were the three months before pregnancy, the total of the first four months of pregnancy, during each trimester and the last month of pregnancy.

Preeclampsia is a condition in which high blood pressure and protein in the urine develop after the 20th week (late second or third trimester) of pregnancy. Symptoms are swelling of the hands, face or eyes, and sudden weight gain. Delivery is the only cure. Preterm delivery was defined for this study as occurring less than 37 weeks of gestation.

Analysis of the data showed that the amount of air pollutant exposure at any of the collection times had no effect on either of the pregnancy problems.

In this geographic setting and population, these two air pollutant exposures do not appear to increase risks of preeclampsia and preterm delivery, notes Rudra. She now is planning to examine women's health outcomes in relation to air pollutants in Western New York.

Lifestyle intervention reduces preschoolers' body fat, improves fitness

Tue, 22 Jun 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Migrant children are at increased risk of obesity, but a new study shows that a program teaching multiple lifestyle changes to predominantly migrant preschoolers and their parents helps the children reduce body fat and improve fitness. The results will be presented Monday at The Endocrine Society's 92nd Annual Meeting in San Diego.

Such interventions may be needed to help curb the global obesity epidemic, the study's lead author Jardena Puder, MD, said. A senior resident at the University of Lausanne, Lausanne, Switzerland, Puder said, Even young children have high rates of obesity today.

In the United States, about 14 percent of children ages 2 to 5 years are obese, statistics show.

The public health program in this study attempted to reduce the risk of obesity among preschool children from areas of Switzerland with high migrant populations. Specifically, it encouraged the children to increase their physical activity, improve nutrition, get more sleep and reduce audiovisual media use, especially TV watching. Excessive media use can contribute to lack of physical activity, and insufficient sleep in early life may play a role in childhood obesity, according to the authors.

Puder and her colleagues included children, their parents and their preschool teachers in the program, which took place during the 2008-2009 school year. They randomly selected 40 preschool classes in migrant-populated areas and then randomly assigned 20 of the classes to participate in the program and 20 classes to not participate and thus serve as controls. Of the 655 children enrolled in the study, 73 percent had at least one migrant parent.

The program included information materials for teachers and parents as well as two informational and discussion evenings for parents. Children received structured lessons from the regular teachers about physical activity, nutrition, media use and sleep.

In addition, the school environment was adapted, such as by adding a climbing wall. This gave unstructured movement an automatic place within school, Puder said.

Before and after completion of the program, the researchers evaluated numerous measures, including overall fitness on an obstacle course and aerobic fitness. For the latter, children performed the 20-meter shuttle run test, in which they repeatedly ran at increasing speeds between two lines spaced 20 meters (just over 22 yards) apart.

Compared with the control group, the group of children who participated in the program had significantly improved overall and aerobic fitness, according to the abstract. Additionally, the intervention group had greater reductions in total and percent of body fat, waist size and media use. They also improved more than controls in some aspects of nutritional behavior, Puder said.

Besides Health Promotion Switzerland, the Swiss National Science Foundation helped fund this study, called Ballabeina. This word means seesaw in Rhaeto-Romanic, a Latin language spoken in parts of Switzerland. Puder said, The name stands for a life in motion but also in balance.

HHS Secretary Sebelius announces $1 billion in NIH Recovery Act awards for research construction

Fri, 14 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) U.S. Health and Human Services Secretary Kathleen Sebelius today announced one billion dollars of American Recovery and Reinvestment Act funds have been awarded to construct, repair and renovate scientific research laboratories and related facilities across the country. The National Institutes of Health (NIH) National Center for Research Resources (NCRR) administered the grants, which are expected to create or sustain jobs nationwide and to help foster scientific advances that may lead to improved human health.

A total of 146 grants to institutions in 44 states, the District of Columbia and Puerto Rico were awarded to upgrade and construct buildings, laboratory spaces and core facilities that are crucial to biomedical and behavioral investigators.

This unprecedented Recovery Act investment in research facility construction will not only give our world-class scientists the modern facilities they need for impact research, it will also help create and maintain jobs in varied business sectors and in all regions of our country, said Secretary Sebelius.

These awards are part of an overall $100 billion federal government investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in emerging industries and create a long-term foundation for economic growth.

These Recovery Act dollars will provide state-of-the-art facilities for hundreds of researchers to conduct cutting-edge science with the latest technologies, said NIH Director Francis S. Collins, M.D., Ph.D. At the same time, they will create job opportunities nationwide.

Highlighted below are four examples that provide a snapshot of how institutions coast-to-coast will use these funds to help advance studies in disease areas such as cancer, HIV/AIDS, autism, pediatric illnesses and other health disorders.

Renovation of Children's Health Research and Evaluation Facility, Indianapolis Nearly $8.5 million in grant funding will help to create a state-of-the-art facility for pediatric clinical research and to create a core facility of pediatric phenotyping laboratories and patient research resources at the Indiana University School of Medicine. Phenotyping is the use of epidemiologic, biological, molecular or computational methods to systematically select features of a disorder that might result from distinct genetic influences. The project will bring together a range of existing pediatrics laboratory programs into a single core to create collaborative, quantitative phenotyping of diseases and treatments.

The Genome Data Center Initiative, St. Louis The Washington University School of Medicine (WUSM) will use a $14.3 million award to build a world-class data center to support human genome research. WUSM has been involved in genome science since the inception of the field. Its genome center recently embarked on several ambitious projects to decode the genomics of hundreds of cancer patients and their tumors. The research has the potential to transform the diagnosis and treatment of cancer. The new 15,000 square-foot data center will support the computational power and storage needs that projects like these require.

The San Francisco Office of AIDS Renovation (SOAR) Project A grant of more than $9.5 million will allow three prominent United States-based HIV/AIDS prevention research units within the San Francisco Department of Public Health to increase their capacity to recruit, enroll and retain large, diverse populations of study participants efficiently and effectively, and to provide critical data on new HIV/AIDS cases to investigators worldwide. The SOAR project will provide researchers with the space and data needs required for large patient studies, improved security for records storage and space needed for training. The project also will have an impact on current and future biomedical HIV/AIDS research and training initiatives.

Cell and DNA Repository Renovation, New Brunswick, N.J. Data sharing is essential for expedited translation of research results into knowledge, products and procedures to improve human health. Central storage units such as the Rutgers University Cell and DNA Repository (RUCDR) help investigators nationwide share data and biological specimens. To address space shortages and infrastructural needs and to broaden the scope of the molecular biology services, RUCDR has been awarded $9.5 million to renovate their biology laboratory. RUCDR's services provide approximately 90 NIH-funded grantees with resources that aid research in disease areas, including autism, schizophrenia, bipolar disorder and kidney diseases.

Despite tests, high blood pressure hard to recognize in children

Mon, 03 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) A Johns Hopkins Children's Center study of 2,500 patient records suggests that medical staff fails to check a child's blood pressure a fifth of the time, and is not recognizing what constitutes an abnormal reading in those whose blood pressure they do check.

Researchers at Hopkins Children's say the consequences are that pediatricians and nurses may be missing the development of hypertension and its serious consequences, even when they do take blood pressure measurements.

The American Academy of Pediatrics' (AAP) guidelines call for regular blood pressure checks in children 3 years and older to screen for elevated blood pressure, and say elevated blood pressure on three consecutive medical visits qualifies as hypertension. Even a single episode of high blood pressure can indicate hypertension and should trigger repeat measurements during the visit and subsequent doctor visits, the AAP says.

The problem is that measuring a child's blood pressure is far more complicated than it is in adults and requires interpreting each individual measure against a reference table for age, gender and height, says lead investigator Tammy Brady, M.D., M.H.S., a nephrologist at Hopkins Children's.

The researchers analyzed 2,500 records of visits to the pediatrician's office. Medical staff did not check blood pressure in 500 of the cases. Elevated blood pressure scores were recorded in 726 cases of the 2,000 measurements taken, but the implications went unrecognized and unremarked upon in 87 percent of them, the study found.

The findings, to be published in June's Pediatrics and appearing online May 3, underscore the need for better recognition and aggressive monitoring of all children to prevent both the short-term and long-term complications of hypertension, the investigators say.

The study found that medical staff was more likely to miss elevated blood pressures in children of normal weight and in those without a family history of cardiovascular disease. The same was true for those children whose blood pressure was at or below 120/80, a score considered ideal in adults, but one that may portend trouble in a child, depending on height, gender and age.

Blood pressure parameters in adults are clearly defined, but the complicated arithmetic involved in children's blood pressure may be one of the greatest barriers to recognizing a child's elevated pressure, the investigators say.

Brady says more education and automated systems that alert the medical staff if a child's blood pressure is out of range can help. Hopkins Children's is currently testing one such alert system and will soon publish data on its effectiveness.

Hypertension, defined as persistently elevated blood pressure, can cause kidney, eye and heart damage, but while some complications take years and decades to develop, certain ones evolve quickly, the researchers say. A dangerous thickening of the heart muscle called left-ventricular hypertrophy can develop in a matter of months in children with untreated hypertension, but is reversible with early treatment.

Because high blood pressure rarely causes symptoms, medical staff may overlook a child who has no traditional risk factors, such as obesity or family history, the researchers say. Half of the children in the study with elevated blood pressure were normal weight.

Nurses and doctors may be so falsely reassured by a child's lack of symptoms and risk factors that they either miss milder elevations or may chalk them up to measurement error and never follow up on them, Brady says.

In the study, covering children ages 3 to 20 visiting a primary care pediatric clinic at Johns Hopkins, high blood pressure was discovered in six percent of healthy-weight children and in 20 percent of overweight and obese children. Even though medical staff was more attentive to elevated blood pressure among overweight and obese children, high blood pressure was still missed in four out five of them. Children with scores below 120/80 were nearly eight times more likely to have their high blood pressure missed than children with blood pressure above 120/80. Children without a family history of cardiovascular disease were twice as likely to have their high blood pressure unrecognized as those with family history.

Children living in apartments with nonsmoking adults still exposed

Sat, 01 May 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The majority of children living in apartments are exposed to secondhand smoke, even when they don't live with smokers. This study from the University of Rochester Medical Center is the first to examine whether housing type is a potential contributor to children's exposure to cigarette smoke. The abstract was presented this morning at the Pediatric Academic Society Meeting in Vancouver, Canada.

Among children who lived in an apartment, 84 percent had been exposed to tobacco smoke, according to the level of a biomarker (cotinine) in their blood that indicates exposure to nicotine found in tobacco, and this included more than 9 of 10 African-American and white children. Even among children who lived in detached houses, 70 percent showed evidence of exposure.

We are starting to understand the role that seepage through walls and through shared ventilation may impact tobacco smoke exposure in apartments, said Karen Wilson, M.D., MPH, author of the study and an assistant professor of Pediatrics at the University of Rochester Medical Center's Golisano Children's Hospital. We see that children are being exposed in ways we are not picking up, and it's important, for their health, that we figure out where this exposure is taking place, and work to eliminate it. Multi-unit housing is one potential source, but a very important one.

Previous studies have shown that children with cotinine levels indicating tobacco smoke exposure have higher rates of respiratory diseases, decreased cognitive abilities and decreased antioxidant levels.

The study analyzed data from almost 6,000 children between 6- and 18-years-old in a national database (National Health and Nutrition Examination Survey 2001-2006) to see if there was any relationship between their smoke exposure and their housing type. Apartment living was associated with a 45 percent increase in cotinine levels for African American children and a 207 percent increase for white children. About 18 percent of U.S. children live in apartments, and many of these children are living in subsidized housing communities where smoking is more prevalent.

Wilson said many parents are trying to limit their children's tobacco smoke exposure by not allowing smoking in their apartments, but they say they can smell tobacco smoke coming from other apartments or from common areas. Last summer, the U.S. Department of Housing and Urban Development released a memo recommending that their housing developments enact smoke-free policies. A smoking ban within multi-unit, subsidized housing could further reduce the tobacco smoke exposure for children and reduce smoking rates among residents.

Strategy to help doctors determine when to treat retinopathy of prematurity

Thu, 29 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (April 29, 2010) -- Scientists have shown that through eye examinations, doctors can identify infants who are most likely to benefit from early treatment for a potentially blinding eye condition called retinopathy of prematurity (ROP), resulting in better vision for many children.

These long-term results of the Early Treatment for Retinopathy of Prematurity (ETROP) study confirm that the visual benefit of early treatment for selected infants continues through six years of age. The research is published in the April 12 online issue of Archives of Ophthalmology and was supported by the National Eye Institute (NEI), part of the National Institutes of Health. The Edward S. Harkness Eye Institute at NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian/Morgan Stanley Children's Hospital were among the 26 participating study sites.

We showed that early treatment for high-risk premature babies can improve their vision. This research promises to transform the way babies with ROP are treated, says Dr. John Flynn, study principal investigator and the Anne S. Cohen Professor of Clinical Pediatric Ophthalmology at Columbia University College of Physicians and Surgeons and an ophthalmologist at NewYork-Presbyterian/Morgan Stanley Children's Hospital and professor of medicine at Weill Cornell Medical College.

We showed there isn't a single treatment strategy that works for all infants with ROP, but rather that doctors need to determine whether the baby has a mild or severe form of the disease before proceeding with retinal surgery, adds study co-author Dr. Michael Chiang, associate professor of ophthalmology at Columbia University College of Physicians and Surgeons and an ophthalmologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. This can be determined with a simple bedside exam using an ophthalmoscope to look at blood vessels in the retina.

An estimated 15,000 premature infants born each year in the United States are affected by some degree of ROP. At-risk infants generally are born before 31 weeks of the mother's pregnancy and weigh 2.75 pounds or less.

This disease, which usually develops in both eyes, is one of the most common causes of vision loss in children. About 90 percent of infants with ROP have a mild form that does not require treatment, but those who have a more severe form can develop lifelong visual impairment, and possibly blindness.

During pregnancy, the blood vessels of the eye gradually grow to supply oxygen and essential nutrients to the light-sensitive retina. If a baby is born prematurely, growth of the blood vessels may stop before they reach the edge of the retina. In these newborns, abnormal, fragile blood vessels and retinal tissue may develop at the edges of the normal tissue. The abnormal vessels can bleed, resulting in scars that pull on the retina. The main cause of visual impairment and blindness in ROP is retinal detachment. Laser therapy or cryotherapy, using freezing temperatures, are the most effective treatments to slow or stop the growth of abnormal blood vessels.

Previously, doctors treated infants with ROP when they estimated their risk for retinal detachment to be 50 percent, a strategy developed through the NEI-supported Cryotherapy for Retinopathy of Prematurity study. Although this was a major finding, many infants still went on to develop severe eye disease. Therefore, the first phase of the ETROP study aimed to discover if doctors could identify infants at a higher risk for progression of the disease and intervene early to improve their vision.

In 2003, the ETROP study found that early treatment -- upon diagnosis as higher risk for severe ROP -- improved the vision and retinal health of certain infants after nine months. These infants had dilated or twisted blood vessels in the retina and substantial growth of new blood vessels, classified as Type 1 disease. Eyes with Type 2 ROP, or a more moderate amount of new blood vessel growth, did not benefit from early treatment. Doctors could predict which infants were more likely to benefit from early treatment by identifying certain eye characteristics, such as the appearance and location of the blood vessels.

The current study followed the same 370 children through six years of age, when researchers checked their vision and examined the development of their eyes. The nine-month study recommendations were confirmed through six years. Type 1 eyes benefitted from early treatment, and Type 2 eyes had similar results with either early treatment or treatment at the standard time. Seventy-five percent of the early-treated Type 1 eyes were spared legal blindness, compared with 67 percent of Type 1 eyes that received treatment at the standard time. Of the Type 2 eyes that were carefully monitored for disease progression through the standard protocol, more than half improved without treatment.

Keeping kids away from R-rated movies may prevent early drinking

Mon, 26 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Middle-school children whose parents restrict access to R-rated movies are substantially less likely to start drinking than their peers who are allowed to see such films, a new study suggests.

In a study of nearly 3,600 New England middle school students, researchers found that among kids who said their parents never allowed them to watch R movies, few took up drinking over the next couple years.

Of that group, 3 percent said they had started drinking when questioned 13 to 26 months after the initial survey. That compared with 19 percent of their peers who'd said their parents sometimes let them see R-rated films, and one-quarter of students who'd said their parents allowed such movies all the time.

The researchers say the findings, reported in the May issue of the Journal of Studies on Alcohol and Drugs, underscore the importance of parents paying close attention to their children's media exposure.

We think this is a very important aspect of parenting, and one that is often overlooked, said Dr. James D. Sargent, a professor of pediatrics at Dartmouth Medical School in Hanover, New Hampshire.

The current findings build on evidence linking children's exposure to R-rated movies and onscreen adult content in general not only to early drinking but also to early smoking and kids' likelihood of having sex or behaving violently.

The research to date suggests that keeping kids from R-rated movies can help keep them from drinking, smoking and doing a lot of other things that parents don't want them to do, Sargent said.

He pointed out that it could be argued that parents who restrict access to R movies are simply more careful in general -- keeping tabs on their children's friends or making sure their kids have no access to alcohol at home, for instance. However, Sargent and his colleagues accounted for this in the current study by asking students questions that gauge authoritative parenting -- which gauges the adolescent's perception of parental responsiveness (ability to respond to the adolescent's point of view) and demandingness (ability to set and enforce limits).

The researchers found that, even with such factors considered, exposure to R-rated movies was still linked to the likelihood of early drinking.

Ninety percent of R-rated films have depictions of drinking, and that may be one reason that middle-schoolers who see the films are more vulnerable to early drinking. But Sargent said that the R-rated movie effect goes beyond that. Other research suggests that children who see R-rated movies become more prone to sensation seeking and risk taking. We think seeing the adult content actually changes their personality, Sargent said.

The bottom line, according to the researcher, is that parents should restrict their kids from seeing R-rated films. But he also pointed out that PG-13 movies, as well as many TV shows, often portray drinking and other adult situations -- and that supports limiting children's media time in general.

The American Academy of Pediatrics currently recommends that children watch no more than one to two hours of quality media, including movies, TV and videos, each day.

Nutrition researchers to develop new growth charts for children with Down syndrome

Thu, 22 Apr 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Parents and doctors have known for a long time that children with Down syndrome tend to grow more slowly and are considerably shorter than most other children. But pediatricians needing to record growth milestones at regular office visits have an outdated set of growth charts based on data collected more than 25 years ago. Since that time, there have been major advances in the medical care of children with Down syndrome. In addition, the demographics of the general U.S. population have changed, and children are taller, but also more overweight.

Now researchers at The Children's Hospital of Philadelphia will be measuring children with Down syndrome from birth to age 21 to develop updated growth charts. A four-year, $1.2 million grant from the Centers for Disease Control and Prevention (CDC) is supporting this effort, which brings together experts from the Hospital in growth and nutrition, Down syndrome (also called trisomy 21), and general pediatrics.

One of the most common birth defects, Down syndrome occurs in approximately one in 700 births. The National Down Syndrome Society estimates that there are more than 400,000 people living with Down syndrome in the U.S. It is a genetic disorder, usually resulting from having three copies of chromosome 21, instead of the usual two copies.

Because the extra chromosome generally occurs in every cell in the body, it can affect many different systems, causing congenital heart disease, recurrent ear and sinus infections, hearing loss, thyroid disorders, visual impairment, and gastrointestinal disorders. Neurological effects include developmental disability, which can range from low-average abilities to severe intellectual impairment.

The past 20 years have seen significant improvements in the care of children with Down syndrome, accompanied by longer life expectancy, said the grant's principal investigator, Babette S. Zemel, Ph.D., director of the Nutrition and Growth Laboratory at The Children's Hospital of Philadelphia. We believe that children with Down syndrome are growing better now than they were 20 years ago. We also want to look at how they are growing throughout childhood, from infancy to young adulthood, at how body mass index changes across time, and how that relates to body fat composition.

If we can better understand the growth patterns and the rates of other illnesses that co-occur with Down syndrome, researchers may be better able to plan treatment and design preventive health programs, added Zemel. The CDC has recognized updated growth charts as an important tool for people providing health care to children with Down syndrome. In its grant guidelines, the CDC states that new growth charts produced from the study will be broadly distributed free of charge.

Under the grant, Zemel and colleagues will recruit approximately 600 children with Down syndrome, from birth to 20 years old, from Southeastern Pennsylvania, New Jersey and Delaware. In regularly scheduled follow-up visits, the researchers will measure the patients' growth and body dimensions and collect data about their health, dietary patterns and physical activities.

In addition to developing more representative growth charts, we also expect to better understand what factors may contribute to growth-related problems in children with Down syndrome, added Zemel. Another important goal is to develop a screening tool for identifying children at risk for overweight and obesity, which are common concerns for adolescents and young adults with Down syndrome.

Children's sense of threat from parental fighting determines trauma symptoms

Mon, 29 Mar 2010 04:00:00 PST

( from http://www.rxpgnews.com ) If children feel threatened by even very low levels of violence between their parents, they may be at increased risk for developing trauma symptoms, new research suggests.

A study by psychologists at Southern Methodist University in Dallas found that children who witness violence between their mother and her intimate partner report fewer trauma symptoms if they don't perceive the violence as threatening.

The research highlights the importance of assessing how threatened a child feels when his or her parents are violent toward one another, and how that sense of threat may be linked to symptoms of trauma.

Our results indicated a relation between children's perception of threat and their trauma symptoms in a community sample reporting relatively low levels of violence, said Deborah Corbitt-Shindler, a doctoral candidate in the psychology department at SMU. The results of the study suggest that even very low levels of violence, if interpreted as threatening by children, can influence the development of trauma symptoms in children.

The researchers presented their findings February 24 at the National Summit on Interpersonal Violence and Abuse Across the Lifespan: Forging a Shared Agenda in Dallas. The scientific conference was sponsored by the National Partnership to End Interpersonal Violence Across the Lifespan.

Family violence experts estimate that more than half of children exposed to intimate partner violence experience trauma symptoms, such as bad dreams, nightmares and trying to forget about the fights.

The SMU study of 532 children and their mothers looked at the link between intimate partner violence and trauma symptoms in children. The families were recruited from communities in the urban Dallas area. The National Institute of Mental Health funded the research. For more information see www.smuresearch.com.

In the study, mothers were asked to describe any violent arguments they'd had with their intimate partners, and they were asked about trauma symptoms they may have experienced because of the violence.

Similarly, the children in the study, age 7 to 10 years old, were asked to appraise how threatened they felt by the violence they witnessed, and about trauma symptoms they may have experienced because of the violence. The researchers defined threat as the extent to which children are concerned that: a family member might be harmed, the stability of the family is threatened, or a parent won't be able to care for them.

To assess trauma, children were asked questions such as if they've had bad dreams or nightmares about their mom's and dad's arguments or fights; if thoughts of the arguments or fights ever just pop into their mind; if they ever try to forget all about the arguments and fights; and if they ever wish they could turn off feelings that remind them of the arguments and fights.

The SMU researchers found that even when mothers reported an episode of intimate partner violence, their children reported fewer trauma symptoms when they didn't view the episode as threatening. Although a mother's emotions sometimes affect their children's emotions, in this study the mothers' trauma symptoms were unrelated to the children's traumatic responses to the violence.

Soothing infants with food focus of childhood obesity study

Wed, 10 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Both genetics and parents who comfort their infants with food are the focus of a study funded for $1 million by the National Institute of Diabetes and Digestion and Kidney Disease investigating risk factors for childhood obesity. The grant is part of the National Institutes of Health American Recovery and Reinvestment Act funding.

When the infant cries, parents typically have a set of soothing techniques they'll use to comfort their child -- if one doesn't work, they move to the next -- and somewhere on that list is feeding, said Cynthia Stifter, professor of human development and family studies and principal investigator on the project. It may be, with some children, that using food as a means of soothing distress promotes the association of food with emotional comfort, a characteristic of emotional eaters that is associated with adult obesity.

One goal of Stifter's study is to provide a detailed description of how and when parents use feeding to soothe infants and its relation to weight gain in infancy. Rapid weight gain in infancy has been linked to childhood obesity.

There has been much speculation about the role of food in parent soothing of infant distress, but there is no research, said Stifter. What is known is that food, especially that containing sugar, has an immediate effect on infant distress and that many middle-income and lower-income mothers endorse using food to soothe an infant's distress.

To see how parents respond to their infants' distress, researchers will go with families to routine doctor appointments where infants receive vaccinations. These immunizations commonly cause distress. The researchers will also keep track of children's rate of weight gain and parents will complete a daily diary, at five minute intervals for three days, recording whether their child fussed, cried, slept, was content or was fed. Parents will also participate in a number of laboratory visits to assess the infants' emotional reactivity and regulation, and a variety of interviews including one conducted by Penn State's Diet Assessment Center, which will examine the food environment -- meal location, the context in which food is eaten -- whether the child was crying or fell asleep after eating and child feeding practices -- whether food was offered to soothe the child.

Stifter will also look at the brain's natural reward system, which releases dopamine into the brain, producing a feeling of pleasure.

Dopamine basically makes you want more of something, says Stifter.

Dopamine in the brain is associated with nicotine, alcohol and other addictions. Stifter and her colleagues will consider food as the object of an addiction for certain individuals. They will draw upon previous research pinpointing a set of genes that determine a person's dopamine system activity. Certain individuals may be genetically predisposed to be more sensitive to their brain's reward system.

We are hypothesizing that the parenting practice of feeding to soothe, or the use of food to soothe infant distress not related to hunger, may interfere with the development of the ability to read internal cues of hunger and fullness, which, in certain children with sensitive dopamine systems, may lead to increased energy intake, rapid weight gain in infancy, and subsequent childhood obesity, said Stifter.

No previous studies have examined parent feeding style in infancy and genetics as precursors to childhood obesity.

NHLBI funds preclinical tests on devices for infants and children with congenital heart defects

Thu, 04 Feb 2010 05:00:00 PST

( from http://www.rxpgnews.com ) The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has awarded four contracts totaling $23.6 million to begin preclinical testing of devices to help children born with congenital heart defects or those who develop heart failure. The four-year program is called Pumps for Kids, Infants, and Neonates (PumpKIN).

Each year in the United States, nearly 1,800 infants die as a result of congenital heart defects and another 350 develop heart disease, which leads to heart failure for many. Approximately 60 infants and children under 5 years old who are placed on the heart transplant waiting list die each year before receiving one. Mechanically assisted circulatory support could be used to sustain these young patients as they seek to recover or wait to receive a heart transplant.

This research seeks to develop technologies to expand life-saving options for infants and children born with congenital heart defects or those who develop heart failure, said NHLBI Acting Director Susan B. Shurin, M.D., a pediatrician. The NHLBI is committed to saving the lives of our youngest patients. Well-designed circulatory support devices are expected to substantially improve the outcomes of the infants and young children who need them as they seek to recover or wait to receive a heart transplant.

The options for chronic circulatory support devices for infants and young children are limited, and all have substantial risks for serious adverse events such as infection, stroke, and device failure. With this in mind, the NHLBI launched the Pediatric Circulatory Support Program in 2004 by funding the development of five novel circulatory support devices for infants and young children with congenital and acquired cardiovascular disease.

The PumpKIN program is the next phase of NHLBI support for the development and clinical realization of these devices. The program's goal is to complete the needed animal studies and other tests in artificial environments for the most promising devices in order to gain approval from the FDA to begin clinical testing.

Devices in the program will provide suitable circulatory support for newborns, older infants, and children less than 55 pounds who experience heart failure due to congenital and acquired cardiovascular disease. They are designed to supply adequate blood flow to prevent organ damage while minimizing the risk of blood vessel damage, infection, breakdown of red blood cells, excessive bleeding, brain damage, and dangerous blood clots. The devices are intended to support circulation in pediatric patients for one to six months, be sufficiently small and reasonably portable, and be able to be routinely positioned and functioning in less than one hour, among other specifications.

Similar devices are used in adults, Shurin noted. As an adult, your heart is normally about the size of your fist; devices for small children require radically different designs from adult devices to adapt to the differences in the size of the patients.

The program will test ventricular assist devices (VADs) and advanced extracorporeal membrane oxygenator (ECMO) devices. The VADs in the PumpKIN program are very small rotary pumps which are implanted to provide circulatory support for extended periods of use. They work by drawing blood from the heart and pumping it to the body. ECMO devices circulate and supply oxygen to the blood, and are commonly used for patients who need both heart and lung support. For ECMO devices, tubes connecting the patient to the device are placed directly into large blood vessels near the base of the neck. Blood is drawn from the right side of the heart, pumped through the oxygenator, and then returned to the body on the left side of the heart so the oxygen-rich blood can be delivered throughout the body.

The contractors will conduct all preclinical animal testing and analysis in the first three years of the contract. During the third year, they will partner with a data coordinating center (the contract for which is still to be awarded) to complete the necessary activities to seek FDA approval to begin the clinical trial.

Bypass procedure used during infant heart surgery does not impair later neurological outcomes

Tue, 26 Jan 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Congenital heart defects (CHD) are the most common birth defects in humans, affecting 8 per 1000 live births with one third of affected children requiring intervention in early infancy. Increasing numbers of survivors combined with developmental expectations for independence, behavioral self-regulation and academic achievement have led to a growing identification of neurobehavioral symptoms in some survivors. A study now suggests that a cooling technique often used in heart operations does not impair neurological outcomes.

Congenital heart disease and its treatment were originally thought to potentially increase neurologic injury in these patients. The technique of deep hypothermic circulatory arrest (DHCA) is used in order to repair these congenital cardiac defects by providing a bloodless surgical field, which may facilitate completion of the best physiologic repair, and decrease the duration of blood exposure to the bypass circuit. However, it involves a period of reduced blood flow in the brain. Cooling is a protective mechanism to reduce metabolism of the brain and other organs during periods of low blood flow.

Stephanie Fuller, M.D., a cardiothoracic surgeon at The Children's Hospital of Philadelphia, presented these research findings yesterday in the prestigious J. Maxwell Chamberlain Lecture at the annual meeting of the Society of Thoracic Surgeons in Fort Lauderdale, Fla. According to the study, DHCA does not impair language skills, attention, and other neurocognitive abilities in school-age children.

Dr. Fuller and colleagues from Children's Hospital and the University of Washington assessed the use of DHCA as a predictor of neurodevelopmental outcomes in children who had cardiac surgery as infants. The infants were enrolled in a prospective study of apolipoprotein-E (APOE) polymorphisms and neurodevelopmental outcome after cardiac surgery and underwent formal neurodevelopmental testing at four years of age.

Neurodevelopmental testing was completed in 238 out of 307 eligible patients. The surgeons used DHCA in 92 of those infants as deemed necessary to provide better operative exposure with a bloodless and less cluttered surgical field and therefore a shorter total cardiopulmonary support time. Use of DHCA was not predictive of worse performance for any neurodevelopmental outcome. Significant predictors of worse outcome included lower socioeconomic status, preoperative mechanical ventilation and babies that were younger and smaller at the time of first operation. Neurodevelopmental assessment included cognition, language skills, attention, impulsivity, executive function, social competence, and visual-motor and fine-motor skills.

Selective use of DHCA during cardiac surgery in infancy may facilitate operative repair and is not associated with impaired neurodevelopmental outcomes, said Dr. Fuller. Despite added risk factors, the selective use of DHCA during infancy for repair of congenital heart disease without an obstruction in the aorta was not predictive of worse performance at four years of age.

Dr. Fuller added use of DHCA as a support technique during cardiac surgery in infancy has many advantages; it is not necessary to sacrifice these advantages merely to avoid use of DHCA. Our study adds to the growing literature showing no adverse influence of limited periods of DHCA. New support techniques must be carefully evaluated prior to wide-spread acceptance to confirm they are not inferior to conventional management strategies.

Researchers to investigate the genetics of congenital heart disease

Tue, 22 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Researchers at Children's Hospital Boston and Brigham and Women's Hospital have received funding from the National Heart, Lung, and Blood Institute (NHLBI) to support their search for undiscovered gene defects that cause congenital heart disease. The $4.19 million, 6-year grant is part of the Pediatric Cardiac Genomics Consortium (PCGC), which seeks to identify genetic and epigenetic causes of human congenital heart disease, and relate genetic variants present in the congenital heart disease patient population to clinical outcomes.

Though individual congenital heart defects are rare, together they affect 35,000-40,000 U.S. infants born annually, making congenital heart disease the most common group of birth defects. The ultimate goal of the PCGC, part of the newly established Bench to Bassinet initiative at NHLBI, is to identify preventive strategies, targets for treatment, and better diagnostic and prognostic information for families.

Too many young lives are lost each year due to congenital heart defects, said Susan B. Shurin, MD, acting director of the National Heart, Lung, and Blood Institute at the National Institutes of Health. To help give these children a chance at a healthier life, the Bench to Bassinet program will delve into how the cardiovascular system develops and help translate the best research findings into clinical practice.

We are thrilled to be part of this ground-breaking new endeavor, says Jane Newburger, MD, MPH, Associate Chief for Academic Affairs in the Department of Cardiology at Children's, Commonwealth Professor of Pediatrics at Harvard Medical School, and Principal Investigator on the grant together with Christine E. Seidman, MD, Director of the Cardiovascular Genetics Center at Brigham and Women's Hospital and Thomas W. Smith Professor of Medicine at Harvard Medical School. Jonathan Seidman, PhD, Henrietta B. and Frederick H. Bugher Foundation Professor of Genetics at Harvard Medical School, is also a key co-investigator. The other PCGC institutions are Yale University, Mt. Sinai School of Medicine, Columbia University, and Children's Hospital of Philadelphia.

Although a few genetic causes of congenital heart disease are already known, the researchers hope to zero in on novel, undiscovered genes. Because gene discovery research requires a high number of patient samples, a collaborative consortium such as the PCGC will propel research forward by allowing scientists to share patient samples, data and technology. Everybody recognizes that no one center alone can do this research, Newburger says.

Several other Children's Hospital Boston researchers are co-investigators in the PCGC. Steven Colan, MD, Associate Chief for Clinical Operations in the Department of Cardiology and Professor of Pediatrics at Harvard Medical School, will lead the echocardiography and other cardiac imaging studies which are essential to characterize the exact form or phenotype of the patients' heart conditions. Roger Breitbart, MD, Assistant Professor of Pediatrics at Harvard Medical School, will serve as an important liaison between the clinical effort and research laboratory. Amy Roberts, MD, Assistant Professor in Pediatrics at Harvard Medical School, will lead the recruitment of new patients and collection of DNA.

Competition inspires people to work quickly, but this particular area of research begs for collaboration, says Roberts, who is Director of the Cardiovascular Genetics Research Program at Children's. The collaborative effort is the only way we have a chance of making big discoveries in a short period of time.

H1N1 more risky than seasonal flu in children with sickle cell disease

Mon, 07 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Infection with the H1N1 virus, or swine flu, causes more life-threatening complications than seasonal flu in children with sickle cell disease, according to research from Johns Hopkins Children's Center. The findings, to be presented on Dec. 7 at the annual meeting of the American Society of Hematology, warn parents and caregivers that such children are more likely to need emergency treatment and stays in an intensive-care unit.

The researchers analyzed the records of 118 children with sickle cell disease treated for any kind of flu at Hopkins Children's between September of 1993 and November of 2009. Of them, 28 were infected with the H1N1 virus, a new strain that emerged for the first time in April of 2009.

While both the seasonal flu and the H1N1 virus caused similar general symptoms like fever, cough and a runny nose in most of the children, sickle cell patients infected with H1N1 were three times more likely to develop acute chest syndrome, a leading cause of death among these patients, marked by inflammation of the lungs, reduced oxygen capacity and shortness of breath. H1N1-infected children were five times more likely to end up in the intensive-care unit, and were overall more likely to end up on a ventilator and more likely to need a blood transfusion than those with seasonal flu.

Another Hopkins Children's study, released earlier this year, found that children with sickle cell disease are hospitalized with seasonal flu nearly 80 times more often than other children.

The researchers say their findings point to the need to include children with sickle cell disease in the list of those who must be immunized against all flu strains, which already includes children with asthma, diabetes, heart disease and other chronic conditions.

Children with sickle cell disease are hospitalized about once a year for pain crises and other complications, so we should do everything we can to prevent hospitalization from the flu by using safe and effective vaccines, says lead investigator John J. Strouse, M.D. Ph.D., a pediatric hematologist at Hopkins Children's.

Named for the unusually sickle-shaped red blood cells caused by a genetic abnormality, sickle cell anemia affects nearly 100,000 Americans. The cells' abnormal structure reduces their oxygen delivery to vital organs and causes them to get stuck in the blood vessels, leading to severe pain and so-called sickling crises, which require hospitalization.

The CDC recommends that all children over 6 months of age get seasonal and H1N1 flu shots, except those who are allergic to eggs or have had a severe reaction to a flu vaccine in the past.

New study finds barriers to pain treatment in children with sickle cell disease

Sun, 06 Dec 2009 05:00:00 PST

( from http://www.rxpgnews.com ) A new study by researchers from the Medical College of Wisconsin, in Milwaukee, found a substantial variation in hydroxyurea utilization for pain and other sickle cell disease complications in children. Barriers to its use on the part of both providers and patients were also identified. The study led by Amanda M. Brandow, DO, MS, assistant professor of pediatrics at the Medical College and Children's Research Institute at the Children's Hospital of Wisconsin, will be presented at the American Society of Hematology meeting Dec. 7, 2009, in New Orleans.

The study was funded by the National Heart Lung and Blood Institute of the National Institutes of Health. Dr. Brandow is an NIH sickle cell scholar.

Sickle cell disease is often marked by episodes of severe and incapacitating pain called vaso-occlusive painful events, which can sometimes require hospitalization. Hydroxyurea, an oral drug that is most commonly taken once daily, was approved by the U.S. Food and Drug Administration for use in sickle cell disease patients in 1998. While hydroxyurea remains the standard of care for reducing these painful events in adults, little is known about its practice patterns in children.

The researchers surveyed members of the American Society of Pediatric Hematology/Oncology about their practices and patients to evaluate patterns and barriers to hydroxyurea use. Of the 1,128 surveys disseminated, 31 percent (350 surveys) were returned.

To standardize and increase the quality of care for both adults and children with sickle cell disease, the National Heart, Lung, and Blood Institute (NHLBI) provides clinical practice guidelines for the management of this blood disorder. Most of the survey respondents had heard of (87 percent) and read (78 percent) these guidelines, and provider utilization of hydroxyurea correlated with awareness of the NHLBI recommendations.

The survey found that only eight percent of providers had half or most (50 to 90 percent) of their pediatric patients with sickle cell disease on hydroxyurea. Another 54 percent of providers had 10 to 30 percent of pediatric patients on the therapy, and 10 percent of providers had fewer than 10 percent of pediatric patients on hydroxyurea. Although a majority of providers (90 percent) felt that hydroxyurea was effective or very effective for the prevention of pain, some still did not prescribe the drug to eligible children because of apprehension about future reproductive issues (birth defects and infertility in males), despite insufficient evidence to support this concern.

Low patient compliance was cited by 86 percent of providers as another reason they did not prescribe hydroxyurea. Providers reported that children and their families refused hydroxyurea because of a fear of cancer or other possible side effects, concerns that the drug would not work, compliance with required laboratory monitoring, or because they simply did not want to take medication.

The study also found that many providers prescribed hydroxyurea for reasons other than that for which it was intended, despite insufficient evidence of its efficacy for other complications of the disease.

According to Dr. Brandow, To alleviate this problem, future research in the following areas may help: continued funding of studies to determine the efficacy of hydroxyurea for complications other than pain, evaluating unconfirmed toxicities of the drug that influence practice, exploring how access to care contributes to noncompliance, and research on methods to promote patient adherence to recommended medical care.

NIH awards $8.5 million for research on pharmaceuticals for children

Tue, 17 Nov 2009 04:59:36 PST

( from http://www.rxpgnews.com ) Studying drugs in pediatric populations is challenging because drugs often affect children differently than they do adults. The scarcity of pediatric studies limits the ability of doctors and scientists to predict drug dosing, safety and efficacy in children. To address this gap, the National Institutes of Health announced today 18 grants to help determine outcome measures and increase the likelihood of success of future trials of treatments for children.

The grants were awarded to 17 Clinical and Translational Science Award (CTSA) institutions to support 18 studies of pharmaceutical treatments for children. The CTSA consortium is a national network of 46 medical research institutions working together to improve the way biomedical research is conducted across the country. The $8.5 million in funding will support studies which focus on three areas critical to health: pediatric cardiology, neonatology and pediatric neurology.

The awards will be administered by the National Center for Research Resources (NCRR) while the funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The NCRR and NICHD are part of the NIH.

These awards exemplify what the CTSA program supports: innovative, transformative and collaborative research, said Barbara Alving, M.D., director of NCRR. These CTSA institutions are uniquely positioned to deliver outcomes in these studies that may translate into better treatments for children in the future.

The funding is part of NIH's continuing efforts in studying drugs for use in pediatric populations. The Best Pharmaceuticals for Children Act of 2002 established a process to study on-patent and off-patent drugs for children and to improve pediatric therapeutics through collaboration on scientific investigation, clinical study design, weight of evidence, and ethical and labeling issues.

People of different ages require research outcome measures that are tailored to their size and condition, said Steven Hirschfeld, M.D., Ph.D., NICHD associate director for clinical research. These studies will fill a critical gap by providing the precision needed to understand outcomes for younger patients who may respond differently than adults, and thereby enhance the quality of pediatric research.

As an example, premature infants often suffer from a lung condition called bronchopulmonary dysplasia (BPD), which requires the use of oxygen and other supportive measures, and places them at high risk for developing chronic respiratory obstruction later in life. However, researchers have found that the success of therapies used to treat BPD in newborns did not necessarily correlate with success in staving off the chronic conditions, suggesting the currently used outcome measures are not reliable. To address this deficiency, two separate projects have been funded and will be conducted by researchers at the University of North Carolina at Chapel Hill and at Tufts University. The goals of the of these projects are to develop new tools to define the extent of functional impairment due to BPD in neonates and to establish a registry to track and quantify the onset and extent of chronic lung problems in these at-risk infants as they grow older, respectively.

In another example, the tools such as blood pressure cuffs that doctors use to diagnose and treat hypertension were developed for adults and have never been validated in children. As a result, researchers have had a hard time detailing the effectiveness of treatments for high blood pressure in children. To address this problem, researchers at Case Western Reserve University received funding to adapt the blood pressure cuffs to children. To better understand blood pressure patterns in children, a consortium of five CTSAs led by investigators at the Albert Einstein College of Medicine will enroll children between the ages of 10 and18 years into a six-month study of the effect of home-based diet and lifestyle modification on blood pressure.

St. Jude and UF Proton Therapy Institute to begin proton therapy clinical trial

Mon, 09 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) St. Jude Children's Research Hospital and the University of Florida Proton Therapy Institute have formed a collaboration to provide proton therapy for St. Jude patients. The announcement follows the approval of the first clinical study to evaluate the use of proton therapy for rare brain cancers in children younger than 3 years old.

Under the clinical protocol, St. Jude will refer patients to receive proton therapy at the UF Proton Therapy Institute in Jacksonville, Fla. The purpose of the clinical study is to improve response rates and decrease treatment-related side effects.

Proton therapy is being studied as a way to reduce potential damage to healthy tissue that may result from conventional radiation therapy. This is especially important in treating children with brain and spinal tumors to potentially avoid interference with development, growth and cognitive functioning.

St. Jude has the world's largest protocol-based, pediatric brain tumor research and treatment program, which puts it in an excellent position to scientifically document the advantages realized with proton beam radiation therapy.

Proton beam therapy is potentially of great importance to St. Jude and our patients, said Dr. Joseph H. Laver, St. Jude executive vice president and clinical director. Although most proton facilities operating in the U.S. recognize pediatrics as a major area of focus, there is very little meaningful data using this modality in children. Working with UF Proton Therapy Institute, we are well-positioned to answer key questions regarding this therapy for children with cancer.

St. Jude patients accepted for the clinical study will be in Jacksonville for proton therapy treatment for six to eight weeks. It is expected that up to 15 patients will receive treatment during the first year of the study. While in Jacksonville, hospital care for St. Jude patients will be provided by Nemours Children's Clinic Jacksonville and Wolfson Children's Hospital. The Ronald McDonald House in Jacksonville will house St. Jude patients while they are receiving treatment in Florida.

It is central to our mission to realize the full potential of protons in the treatment of children, said Dr. Nancy Mendenhall, medical director at UF Proton Therapy Institute. In cooperation with St. Jude, we will have both clinical and research expertise to provide the best outcomes for patients and to create new knowledge that will guide the development of proton therapy for future patients.

St. Jude leads the field in the application of intensified modulated radiation therapy, known as IMRT. The technique is effective at avoiding damage to adjacent tissues; however, IMRT can still deliver significant radiation doses to underlying tissues resulting in unavoidable side effects for some children. Proton therapy can be focused more precisely and intensely on specific areas of cancerous activity. Protons can also be energized for a desired degree of tumor penetration, thus sparing underlying tissues from radiation exposure.

UF Proton Therapy Institute is one of only six proton therapy centers in the United States. Since opening in August 2006, UF Proton Therapy Institute has treated 100 pediatric patients.

Children who often drink full-fat milk weigh less

Tue, 03 Nov 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Eight-year-old children who drink full-fat milk every day have a lower BMI than those who seldom drink milk. This is not the case for children who often drink medium-fat or low-fat milk. This is one conclusion of a thesis presented at the Sahlgrenska Academy at the University of Gothenburg, Sweden.

The study showed that children who drink full-fat milk every day weigh on average just over 4 kg less.

This is an interesting observation, but we don't know why it is so. It may be the case that children who drink full-fat milk tend also to eat other things that affect their weight. Another possible explanation is that children who do not drink full-fat milk drink more soft drinks instead, says dietician Susanne Eriksson, author of the thesis.

The scientists also discovered a difference between overweight children who drink full-fat milk every day and those who do not. Children who often drink milk with a fat content of 3% are less overweight. The thesis shows also that the children eat more saturated fat than recommended, but those children who have a high intake of fat have a lower BMI than the children with a lower intake of fat.

Susanne Eriksson has investigated the nutrition, body composition and bone mineralization of 120 healthy 8-year-olds. Much of the results can now be used as a standard to determine what is normal for healthy children at that age. The children recounted what they had eaten during the previous day, and answered questions concerning how often they ate certain foods. Various risk markers in the children's blood were also measured.

Many of these children had been examined when they were four years old, and we discovered that their eating habits were pretty much unchanged four years later. It appears to be the case that eating habits are established early, says Susanne Eriksson.

The thesis found that 62% of the children had low levels of vitamin D in their blood. The general guideline value for all people for vitamin D is 75-100 nmol/l, but most children had less than this. High levels of vitamin D are found in oily fish, while certain dairy products have been fortified with vitamin D. It can be difficult to obtain sufficient levels of the vitamin through the diet.

We could not determine whether the children's level of vitamin D is correlated with their consumption of fish, but we did see that those children who ate oily fish, such as salmon and mackerel, at least once a week have higher values of the long-chain fatty acids EPA and DHA in their blood. This shows how important it is to eat such fish, instead of processed fish such as fish fingers, says Susanne Eriksson.

Tufts CTSI and Tufts University receive 4 NIH supplemental grant awards

Tue, 27 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The Tufts Clinical and Translational Science Institute (CTSI) and Tufts University today announced they are the recipients of four supplemental grant awards from the National Institutes of Health. These new awards, totaling approximately $1.73 million, are supplements to the original Clinical and Translational Science Award (CTSA) grant, UL1 RR025752 that Tufts University received in 2008 from the National Center for Research Resources.

Community Engagement Research is a two-year project that will expand the scope of Tufts CTSI's current community engagement program by enhancing the ability of community partners to participate more effectively in the development of research plans and outcomes. Begun in September 2009, the project has already established an alliance between the Tufts CTSI, the Harvard Clinical and Translational Science Center, and two pivotal community partners, the Center for Community Health Education, Research, and Service (CCHERS) and the Immigrant Service Providers Group/Health (ISG/H). This alliance is creating a curriculum and evaluation for a self-study and face-to-face program entitled Fostering Community Partners in Translational Research (FCPTR) that will target community agencies and health centers. The Program Director is Laurel Leslie, MD, MPH, Associate Professor of Medicine at Tufts University School of Medicine.

Improving BPD Predictors and Outcomes for Clinical Trials builds on prior landmark research that identified a constellation of signs and symptoms in high risk newborns to accurately define bronchopulmonary dysplasia (BPD) and predict the subsequent development of chronic respiratory morbidity (CRM) later in childhood and adolescence. While treatment with recombinant human superoxide dismutase to premature newborns has been proven to have a 55% reduction in CRM compared to placebo controls, current definitions of BPD may be unreliable predictors of CRM and a more robust reduction in CRM is needed. Superoxide dismutase is an enzyme that converts superoxide radicals (highly reactive oxygen molecules produced during metabolism and capable of damaging body tissues) into less toxic agents. This one-year study is a prospective, longitudinal, observational study in 85 preterm infants 24-29 weeks gestation. The Program Director is Jonathan Davis, MD, Chief of Newborn Medicine, The Floating Hospital for Children at Tufts Medical Center, Program Director at the Clinical and Translational Research Center, and Professor of Pediatrics, Tufts University School of Medicine. Partners in this study include Brigham and Women's Hospital (Harvard University), Beth Israel Hospital (Harvard University), Nationwide Children's Hospital (Ohio State), and King's College in London.

Searching for Persistence of Infection in Lyme Disease is a highly innovative Bench-to- Bedside research project that could have an extraordinarily significant impact on the field of Lyme disease. Although antibiotic therapy is clinically effective in treating the symptoms of Lyme disease for most patients early in the course of disease, a significant number of patients who receive therapy report persistent symptoms. A range of theories have been proposed for why this occurs. Moreover, commonly available tests for human Lyme disease are not able to determine persistent infection after antibiotic therapy. Program Director, Linden Hu, MD (Associate Professor of Medicine, Tufts University School of Medicine and Associate Professor of Microbiology, Sackler School of Biomedical Graduate Sciences) has begun an unconventional study examining whether xenodiagnosis (the feeding of uninfected Ixodes ticks on infected animals) can be used to determine when persistent infection occurs in humans. Xenodiagnosis has been used for other difficult to diagnose diseases such as Chagas disease and can sometimes definitively identify the presence of an organism in animals where other techniques cannot. Whether xenodiagnosis is effective in humans is unknown. This two-year project seeks to test the utility of xenodiagnosis for identifying persistence of B. burgdorferi, the spirochetal bacteria that cause Lyme disease, after antibiotic treatment of the disease. Dr. Linden's team will test subjects with elevated C6 antibody levels or persistent symptoms after antibiotic therapy and patients with Lyme arthritis. Evidence that B. burgdorferi can be identified by xenodiagnosis after antibiotic therapy in subjects with continued symptoms would significantly change the current paradigm for potential mechanisms of disease and provide researchers and clinicians with a novel tool for identifying patients with persistent infection.

Tufts CTSI currently has a Pilot Studies Program that funds new interdisciplinary research teams, seeds novel ideas, and provides the means to acquire necessary preliminary data for larger, multi-year grant applications. A new supplemental project, The Pilot Project Mechanism, is led by Susan K. Parsons, MD, MRP, Director, The Health Institute, Institute for Clinical Research and Health Policy Studies and Associate Professor of Medicine and Pediatrics, Tufts University School of Medicine, and Amy Yee, PhD, Professor of Biochemistry, Sackler School of Biomedical Graduate Sciences. This two-year project expands the current program to influence research not just within the Tufts enterprise, but also throughout the Commonwealth of Massachusetts and into New England via Tufts CTSI's forty-three collaborating partners by soliciting interinstitutional and multidisciplinary applications. Many of the identified programs will hire and support undergraduate and graduate students and postdoctoral fellows, thereby creating jobs throughout New England and also increasing the pipeline for translational researchers.

Trial to test whether behavioral therapy can reduce anxiety in young adolescents with autism

Tue, 27 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Oct. 27, 2009 -- The USF Health Rothman Center for Neuropsychiatry in St. Petersburg, FL, is conducting a two-year federal trial testing the effectiveness of behavioral psychotherapy in treating anxiety among young adolescents with autism.

The University of South Florida is one three sites for the $1-million study, sponsored by the National Institute of Child Health and Development (NICHD) through the American Recovery and Reinvestment Act. The other two sites are the University of California at Los Angeles and the University of Miami. The USF arm of the study will receive approximately $500,000.

Autism spectrum disorders, collectively referred to as autism, cause pervasive impairment in thinking, feeling, language and the ability to relate to others and can range from a severe from (called autistic disorder) to a much milder form known as Asperger syndrome. Anxiety disorders affect as many as 80 percent of children and adolescents with autism spectrum disorders, triggering distress and impairment over and above that caused by an autism diagnosis alone, said Eric Storch, PhD, principal investigator for the multi-site trial and associate professor of pediatrics and psychiatry at USF Health.

As yet, there are no tried-and-true methods for treating the anxiety that often accompanies autism, Dr. Storch said. Cognitive behavioral therapy has worked very well for typically developing kids with anxiety. The goal of this study is to adapt this therapy for use in early adolescents with autism and co-occurring anxiety.

Cognitive behavioral therapy (CBT) involves exposing a patient to what they fear in controlled, graduated doses in an attempt to decrease their anxiety over time and prevent a compulsive or avoidance response. It has become a gold standard treatment for youngsters with anxiety disorders who do not have complicating conditions like autism or attention deficit hyperactivity disorder.

The researchers will first adapt a CBT protocol they have developed for younger children to meet the characteristics and clinical needs of early adolescents (ages 11 to 14) with autism. They will accomplish this by treating numerous youngsters and consulting with other autism experts. Then, the team will enroll 32 adolescents with autism in a randomized trial across the sites. The participants will receive either the newly developed CBT protocol or a modified relaxation training protocol (control group). Those who receive the control treatment will receive CBT afterwards.

Considering the rising number of young adolescents diagnosed with autism, and the lack of proven treatment options for those suffering from anxiety, Dr. Storch said, our work developing a treatment protocol could substantially help address the mental health needs of early adolescents with autism.

USF co-investigators for the NICHD study include Tanya Murphy, MD, professor and Rothman Endowed Chair of Developmental Pediatrics in the Departments of Pediatrics and Psychiatry; and Adam Lewin, PhD, and Jane Mutch, PhD, both assistant professors of pediatrics.

Major health care challenges persist for D.C. children despite high rates of health insurance coverage, RAND study finds

Thu, 08 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Despite high rates of health insurance coverage among children in the District of Columbia, children's access to health care is inadequate and poses a significant health problem for the city's young residents, particularly those who are publicly insured, according to a RAND Corporation study issued today.

The study, conducted by RAND Health and funded by Children's National Medical Center, assesses health and health care among the more than 100,000 youth residing in Washington, D.C. Researchers suggest that health promotion efforts must focus on a partnership involving numerous private and public sector organizations that serve children, including schools, community-based organizations and child care centers.

The District of Columbia leads the nation in children with health coverage, with only 3.5 percent estimated to be uninsured in 2007. Nationally, an estimated 9.1 percent of children lack health insurance.

But having health insurance in the District of Columbia does not automatically translate into access to health care, said Anita Chandra, the report's lead author and a behavioral scientist at RAND.

Access problems appear especially profound for children who have publicly funded insurance. The study finds that rates of well-child care among publicly insured children are substantially below national norms and more than one in four publicly insured children in the District receives care at a hospital emergency department at least once a year.

The study is the first to comprehensively focus on children's health issues and examine not only the health service delivery system, but the communities in which children live in the District of Columbia. Researchers aim to provide a foundation for District policymakers to examine children's health issues, as well as assist the Children's National Medical Center in allocating its community benefit resources.

The study finds that numerous barriers prevent residents from getting primary and specialty health care in non-hospital settings. One major factor is the uneven distribution of primary and specialty care providers across the District. Other barriers cited by District residents in the study include a perceived lack of provider understanding of cultural and neighborhood issues, as well as a limited availability of health care providers who speak languages other than English. The study also finds that particular health conditions and health behaviors require special attention because of their prevalence and potential severity. Although children are generally healthier than adults, researchers identified several chronic health conditions that are prevalent among District youth, including asthma, sickle cell anemia, HIV/AIDS and obesity.

Children with asthma, in particular, are substantial users of hospital-based care, said Carole Roan Gresenz, a study co-author and senior economist at RAND. District of Columbia leaders will want to focus on services that will help children manage their asthma and other chronic conditions before they end up in the emergency department or hospital.

Researchers find that socioeconomic, environment and safety conditions also are crucial issues facing District youth.

Though the rate of children in poverty in the District has declined in recent years, the percentage of children who live in poverty in the District remains higher than the national percentage (23 percent versus 18 percent).

Safety and violence are particularly important issues. The rate of dating violence in the District increased from 11 percent to 17 percent from 2005 to 2007, and rates of child abuse and neglect are twice the national average. As a result, far more children are in the District's foster care system than the national average.

The study includes a unique synthesis of information from previous research, including vital statistic reports and studies of school nursing and school mental health programs, along with original data analysis of existing survey and administrative information. The research also included information obtained from focus groups with parents, adolescents and health care providers.

The report's key recommendations include:

UCSF to lead new NIH-funded consortium for studying immune disorders

Thu, 08 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) The University of California, San Francisco has been designated to lead a new consortium that will study a group of severe immune disorders known as primary immunodeficiencies and aims to improve treatment for these often life-threatening diseases. The Primary Immune Deficiency Treatment Consortium comprises 13 centers throughout the United States and has a $6.25 million funding commitment over five years from the National Institutes of Health.

Serving as the consortium's principal investigator is Morton Cowan, MD, chief of the Pediatric Blood and Marrow Transplant Program at UCSF Children's Hospital. According to Cowan, the participating centers all share the common goals of improving the diagnosis, treatment and survival rates for primary immunodeficiencies, which are caused by inherited genetic defects that result in a child being born either without any immune system at all or one that is seriously hampered in its ability to function.

With this consortium we have an unique opportunity to bring together scientists, physicians and immunologists from centers throughout North America with expertise in and commitment to the diagnosis and management of serious immune disorders, said Cowan.

While there are more than 140 types of primary immunodeficiencies, each with its own distinct genetic mutations, the consortium will focus on a subset of three disorders that are representative of the entire group in terms of major diagnostic and treatment issues. Consortium researchers will study severe combined immunodeficiency, or SCID; Wiskott-Aldrich syndrome, or WAS; and chronic granulomatous disease, or CGD, both retrospectively, in patients who have already received treatment, and prospectively, by developing new clinical trials.

It is our hope that this consortium will enable us to better understand these disorders so that we can more effectively treat patients and save lives, said Jennifer Puck, MD, a professor of pediatrics and human genetics and director of the Pediatric Clinical Research Center at UCSF Children's Hospital. Puck is a member of the consortium's steering committee and will oversee a pilot project to assess the effectiveness of a newborn screening test she has developed for SCID.

The consortium will focus on the treatment of the three disorders using hematopoietic stem cell transplantation, or HSCT. HSCT involves taking healthy blood stem cells from the bone marrow or peripheral blood of a healthy donor and intravenously transplanting the cells into a patient. When successful, the implanted cells repopulate the bone marrow and produce new healthy cells, resulting in a normally functioning immune system.

Currently, individual centers have their own approaches to administering HSCT for children with primary immunodeficiencies, which vary in terms of the timing of treatment, the source of donor cells, how the cells are processed and other key factors. Now with the consortium in place, clinical research data will be pooled so that a consensus for best treatment practices can be reached and protocols can be standardized and evaluated prospectively, Cowan explained.

These are very rare diseases, and no single center sees enough cases to do a large-scale study on its own, so collaboration is particularly important, Cowan added. The formation of the Primary Immune Deficiency Treatment Consortium is a quantum step forward in optimizing care for all primary immunodeficiencies.

The 13 core pediatric centers in the consortium currently treat more than 60 percent of patients with primary immunodeficiencies in North America. A group of 19 smaller centers in the U.S. and Canada that actively treat these disorders and account for another 20 percent of patients also will participate in the research projects.

The consortium will receive $1.25 million each year for the next five years from the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health. In addition to using the funds for research, the consortium will support two fellowships in primary immunodeficiency research at the postdoctoral level each year.

Scientific and administrative aspects of the consortium will be managed by a steering committee whose members include Cowan and Puck of UCSF, as well as Luigi Notarangelo, MD, a professor of pediatrics and pathology at Harvard Medical School; and Donald Kohn, MD, a professor of microbiology, immunology, molecular genetics and pediatrics at the University of California, Los Angeles and director of UCLA's Human Gene Medicine Program.

The additional core centers are Cardinal Glennon Children's Medical Center, Cincinnati Children's Hospital, Children's Hospital Boston, Children's Memorial Hospital, The Children's Hospital of Philadelphia, Children's Hospital Seattle, Duke University Medical Center, Memorial Sloan-Kettering Cancer Center, St. Jude Children's Research Hospital, Texas Children's Hospital, and the University of Minnesota Medical Center.

Vitamin D's role in preventing asthma studied in pregnant women

Thu, 01 Oct 2009 04:00:00 PST

( from http://www.rxpgnews.com ) A group of pregnant women who have asthma or allergies will get extra vitamin D as part of a study to determine if the vitamin can prevent their children from developing asthma.

Washington University School of Medicine in St. Louis is part of the multi-center trial in collaboration with Boston University and Brigham and Women's Hospital in Boston and Kaiser Permanente Medical Center in San Diego.

Children born to one or both parents with asthma or allergies have a higher risk of developing asthma than children whose parents don't have asthma or allergies. Recent studies have shown that vitamin D plays a role late in pregnancy in developing lungs and that higher levels of maternal vitamin D may be associated with lower rates of asthma in their children. However, researchers don't know if increasing or correcting those vitamin D levels prior to or during pregnancy can prevent the disease.

We want to find a definitive answer to that question, says Robert C. Strunk, M.D., a Washington University pediatric asthma and allergy specialist at St. Louis Children's Hospital. If we could simply supplement women during pregnancy and decrease asthma prevalence in children, that would be a huge impact on child health.

Strunk, lead investigator of the trial, said asthma has doubled in U.S. children over the last two decades. About 6.7 million American children suffer from asthma, according to the Centers for Disease Control and Prevention, making it the most common chronic childhood illness. About 90 percent of all cases are diagnosed before age 6.

Vitamin D deficiency is also prevalent in the United States, occurring in healthy children and adults despite fortification of foods and intake of multivitamins. Pregnant and lactating women and their children are at high risk for vitamin D deficiency, although most pregnant women take prenatal vitamins. Researchers say the shift from outdoor activities and less time spent in the sun is one factor.

The Vitamin D Antenatal Asthma Reduction Trial (VDAART), a five-year research study funded by the National Institutes of Health, will enroll women between 10-18 weeks of pregnancy and randomly divide them into two groups. One group will receive a typical prenatal vitamin with 400 units of vitamin D and a 4,000-unit vitamin D supplement. The other group will receive the same prenatal vitamin plus a placebo.

The trial seeks to enroll 870 women nationwide. Washington University School of Medicine seeks to enroll 290 women from its obstetrics and gynecology clinics and one outside clinic.

During the course of the study, patients will attend regular visits with their obstetrician, provide blood and urine samples and answer questionnaires about diet, pregnancy, sunlight exposure, physical activity, health and medications. Their children born during the study will be evaluated for asthma and recurrent wheezing at ages 1, 2 and 3.

What's very attractive about this study is how simple it is, said George A. Macones, M.D., the Mitchell and Elaine Yanow Professor and head of Obstetrics and Gynecology at the School of Medicine and a co-investigator on the study. We hope that supplementing mothers with extra Vitamin D during pregnancy will help to reduce risks of asthma in children and will improve children's health over the long term.

Piece from childhood virus may save soldiers' lives

Sun, 06 Sep 2009 03:59:12 PST

( from http://www.rxpgnews.com ) A harmless shard from the shell of a common childhood virus may halt a biological process that kills a significant percentage of battlefield casualties, heart attack victims and oxygen-deprived newborns, according to research presented Sunday, September 6, 2009, at the 12th European meeting on complement in human disease in Budapest, Hungary.

Introducing the virus's shell in vitro shuts down what's known as the complement response, a primordial part of the immune system that attacks and destroys the organs and vascular lining of people who have been deprived of oxygen for prolonged periods, according to researchers at Children's Hospital of The King's Daughters (CHKD) and Eastern Virginia Medical School (EVMS), in Norfolk, Va.

The complement response kicks in after the victim has been revived, in what is known as a reperfusion injury. It does its work slowly but unrelentingly, killing soldiers, infants or heart attack victims over the course of days.

To find a way to manipulate the complement system pharmacologically has been like a search for the Holy Grail, said one of the lead researchers, Dr. Kenji Cunnion, an infectious disease physician at CHKD and an associate professor of pediatrics at EVMS.

While Cunnion and Neel Krishna, Ph.D., a pediatric virologist at CHKD and assistant professor of microbiology at EVMS, focus on pediatric research, they see clear military applications.

The complement reaction is one of the major causes of death of the battlefield, said Krishna. By the time you get a victim to the hospital, it may be too late.

Dr. L.D. Britt, M.D., MPH, Brickhouse professor and chairman of surgery at EVMS, agrees.

Hemorrhagic shock is the leading cause of death in combat trauma and reperfusion injury plays a significant role both in increased mortality and increased brain damage, said Britt, senior consultant to the military on combat trauma. This research could help save the lives of soldiers, as well as the lives of other trauma victims who have been without oxygen for extended periods.

Britt has joined Cunnion in Krishna in seeking a grant from the Department of Defense to expedite research and development.

The complement system ranks as one of the oldest biological mechanisms in life's evolution and exists in almost identical form in everything from seagulls to starfish.

Essentially, the complement system recognizes and destroys potentially toxic substances that gain entry into an organism's bloodstream. When a starfish loses a limb, for instance, the complement system sends a contingent of killer cells to block and attack anything that tries to work its way inside.

In human evolution, complement provided an essential natural defense.

Up until 100 years ago, the vast majority of humans died from infectious diseases, said Cunnion. Nobody died of old age and almost nobody lived long enough to die of a heart attack.

Thanks to modern medicine, people now live long enough to die from trauma, such as car accidents, or from conditions, such as heart attack and stroke, that can leave cells throughout the body starved for oxygen. Cells deprived of oxygen often undergo biochemical changes, essentially marking themselves for death. When blood flow and oxygen are restored, these changes trigger the complement cascade. The marauding cells unleashed by complement cascade are indiscriminate, killing not only the cell with the biochemical marker but innocent bystander cells as well.

It's like throwing a grenade, said Krishna.

A patient, who has suffered survivable brain damage from oxygen deprivation, might die over several days as swaths of cells are destroyed by this seemingly unstoppable reaction. Animal research has shown that stopping this complement reaction significantly reduces brain damage.

The complement system is so complex that research scientists spend entire careers studying it, publishing in journals that specialize in this primordial defense mechanism.

In the case of Cunnion and Krishna, discovering how to shut down the complement system resulted from happenstance. As they worked in neighboring labs, they noticed a similarity in the structure of molecules Cunnion used in his experiments and the protein shell of the astrovirus Krishna studied. They wondered what would happen if they introduced the astrovirus shell into an assay routinely used in Cunnion's lab to assess complement activation.

It was kind of a shot in the dark, Krishna said. We didn't expect anything to happen.

The complement reaction completely stopped.

Longitudinal study investigates cocaine's impact on adolescent development

Wed, 19 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Teen years are filled with experimenting. Sometimes that means trying some risky behaviors.

Nearly 400 teens, half of which were prenatally exposed to cocaine, will be studied in their adolescent years. Researchers will look at the youths' choices when it comes to using drugs, having sex or engaging in delinquent behaviors, and see if there is an association with prenatal cocaine exposure. The study will also closely follow the cognitive development and mental health behavior of the young people.

Sonia Minnes, an assistant professor from the Mandel School of Applied Social Sciences at Case Western Reserve University and now the lead researcher in phase four of a long-term study of cocaine exposed children, has received a five-year, nearly $5 million grant from the National Institute on Drug Abuse (NIDA).

This latest funding will help us to continue to tell the story of what happens in the development of prenatally cocaine-exposed children, says Minnes.

With the inception of this new study, Prenatal Cocaine Exposure in Adolescence, Minnes and her co-investigators will follow the children through age 18.

The study began with 415 infant-mother (or caretaker) pairs recruited at the infant's birth. Over the years, the children's development has been followed, as well as the mental health and substance abuse by the mother or caregiver. In three previous phases of NIDA funding, the researchers found that prenatal cocaine exposure negatively affects attention, language development, behavior and the ability to process visual information.

Most people know that mothers should not use drugs during pregnancy, says Minnes. This study over time will tell us what risks are associated with a specific prenatal drug exposure and how environmental influences shape developmental outcomes.

She adds that they have found important environmental factors such as elevated blood lead, maternal mental health and vocabulary level and the type of caregiver placement, are important to consider in evaluating prenatal cocaine exposure's effect on developmental outcome. The study will help us understand what interventions are needed at different developmental stages in their lives.

The study has been underway since 1994, when Lynn Singer, deputy provost and professor of pediatrics in the school of medicine, questioned what happens to prenatally cocaine-exposed children as they grow older. Minnes, who worked as the project coordinator since its beginning, became the study's principal investigator in 2007.

Her recent appointment to the Mandel School of Applied Social Science, where she earned her doctorate in social work, comes at a pivotal point in the study's progress as the focus shifts towards social behavior issues traditionally studied in the realm of social work, says Minnes. She will draw from the expertise of colleagues at MSASS who can provide additional insight regarding the effects of neighborhood and family violence, parental substance use, and placement issues on the development of prenatally cocaine-exposed adolescents.

Findings from the study will provide important information to early intervention specialists and child policy experts who can then develop targeted therapeutic interventions.

Delays in UK child brain tumor diagnosis

Fri, 07 Aug 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Significant numbers of children in the UK are suffering from preventable levels of disability, particularly blindness, and premature death because of poor diagnosis of brain tumours.

A new study by scientists at The University of Nottingham's Children's Brain Tumour Research Centre, funded by the Samantha Dickson Brain Tumour Trust, shows that prolonged and slow diagnosis can make long term survivors of childhood brain tumours up to 10 times more likely to suffer disability. 450 children in the UK are diagnosed with a brain tumour every year. The average time between the onset of symptoms and diagnosis in children in the UK is between two and three months, that's up to three times longer than the rest of Europe and the USA.

David Walker, Professor of Paediatric Oncology at the Children's Brain Tumour Research Centre, University of Nottingham, said: Our study showed that the UK health system is the slowest system for making this diagnosis compared to reports from other countries. It takes more than 13 weeks in the UK to make this diagnosis for half of the patients, whilst in the US and Poland this is achieved within 5 weeks. The research also showed that symptoms increased in number and that disability increased in severity as time passed before diagnosis. This indicates that delays in diagnosis are affecting the severity of disability for the children and young people, which can have life-long consequences.

Chief Executive of the Samantha Dickson Brain Tumour Trust, Paul Carbury said: A quarter of all childhood cancers now occur in the brain and more children are dying of brain tumours than any other cancer. We are concerned that children in the UK are being short-changed by delays in diagnosis, which are leading to poor outcomes compared with the rest of Europe and the USA. This is true for teenagers too, with evidence suggesting that many visit their GP numerous times before being referred.

David Kershaw, who lost his two year old son, Jake, to a brain tumour, is angry about the slow diagnosis they suffered. He said: There is still so much ignorance regarding the diagnosis of brain tumours. I had to fight extremely hard to be taken seriously when Jake became unwell. It is very clear to me that more work needs to be done within the medical profession to hasten diagnosis, which will improve the long term outcome for other children.

ART therapy for babies, mothers safely reduces HIV transmission

Wed, 22 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Giving daily antiretroviral syrup to breastfeeding infants or treating their HIV-infected mothers with highly active antiretroviral drugs is safe and effective in preventing mother-to-child HIV transmission through breast milk, a study led by University of North Carolina at Chapel Hill investigators has found.

This is an exciting development, said Charles van der Horst, M.D., a professor in the UNC School of Medicine and the study's lead investigator. We may be able to spare mothers in the developing world a horrible choice by offering them an effective method for preventing transmission of HIV during breastfeeding.

These findings, from investigators at UNC-Chapel Hill, UNC Project-Malawi in Lilongwe, Malawi and the U.S. Centers for Disease Control and Prevention (CDC), were presented July 22 at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa (Abstract .WELBC1 - Late Breaker C 16:30 - 17:30 Session Room 2).

Approximately 420,000 infants are infected with HIV annually, half through breast milk. HIV-infected women in resource-constrained areas face a terrible dilemma: provide the many health and nutritional benefits of breast milk but face a 20 percent chance of transmitting the virus to their baby or choose costly formula, which relies on an unsafe water supply and carries a higher risk of morbidity and mortality, and avoid transmitting HIV.

The Breastfeeding, Antiretrovirals and Nutrition (BAN) study is the only large-scale, randomized trial comparing infant prophylaxis or maternal treatment to an enhanced standard-of-care arm in the prevention of HIV transmission through breast milk. The study was conducted in Lilongwe, Malawi at a single site. Investigators randomly assigned at total of 2,367 mother-infant pairs to one of three treatment arms. For both the interventions, the probability of HIV-infection was significantly lower than in the enhanced control arm.

Of the randomized infants, 4.9 percent were found to be HIV positive at birth. Among infants who were HIV-free at one week old, 6.4 percent on the enhanced control arm were infected by 28 weeks, compared to 3.0 percent of the infants on the maternal treatment arm and 1.8 percent of the infants who received daily nevirapine syrup. Upon examining the probability of HIV infection or death by 28 weeks postpartum, 7.6 percent of the infants on the enhanced control arm were HIV-infected or died compared to 4.7 percent of the infants on the maternal treatment arm, and 2.9 percent of the infants on the infant prophylaxis arm.

The BAN study results give global and national policy makers the choice of which intervention (maternal or infant antiretroviral intervention) to implement based on the conditions and resources in their particular setting. We hope to see these results translated quickly into program and policy.

New method for HIV testing holds promise for developing world

Tue, 21 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) DURHAM, NC -- A new technique that detects the HIV virus early and monitors its development without requiring refrigeration may make AIDS testing more accessible in sub-Saharan Africa.

According to UNAIDS, sub-Saharan Africa accounts for almost a third of all new HIV infections and AIDS-related deaths globally. Yet there may be many people who do not get tested due to the high cost of treatment and minimal access to health care.

Duke Physician John Crump and a team of researchers recently completed a 10-month experiment at two remote sites in Tanzania. They examined Tanzanian infants born to HIV-infected parents and people with known HIV infections who needed monitoring of their viral loads. Viral load is a measurement used to diagnose HIV infection or determine the severity of HIV infection.

In the largest field study of its kind, researchers compared viral load measurements by using the current standard of frozen plasma and the alternative method of dried blood spots (DBS). The samples were measured at a central lab at the Kilimanjaro Christian Medical Centre in Moshi, some 250 and 350 kilometers away from the two study sites.

The Duke study found a strong correlation between viral load values in plasma and DBS, making the two testing approaches comparable. This finding could lay the foundation for a new way of testing for and monitoring patients with HIV in the future, according to Dr. John Bartlett, Duke Global Health Institute Associate Director for Research.

The sooner infants are diagnosed with HIV, the sooner they can receive life-prolonging medications to treat the disease. The infection cannot be detected in newborns using the typical HIV antibody test, and must be detected with other techniques, including viral load testing.

Viral load testing is also the optimal way for monitoring HIV infection in patients with known infections, especially for those receiving treatment.

But few labs in Tanzania perform the viral load procedure, and blood samples must be transported long distances to specialized medical facilities for testing. Plasma requires continuous cold storage during shipment, which can be challenging or impossible in resource-limited settings. This may prevent people from getting tested or result in inaccurate tests.

Dried blood spots offer the advantage of not requiring cold storage, says Bartlett, who also points out that this method may result in lower total health care costs. Before using it for care and treatment programs, it will need further evaluation. But, this is the largest field study of DBS's done to date, and the results appear promising.

A child's IQ can be affected by mother's exposure to urban air pollutants

Tue, 21 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) A mother's exposure to urban air pollutants known as polycyclic aromatic hydrocarbons (PAHs) can adversely affect a child's intelligence quotient or IQ, a study reports. PAHs are chemicals released into the air from the burning of coal, diesel, oil and gas, or other organic substances such as tobacco. In urban areas motor vehicles are a major source of PAHs.

The study, funded by the National Institute of Environmental Health Sciences (NIEHS), a component of the National Institutes of Health, the U.S. Environmental Protection Agency and several private foundations, found that children exposed to high levels of PAHs in New York City had full scale and verbal IQ scores that were 4.31 and 4.67 points lower than those of less exposed children. High PAH levels were defined as above the median of 2.26 nanograms per cubic meter (ng/m3). A difference of four points, which was the average seen in this study, could be educationally meaningful in terms of school success, as reflected, for example, in standardized testing and other measures of academic performance. However, the researchers point out that the effects may vary among individual children.

This research clearly shows that environmental PAHs at levels encountered in an urban setting can adversely affect a child's IQ, said Linda Birnbaum, Ph.D., director of NIEHS. This is the first study to report an association between PAH exposure and IQ, and it should serve as a warning bell to us all. We need to do more to prevent environmental exposures from harming our children.

The study was conducted by scientists from the Columbia University Center for Children's Environmental Health. It included children who were born to non-smoking black and Dominican-American women age 18 to 35 who resided in Washington Heights, Harlem or the South Bronx in New York. The children were followed from utero to 5 years of age. The mothers wore personal air monitors during pregnancy to measure exposure to PAHs and they responded to questionnaires.

At 5 years of age, 249 children were given an intelligence test known as the Wechsler Preschool and Primary Scale of the Intelligence, which provides verbal, performance and full-scale IQ scores. The test is regarded as a well validated, reliable and sensitive instrument for assessing intelligence. The researchers developed models to calculate the associations between prenatal PAH exposure and IQ. They accounted for other factors such as second-hand smoke exposure, lead, mother's education and the quality of the home caretaking environment. Study participants exposed to air pollution levels below the average were designated as having low exposure, while those exposed to pollution levels above the median were identified as high exposure.

The decrease in full-scale IQ score among the more exposed children is similar to that seen with low-level lead exposure, said lead author Frederica P. Perera, Dr.P.H., professor at Columbia's Mailman School of Public Health and director of the Columbia Center for Children's Environmental Health.

This finding is of concern, said Perera. IQ is an important predictor of future academic performance, and PAHs are widespread in urban environments and throughout the world. Fortunately, airborne PAH concentrations can be reduced through currently available controls, alternative energy sources and policy interventions.

Falling birth rates shift rotavirus epidemics

Thu, 16 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Fewer births in states such as California may be delaying the annual onset of a common intestinal virus in the southwest, according to epidemiologists. The timing of infectious outbreaks in other locations such as the northeast remains more or less unchanged.

Rotavirus is a leading cause of diarrhea among children, both in the developed and developing world. In the United States, the virus causes about 60,000 hospitalizations each year and kills about 40 children below the age of five.

It is an imperfectly immunizing infection, said Virginia Pitzer, postdoctoral researcher in the Center for Infectious Disease Dynamics and the department of biology, Penn State. So you can get infected multiple times throughout your life.

Up until the late 1990s, annual rotavirus epidemics in the U.S. followed a predictable pattern. Infections appeared in the southwest and peaked in December or January, then spread to the northeast, where they peaked in March. In recent years epidemics in the southwest have begun later than usual.

Pitzer and her colleagues initially looked at environmental factors such as solar radiation, precipitation and temperature but these could not explain the shifts in outbreaks of new infections. Unlike other viruses that die out and are replenished each year with new strains from outside the United States, rotavirus infections tend to linger in the summer months.

In general, the pattern of spread of rotavirus outbreaks from the southwest to the northeast is not consistent with any climatic factors, explained Pitzer, whose findings appear today (July 17) in Science. For instance, temperature tends to be high in the southwest but it also tends to be high in places like Florida, where epidemics occur much later.

Instead, Pitzer and her colleagues looked at human birth rates and the potential link to the timing of rotavirus epidemics. While birth rates are typically high in the southwest and low in the northeast, census data indicates a recent decline in the southwest, particularly in California.

Statistical analysis suggested a negative correlation between birth rates and the timing of the epidemics between 1991 and 2006.

Each time there was a decline in birth rate, whether from state to state or year to year, infections tended to happen later, explained Pitzer.

A mathematical model using information on the epidemiology of rotavirus and birth rates from states confirmed the statistical correlation and predicted that given the declining birth rate in California, rotavirus epidemics in the state would gradually shift from December to February.

Since infants often have diarrhea and can be very infectious when they get rotavirus, they are the ones who tend to drive the epidemics, said Pitzer, who is also associated with Fogarty International Center at the National Institutes of Health through the Research and Policy for Infectious Disease Dynamics program. Thus, you can get outbreaks of rotavirus happening a lot sooner when and where there are more infants being born.

Vaccines introduced in 2006 further confirm Pitzer's model. Since vaccination reduces the number of infants vulnerable to symptomatic infections, the effect is analogous to a decline in birth rate.

With the effects of vaccination factored in, the model accurately predicted a small decrease in the incidence of severe diarrhea during the 2006-2007 season, and a larger decline and delay during 2007-2008, providing validation for our model, said Pitzer.

Researchers add that high levels of vaccination could further limit the intensity of new epidemics and lead to a period of years with very few cases of severe diarrhea caused by rotavirus.

The important message here is that vaccination can have a big impact in controlling rotavirus infections, explained Pitzer. Even those not vaccinated can benefit from those vaccinated because it lowers the overall prevalence of the infection in the population.

Falling birth rates shift rotavirus epidemics

Thu, 16 Jul 2009 04:00:00 PST

Nondrug interventions may comfort children having an anesthetic

Tue, 07 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Parental acupuncture, clown doctors, hypnotherapy, low sensory stimulation and hand-held video games are promising non-drug interventions that are likely to help reduce children's anxiety during the onset of their anaesthetic, is the main conclusion of a new Cochrane Systematic Review.

The review was conducted because undergoing a general anaesthetic can be a frightening experience for a young child and distressing to parents. Children can be given a premed to sedate them when anaesthesia is being administered, but these drugs can have unwanted harmful effects. Some non-drug alternatives have been tested to see if they could be used instead of sedative drugs when anaesthesia is being administered to children. A new study is the first systematic review to investigate whether non-drug interventions are helpful in alleviating stress in children undergoing general anaesthetics.

The researchers reviewed data from 17 trials that together involved 1,796 children between the ages of 10 months and 17 years. The eight studies focusing on parental presence did not find parental presence to be helpful in alleviating anxiety or improving cooperation in their children whilst the anaesthetic was being administered. It is interesting that parental presence is often encouraged, even though there it has not been shown to help, says lead researcher Allan Cyna of the Women's and Children's Hospital in Adelaide, Australia. Based on our findings, we would recommend that parents do not need to stay for their child's anaesthetic unless they are keen to do so.

The Cochrane Researchers concluded that a number of different interventions show promise in being effective in increasing cooperation and reducing anxiety in children during anaesthetic administration and need further research. In single studies, clown doctors, a quiet environment, video games and computer packages (but not music therapy) each showed benefits. These promising interventions need to be tested in additional trials.

The authors also suggest that relaxation techniques targeted at parents merit further investigation, since in one trial children seemed to benefit when their parents were given acupuncture to reduce anxiety. Parental stress can be transmitted to the child. It is likely that parents who are relaxed are more likely to help their children stay calm during the administration of anaesthesia. Yoga, hypnosis and meditation may help parents relax and could be explored in future studies.

We also need more trials investigating the effects of the promising non drug interventions for children identified in this review. These, and other, methods need to be tested in further trials. says Dr Cyna.

Lap-band weight-loss surgery can reverse metabolic syndrome in obese teens

Wed, 01 Jul 2009 04:00:00 PST

( from http://www.rxpgnews.com ) NEW YORK (June 30, 2009) -- A new study of obese adolescents has shown that laparoscopic gastric banding surgery -- the Lap-Band procedure -- not only helps them achieve significant weight loss but can also improve and even reverse metabolic syndrome, reducing their risk for cardiovascular disease and diabetes.

Metabolic syndrome is defined as a cluster of risk factors -- high blood pressure; low levels of HDL or good cholesterol; excessive abdominal fat; and elevated levels of blood sugar, C-reactive protein and triglycerides -- that increase a person's chances of developing cardiovascular disease or diabetes later in life. The single biggest risk factor is obesity, and metabolic syndrome usually improves when a person loses weight.

The study was led by Drs. Ilene Fennoy, Jeffrey Zitsman and colleagues at NewYork-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center and presented at the annual Endocrine Society meeting in Washington, D.C.

An estimated 17 percent of all American adolescents are obese, and increasing numbers of them also have metabolic syndrome, says Dr. Fennoy, a pediatric endocrinologist at NewYork-Presbyterian Morgan Stanley Children's Hospital, clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons and co-author of the study. Until recently, there have been few treatments capable of helping these young patients lose weight, much less improving their lifelong health prospects. The Lap-Band may well be a useful intervention for tackling teen obesity -- which is why it is so important to investigate the procedure's safety and efficacy in this growing population.

In the new study, Dr. Fennoy and her colleagues followed 24 morbidly obese adolescents between the ages of 14 and 17 who underwent the Lap-Band procedure. The study participants either had a BMI of greater than 40 or greater than 35 if already suffering from diabetes or obesity-related illnesses.

Six months after surgery, they noted a significant drop in participants' BMI, waist circumference, and blood levels of C-reactive protein. These indicators continued to improve among the 12 patients being followed up at the one-year point.

Other measures of metabolic syndrome such as blood lipid and sugar levels, the authors reported, came down quickly in the first six months, with less dramatic changes seen one year after surgery.

Of all the bariatric procedures, she says, the Lap-Band is the most benign, with complication rates of less than 1 percent. The device, inserted via minimally invasive laparoscopic surgery, consists of a simple band to make the stomach smaller and a balloon that can be decompressed when necessary, she explains.

Although it is technically reversible, the procedure should be considered a long-term solution for extreme and intractable obesity.

The Lap-Band is the favored bariatric procedure in Europe, while in the U.S., gastric bypass has been the preferred approach. At present, NewYork-Presbyterian Morgan Stanley Children's Hospital/Columbia University Medical Center is one of a few medical centers offering the Lap-Band option in this country.

The Lap-Band procedure, an approved treatment for adults with extreme obesity, has not yet been thoroughly studied in adolescents. Larger, multicenter studies with longer follow-up periods will be needed, Dr. Fennoy says, to validate the findings of the current study.

Postpartum anxiety delays puberty in offspring

Wed, 10 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Hormonal changes early in pregnancy cause maternal postpartum anxiety and behavior changes that can lead to a delayed onset of puberty in both birth and adoptive daughters, according to a new study conducted in mice. The results will be presented Wednesday at The Endocrine Society's 91st Annual Meeting in Washington, D.C.

Women have an increased rate of anxiety during pregnancy and for 2 years after giving birth, said the study's lead author, Caroline Larsen, PhD, a postdoctoral fellow at the University of Otago in Dunedin, New Zealand.

Postpartum anxiety disorders are poorly understood and difficult to treat, Larsen said. There is growing evidence that untreated anxiety disorder during pregnancy may contribute to premature birth and also can have major and lasting adverse effects on the infant's development and behavior.

Prolactin is a hormone that may protect against anxiety. Recently Larsen and her co-workers found that mice with induced low levels of prolactin in early pregnancy displayed substantial anxiety after they gave birth. Because the researchers also noted that daughters of the anxious mothers had delayed onset of puberty, they conducted the current study to learn what causes this late physical transition to sexual maturation.

Daughters of female mice made anxious by low prolactin were raised either by their birth mother or by a mouse who was not anxious (control mother). Another group consisted of daughters of nonanxious mice, and these mice were raised by either a control mother or an anxious mother. There were at least six mice in each of the four groups. The researchers determined onset of puberty by examining when the vagina opened and noting the time of first estrus (equivalent to the first menstrual cycle in humans).

Remarkably, puberty was still delayed even if the daughters of anxious mothers were raised by nonanxious mice, Larsen said. And delayed puberty also occurred in daughters born to nonanxious mothers who were raised by anxious mothers.

This result demonstrates that hormonal changes in early pregnancy, as well as changes in maternal behavior caused by these hormone changes, can alter brain development in the offspring and delay puberty, she explained. Larsen believes that their work, with further study, may translate to people.

Finding the hormonal mechanisms that trigger the timing of puberty in mice may help identify potential targets for the prevention and treatment of delayed or early puberty in humans, she said.

Late puberty in humans is linked to shortened height and psychological problems that can persist into adulthood.

Pre-pregnancy depressed mood may heighten risk for premature birth

Wed, 10 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers trying to uncover why premature birth is a growing problem in the United States and one that disproportionately affects black women have found that pre-pregnancy depressive mood appears to be a risk factor in preterm birth among both blacks and whites.

Black women, however, have nearly two times the odds of having a preterm birth compared to white women, according to Amelia Gavin, a University of Washington assistant professor of social work and lead author of a new study that appears online in the June issue of the Journal of Women's Health.

Preterm births are one of the most significant health disparities in the United States and the overall number of these births increased from 10.6 percent in 2000 to 12.8 percent in 2005, she said.

While there appears to be some sort of link between giving birth prematurely and depressed mood, the study found no cause and effect, said Gavin, who studies health disparities. She believes the higher preterm birth rate among blacks may be the result of declining health over time among black women.

For this study, premature birth referred to any child born after less than 37 weeks of gestation. Normal gestation ranges from 38 to 42 weeks. Data for the study was drawn from a larger longitudinal investigation looking at the risks for cardiovascular disease among more than 5,000 young adults in four metropolitan areas. The Coronary Artery Risk Development in Young Adults Study also collected information about mental health and pregnancy outcomes. Between 1990 and 1996, 555 women in the larger study gave birth. These women were the subjects in the depression-premature birth study.

At this point we can't say that pre-pregnancy depressive mood is a cause of preterm birth or how race effects this association, said Gavin. But it seems to be a risk factor in giving birth prematurely and higher pre-pregnancy depressive mood among black women compared to white women may indirectly contribute to the greater odds of preterm birth found among black women.

In the study 18.1 percent of the black women had a preterm birth compared to 8.5 percent of the white women.

This difference may be the result of what she calls weathering, or accelerated declines in health due to repeated socioeconomic and political factors.

What some people experience by being black takes a toll on the physiological system, and over time wear and tear that occurs across neural, neuroendocrine and immune systems as a result of chronic exposure to stressors lead to health disparities for blacks. Some of this may manifest itself in premature birth and low-birth weight, Gavin said.

The study did not look at depressive mood or depression during pregnancy because the larger research project did not collect that data. She hopes to replicate and expand her findings by analyzing data from another study to look at depressive mood prior to pregnancy and childhood poverty to see if those two factors in part explain the black and white difference in preterm delivery. That study also will look at the role antidepressive medication plays in preterm birth.

My ultimate goal is to incorporate a life course health development framework to examine disparities in birth outcomes, she said. You have to look at the context of health across the life course of a woman, not just during pregnancy.

The consequences of higher preterm delivery are a growing burden on the health care system and parents. Studies have shown that preterm babies have higher morbidity rates and U.S. preterm birth rates are creeping up with no good explanation. In the U.S. the population at greatest risk for major depression is women of childbearing age and the onset and course of depression are often intertwined with reproductive events. A recent national study reported that 8.4 percent of pregnant women in the past year experienced major depression and only slightly more than 14 percent of those women sought treatment for any mood disorder.

More costly private model of foster care could save $6.3 billion in long term

Tue, 02 Jun 2009 04:00:00 PST

( from http://www.rxpgnews.com ) In these times of trillion-dollar budgets and deficits, $6.3 billion may not seem like much money, but that's what the United States potentially could save on each group of adolescents who enter foster care every year.

These savings could be achieved by using a more intensive and more costly private model of foster care than programs offered by public agencies across the country, according to new research led by economists and foster care experts from the University of Washington and Casey Family Programs, a non-profit agency with offices in Washington and Oregon.

The researchers analyzed the long-term benefits and costs of nearly 500 alumni from public and private foster care programs in Washington and Oregon. Every year about 100,000 adolescents age 12-17 enter foster care in the U.S., and if each entered the more costly program the researchers studied, the lifetime savings for that group would be $6.3 billion in 2007 dollars.

Only in recent years has cost-benefit analysis been understood and it can provide a great deal of knowledge for social programs if we evaluate programs before implementing them. The potential savings are huge, said Richard Zerbe, an economist and professor in the UW's Evans School of Public Affairs. He and Robert Plotnick, also an economist and Evans School professor; Peter Pecora, director of research at Casey Family Programs and a UW professor of Social Work; and Ronald Kessler of Harvard Medical School, headed the research team.

Most of the savings projected by the study came from increased future earnings and lower future medical care costs. Even though the Casey program had higher daily costs, its alumni were earning slightly more than $7,000 a year as working adults than alumni of the two state agencies. Casey alumni also reported fewer physical and mental health problems, which meant lower estimated future health care costs.

The study looked at 479 individuals who between 1988 and 1998 were in foster care operated by Casey Family Programs, the Oregon Department of Human Services or the Washington state Department of Social and Health Services for at least l2 months. None of the subjects had a physical or developmental disability because at the time Casey did not serve adolescents who would not be able to function independently when they became adults. Those in the study ranged in age from 20 to 33 when they were interviewed, and there were slightly more women than men, mirroring the population in foster care.

In the Casey program, workers had smaller case loads (15-16 compared to 20-30 for state workers), higher levels of education and lower annual turnover rates. Foster parents were paid comparably by Casey and the two states, but Casey parents also received a $100 month retainer for staying with the program, an allowance to provide better clothing, an extra monthly payment if handling a difficult-to-place child and funds to pay for braces and extracurricular activities such as scouting, music or dance lessons and summer camp.

As a result, the study showed that the average daily cost for a child being served by Casey was $82, compared to $50.53 for one served by Washington state and $49.16 for one cared for by Oregon.

Zerbe and Plotnick noted that the cost-benefit analysis was based on outcomes that could be calculated. Factors that were difficult to put a dollar value on, such as increased homelessness among alumni of public agencies and more supportive social networks and improved quality of life among Casey graduates, were conservatively estimated.

The Casey program invested in key areas, said Pecora. If you have case workers with more education they can help youth more effectively when they hit bumps in the road. Children in the Casey program had better placements, foster parents had better support and there were fewer placement changes. That meant more stability at home and in school.

These youth received more consistent high-quality service, although so did many children under state care.

What will it take for state, county and city agencies to adopt something like the Casey model?

Consistent leadership, said Pecora. It is hard to change a system when the leadership turns over every two or three years. You also need to involve the community. Businesses, schools and faith-based organizations can help because children in foster care are everyone's responsibility. This is not a private versus public issue. It is about service quality. If you pursue that you will get results.

Plotnick added, If you offer more services you get better outcomes. We often make short-sighted decisions. Cost-benefit analysis can provide a stronger case that a program is worth doing.

MIT robotic therapy holds promise for cerebral palsy

Wed, 20 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) CAMBRIDGE, Mass.--Over the past few years, MIT engineers have successfully tested robotic devices to help stroke patients learn to control their arms and legs. Now, they're building on that work to help children with cerebral palsy.

Robotic therapy can potentially help reduce impairment and facilitate neuro-development of youngsters with cerebral palsy, says Hermano Igo Krebs, principal research scientist in mechanical engineering and one of the project's leaders.

Krebs and others at MIT, including professor of mechanical engineering Neville Hogan, pioneered the use of robotic therapy in the late 1980s, and since then the field has taken off.

We started with stroke because it's the biggest elephant in the room, and then started to build it out to other areas, including cerebral palsy as well as multiple sclerosis, Parkinson's disease and spinal cord injury, says Krebs.

The team's suite of robots for shoulder-and-elbow, wrist, hand and ankle has been in clinical trials for more than 15 years with more than 400 stroke patients. The Department of Veterans Affairs has just completed a large-scale, randomized, multi-site clinical study with these devices.

All the devices are based on the same principle: that it is possible to help rebuild brain connections using robotic devices that gently guide the limb as a patient tries to make a specific movement.

When the researchers first decided to apply their work to children with cerebral palsy, Krebs was optimistic that it would succeed, because children's developing brains are more plastic than adults', meaning they are more able to establish new connections.

The MIT team is focusing on improving cerebral palsy patients' ability to reach for and grasp objects. Patients handshake with the robot via a handle, which is connected to a computer monitor that displays tasks similar to those of simple video games.

In a typical task, the youngster attempts to move the robot handle toward a moving or stationary target shown on the computer monitor. If the child starts moving in the wrong direction or does not move, the robotic arm gently nudges the child's arm in the right direction.

Krebs began working in robotic therapy as a graduate student at MIT almost 20 years ago. In his early studies, he and his colleagues found that it's important for stroke patients to make a conscious effort during physical therapy. When signals from the brain are paired with assisted movement from the robot, it helps the brain form new connections that help it relearn to move the limb on its own.

Even though a stroke kills many neurons, the remaining neurons can very quickly establish new synapses or reinforce dormant synapses, says Krebs.

Infant sleep patterns and parenting focus of study

Thu, 14 May 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Infants' sleep patterns and their parents' influence on it are the focus of the SIESTA II project, supported by a five-year, $2.67 million grant from the National Institute of Child Health and Human Development to Douglas M. Teti, professor of human development and psychology, Penn State.

SIESTA II -- Study of Infants' Emergent Sleep Trajectories, Phase II -- will study the role of parenting in the development of infant sleep patterns. Researchers will visit 150 homes in the Hershey, Harrisburg and State College areas to collect data and 25 percent of the homes will have minority families. Researchers will visit each home seven times in two years. Infrared cameras in participants' homes will document several aspects of bed time and night time rituals for infants including daily bed time routines, use of close contact, soothing vs. arousing behaviors, parental reactions to infant sleep disruptions, parental emotional availability and infant emotional reactions. Parents will also keep infant sleep diaries.

Most literature on infant sleep patterns comes from pediatric journals, but tends to ignore perspectives from developmental science -- we hope to change that, says Teti. There's probably not one universal formula that parents should use to promote sleep quality and well-being in infants. It's more likely that how parents feel about their children's sleep and how well they adapt emotionally plays just as large a role in the development of infant sleep as the parenting practices being used.

The researchers will test whether consistent bed time rituals promote self-regulated sleep habits in infants; whether support from a partner enhances a mother's ability to adapt to a temperamental infant; whether parents who do not adapt are less emotionally available to their infants and experience more stress, and whether parents' stress increases the number of infant sleep disruptions. They will also test the idea that cognitive functions in infants, such as the capacity for information processing, are sensitive to and influenced by sleep quality.

As part of the project, the grant will be used to fund several graduate students who will work as researchers at the University Park or Harrisburg campuses.

SIESTA I, which was funded by Penn State's Children, Youth and Families Consortium, was a pilot study and laid the groundwork that makes SIESTA II possible. Researchers established that infrared cameras would provide clear video and audio and accurately capture the emotional quality of infant and parental behaviors in the middle of the night. SIESTA I also gave the investigative team the opportunity to pilot a number of different measures and procedures currently being used in SIESTA II.

Co-investigators for SIESTA II include Pamela Cole, professor of psychology; Cindy Stifter, professor of human development and psychology; Mike Rovine, professor of human development, all from Penn State; Ian Paul, professor of pediatrics, Penn State Milton S. Hershey Medical Center, and Thomas Anders, professor emeritus of psychiatry and behavioral sciences, University of California, Davis.

FSU researcher wins $2.2 million grant to study childhood obesity

Mon, 27 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) TALLAHASSEE, Fla. -- In response to a worrisome rise in childhood obesity, Florida school districts have begun to monitor student growth development every year, but there is little research available to determine if the effort is having an effect.

Now, with a $2.2 million grant from the National Institutes of Health and with the cooperation of Leon County Schools, a Florida State University College of Medicine researcher will explore the impact of school-based screening on student fitness and parent behavior.

NIH, the Institute of Medicine, and the Centers for Disease Control really want this question answered. There will be a lot of people interested in this, said Suzanne Johnson, department chair in medical humanities and social sciences at the College of Medicine, who was awarded the four-year grant. It's a very big undertaking, involving the cooperation of 12 elementary schools and a massive amount of data collection.

The stakes are huge. In the past 30 years, according to several studies, childhood obesity has doubled for preschoolers and adolescents and tripled for those ages 6 to 11. High obesity rates are particularly common in ethnic-minority children. An obese child often becomes an obese adult, and obesity opens the door to many health problems.

Among them is type 2 diabetes, previously considered a disease of older overweight adults but now increasingly prevalent among children. At current U.S. rates, a 2003 study indicates, 33 percent of boys and 39 percent of girls born in 2000 are expected to develop it in their lifetime.

Type 2 diabetes is totally preventable, Johnson said. It's just terrible to have kids with type 2 diabetes. It's simply unacceptable.

She and her research team will monitor children at 12 Leon County elementary schools that have a high percentage of ethnic-minority students.

The primary aim is to study the impact of BMI (body mass index) screenings. BMI, calculated from weight and height measurements, is a reliable indicator of whether children are overweight. Each school offers three wellness programs: a free after-school exercise program for children sponsored by Capital Health Plan; expanded health assessments sponsored by the FSU College of Medicine using funds generated by Dance Marathon on the FSU campus; and a wellness Web site that promotes healthy eating and activity. Researchers will track the children to document how much their health changes and how much their parents take advantage of the wellness programs.

Because the study continues over several years, researchers also will get to assess what happens when the children aren't in school.

Data suggest overweight children often show improvement in fitness during the school year if they participate in physical education or other types of physical activity programs. However, they often gain the weight back in the summer, Johnson said. We'll be able to track whether this phenomenon really happens.

Parents are a key part of this project. They play a crucial role in the diet and health habits their children develop.

If you're overweight as a child, you're more likely to be overweight as an adult, Johnson said. If you're an overweight kindergartner and we can get your weight down, you're far less likely to be obese as an adult.

Johnson recently was chosen to receive a Distinguished Research Professor Award from The Florida State University. It honors outstanding research among full professors who have attained national and international visibility. She previously held that distinction at the University of Florida and is the first from the young FSU College of Medicine research program to be selected for the honor.

Dr. Johnson is an outstanding scholar in her field, College of Medicine Dean John P. Fogarty wrote in his nomination letter, and is one of the first behavioral scientists to apply behavioral and psychological science to serious medical problems in children.

New evidence explains poor infant immune response to certain vaccines, says MU researcher

Wed, 01 Apr 2009 04:00:00 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo. ̗ For years, researchers and physicians have known that infants' immune systems do not respond well to certain vaccines, thus the need for additional boosters as children develop. Now, in a new study from the University of Missouri, one researcher has found an explanation for that poor response. In the study, the MU scientist found evidence that the immune systems of newborns might require some time after birth to mature to a point where the benefits of vaccines can be fully realized.

Habib Zaghouani, a professor of molecular microbiology and immunology and child health at the MU School of Medicine, recently found that a slowly maturing component of the immune system might explain why newborns contract infections easily. In his work, Zaghouani studied newborn mice and how their immune systems reacted when they were repeatedly exposed to an antigen that simulates a virus.

Zaghouani found that while the antigen would prompt a response of the immune system, it was not the expected response. In the adult immune system, two major types of cells, known as T-helper 1 (Th-1) and T-helper 2 (Th-2) cells, are instrumental in the development of an effective immune response. Typically, Th-1 cells respond when dangerous microbes enter the body. The Th-1 cells then work to help destroy the foreign microbes. When an antigen from a vaccine enters a body with a mature immune system, Th-1 cells respond and, after destroying the invader, the Th-1 cells remember how to fight the antigen for future battles. Th-2 cells typically develop when the body is exposed to allergens. The responses of Th-2 cells are usually strong and manifest in the form of allergic reactions.

When Zaghouani gave the newborn mice an antigen shortly after birth, he noticed the presence of both Th-1 and Th-2 cells. However, when he gave the antigen a second time, he noticed an abundance of Th-2 cells that responded to the antigen instead of Th-1 cells. Zaghouani was surprised to notice that the Th-2 cells worked to destroy the small contingent of Th-1 cells that had responded to the antigen given at birth.

Perhaps we should test vaccines at a very early age in animals to establish a regimen with the most effectiveness, Zaghouani said.

When a baby first gets an infection, the immature immune system responds with both types of T cells. Unfortunately, Th-1 cells have an unusual receptor that binds to a specific hormone, which is deadly to the Th-1 cells. Ironically, this particular hormone is produced by the Th-2 cells. This results in an overabundance of Th-2 cells during the first few days of life.

We found that after six days, the immune systems in the mice matured enough to stop the death of the Th-1 cells, Zaghouani said. After those initial days, the immune system is producing Th-1 cells with diminished hormonal receptors, thus surviving the effect of the compound that the Th-2 cells make.

Brain abnormality found in boys with attention deficit hyperactivity disorder

Tue, 17 Mar 2009 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers trying to uncover the mechanisms that cause attention deficit hyperactivity disorder and conduct disorder have found an abnormality in the brains of adolescent boys suffering from the conditions, but not where they expected to find it.

Boys with either or both of these disorders exhibited a different pattern of brain activity than normally developing boys when they played a simple game that sometimes gave them a monetary reward for correct answers, according to a new study by a University of Washington research team.

The research focused on two brain areas, the striatum and anterior cingulate cortex. The striatal region is a network of structures in the mid brain that motivates people to engage in pleasurable or rewarding behavior. The anterior cingulate is higher in the brain and normally activates when an expected reward stops. However, this process, called extinction, doesn't occur, at least as quickly, in boys with attention deficit hyperactivity or conduct disorders. Instead, the striatal region continues to be activated, said Theodore Beauchaine, a UW associate professor of psychology and senior author of the paper.

When children engage in impulsive behavior they are looking to stimulate themselves and have fun. Children with attention deficit hyperactivity disorder are always looking to have fun and that is what gets them in trouble, he said. A behavior should stop when the reward stops. When you stop the reward for children with these disorders, they continue to focus on the reward long afterward and the anterior cingulate does not appear to become activated.

Attention deficit hyperactivity disorder is one of the most common mental disorders among children, affecting between 3 and 5 percent of school-age youngsters, or an estimated 2 million.

The researchers used functional magnetic resonance imaging to compare brain activity in 19 boys with either or both disorders and 11 normally developing boys. The adolescents ranged in age from 12 to 16.

Their brains were scanned while they played the game. The boys looked at a screen and there was a button under each of their thumbs. When a light flashed on the left or right side of the screen they were instructed to press the button on that side. The screen lit up very fast, up to 100 times a minute. The boys received five cents for each correct response and could win up to $50. They were not penalized for wrong answers and their accumulated winnings showed up on the screen.

Each boy had four five-minute blocks of trials. The first and third trials involved opportunities to earn money. The second and fourth trials did not involve winning money, but the boys were told to keep playing the game because the game would change at some point.

More dog bites in warmer temperatures and young children

Sun, 01 Mar 2009 09:08:22 PST

( from http://www.rxpgnews.com ) Young children are especially vulnerable to severe dog bites in the head and neck areas, and there is a correlation between cases of dog bites and rising temperatures, according to new research published in the March 2009 issue of Otolaryngology-Head and Neck Surgery.

In an evaluation of 84 cases of dog bites in children over an eight-year period, the authors found that most injuries were caused by family pets (27%), with a high frequency of injuries occurring during the summer months. While the reason for this is unknown, the authors suggest it may be because of children spending time outdoors playing with dogs in the warmer temperatures, or due to a general increase in the irritability of dogs during the warmer months.

The most common sites of bites to the head and neck were the cheeks (34%), lips (21%), and nose and ears (both 8%). Sixty-four percent suffered wounds in more than one location, with the average wound size 7.15 cm. Pit bulls were the breed most commonly cited as the cause for the attack.

The authors believe that by implementing more accurate and timely reporting of dog bites to local health authorities, medical professionals can be educated on how to identify trends and develop prevention strategies. The authors recommend a system for uniform data collection to include the circumstances of the dog bite (signs of provocation, adequacy of child supervision, breed of dog, sex of animal, spay/neuter status, history of prior aggression of the dog, dog restraint, time of event, patients previous histories of dog bites, length of dog ownership, location where dog bite injury occurred, disposition of dog afterwards, and vaccination profile rabies/tetanus). Furthermore, families should be made aware of the increased likelihood of dog bite injuries during the summer months.

It is estimated that 1 percent of all emergency room visits can be attributed to dog bite injuries, including 44,000 annual cases of facial injuries in the United States alone

New study raises concerns about screen time among urban children with asthma

Wed, 04 Feb 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Urban children with asthma engage in an average of an hour more of screen time daily than the maximum amount American Academy of Pediatrics (AAP) recommends. This is the first study to examine screen time among children with asthma.

We know that both asthma and excessive screen time can be associated with other difficulties, including behavior problems, difficulty with attention, poor school performance and obesity, said Kelly M. Conn, M.P.H., of General Pediatrics at Golisano Children's Hospital at Strong and lead author of the study, which was published recently in Academic Pediatrics. (Academic Pediatrics changed its name from Ambulatory Pediatrics this year.) The study was conducted out of the University of Rochester Medical Center.

As a part of a larger study on how to more effectively treat asthma, Conn and her colleagues surveyed parents of urban children with asthma in Rochester, NY, to better understand their screen time viewing habits. Screen time includes TV watching and video tapes, playing video and computer games and using the Internet. The study found that 74 percent of the 226 children whose parents were surveyed exceeded more than two hours of screen time per day. On average, these children with asthma watched 3.4 hours daily.

Even though these findings are preliminary, a message for parents would be to remain aware of the amount of time your child is spending in front of screens and try to encourage your child to participate in a range of activities, Conn said. The types of programs children watch are also important; young children should watch shows meant for their age group, rather than watching PG-13 or R-rated movies, or playing Teen-rated games.

More than half of the parents interviewed knew that the AAP recommends a maximum of two hours of screen time per day and most parents who reported that their child had too much screen time were worried that this was the case. Though the AAP recommends that no child have a television in their bedroom, 77 percent of the children had a TV in their room and nearly half the children owned a hand-held video game system. The widespread presence and popularity of screen time activities in children's lives makes monitoring and setting limits for screen use very difficult. In addition, in an urban setting, safety concerns often limit a child's ability to engage in activities outside of the home.

Even though the goals of asthma therapy are to quell asthmatic symptoms and prevent limitations with activities, about 63 percent of children used screen time when their asthma symptoms physically limited their activities. Those children who used screens when they were having physically limiting symptoms used an average of 3.67 hours daily, which is more than half an hour extra daily than children who engaged in other non-physical activities such as resting, reading or coloring. Researchers suspect that some parents could have underestimated their child's screen time, which would demonstrate an even larger problem of excessive screen time and lack of other physical and mental activities than the study found.

The study did not have a control group of children without asthma. Children with asthma most likely watch a similar amount of screen time to all children, but children with asthma are more at risk for the health problems associated with too much screen time. In the study, children included were between 3- and 10-years-old. According to the Kaiser Family Foundation, on average children in this age range watch between two and four hours of screen time daily. So, while they may not spend more time on screens than children without asthma, the lost opportunities for physical and mental engagement may be even more detrimental to these vulnerable children.

It is not unreasonable or uncommon for children to watch TV or play a video game when they are not feeling well or when they need to slow down their activity. For all children, it is important for parents to be aware of how much screen time their children have and the types of programs they are watching, Conn said.

Conn suggests that parents of children with asthma can encourage a variety of alternate activities for their child, including reading, drawing and arts and crafts, or playing board games or puzzles. In addition, if a child is experiencing limitation of activity due to their asthma, parents should speak with their child's medical provider about ways to improve their asthma control. Many areas have organizations that were created to provide resources and support for families of children with asthma.

Vitamin supplementations being taken by children who dont need them

Tue, 03 Feb 2009 23:27:26 PST

( from http://www.rxpgnews.com ) A study by UC Davis Children's Hospital researchers published in the February 2009 issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals, has found that most of the healthy children and teenagers in the United States who are taking daily vitamin and mineral supplements probably don't need them.

The study also found that the children who most need to take vitamins aren’t getting them.

“Many of the children and adolescents who are using daily vitamin supplements may not need to take them, because they are receiving adequate nutrition from the foods they eat,” said Ulfat Shaikh, lead study author, assistant professor of pediatrics at the UC Davis School of Medicine and a clinician at UC Davis Children’s Hospital.

“Our study also indicates that children and adolescents who may face the greatest risks of vitamin and mineral deficiency are the least likely to be taking supplements,” Shaikh said.

Shaikh and her colleagues analyzed data from 10,828 children between 2 and 17 years old who took part in the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Children were considered to be vitamin and mineral supplement users if they had taken a supplement within the month preceding their inclusion in the survey. The researchers also looked at how much exercise they got, the types of foods they ate and whether or not they were covered by health insurance, among other factors.

“We wanted to know more about which children take vitamin and mineral supplements and whether vitamin and mineral supplements may be used by parents to prevent medical problems related to poor diet or lower food security,” Shaikh said.

The American Academy of Pediatrics (AAP) does not recommend vitamin use in healthy children over 1 year old. Previous studies have shown that about one-third of children in the United States take a daily multi-vitamin. The current study found that children who are healthier, more active, eat a balanced diet and have greater access to health care are more likely to take vitamins. The study found that, among children who were in excellent health, 37 percent took vitamins. But only about 28 percent of children in fair or poor health took them.

“As expected, we found that a large number of underweight children had taken a multivitamin in the previous month. But we also found that between 30 and 40 percent of children who regularly eat vegetables and drink milk are taking supplements. Supplements for children and adolescents who are healthy and eat a varied diet are not only medically unnecessary but they are not regulated by the Food and Drug Administration (FDA),” Shaikh said.

In addition, overdose is more likely in 2- to 4-year-old children who may associate taking vitamins with eating candy, she said. Taken in large quantities, vitamin and mineral supplements can cause adverse effects ranging from vomiting to serious side effects, such as damage to the kidneys. Shaikh said that future research on this issue will likely include direct interviews with parents to find out why they chose to give their children vitamins in cases where a medical reason for vitamin and mineral supplement use may not be present.

"This is a descriptive study,” Shaikh said. “The next step will be to explore with parents the reasons behind their decisions to provide their children with multi-vitamins.”

The study also noted that socio-demographic factors influencing vitamin and mineral supplement use are the same ones that have been shown to interfere with children eating healthy diets, exercising regularly and maintaining a healthy body weight. The study proposes that cost may be one reason that children who need vitamins don’t get them.

The study findings seem to bear out the hypothesis that cost is a barrier to children getting vitamins. Among households considered below the poverty level, 22 percent of children used vitamins. The number jumped to 43 percent among those not considered poor. Among households not enrolled in the federal Food Stamp Program, 38 percent of children used vitamins. But in households using food stamps, vitamin use was around 18 percent. Children in 36 percent of households where there is no hunger use vitamins; only 15 percent use vitamins in households where there is "food insecurity and hunger.”

Other study authors include UC Davis associate professor of pediatrics Robert Byrd and Peggy Auinger of the University of Rochester School of Medicine and Dentistry.

New data show periodontal treatment doesn't reduce preterm birth risk

Thu, 29 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) The study, involving researchers from Duke University Medical Center and the University of North Carolina at Chapel Hill, is one of the largest randomized trials to date to look at the link between the two conditions.

Previous research had suggested that gum disease was associated with very preterm deliveries (defined as less than 32 weeks gestation). That led insurance policies and healthcare providers to recommend scaling and root planing, sometimes referred to as deep cleaning, in pregnant women. It was thought that such care had the potential to reduce preterm delivery risk.

These new findings, based on a randomized trial of 1,800 pregnant women with periodontal disease, indicate that routine gum treatments do not reduce the risk of early delivery.

I'm always asked whether we should mandate dental treatment for all pregnant women, said Amy Murtha, MD, director of obstetrics research at Duke University Medical Center in Durham, NC, who presented the findings at the annual meeting of the Society for Maternal-Fetal Medicine in San Diego. The biggest implication of this study is that this level of standard periodontal care will not affect the birth outcome.

That's not to say pregnant women should not get dental exams and treatment as needed; they should, Murtha added. Our study emphasizes that treating periodontal disease during pregnancy is safe, but that standard periodontal care is not enough.

Progression, or worsening of periodontal disease occurs in about 25 percent of pregnancies, said Steven Offenbacher, DDS, PhD, the study's lead investigator and director of the UNC-Chapel Hill School of Dentistry-based Center for Oral and Systemic Diseases. The bacterial infection attacks the teeth-supporting tissues below the gum line. Left untreated, it can lead to tooth loss as well as a host of other problems.

This study, conducted at Duke, the University of Alabama at Birmingham and the University of Texas at San Antonio, was overseen by the UNC-Chapel Hill School of Dentistry. Pregnant women with periodontal disease were randomly assigned to two groups: one received periodontal treatment before 23 weeks gestation; the other did not. Overall, no significant differences were reported regarding obstetric or neonatal outcomes when the two groups were compared.

Despite the findings, Murtha said much remains unknown about the relationship between the two conditions. Periodontal disease and poor pregnancy outcomes travel together, but we don't know why.

Nor do researchers understand how or why pregnancy appears to jumpstart the onset and progression of the disease. Murtha said it may be that preterm birth and periodontal disease share a common underlying trait, such as an exaggerated inflammatory response, but more studies are needed to fully explain the connection.

Additional research is also needed to determine whether more intensive periodontal care during pregnancy might make a difference. Although we did not reduce the risk of preterm births, the level of periodontal care provided in this study was not as effective as compared to earlier studies, Offenbacher said. It may be that a more aggressive approach to periodontal disease management could have a different outcome, he added.

Infants draw on past to interpret present, understand other people's behavior

Thu, 22 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) The old real estate maxim location, location, location also plays a role in how infants learn to understand the ambiguous actions and behavior of other people.

University of Washington psychologists have learned that 10-month-old infants use their prior exposure and understanding of familiar actions by a person to unravel novel actions. However, this ability is limited by the location in which the new action is performed.

Infants' understanding of and exposure to familiar actions can boost their understanding of ambiguous action sequences. Their ability to draw on the past to interpret the present represents an important advance in their developing understanding of other people's behavior, said Jessica Sommerville, a UW assistant professor of psychology who is also affiliated with the university's Institute for Learning and Brain Sciences.

Although the research was conducted on infants, she believes the findings apply across all ages.

Providing advance information about the ultimate goal or objective of what you are trying to teach before delivering the actual content helps people learn. College instructors and school teachers are often instructed to highlight the goal of a lecture, course or lesson in advance to facilitate learning. Our work demonstrates that this phenomenon is present in infancy. Advance information about an individual's goals helps infants understand and learn from another person's actions within the first year of life.

UW researchers conducted two experiments to test how well infants can use prior information.

In the first, 48 typically developing infants took part in a two-phase experiment. During the first phase, infants received information about which of two objects a research assistant desired. Across five trials, infants consistently saw the assistant reach for, grasp and pick up one of two plastic toys ( a green frog or a red fish) while saying Wow! For the second phase, the infants were randomly divided into same- and different-room conditions.

Half the babies stayed in the same room, but the setup was slightly different. This time the frog and fish each sat out of reach of the assistant on top of distinctly different colored cloths. Infants watched as the assistant used the cloth supporting the toy that she had previous desired to retrieve the target toy. Infants' visual attention to these events was measured, and after infants' attention declined they participated in novel test trials. The test trials varied. Some of them featured a change in the toy the assistant went after while others featured a change in the cloth that was used by the assistant. The procedure was the same for the different-room group, except these infant receive the second phase in another room.

Prior research suggests that 10-month-old infants do not spontaneously recognize the meaning behind the cloth-pulling sequence. They apparently don't understand that a person pulls the cloth to retrieve the desired out-of-reach toy. The UW researchers wanted to know if the infants could use information from the first phase to identify the assistant's intention in the second phase. They used infants' visual attention to the novel test events to gauge infants' understanding of the cloth-pulling sequence. Infants in the same-room condition showed heightened attention to a change in the toy that the assistant retrieved rather than a change in the cloth she used. This suggests that the infants understood that the assistant pulled the cloth in order to obtain her desired toy, and were surprised when her intention changed, according to Sommerville.

In contrast, infants in the different-room condition did not distinguish between the two test events.

The second experiment was virtually identical to the first, except half of the infants were taken out of the testing room for 30 seconds after the first phase, matching the time it took the different-room group to switch rooms in the first experiment. Then they returned to the same room. This time both groups of infants looked significantly longer at the change in the toy the assistant pulled with the cloth.

Our findings suggest that infants use prior information about a person's goals and desires to understand novel or ambiguous action. But they also suggest that infants may be limited in their ability to generalize this information to new contexts at 10 months of age, said Sommerville. Alternately, infants may be able to generalize information across a change in context, but they may be more reluctant to generalize expectations about others' behavior than are older children or adults.

She said the research also has practical applications that parents could use when they want to teach their children something.

Our work suggests that children's learning may benefit if they are provided with information about the desired end result of a game or activity before starting it. For example, if a parent wants to show a child how to operate a jack-in-the-box it might be helpful to show the desired outcome (the jack popped out of the box), and then demonstrate the step that are necessary to achieve that result.

Standardized test battery to aid those with Down syndrome

Mon, 12 Jan 2009 05:00:00 PST

( from http://www.rxpgnews.com ) Researchers at The University of Arizona are developing a set of standardized tests that could improve the lives of people with Down syndrome.

The condition, which occurs once in every approximately 800 to 1,000 live births, is signaled by the presence of an extra 21st chromosome. Those with Down syndrome often have mild to severe developmental disabilities, and other health issues that include heart defects and the early onset of Alzheimer's dementia. New research also suggests connections between chromosome 21 and other genes point to some of these problems.

For the past 25 years, Lynn Nadel has been studying the cognitive aspects of Down syndrome. Nadel, a Regents' Professor in the UA psychology department, has spent the bulk of his career studying the hippocampus, the area located deep within the brain that is associated with memory and spatial navigation.

Nadel said while some researchers may be involved with Down syndrome, he was drawn to it as an interesting scientific problem. The hippocampus develops later than other parts of the brain, including after birth, and is susceptible to disruptions. Nadel became interested in the possible implications of environmental impacts such as fetal alcohol syndrome, autism, lead and mercury poisoning and others.

A lot of things that happen early in life have an impact on the development of this structure because it is still plastic and developing, Nadel said.

Since the hippocampus is one of the later developing parts of the nervous system, it made sense to think there might be some connection between this late development story and cognitive problems in Down syndrome.

Starting in the mid-1980s, Nadel began to speculate on the possibility that problems with hippocampal development might also contribute to cognitive problems in Down syndrome. He said the existing literature and later research added to the mounting evidence connecting the two. His own neuropsychological work and cognitive testing supported the case.

In the early 1990s, Nadel and his colleagues in Denver decided that in order to make any further progress, they would need a very accurate profile of the cognitive deficits in children with Down syndrome. For a while, their research slowed until Roger Reeves, a heart specialist at Johns Hopkins who had worked on heart problems in Down syndrome, asked about Nadel's research.

Like the hippocampus, there are anatomical features in the heart that develop very late, like the closing of the valves. Reeves wondered if children with Down syndrome were more likely to have late-developing heart problems. On one of his heart projects, Reeves related the probability of heart defects not just to chromosome 21, but other genes that interact with the extra chromosome 21, and had shown the feasability of using that as a predictor.

Nadel thought he could do that for cognitive function, and suggested they team up to determine the best way to profile cognitive deficits to use in combination with genetic and intervention studies. This could be a way to determine what else contributes to the exact outcome to any particular child with Down syndrome.

Nadel and Reeves brought in genetics experts from Emory University to complete the team.

We're also planning to bring in researchers in Pittsburgh and setting up two or three sites around the country to increase the sample size to get even more exact data on how to make a direct link between the genetic profile of a given child with Down syndrome and their cognitive outcome. You want to predict as early as possible their likely trajectory, and which kids you should intervene with more aggressively, Nadel said.

Most researchers assume that the range of variability in children with Down syndrome is no different than for the rest of the population. There is a very large range in typically developing children, everything from high-functioning to low-functioning. And there is every reason to assume the same in Down syndrome.

We're trying to figure out how to most accurately assess as early as possible, within the first year or two of life. What is the likely trajectory. The kids at age 1 you could already predict by looking at their genetic makeup and a few cognitive tests that we're trying to work out that would be sensitive to cognitive function in the first year or two of life.

An accurate assessment of a child's learning trajectory would enable parents and medical and education specialists time to develop appropriate strategies for learning and possible drug therapies.

The earlier we can make the prediction, the better advice we can give to parents about what they need to do to optimize their kids' development, Nadel said.

The key to finding out where people with Down syndrome are cognitively, he said, is through the use of standardized tests.

We're working on developing a standardized battery for 8 to 18 year olds, the adolescent range that is easiest to develop tests that have adequate controls for in the developing population. Once we have that figured out for that age range, we want to move in both directions.

That includes tests for much younger children, but also for those in the 25-35 age range. Until a few decades ago, many with Down syndrome died in their 30s and 40s, usually from heart problems. Medical advances have helped stave off heart-related deaths, but it exposed another health risk for this group.

By age 35, and certainly by age 40, just about everyone with Down syndrome has characteristic neuropathology associated with Alzheimer's, Nadel said. Every individual with Down syndrome who has died past that age all have this pathology.

What we also know is that for individuals with Down syndrome who are alive past age 35, about 35 to 40 percent actually seem to have early Alzheimer's. They all have mental retardation, either high or low functioning, but they don't seem to have dementia of the Alzheimer's type. This itself presents another interesting scientific question. Why do they have what appears to be the pathology associated with Alzheimer's disease, but don't have it? Given that they all have the neuropathology, we need another indicator, like behavior testing, to find out which ones have dementia or are more likely to get it.

Developing tests requires a large number of subjects. Several dozen have been tested in Tucson, Baltimore and Atlanta. Nadel is creating a fixed battery of nine or 10 tests that can be useful worldwide.

The test battery has to be precise in its ability to tell researchers about a particular brain structure. Three of these tests are targeted as assays, like blood tests that detect the presence of blood sugar. Performance on a cognitive test indicates how well the subject's hippocampus or the prefrontal cortex, another structure thought to be compromised in Down syndrome, are functioning.

The battery has to be designed to be quite specific to only assay one particular structure and not be affected by the function of other structures, Nadel said.

They have to be targeted and precise. They also have to be fairly short. All kids have a short attention span, so we want tests that are precise and targeted and short. They typically are computer based, but not always.

They also are portable. We want to be able to test not only on kids or individuals who can make it into a university or hospital laboratory, but in schools and homes, he said.

Nadel said a number of criteria constrain the development of this battery but the goal is to have something that is repeatable, to test subjects initially and then bring it back a month later and still get reliable results.

Down syndrome also cuts across languages and cultures, so tests have to work the same way anywhere in the world.

Luckily, we're based in Tucson, where there is a substantial Hispanic population. A number of students working on the project speak both English and Spanish fluently, so they were able to help us navigate testing kids who come from Spanish-speaking families. So we've been able to jump that hurdle, Nadel said.

Nadel and his group are now establishing contacts with colleagues in Barcelona, Spain. One of his students is going to do her study-abroad semester in Argentina and will look into what is happening there. The family of another student runs a home for kids with developmental disabilities in Indonesia.

There are cultural differences in how people with developmental disabilities are treated. But worldwide Down is emerging from the closet and kids are being mainstreamed and treated as educable and worth doing something for. That's happened over the last 20 or so years as a function of what we're learning about it.

Nadel said the test battery is near completion, likely in 2009, after a year and a half in development and presentations at meetings. A journal article is near as well.

We're pretty much there, and should have a finished product that we will be happy to share with others doing the same thing around the world who want to use this standardized approach. People are pretty much waiting on us to finish.

Standardized tests, he said, will also aid other researchers working on drug treatments and other kinds of early stimulation, especially for clinical trials that require before-and-after comparisons.

Nadel also has found popular support from the parents of children with Down syndrome. The research testing was developed so that the children would enjoy it. There are boring parts, but Nadel said they try to work around those.

The parents in Tucson and Denver and wherever I've worked with these groups are enormously positive and cooperative about the work. Most of our research is from private foundations that get their money from families with kids with Down syndrome and want to see this research go forward.

What it will make possible is a way of assessing kids, but also for assessing the efficacy of clinical trials. That's been missing. There's always been lots of anecdotal stories about the value of ginkgo or vitamin E. What has been lacking in the field has been some sort of solid scientific way of assessing the virtues of and value of things. So, parents are very excited that we're getting close to having this kind of measurement tool.

The research has also drawn interest from UA students. Nadel said this avenue of research is an area where the rewards are obvious.

One of the most exciting things is how many students want to work on this project. Six or seven right now. It's been an immediate hit. This is good and interesting science and connects to the real world and they can sink their teeth into it and make a difference. It's been a magnet for undergraduate students who want to get involved in research, in something connected to the world.

This one of those perfect examples of how teaching and research mesh completely. In the classroom you talk about brain development and cognition and how it goes right and how it goes wrong. Here is the opportunity for undergrads to actually go in and discover something about that process and make a difference.