RxPG News : Paediatrics

NIH awards $8.5 million for research on pharmaceuticals for children

Tue, 17 Nov 2009 04:59:12 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 04:59:36 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 04:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:58:48 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 PST

Nondrug interventions may comfort children having an anesthetic

Tue, 07 Jul 2009 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 03:59:36 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 09:07:58 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 04:59:36 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 23:27:02 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 04:59:36 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 04:59:36 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 04:59:36 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.

Study to explore ethical challenges health professionals face while caring for children with LTNMDs

Wed, 07 Jan 2009 04:59:36 PST

( from http://www.rxpgnews.com ) (Baltimore) The Greenwall Foundation recently awarded two core faculty members of the Johns Hopkins Berman Institute of Bioethics a grant that will allow Drs. Gail Geller and Cynda Hylton Rushton to explore the ethical challenges health professionals face while caring for children and families affected by life-threatening neuromuscular diseases (LTNMD).

The concept for this latest LTNMD study grew out of the work of the international HeartSongs Project funded by the Stavros Niarchos Foundation. The goal of the HeartSongs Project is to develop a worldwide network of professionals from a range of disciplines, parents and affected children who share a common vision of comprehensive care for children with LTNMD. In addition to the United States, countries involved in the HeartSongs project include the United Kingdom, Canada, Australia, France, Denmark and Greece. The Project aims to integrate the principles of pediatric palliative care (PPC) into the care of individuals living with LTNMDs. PPC can be described as a holistic, interdisciplinary model of care that incorporates emotional, spiritual, developmental, and physical dimensions. The HeartSongs' International Consortium will develop recommendations regarding promising practices in comprehensive and integrated care. The two-year project, co-directed by Geller and Rushton, opened with a summit in England this past April and will culminate in a second summit to be held in Greece in March 2009. Hopes for a HeartSongs II call for expanding the project to include more European countries as well as countries in South America, Africa, Asia and the Middle East.

The HeartSongs Project is named in honor of the young American poet Mattie J.T. Stepanek who lived with a rare form of muscular dystrophy. Mattie's messages of love, hope and peace have stirred the hearts and souls of millions worldwide. The author of 7 books, Mattie shared hope through his 'Heartsongs' poetry, and collaborated with Former President Jimmy Carter on an essay book, Just Peace. (http://www.mattieonline.com/) Mattie died in 2004 just before his fourteenth birthday. According to Dr. Rushton, Mattie's legacy for a better world for all children has inspired our work to improve the lives of children, like Mattie, who live with LTNMDs.

Geller and Rushton's earlier research, also funded by the Stavros Niarchos Foundation, revealed that many parents of children living with LTNMD often do not take advantage of Advanced Care Planning (ACP) as early as experts recommend. Because the life expectancy of LTNMDs is uncertain and unpredictable, Drs. Geller and Rushton claim that ACP, and palliative care more broadly, should not be restricted solely to children who are considered close to death.

Geller and Rushton's newest Greenwall Foundation funded study will focus on the attitudes and behaviors of health professionals who care for patients living with Duchnne Muscular Dystrophy (DMD) and Spinal Muscular Atrophy (SMA Type 1), the two most common pediatric LTNMDs worldwide. Although both diseases are life threatening, says Dr. Geller, each has a unique life expectancy and disease trajectory thereby creating distinct ethical challenges for the children, their families and the health care team. Dr. Rushton says, based on a review of the literature and our own prior work, there is a need to more fully understand the nature, prevalence, and consequences of ethical challenges experienced by Neuromuscular Disease specialists who care for these children, adolescents and their families. These findings will fill an important gap that will inform the development of targeted interventions to support patient/family centered care of children with LTNMD's and their families.

Rushton and Geller say results of the national survey of health care practitioners will be presented to a focus group of regional Muscular Dystrophy Association-clinic directors and pediatric palliative care specialists to develop clinical and policy recommendations for enhancing ethically appropriate care for children with LTNMD.

Premature babies are less sensitive to temperature sensations later in life

Sun, 28 Dec 2008 14:51:50 PST

( from http://www.rxpgnews.com ) Premature infants who need intensive care or surgery are less sensitive to hot and cold sensations later in life, according to a study.

The research conducted by University College London - suggests that pain and injury related to major medical interventions in early development may alter how children respond to painful stimuli much later in life.

In the study, 43 11-year-old children born at less than 26 weeks of gestation - who are being followed up by the EPICure study group, were tested for their responses to different sensations - temperature and light touch - using quantitative sensory testing.

Compared to a group of children who had been born at full term, the premature children were less sensitive to temperature - but not to light touch, and this was most marked in those who had also undergone a surgical operation as a baby.

The researchers also found a more marked decrease in sensitivity to temperature and to touch close to scars relating to major chest surgery, again suggesting that the severity of injury in early life influences the degree of sensory change, said an UCL release.

A survey showed that the children's everyday pain experiences were similar, but there were some minor differences between the two groups in the way children coped with pain.

Suellen Walker of the UCL Institute of Child Health said: 'Our study shows that babies who are born premature and need intensive care or surgery develop long-term changes in their responses to hot and cold sensations.'

The study was published in the journal Pain.

K-State researcher finds correlation between childhood obesity and asthma

Fri, 12 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) MANHATTAN -- A Kansas State University graduate student has found a correlation between childhood obesity and asthma.

Sara Rosenkranz, doctoral student in human nutrition, Manhattan, conducted research that found that healthy children with higher levels of body fat and lower levels of physical activity had greater amounts of airway narrowing after exercise.

Kids who are overweight and inactive are having -- even at the age of 8 to 10 years old -- a negative response to exercise challenge tests, which might be contributing to the increase that we've been seeing over the past several decades in asthma prevalence as well as obesity prevalence, Rosenkranz said.

Rosenkranz worked with other K-State faculty and students to recruit 40 children in the 8- to 10-year-old age range to participate in exercise studies. All of the children were healthy, meaning none of took medication or had a diagnoses or history of acute or chronic disease, including asthma.

For Rosenkranz's project, the children completed pulmonary function tests, an exercise test that doctors often conduct to determine if children have asthma, and body composition tests.

The children also took questionnaires to determine if they were active or inactive compared to the standards of their age, gender and ethnicity.

After the exercise challenge, the researchers measured the children's FEV-1, which determines if the individual's airwaves narrow post-exercise. The researchers found that the higher the body fat and the lower the level of activity of the child, the more likely they were to have asthma-like symptoms following exercise. In fact, these specific children had FEV-1 measures that many consider to be classified as exercise-induced asthma.

It was pretty interesting. There's that whole idea that it's possible to be fit and fat in adults, but that really hasn't been looked at closely in kids, Rosenkranz said. That's what spurred the idea for this research.

At the completion of the project, a follow-up letter was sent to the parents that showed their child's pulmonary test results and body fat percentage, which also had the corresponding fat group based on the child's age, gender and ethnicity.

It's important for parents to know what's going on with their children at a young age so that they can help do something to maybe stop a downward cycle, Rosenkranz said. It's especially important for those kids who already are overweight and are very physically inactive.

For many of the students that had higher levels of body fat and lower levels of activity, Rosenkranz said it is possible that they had the early stages of asthma and they didn't know it.

They might not know it because they might not be doing anything that could ever trigger it, she said.

When an asthma diagnosis is made, Rosenkranz said it is important that the child remain active to prevent airway problems.

Before the study, little was known about the role body composition and physical activity have in airway health in children, Rosenkranz said. When considering childhood obesity, pulmonary function wasn't often considered, she said.

At K-State, we just started working with the childhood population, she said. We've been working more with college-age students because that's a handy group to have access to, but with kids, it's a whole new world and there's not much information out there.

UB driver simulation study targets high-risk teenage drivers

Thu, 11 Dec 2008 04:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- Using the bells and whistles of a state-of-the-art entertainment arcade, a University at Buffalo Graduate School of Education project aims to improve the driving habits of teenagers at the very top of the risk pool, and at the same time bring child and parent together for a happier, better functioning family.

The population identified as risky drivers: teenagers with ADHD or attention-deficit hyperactivity disorder.

The method: a high-tech and newly improved driving simulation program complete with real sounds and computer-generated highways based on actual streets and busy intersections around UB's North (Amherst) Campus.

The innovation researchers believe will make the study more authentic and effective: While keeping many of the flashy attractions of the old driving simulator, the new setting is the actual front half of a real car. When the teenagers and their parents participating in the study climb into the shell of the Ford 1999 Contour, they can't help but feel they're actually driving, not putting tokens into a multiplex arcade game.

It has been long known that teenage drivers are the most at risk for just about every negative driving outcome you can imagine -- moving violations, accidents, accidents with injury/death, drunk driving -- it goes on and on, says Gregory A. Fabiano, assistant professor in the Department of Counseling, School and Educational Psychology in UB's Graduate School of Education, and lead investigator for the project. Recent research has shown that a teenager with ADHD is significantly more at risk than this already highly at-risk group.

The effect ADHD has on already at-risk drivers makes sense logically, Fabiano says. Impulsive behavior and inattention to the task at hand -- both common symptoms of teens with ADHD -- run contrary to the caution and continuous focus needed to be a safe driver. When ADHD teens get behind the wheel to learn to drive, it's often a recipe for an acrimonious encounter with a parent doing the driving lessons.

The teen that needs the most instruction gets the least because of ineffective parental and teen communication, says Fabiano.

Fabiano's study, which comes with a $36,000 grant from the UB 2020 Interdisciplinary Research Development Fund from UB's Office of the Vice President for Research, seeks to change that, all of it. Students and parents participating in the program first meet individually with a clinician to work on specific skill building related to effective communication and driving.

For the second part of the session, the teenager and parent take part in a joint activity. Often the teenager practices on the driving simulator while the parent, sitting in the passenger seat, practices a parenting skill. If the parent intends to work on noticing the child's positive behavior, the parent compliments the teenager's good driving skills. Each week the parent and teen also set up a contract to work on a specific behavior related to driving or another issue at home.

Throughout the sessions, those in the study (Fabiano says about 10 families will take part) face a state-of-the-art driving simulator that emphasizes what engineering researchers call an authentic highway experience.

The driving simulator comes complete with screeching noises when the driver speeds or turns too abruptly, deer crossings, slippery roads, a construction zone with hazards, horns and situations related to dealing with aggressive drivers. Drivers and passengers can hear the hum of the car engine or hear the revving noises as the engine accelerates. And since the computer program is based on actual local highways, the teenager/parent team can retrace the path on the actual streets featured on the driving simulator.

Previously, our motion simulator used a generic passenger cabin which seated two people, said Kevin F. Hulme, research associate for the New York State Center for Engineering Design and Industrial Innovation (NYSCEDII), who designed and operates the driving simulator. It was 'open air' (no roof), and it had an 'entertainment' feel to it. So, if we were going to simulate a roller coaster, it served its purpose, but for more serious research applications (i.e., flight, driving and training applications), it just didn't feel authentic enough.

Now, with our latest cabin, participants are actually sitting in a car -- a real car. You cannot get any more authentic than this, because it truly is the real thing. Real seats, a real console, a real windshield, and a real (closed) vehicle shell. Along with the on-board steering wheel and pedals (both of which are well-engineered, and have a realistic feel to them), we are giving our riders the next-best thing to being inside a real vehicle on an actual roadway.

The project aims to give ADHD teenagers and their families an alternative to drug treatment. Fabiano says the most common treatment for ADHD -- stimulant medication -- often does not eliminate the risk of driving. Teens often do not like to take medicine, and even when they do, typical medication is not active during the early morning or evening, which are the most risky times for teen drivers.

There are some well-developed psychological treatments for ADHD, but none focus specifically on teen driving behaviors, Fabiano says. So our team worked to develop a parent-teen driving program that helps parents work on their monitoring and parenting skills with the teen, teaches the teen better communication skills and driving behaviors, and that uses innovative technology to support treatment efforts.

Study: Childhood constipation just as serious as asthma

Wed, 26 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) (COLUMBUS, Ohio) - Car and airplane trips, holiday goodies, new toys, and unfamiliar surroundings. The holidays are a crazy time for kids, often causing their bathroom habits to get out of whack. What might sound like a minor inconvenience is actually a common, sometimes serious problem for children, and not just around the holidays. Now a new study finds childhood constipation is costing us all.

Trips to the bathroom are pretty routine for Kevin Wallace, but it wasn't always that way. A small case of constipation turned into a big problem that took money, time and effort to fix.

It was very traumatic for both of us, because I'm pushing him to do something and he's telling me he's done it and come to find out he was doing the best he could, I just wasn't aware of the symptoms, says Linda Wallace, Kevin's mother.

And the Wallace's aren't alone. One in four children will have constipation at some point, caused by a number of things like, not eating enough fiber or fruits and vegetables, not wanting to use unfamiliar bathrooms and ignoring the urge to go while playing.

And children have a very concrete way of thinking. If something doesn't feel good, 'I'll never do that again, says Carlo Di Lorenzo, MD at Nationwide Children's Hospital.

In a new study, Doctor Carlo Di Lorenzo and his team at Nationwide Children's Hospital found constipation can lead to serious health issues and skyrocketing costs, to the tune of nearly four billion dollars a year.* That equals the cost of treating childhood asthma or even ADHD. Di Lorenzo, who is also with the Ohio State University, says parents don't realize constipation can be just as serious. It can result in pain, problems at school, and sometimes the need for surgery.

It's traumatic to them, then they end up with low self esteem as if something is wrong with them and it's really not, says Hayat Mousa, MD at Nationwide Children's Hospital.

The good news is, most of the time, childhood constipation can be treated with simple changes in diet and behavior, and sometimes mild medication. Now that Kevin is back in his routine, his mom checks in with him regularly, to make sure he stays that way.

Here are some tips for parents: Don't be shy, talk with you children about bowel movements just like you discuss any other bodily function. Make sure your child is going at least every other day. If you find out your child hasn't gone for three to four days, try prune or apple juice, high fiber cereal, or even a warm bath. Over the counter softeners or laxatives made for children can also help.

* Health Utilization and Cost Impact of Childhood Constipation in the United States, slated for publication in

Parents are the unsung heroes

Wed, 26 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) It's a parents worst nightmare, a newborn baby going under the knife to repair a heart defect. If the baby survives, that's when the real work begins for parents. University of Alberta nursing professor Gwen Rempel has seen hundreds of babies on the brink as a former pediatric cardiology nurse; she wanted to find out just what parents go through.

I'm not 100 per cent convinced that health-care professionals get what these parents are doing, said Rempel. I think [pediatric cardiology nurses] really pleased to offer what we offer and we're proud of ourselves that these kids are now surviving.

Rempel interviewed parents from across Western Canada, talking to both mothers and fathers about their day-to-day life with a child growing up with a congenital heart defect.

These parents are extraordinary in what they're doing. Not just what they're doing for their child, but what they're doing to take care of themselves, said Rempel.

In these families, it's all about teamwork. Common public perception is that mothers do most of the work with newborns, but in these families fathers know just as much about their baby. The study found that some of the things both the mothers and the fathers were doing included calculating how much formula the baby needed, feeding the baby and monitoring both the baby's weight and oxygen levels.

I was very struck by how these couples work together, said Rempel. I'm continually struck by that. It's stressful because one parent might be in the hospital all the time, and one's at home trying to keep things spinning, she said. They really do have to make an effort to keep on the same page.

The study also found that the parents in the study have a great support network. These parents were never alone and it's family that's with them. It's amazing the amount of time grandparents will spend at hospitals, as well as aunts and uncles.

That's exactly what these parents need, says Rempel. For these kids to survive, the parents need to look after themselves.

The parents are the ones safeguarding the child's survival. So if the parents are doing okay, there's a better chance the child's going to be okay.

But the parents' ability to succeed starts with asking for help. Rempel says a lot of these parents are just happy their child survived and don't want to ask for anything more. She suggests that health-care professionals need to be stepping up for these families.

Can we teach them to ask for help? They're already doing what they do really well, she said. We need to be more pro-active so that they can do even better.

Drug therapy for premature infants destroys brain cells in mice

Mon, 17 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) A class of drugs that are used in premature infants to treat chronic lung damage can cause damage in the brain. New research at Washington University School of Medicine in St. Louis suggests the drugs may cause cognitive and motor-control problems even when they are given before birth.

The researchers have identified the cells damaged by the drugs, called glucocorticoids, as well as the time window during which brain injury can occur. They say it may be possible to avoid damage to brain cells and still aid the development of premature lungs if synthetic forms of the drugs can be replaced with hormones made naturally in the body.

The researchers reported their findings today at Neuroscience 2008, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news about brain science and health.

Studying the effects of the drugs in mice, the investigators found that the synthetic glucocorticoids dexamethasone and betamethasone, commonly prescribed to spur the development of premature lungs, cause damage in the brain's cerebellum, the structure that controls movement, as well as other functions.

Brain cells in the mice died following glucocorticoid treatment when the drugs were given between four and 10 days after birth. The corresponding window in human infants would be approximately 20 weeks of gestation to six weeks following birth. That's also the time span in which these drugs are given to pregnant women at risk for preterm birth or to prematurely born infants who are having problems breathing.

The cells that are damaged are called neural progenitor cells, which are responsible for producing new neurons, says first author Kevin K. Noguchi, Ph.D., a scientist in the Department of Psychiatry. So you can imagine that if you kill the cells responsible for producing new neurons, you can cause severe neurodevelopmental deficits.

That's exactly what the researchers found when they studied adolescent mice that had been treated with glucocorticoids during infancy. A single exposure to glucocorticoid drugs permanently decreased the number of neurons in the cerebellum of the mouse brain.

In the past, the steroid drugs were given to low-birthweight infants after they were born, but studies determined that exposure to the drugs following birth could lead to cognitive problems and neuromotor deficits, particularly difficulty with balance and coordination. In 2002, the American Academy of Pediatrics recommended post-natal glucocorticoid use be stopped unless used in clinical trials, but the drugs still are given frequently to mothers at risk for preterm birth.

The cerebellum connects to other brain structures, so when granule cells in the cerebellum are lost, you also have detrimental effects on cognitive function in non-motor regions of the brain, says senior investigator Nuri B. Farber, M.D., associate professor of psychiatry. Other researchers have found I.Q. declines in children who have received these drugs early in life, and our findings may help explain why.

But both Farber and Noguchi say therapy with these drugs may be essential for some children with immature lungs as a lifesaving measure. They believe, however, that it may be possible in the future to use different drugs to help the lungs mature without damaging brain cells.

We're looking at differences between glucocorticoids that are made naturally in the body and hormones that are manufactured, says Noguchi. The brain has some natural defenses against exposure to endogenous glucocorticoids but not the synthetic ones. So it may be possible to administer some of those natural hormones, which can help the lungs mature without putting the brain at risk.

It also may be possible to develop other drugs that would assist with lung development without killing cells in the cerebellum. But as they study those possibilities, the investigators say they want parents to know that the observed toxic effects of steroid drugs are not a problem for adults and older children. They estimate that by about three months of age, human infants no longer are at high risk for this damage.

The toxic effects decline when the cerebellum finally finishes its development, Farber says. These drugs are used for many different purposes, so there are other reasons why a baby might get prednisone or dexamethasone or another glucocorticoid, but our research in mice suggests once a human infant is a few months old, these drugs have fairly innocuous effects in the brain.

No drop in IQ seen after bypass for child heart surgery

Mon, 10 Nov 2008 04:59:37 PST

( from http://www.rxpgnews.com ) The use of cardiopulmonary bypass does not cause short-term neurological problems in children and teenagers after surgery for less complex heart defects, according to pediatric researchers. The new finding contrasts favorably with previous studies that showed adverse neurological effects after newborn surgery for more complex heart conditions.

This is good news for school-aged children who receive surgery for these less complex heart defects, said study leader Michael D. Quartermain, M.D., a pediatric cardiologist at The Children's Hospital of Philadelphia. Quartermain presented the study group's results at the American Heart Association's Scientific Sessions today in New Orleans.

The research, conducted at the Cardiac Center of Children's Hospital, studied 41 patients, aged five to 18, who underwent heart surgery at the hospital while a heart-lung machine circulated their blood (under cardiopulmonary bypass, or CPB). All the patients had milder forms of congenital heart disease usually characterized by an abnormal heart valve or by a hole between the heart's chambers.

Such defects, while present from birth, are often not detected until a patient is school age or even older. Patients do not show obvious symptoms and are otherwise healthy, but surgical intervention is often recommended to prevent complications later in life. In contrast, more complex congenital heart defects, such as hypoplastic left heart syndrome, a severely underdeveloped ventricle, are life-threatening in infancy, and require urgent surgical repair.

Previous studies of survivors of more complex heart surgery have found neurological problems, such as impaired motor development, lower I.Q. scores and reduced language skills. As medical regimens and surgical techniques have advanced, more recent studies have found milder neurological problems or normal neurological outcomes, but long-term outcomes remain a concern. Likewise, adults with acquired heart disease have sometimes suffered adverse neurological outcomes after surgery with CPB.

In the current study, researchers compared 41 pediatric heart patients who underwent CPB to a control group receiving non-heart-related surgery without CPB. Neurological and developmental testing were performed two weeks before and six months after surgery in both groups. When controlling for the effects of hospitalization and anxiety, the researchers found no significant difference between the two groups in I.Q. scores and tests of memory, motor skills or attention. Neither of the surgical groups showed a decline in neuropsychological scores after surgery.

Regarding the implications of the study, Quartermain said, It is often challenging for the cardiologist to determine the optimal time to refer a child without symptoms to the operating room for repair of an underlying congenital heart defect. It is now clear that the potential neurodevelopmental sequelae of cardiopulmonary bypass in this group of school-aged patients should not be a major factor in this important decision.

Children's Hospital of Pittsburgh of UPMC scientific director elected to Institute of Medicine

Mon, 13 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) David H. Perlmutter, MD, scientific director and physician-in-chief at Children's Hospital of Pittsburgh of UPMC, has been elected to the prestigious Institute of Medicine (IOM).

The IOM was established in 1970 by the National Academy of Sciences as a national resource for independent, scientifically informed analysis and recommendations on health issues. The institute provides unbiased, evidence-based, authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society and the public at large. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.

Dr. Perlmutter, the Vira I. Heinz Professor and Chair of the Department of Pediatrics at the University of Pittsburgh School of Medicine, is one of only 65 new members and five foreign associates who are being announced at the IOM's annual meeting Monday, Oct. 13, 2008. Current active members elect new members from among candidates nominated for their professional achievement and commitment to service.

Since joining Children's Hospital in 2001, Dr. Perlmutter has led an effort to expand the hospital's basic and clinical research program so that it is ideally poised to investigate the molecular basis of pediatric disease and to develop innovative new therapies for childhood illnesses. Under his leadership, Children's Hospital has become among the fastest growing pediatric research program in the country in terms of National Institutes of Health (NIH) funding from 2000.

It's a tremendous honor to be elected to the Institute of Medicine. I view this recognition as a testament to the great people with whom I have had the opportunity to work in my clinical and research lives at several wonderful institutions, Dr. Perlmutter said. As a physician-scientist, I've dedicated my career to improving children's health, through my basic research and clinical care of young patients, and by fostering the development of new generations of physician-scientists and clinicians who are dedicated to child health issues.

Dr. Perlmutter has carried out basic research on alpha-1-antitrypsin deficiency, the most common genetic liver disease of childhood, for more than 20 years. His work has led to many new concepts about the pathobiology of liver disease in this deficiency and has suggested several new concepts for chemoprophylaxis of chronic liver injury, hepatocellular carcinoma and emphysema in this genetic disease. He is the principal investigator on three NIH grants in this area and also now holds four other NIH grants, including the Child Health Research Center of Excellence Award for training pediatric physician-scientists in the molecular basis of pediatric disease.

Election to the Institute of Medicine is a unique and particularly noteworthy recognition of an individual's professional achievements and contributions to the medical sciences and health care. I can think of no one more deserving of such an honor than Dr. Perlmutter, whose basic research has elucidated the fundamental etiology of pediatric liver disease and whose translation of that knowledge into clinical practice has improved the health of countless children, said Arthur S. Levine, MD, senior vice chancellor for the health sciences and dean of the School of Medicine at the University of Pittsburgh. However, it is his mentorship of an emerging cadre of young physician-scientists and his transformation of the University of Pittsburgh Department of Pediatrics into one of the nation's strongest pediatric research enterprises that secure his enduring legacy in medicine and science.

Dr. Perlmutter's research has been recognized by numerous awards including the E. Mead Johnson Award for Research in Pediatrics. He is a member of the American Society for Clinical Investigation and the Association of American Physicians. He has served as the president of the Society of Pediatric Research and is now a member of the Advisory Council of the National Institute for Diabetes, Digestive and Kidney Diseases.

Dr. Perlmutter earned his bachelor's degree from the University of Rochester and his medical degree from St. Louis University School of Medicine. He completed his residency in pediatrics at The Children's Hospital of Philadelphia and his fellowship in pediatric gastroenterology and nutrition at Children's Hospital Boston.

After several years on the faculty of Harvard Medical School, Dr. Perlmutter joined the faculty at Washington University School of Medicine and St. Louis Children's Hospital. From 1992, he was the director of the Division of Gastroenterology and Nutrition at St. Louis Children's, and in 1996 he became the first to hold the Donald Strominger Endowed Professorship of Washington University School of Medicine. In 2001 he left St. Louis to take his current position in Pittsburgh.

Duke researchers show reading can help obese kids lose weight

Sat, 04 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) DURHAM, N.C. -- It's no secret that reading is beneficial. But can it help kids lose weight? In the first study to look at the impact of literature on obese adolescents, researchers at Duke Children's Hospital discovered that reading the right type of novel may make a difference.

The Duke researchers asked obese females ages 9 to 13 who were already in a comprehensive weight loss program to read an age-appropriate novel called Lake Rescue (Beacon Street Press). It was carefully crafted with the help of pediatric experts to include specific healthy lifestyle and weight management guidance, as well as positive messages and strong role models.

Six months later, the Duke researchers found the 31 girls who read Lake Rescue experienced a significant decrease in their BMI scores (-.71%) when compared to a control group of 14 girls who hadn't (+.05%), explained Alexandra C. Russell, MD, a fourth-year medical student at Duke who led the study and presented the findings at the Obesity Society's annual scientific meeting.

As a pediatrician, I can't count the number of times I tell parents to buy a book that might provide useful advice, yet I've never been able to point to research to back up my recommendations, says Sarah Armstrong, MD, director of Duke's Healthy Lifestyles Program where the research took place. This is the first prospective interventional study that found literature can have a positive impact on healthy lifestyle changes in young girls.

Obesity is becoming more prevalent in children, according to the CDC, which reports that 16 percent of children ages 6 to 19 are overweight or obese, a number that has tripled since 1980. Researchers are looking at a variety of ways to help kids stay healthy, lose weight and be more active, but Armstrong says, most don't work very well. The weight loss options that are effective typically involve taking powerful medications with side effects, or require permanent surgical procedures.

While the BMI decrease attributed to the book is small, Armstrong says any decrease in BMI is encouraging because BMI typically increases in children as they grow and develop. That's okay as long as it follows a normal, progressing curve. In overweight kids, however, BMI usually increases more rapidly. If their BMI percentile goes down, it means they are they are either losing weight or getting tall and not gaining weight. Both are seen as positive indicators in kids who are trying to lose weight, she explains.

The idea that a book can positively influence weight loss and decrease BMI is encouraging because it's fairly easy to implement, she added. And it's a welcome addition to a world where there aren't a lot of alternatives.

UT Health Science Center at Houston to have key role in largest US children's study

Fri, 03 Oct 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The University of Texas Health Science Center at Houston will play a key role in local recruitment for the largest child health study in the United States.

The National Children's Study will follow 100,000 children across the United States from before birth through age 21 to identify genetic and environmental factors that contribute to health disorders and conditions of childhood and adulthood. Across Harris County, 2,000 women will be recruited during pregnancy. In all, there are 105 study locations across the nation.

This is a landmark study. It will be the largest study of women and children that will take place in our lifetime. It should provide valuable information that can help us better understand such conditions as autism, childhood obesity and prematurity, said Sean Blackwell, M.D., principal investigator for The University of Texas Medical School at Houston and associate professor in obstetrics, gynecology and reproductive sciences.

This is a groundbreaking study to assess the influence of gene-environment interactions on the origins of the most important health problems that affect both children and adults. In this respect, this work has the potential to be one of the most informative and useful clinical studies ever conducted, said Giuseppe Colasurdo, M.D., dean of the UT Medical School at Houston. Blackwell, director of Pregnancy and Birth Assessment for the UT portion of the study, and Chris Greeley, M.D., director of the pediatric component, will lead the effort in assessing women and children in Harris County, Colasurdo said.

Both the UT Medical School at Houston and The University of Texas School of Public Health, which are part of the UT Health Science Center, will participate in the study.

By studying children through their different phases of growth and development, researchers will be better able to understand the role genetic and environmental factors have on health and disease. According to a statement by the National Children's Study, Findings from the study will be made available as the research progresses, making potential benefits known to the public as soon as possible. Ultimately, the National Children's Study will be one of the richest research efforts geared towards studying children's health and development and will form the basis of child health guidance, interventions and policy for generations to come.

Researchers at the UT School of Public Health will be able to assess children and pregnant women in Harris Country for exposure to diverse environmental agents in the area, which is home to a number of large petrochemical and port facilities. This information will provide us with a better understanding of how these environmental conditions interact with other factors to influence health outcomes, said Guy S. Parcel, Ph.D., John P. McGovern Professor in Health Promotion and dean of the School of Public Health.

Ken Sexton, Sc.D., professor and director of the Division of Environmental and Occupational Health Sciences, and Beatrice Selwyn, Sc.D., associate professor of epidemiology, will lead the School of Public Health effort to study the impact of the environment on Harris County children.

The UT Health Science Center at Houston will receive $3.5 million from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to fund its efforts.

Due to the strengths of our clinical research programs in obstetrics and neonatology, with the leadership of Drs. Susan Ramin and Kathleen Kennedy and our strong partnerships with the Memorial Hermann Healthcare System and Harris County Hospital District, we are able to be key players in the National Children's Study for Harris County, said Blackwell. This is a unique opportunity for collaborations among investigators from different disciplines. We are very fortunate to have such an infrastructure as the Center for Clinical and Translational Sciences, which I hope will facilitate these efforts.

To conduct the research, the UT Medical School at Houston and the UT School of Public Health will be working with Baylor College of Medicine, which is the lead institution for Harris County, and The University of Texas M.D. Anderson Cancer Center.

Being awarded the NCS grant is a wonderful opportunity for the Houston community. It is absolutely terrific to have joint collaboration among the various medical institutions, said Susan Ramin, M.D., Emma Sue Hightower Professor and chair of obstetrics, gynecology and reproductive sciences at the medical school.

Study into pre and pro-biotic use in primary prevention of necrotizing enterocolitis

Sat, 06 Sep 2008 10:15:44 PST

( from http://www.rxpgnews.com ) Scientists at UC Davis will launch a groundbreaking study to determine the best cocktail of pre- and probiotic supplements to give to premature infants to prevent a deadly intestinal disease.

Probiotics are live, beneficial microorganisms that confer health benefits, like the live bacteria in yogurt. Prebiotics are sugars that stimulate the growth of these bacteria.

The study is a novel approach to the primary prevention of necrotizing enterocolitis (NEC), the third-leading cause of death among preemies.

"It would be wonderful to be able to find a way to prevent this debilitating disease in infants and we believe that probiotics are a safe and effective way to do that," said study co-principal investigator Mark Underwood, an assistant clinical professor of neonatology at UC Davis Children's Hospital.

The study is unique because it will combine the expertise of neonatologists at UC Davis Children's Hospital with the expertise of researchers on the UC Davis campus in the departments of chemistry and viticulture and enology who specialize in research on the bacteria enriched by human milk.

The babies in the study will receive doses of both pre- and probiotic supplements identified by UC Davis milk researcher Carlito Lebrilla, a professor of chemistry, and David Mills, a microbiologist and professor of viticulture and enology.

Lebrilla, a chemist, identified the prebiotics in human milk, called oligosaccharides, and described their structure.

Microbiologist Mills has found that these sugars stimulate the growth of healthy bacteria, called bifidobacteria, in the intestine. Bifidobacteria normally flourish in gastrointestinal tract of healthy breast-fed infants.

"Certain bifidobacteria are amazingly adept at breaking down and consuming these complex oligosaccharides from milk," Mills said.

Lebrilla and a group of scientists at UC Davis have been examining the components of human milk that previously had no known nutritional value to the infant. It now appears that the purpose of these milk components is to nourish healthy bacteria in the intestine.

"That seems to one of their main functions," Lebrilla said. "If you feed the prebiotics, or oligosaccharides, to unhealthy bacteria they won't eat it."

Lebrilla said that the purpose of the healthy bacteria in the intestine is not known. But one idea is that they simply block the proliferation of unhealthy bacteria, he said.

"The beauty of this collaboration is that we can go from fundamental research to clinical trials quickly because we have all the expertise at UC Davis," Lebrilla said.

In the study, preemies in the UC Davis Children's Hospital Neonatal Intensive Care Unit will receive the oligosaccharides and two different types of bifidobacteria twice a day from birth until their discharge from the hospital. Researchers will examine saliva and other specimens to see what dose, type and combination of the pre- and probiotics work best to grow healthy bacteria.

"I don't think you could have put together a research group like this together anywhere else in the country," Underwood said. "This could only happen at UC Davis."

The cause of NEC is unknown. The disease doesn't occur often in healthy full-term infants and is seen less in premature babies who receive breast milk. However, 10 percent of preemies get NEC and of those, 40 percent die.

Scientists think NEC may be caused by exposure to disease-causing bacteria rather than healthy bacteria.

"Healthy babies are held, kissed, breast-fed and get good bacteria from their mothers and fathers. Preemies live in hospitals and can't be held because they're too fragile. They get colonized with unhealthy bacteria. We think that makes them sick," Underwood said.

Infants born at between 24 to 33 weeks gestation and weighing less than 1,500 grams — under three pounds — are considered premature and spend months in the hospital. About 13 percent of U.S. infants were born prematurely in 2006.

The NEC study is funded by a five-year, $3 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Allergy and Infectious Disease.

The grant will also fund research to identify the role that "defensins," protein-like molecules that act as natural antibiotics in the body, play in NEC. Defensins are found in every species of plant and animal and, in humans, on the skin, in white blood cells, and the linings of the surfaces of the eyes, ears, mouth, nose, intestines, lungs and urinary tract.

Charles Bevins, a professor in the Department of Medical Microbiology and Immunology, has found that premature infants have low levels of defensins in the intestinal tract. Bevins will research whether premature infants with the lowest levels of defensins are at greatest risk of getting NEC.

Syracuse University partners with Serum Institute of India to develop vaccines for children

Thu, 04 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A unique partnership between Syracuse University and the Serum Institute of India could lead to better access to life-saving vaccines for children living in some of the most impoverished areas of the world. The Institute recently awarded $250,000 to a team of SU researchers led by Robert Doyle, assistant professor of chemistry in the College of Arts and Sciences, to develop new oral vaccines against tetanus and rotavirus, a severe form of diarrhea that affects infants and young children worldwide.

Tetanus is caused by a toxin produced by bacteria naturally found in soil. The vaccine is only available by injection. While the disease is rare in the Western world, tetanus caused an estimated 257,000 deaths in low-income countries between 2000 and 2003, according to the World Health Organization's (WHO) latest report. A significant percentage involved infants born in predominately rural areas who were exposed to the tetanus bacteria during unsanitary delivery procedures. Likewise, infants and young children in these same countries have a much higher risk of dying from rotavirus than those living in Western nations. The disease killed an estimated 500,000 children in developing nations during 2004, according to a 2007 WHO report.

We are very excited to be working with the Serum Institute of India on these projects, Doyle says. This is a difficult area of research due to the nature of the molecules we will be working with. But, if we are successful, our work could have an enormously positive impact on the lives of people well beyond Syracuse University. This is truly scholarship in action.

Founded in 1966, the Serum Institute of India produces and supplies low-cost, life-saving vaccines for children and adults living in low-income countries. It is the world's largest producer of measles and diphtheria-tetanus-pertussis (DPT) vaccines. An estimated two out of every three immunized children in the world have received a vaccine manufactured by the Serum Institute.

Our company's philanthropic philosophy is to make high-quality, affordable, life-saving vaccines available for under-privileged children in both India and in more than 140 countries across the world, says S.V.Kapre, executive director of the Serum Institute of India. This new partnership with Syracuse University will help the Serum Institute further this endeavor as it will open new doors of vaccine usage.

The Institute approached Doyle because of his successful research to develop an oral form of insulin, which may someday enable people with insulin-dependent diabetes to take fewer daily injections. An oral vaccine for tetanus would enhance distribution in impoverished countries. Doyle's team will also explore new ways to synthesize the rotavirus vaccine to make it more accessible to children in developing nations.

A new laboratory has been established in SU's Center for Science and Technology for the research, which poses a number of challenges. Similarly to insulin, the protein molecules used in the tetanus vaccine are destroyed in the digestive system. However, the tetanus molecules are 30 times larger than insulin, making them more difficult to transport. The vaccine is created by literally boiling the tetanus bacteria in a chemical solution, causing the protein to completely unfold. In its new, unfolded state, the tetanus protein is harmless, but is still recognized as tetanus by the immune system so as to trigger a response that protects the person from the disease.

It's like frying an egg, Doyle says. The egg white, which is a protein, is clear when you crack the egg into a pan. When the egg heats up, the egg white becomes opaque as the protein unfolds. You still recognize it as an egg, but you can't make the egg white clear again after it's been heated.

The challenge is to figure out how to package this large molecule, sneak it through the digestive system unharmed, and transport it through the wall of the small intestine where it can be absorbed into the bloodstream. Tetanus is a strange and wonderful molecule, Doyle says. We need to get a better idea of what the unfolded protein looks like and try to predict areas that would make good targets for attaching a transport vehicle.

Problem is, you can't actually see a protein molecule or the thousands of chemical reactions that take place within it over nanoseconds of time. However, researchers can develop computerized models of the molecules to predict their behavior and zoom in on possible targets. Damian Allis, research professor in the chemistry department, will be developing models for both projects. The simulations allow us to view the process and identify sticky ends of the proteins that could potentially be used as binding sites for transport molecules, Allis says.

Participating in religion may make adolescents from certain races more depressed

Wed, 03 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBUS, Ohio -- One of the few studies to look at the effects of religious participation on the mental health of minorities suggests that for some of them, religion may actually be contributing to adolescent depression.

Previous research has shown that teens who are active in religious services are depressed less often because it provides these adolescents with social support and a sense of belonging.

But new research has found that this does not hold true for all adolescents, particularly for minorities and some females. The study found that white and African-American adolescents generally had fewer symptoms of depressive at high levels of religious participation. But for some Latino and Asian-American adolescents, attending church more often was actually affecting their mood in a negative way.

Asian-American adolescents who reported high levels of participation in their church had the highest number of depressive symptoms among teens of their race.

Likewise, Latino adolescents who were highly active in their church were more depressed than their peers who went to church less often. Females of all races and ethnic groups were also more likely to have symptoms of depression than males overall.

Setting all other factors aside, the results suggest that participating in religion at high levels may be detrimental to some teens because of the tensions they face in balancing the conflicting ideals and customs of their religion with those of mainstream culture, said Richard Petts, co-author of the study, who did the work as a doctoral student in sociology at Ohio State University.

Most research has shown that religious participation, for the most part, is good and can be very helpful for battling depression. But our research has shown that this relationship does not hold true in all instances, he said.

While the study shows that females and males from certain groups may be more inclined to become depressed, involvement in religious services still had an overall positive affect for many youth in the study. The results do provide important insight into the impact of religious participation on teenage depression, but race and gender may only be part of the reason certain youth were more depressed, Petts said.

The study shows that we need to consider the broader social aspects of institutions such as religion on an individual's well being, both good and bad. We focus specifically on race and gender, but these are not the only two factors that may be contributing to higher and lower depression among youth, he said.

Petts, who is now an assistant professor of sociology at Ball State University, conducted the study with Anne Jolliff when they were both doctoral students at Ohio State. Jolliff is now a research coordinator at Indiana University-Purdue University Indianapolis. The pair based the study on data from the National Longitudinal Study of Adolescent Health, a study surveying middle and high school students throughout the United States.

Adolescents in grades 7 through 12 were initially interviewed in school and a random number of students were again interviewed at home. Students were asked to identify the positive and negative feelings they had experienced in the preceding week such as depression, loneliness, isolation, happiness, or excitement. They were also asked about their behavior in the last year and asked to identify their race, religious preference, and how often they attended services during the same period of time.

Adolescents were then interviewed a second time one year later at home about the same topics. Parents of these adolescents were also asked about their child's moods and behaviors. Only the 12,155 adolescents who participated in both parts of the study and had information from their parents were included in this study.

The results were recently published in the journal

Study finds few parents of chronically ill children use California paid family leave program

Tue, 02 Sep 2008 03:59:37 PST

( from http://www.rxpgnews.com ) California's pioneering paid family leave program has largely failed to reach one of its major target groups, according to a new study by RAND Corporation researchers.

Few parents of children with serious chronic illnesses have used the program, despite having paid into the program through payroll withholdings, and the vast majority of these parents aren't even aware that the program exists, according to researchers.

Studying parents of chronically ill children, researchers found that just 18 percent of those surveyed were aware of the program and only 5 percent had used the benefits, according to the RAND Health study published in the Sept. 3 edition of the Journal of the American Medical Association.

Most parents who took enough leave to qualify for payment through the program simply didn't know about it. Perhaps more disturbingly, most parents who did not take leave even when they felt their child's illness required it didn't know about the program, according to researchers.

We focused on parents with chronically ill children because they were a major target of the California legislation, said Dr. Mark Schuster, a RAND researcher and chief of general pediatrics at Children's Hospital Boston. These children spend a lot of time in the hospital or stay home from school because of illness. Parents often face a tough decision between going to work and taking care of their ill child.

Adopted in 2004, the California program is the nation's first paid family leave law. It is funded by employees through an automatic payroll deduction (averaging about $1 a week) that goes into a state insurance pool. After a one-week waiting period, the program annually provides most employees six weeks of non-job-protected paid leave (paying up to 55 percent of an individual's salary) to care for ill family members. Congress and many other states are considering proposals to create similar programs.

We thought these parents would learn about the law and would use it to spend more time with their seriously ill children, said Schuster, also a professor of pediatrics at Harvard Medical School. But the law had virtually no impact.

Parents of chronically ill children remained at work because they feared losing income, losing their jobs and damaging their careers.

Six months before the paid family leave program began, about 81 percent of the parents surveyed reported taking at least one day off in the proceeding year to care for their child and 21 percent of parents reported taking at least four weeks of leave. About 18 months after the program began, there was no significant change in these percentages, even when compared with similar groups of parents in Illinois, a state without paid family leave.

We were surprised that the vast majority of these parents didn't even know about the program, Schuster said. Parents seem to have no idea that they are paying for this benefit. They're leaving money on the table at a time when they could really use it to be with their sick kids.

The researchers said that the California law failed to require employers to notify all employees about paid family leave, and the state never adopted a comprehensive public education campaign about the program. The payroll deduction is not identified on the paycheck, but is rather added into the temporary disability insurance line, so employees are unlikely to realize that they are paying for state-mandated paid family leave insurance.

In contrast, the federal Family and Medical Leave Act, which since 1993 has provided 12 weeks of job-protected unpaid leave to most full-time employees in large companies, was supported by strong reporting requirements and a vigorous two-year public awareness campaign. After the public-awareness campaign ended, over half of employees knew about the law.

The researchers also noted that awareness may not be the only issue preventing use of paid leave.

The lack of job protection could be raising legitimate fears among some employees that taking leave may cost them their jobs, said Dr. Paul Chung, a RAND researcher and assistant professor of pediatrics at the David Geffen School of Medicine at UCLA. The fact that employees receive half their salary during leave might also be a disincentive to those who don't feel they can afford to lose any income.

Caesarean babies more likely to develop diabetes

Tue, 26 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Babies delivered by Caesarean section have a 20 per cent higher risk than normal deliveries of developing the most common type of diabetes in childhood, according to a study led by Queen's University Belfast.

The team, led by Dr Chris Cardwell and Dr Chris Patterson, examined 20 published studies from 16 countries including around 10,000 children with Type 1 diabetes and over a million control children.

They found a 20 per cent increase in the risk of children born by Caesarean section developing the disease. The increase could not be explained by factors such as birth weight, the age of the mother, order of birth, gestational diabetes and whether the baby was breast-fed or not, all factors associated with childhood diabetes in previous studies.

Dr Cardwell, from the School of Medicine, Dentistry and Biomedical Sciences, said: This study revealed a consistent 20 per cent increase in the risk of Type 1 diabetes. It is important to stress that the reason for this is still not understood. It is possible that children born by Caesarean section differ from other children with respect to some unknown characteristic which consequently increases their risk of diabetes, but it is also possible that Caesarean section itself is responsible.

Type 1 diabetes occurs when the immune system destroys the insulin producing cells in the pancreas, and one theory suggests that being born by Caesarean section may affect the development of the immune system because babies are first exposed to bacteria originating from the hospital environment rather than to maternal bacteria.

Dr Chris Patterson said: The study findings are interesting, but unless a biological mechanism is established it would be unwise to read too much into this association between Caesarean section delivery and diabetes.

Fortunately figures from the Northern Ireland Type 1 diabetes register indicate that only around two per 1,000 children will develop diabetes by their 15th birthday so a 20 per cent increase is on quite a low baseline risk.

Diabetes is a serious condition that, if not managed, can lead to fatal complications including heart disease, stroke, kidney failure and amputations. There are 2.3 million people in the UK diagnosed with diabetes and 250,000 with Type 1 diabetes. In Northern Ireland over 62,000 people have diabetes, 6,000 of them with Type 1 diabetes.

Around one in four babies in Northern Ireland are delivered by Caesarean section, which is significantly higher that the World Health Organisation's recommended rate of 15 per cent.

Iain Foster, Director of Diabetes UK Northern Ireland, said: Not all women have the choice of whether to have a Caesarean section or not, but those who do may wish to take this risk into consideration before choosing to give birth this way.

We already know that genetics and childhood infections play a vital role in the development of Type 1 diabetes in children, but the findings of this study indicate that the way a baby is delivered could affect how likely it is to develop this condition later in life. Diabetes UK Northern Ireland would welcome more research in this area.

Study: verbal aggression may affect children's behavior

Mon, 04 Aug 2008 03:59:37 PST

( from http://www.rxpgnews.com ) WEST LAFAYETTE, Ind. - The methods mothers use to control their children during playtime and other daily activities could have a negative impact on their child's self-esteem and behavior, according to a new Purdue University study.

It's hard to tell parents how to interact with their children based on one study, but what we see here is that parents who have a propensity for being verbally aggressive have a tendency to try to direct and control their children during a play period, said Steven R. Wilson, a professor of communication who specializes in family issues. As a result, these children were less cooperative, and not only are parents setting up situations that are challenging for them to handle, but they also are subtly undermining their child's self-esteem.

Wilson and Felicia Roberts, an associate professor of communication, are lead authors of a study that appears in the July issue of Human Communication Research journal. The researchers videotaped 40 mothers as they played with one of their children, ages 3-8, during a 10-minute, unstructured play period. The mothers also completed a series of questionnaires to assess their general tendency to be verbally aggressive toward others. For example, someone who is verbally aggressive is likely to insult others as a way to motivate them to comply or behave.

The researchers found that mothers who were high in the general tendency to be verbally aggressive often tried to take control of the play period. For example, the four mothers with the highest verbal aggression scores on average were attempting to direct their child's actions once every 12 seconds, while the four mothers with the lowest verbal aggression scores tried to do so only about half as often. In addition to verbally aggressive mothers telling a child to play with a different toy or to stop playing, they also used negative body language, such as restraining a child by the wrist or shoulder, to reinforce their commands.

Of course all parents direct their children, and people in general are always directing others to close a door or hand them something, said Roberts, who has a background in linguistics and is a conversational analyst. It's something we do all the time. But there is a qualitative difference in the kinds of directing going on by these verbally aggressive mothers. By looking at how and when directives occurred, not just how often, we found that moms who scored highest on verbal aggression used directives to control the child and, ultimately, the way the game or activity was played. The aggressive action is not overt, as in a parent hitting or yelling, but these small negative maneuvers can say so much to a child.

Parents interested in learning more about how to improve communication with their children should contact a pediatrician or seek out community family and social service programs, Wilson said.

We all say things to our children that we regret saying, but saying a lot of things that attack a child's self-confidence is not healthy, Wilson said. These parents were in an unstructured, low-stress environment, and if we saw this behavior in such a brief setting, how could such negative interactions, even so subtle, affect a child over the long-term? For example, if the parents always have to control what activity they and their children are going to play - as well as for how long and how they are going to play it - you wonder if this communicates to the child that what they want to do doesn't matter.

The researchers will be looking at how praise plays a role in these types of parent-child interactions.

Children naturally inclined to feel empathy

Sat, 12 Jul 2008 04:01:39 PST

( from http://www.rxpgnews.com ) Children between the ages of seven and 12 appear to be naturally inclined to feel empathy for others in pain, according to researchers at the University of Chicago, who used functional Magnetic Resonance Imaging (fMRI) scans to study responses in children.

The responses on the scans were similar to those found in studies of adults. Researchers found that children, like adults, show responses to pain in the same areas of their brains. The research also found additional aspects of the brain activated in children, when youngsters saw another person intentionally hurt by another individual.

"This study is the first to examine in young children both the neural response to pain in others and the impact of someone causing pain to someone else," said Jean Decety, Professor in the Departments of Psychology and Psychiatry at the University of Chicago, who reported the findings in the article, "Who Caused the Pain? An fMRI Investigation of Empathy and Intentionality in Children," published in the currrent issue of Neuropsychologia. Joining him as co-authors were University students Kalina Michalska and Yuko Aktsuki.
The programming for empathy is something that is "hard-wired" into the brains of normal children, and not entirely the product of parental guidance or other nurturing, said Decety. Understanding the brain's role in responding to pain can help researchers understand how brain impairments influence anti-social behavior, such as bullying, he explained.

For their research, the team showed 17 typically developed children, ages seven to 12, animated photos of people experiencing pain, either received accidentally or inflicted intentionally. The group included nine girls and eight boys.

While undergoing fMRI scans, children where shown animations using three photographs of two people whose right hands or right feet only were visible.

The photographs showed people in pain accidently caused, such as when a heavy bowl was dropped on their hands, and situations in which the people were hurt, such as when a person stepped intentionally on someone's foot. They were also shown pictures without pain and animations in which people helped someone alleviate pain.

The scans showed that the parts of the brain activated when adults see pain were also triggered in children.

"Consistent with previous functional MRI studies of pain empathy with adults, the perception of other people in pain in children was associated with increased hemodymamic activity in the neural circuits involved in the processing of first-hand experience of pain, including the insula, somatosensory cortex, anterior midcigulate cortex, periaqueductal gray and supplementary motor area," Decety wrote.

However, when the children saw animations of someone intentionally hurt, the regions of the brain engaged in social interaction and moral reasoning (the temporo-parietal junction, the paracigulate, orital medial frontal cortices and amygdala) also were activated.

The study, which was supported by the National Science Foundation, provides new insights for children between childrens' perceptions of right and wrong and how their brains process information, Decety said. "Although our study did not tap into explicit moral judgment, perceiving an individual intentionally harming another person is likely to elicit the awareness of moral wrongdoing in the observer," he wrote.

Subsequent interviews with the children showed they were aware of wrong-doing in the animations in which someone was hurt. "Thirteen of the children thought that the situations were unfair, and they asked about the reason that could explain this behavior," Decety said.

Researchers seek children for a study of antibiotics for a urinary tract disorder

Fri, 20 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Researchers conducting a study to learn if children with a urinary tract disorder known as vesicoureteral reflux (VUR) should be treated with an antibiotic for an extended period of time are seeking to enroll more participants. The study, known as the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health (NIH).

VUR is the abnormal flow of urine from the bladder back up into the tubes that run to the kidneys. These tubes are called ureters. Normally, urine flows down the ureters to the bladder. VUR is the most common functional abnormality of the urinary tract in children. It is found in 30 percent to 50 percent of children with urinary tract infections (UTIs) and is thought to increase the risk of kidney damage when children have recurring UTIs. At least 30 percent of children who have at least one UTI will have a recurrence.

Scar tissue in the kidney, called renal scarring, occurs between 5 percent and 40 percent of the time when a child has a UTI. Scarring may build up with each infection and can lead to progressive kidney failure and the need for renal-replacement therapy, such as dialysis.

About 50 years ago physicians began to prescribe an ongoing regimen of daily antibiotics for children with VUR, based on the belief that treatment would prevent infections and reduce scarring and kidney failure. Unfortunately, the number of children developing kidney failure from VUR has not changed in that time, leading physicians to question the value of the practice and adding to concerns about increasing antibiotic resistance in the general population.

The RIVUR study has the potential to help us understand how to provide the best care for tens of thousands of children diagnosed every year with this condition, said Marva Moxey-Mims, M.D., director of NIDDK's pediatric nephrology program in the Division of Kidney, Urologic, and Hematologic Diseases. In addition to finding out if antibiotics reduce the risk of UTIs, we also need to understand the progression of renal scarring and the development of resistance to antibiotics in these children.

The researchers seek to enroll 600 participants. So far, 125 infants and children have joined the study. Participants must be between the ages of 2 months and 6 years and have had their first UTI within the six weeks before their first study visit. With the approval of 20 institutional review boards and an external data safety monitoring board charged with overseeing the safety of children in the trial, each participant receives a daily dose of an antibiotic or a placebo for up to two years. Children who develop recurring fever or other symptoms of infection or scar tissue buildup in the kidney will be switched from the study to routine antibiotic care and referred to a urologist, depending on the number of infections and degree of renal scarring.

Minimally-invasive weight loss surgery improves health and morbidly obese teens

Wed, 18 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) NEW YORK (June 18, 2008) -- Teenagers' obesity-related medical complications improve just six months after laparoscopic gastric banding surgery, according to outcomes data presented this week. The preliminary results by physician-scientists from Morgan Stanley Children's Hospital of NewYork-Presbyterian and Columbia University Medical Center were presented on June 17 at The Endocrine Society's 90th Annual Meeting in San Francisco.

The study reports that the small group of extremely obese teenagers who received the minimally invasive surgery, also called the Lap-Band procedure, as part of a clinical trial lost an average of 20 pounds after six months and had significant improvements in abdominal fat, triglyceride measurements (levels of fat in the blood) and blood sugar levels as measured by hemoglobin A1c -- all risk factors for diabetes and heart disease. The patients' liver function and a measure of immune response also improved, according to the abstract.

Extremely obese teenagers have obesity-related health problems, particularly diabetes and increased cardiovascular risk. Laparoscopic gastric banding, which has been shown to be a safe and effective way to lose weight, now offers the possibility of reducing obesity's medical complications, says lead author Dr. Ilene Fennoy, a pediatric endocrinologist at Morgan Stanley Children's Hospital of NewYork-Presbyterian and clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons. Until recently, these patients have had to rely primarily on non-surgical methods or higher-risk surgeries to lose weight, and few of these treatments have succeeded in achieving major weight loss or greatly improving their overall health.

The Lap-Band procedure, which is approved by the Food and Drug Administration (FDA) for adults but not yet in teenagers, involves making the stomach smaller without staples. Instead, a band is place around the upper part of the stomach, creating a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible. Morgan Stanley Children's Hospital/Columbia University Medical Center is one of three sites in the nation approved to study this procedure in teens.

The study, which is part of the multidisciplinary FDA-approved Lap-Band Trial for Teens being performed at Morgan Stanley Children's Hospital and Columbia University Medical Center, followed 14 adolescents -- six boys and eight girls -- between the ages of 14 and 17 who were, on average, 174 pounds overweight. Patients received dietary counseling and encouragement to exercise, both before and after surgery.

Cancer incidence and mortality in young people decreases with increasing deprivation

Mon, 09 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) London, UK: Results of research into the associations between cancer and socio-economic deprivation and affluence have shown that, in contrast to cancers in older people, the numbers of new cases and deaths from the disease in teenagers and young adults (TYAs) decrease with increasing deprivation.

Professor Jillian Birch told Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine today (Monday) that research by her group also showed increases in the incidence of a number of cancers, including two potentially preventable cancers among younger people: cervical cancer and melanoma.

Prof Birch, Director of the Cancer Research UK Paediatric and Familial Cancer Research group, University of Manchester (UK), explained: Strong associations with socio-economic deprivation and affluence are seen for many diseases. Overall cancer incidence and mortality increase with increasing deprivation. However, different cancers and age groups show different patterns. Geographical variations in incidence, trends over time, and associations with deprivation and affluence can point to lifestyle or other environmental factors as possible causes. Until recently, very little was known about the detailed patterns of cancer in TYAs, but my group has carried out a series of studies to rectify this. The most recent studies have looked at geographical variations, time trends and associations with deprivation.

Results show that in contrast to cancers in older people, in TYAs incidence and mortality decreases with increasing deprivation. This is because the more common types of cancers that occur in young people are associated with affluence, including lymphomas, brain tumours, germ cell tumours and melanoma. These cancers also show significant regional variations in incidence and are increasing over time. However, carcinoma of the cervix, which is one of the more common cancers seen in young women, shows increasing rates with increasing deprivation and an upward trend in incidence over time.

Prof Birch's team showed that the incidence of cervical cancer in TYAs had increased by 1.6% per year during 1979-2003. However, national data show that across all ages, incidence is falling. We therefore analysed trends in 15-39 year olds to look at the changing pattern with age. We found that in 15-19 year olds, rates were increasing by 6.8% per year and by 1.4% per year in 20-24 year olds, but rates were decreasing among those aged 25 and over, she said.

Similar analyses for melanoma showed increasing rates at all ages but a greater rate of increase in 20-29 year olds than at older ages. In 20-24 year olds the annual percentage change was 4.1 and 4.0 in 25-29 year olds, but declined to 3.3 in 30-34 year olds and 2.5 in 35-39 year olds.

Overall, the research showed that cancer incidence rates between 1979-2001, varied from 173 per million person years (per mpyr) in the North East to 208 per mpyr in the South East and South West [1]. National rates have increased during this time period by 1.5% per year. For the whole period, melanoma incidence varied from 12 per mpyr in the East Midlands and London, to 20 per mpyr in the South West. Incidence of melanoma increased nationally by 3.8% per year but the trend was strikingly different in different regions. During 1979-1983 highest rates of around 15 per mpyr were seen in the South and West of England but the rates increased over time more rapidly in the North, so that during 1999-2003 highest rates of between 22 and 32 per mpyr were seen in Northern regions.

Prof Birch said: It is important that public health messages about these two mainly preventable cancers are targeted appropriately. For other TYA cancers, the results of our analyses provide a basis for designing studies to look at possible causes.

Simon Davies, CEO at Teenage Cancer Trust said: It is worrying that cervical cancer and melanoma, two preventable cancers, are increasing in teenagers faster than in other groups. More education is desperately needed so young people can change their behaviour before it's too late. This is why Teenage Cancer Trust funds an education programme for teenagers and young adults throughout schools and colleges in the UK. We are targeting hundreds of thousands of teenagers this summer in our sun safety campaign, fronted by Leona Lewis.

First study to examine vitamin D insufficiency in pediatric patients with low bone density

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Vitamin D insufficiency is common in adults and is emerging in the world of pediatrics. A mild degree of vitamin D deficiency, also known as vitamin D insufficiency, causes rickets in children and can be treated with increased amount of nutritional vitamin D intake as well as increased sun exposure.

A new study conducted by physicians and researchers at Nationwide Children's Hospital, is the first study to investigate vitamin D insufficiency in pediatric patients with low bone density.

According to the study, published in the June issue of Pediatrics, among the 85 patients studied, 80 percent had a vitamin D insufficiency. All the patients had a history of bone fragility or underlying chronic medical conditions that put them at a risk of osteoporosis, which is not just an adult disease, but is seen in children and can originate during childhood. Vitamin D insufficiency may contribute to low bone mass or even make the underlying metabolic bone disease worsen if not treated. Vitamin D is essential in bone growth and mineralization in children and adults.

The study's lead author, Sasigarn Bowden, MD, a pediatric endocrinologist and attending physician in the Metabolic Bone Clinic at Nationwide Children's explains, We need to check vitamin D levels in all patients with history of multiple fractures or low bone density and treat the vitamin D problem if the levels are low. The supplementation of vitamin D should be a priority in the management of pediatric patients with osteoporosis or osteopenia in order to optimize their bone health and potentially prevent fractures.

Potential factors that may account for vitamin D insufficiency in various chronic medical conditions include low vitamin D intake and decreased sun exposure. Four studies in Europe found that 80 percent of healthy children and adolescents had insufficient vitamin D levels in the winter.

Due to the number of recent studies of healthy children or adolescents with a high prevalence of vitamin D insufficiency, the public should be aware of the fact that it is common, especially living in high altitude, said Bowden, also an assistant professor of Pediatrics at The Ohio State University College of Medicine. Sometimes our vitamin D levels get low at the end of winter due to less exposure to sunlight, but if we take a multivitamin D supplement, or consume an adequate amount of vitamin D from dietary sources such as vitamin D fortified milk or orange juice, we should be okay throughout the entire year.

More girls than boys benefit from breastfeeding, Hopkins Children's research shows

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Challenging the long-standing belief that breast-feeding equally protects all babies against disease, research led by Johns Hopkins Children's Center investigators suggests that when it comes to respiratory infections, the protective effects of breast milk are higher in girls than in boys.

Following 119 premature babies in Buenos Aires through their first year of life, researchers found that breast-feeding not only offered more protection to girls than boys, but also that formula-fed girls had the highest risk for severe respiratory infections.

The findings, reported in the June issue of Pediatrics, cast doubt on the theory that immune system chemicals contained in breast milk and passed directly from mother to newborn are responsible for preventing the infections. If this were the case, researchers say, both boys and girls would likely derive equal protection.

In addition, breast-feeding did not appear to affect the number of infections, but rather their severity and the need for hospitalization, meaning that breast milk does not prevent a baby from getting an infection, but helps a baby cope with an infection better.

In light of these results, we are starting to think that milk does not directly transfer protection against lung infections but instead switches on a universal protective mechanism, already in the baby, that is for some reason easier to turn on in girls than in boys, says senior investigator Fernando Polack, M.D., an infectious disease specialist at Hopkins Children's.

Shortly after birth, formula-fed girls were eight times more likely than breast-fed girls to develop serious respiratory infections requiring hospitalization, the study results showed. Formula-fed girls were also more likely to develop such infections than both breast-fed and non-breast-fed boys.

The findings, researchers say, are particularly important for healthcare in developing countries, where antibiotics and other treatments are scarce and where an estimated one-fourth of premature babies end up in the hospital with severe respiratory infections.

When resources are limited, it helps to know that your high-risk group is formula-fed girls, Polack says. The findings also suggest that the mothers of premature girls should be strongly encouraged to breast-feed, investigators say.

In the United States, by contrast, drugs are readily available to prevent complications and hospitalizations are less frequent. However, researchers point out, because these drugs protect against only two of many respiratory viruses and are expensive, mothers should breast-feed both girls and boys when possible. Despite gender differences in the levels of protection against respiratory illness, researchers say that breast-feeding remains the best nutrition for both full-term and premature infants, regardless of sex, and that breastfeeding's benefits extend to brain development and general health.

For the study, investigators tracked responses to a first infection after birth and found that breast-fed girls were the least likely to be hospitalized with an acute respiratory disease. Only 6 percent (two of 31) of breast-fed girls had first infections severe enough to require hospitalization compared to 50 percent (12 out 24) of the non-breast-fed girls. There was virtually no difference in hospitalization for first infection in breast-fed versus non-breast-fed boys, with 18 percent from both the breast-fed and non-breast-fed groups developing severe respiratory infections. This pattern repeated itself throughout the first year of life and in subsequent infections, with breast-fed girls showing fewer complications and hospitalizations than both formula-fed girls and breast-fed and formula-fed boys. In the first year of life, formula-fed girls continued to have the highest risk for severe respiratory disease and hospitalization.

If breast milk does indeed trigger a universal - but variably activated - protective mechanism against multiple viruses, the next step is to figure out exactly how this mechanism gets switched on and why it is relatively harder to activate in boys.

Unraveling this mechanism may one day lead to broad-based therapies that might be as effective as five or six vaccines, Polack says, because vaccines have a narrow spectrum of defense and work only against specific viruses.

Gene therapy involving antibiotics may help patients with Usher syndrome

Mon, 02 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: A new approach to treating vision loss caused by Type 1 Usher syndrome (USH1), the most common condition affecting both sight and hearing, will be unveiled by a scientist at the annual conference of the European Society of Human Genetics tomorrow (Tuesday 3 June). Ms Annie Rebibo Sabbah, from the Genetics Department of the Rappaport Faculty of Medicine, Technion, Haifa, Israel, will tell the conference that preliminary results using a class of drugs called aminoglycosides, commonly used as antibiotics, had had promising effects in vitro and in cell culture.

Usher syndrome is a recessively- inherited disease; in order to have it, the child must receive a mutated form of the Usher gene from each parent. Approximately 3 to 6 percent of all children who are deaf and another 3 to 6 percent of children who are hard-of-hearing have it. In developed countries, about four babies in every 100,000 births have Usher syndrome. Children born with USH1 begin to develop visual problems in early childhood, and these develop quickly into an eye disorder called retinitis pigmentosa, which leads to complete blindness.

There are several types of genetic mutations involved in Usher syndrome, including nonsense mutations. In this type of mutations the protein in the cell is totally absent, or abnormally short, says Ms Rebibo Sabbah. We knew that aminoglycosides are able to suppress nonsense mutations to the extent that, instead of having no protein at all, or a truncated protein, the cell receives a partial amount of full-length protein that may even be functional.

As a model, the team took several nonsense mutations of the PCDH15 gene, which is responsible for Usher syndrome. They were able to produce partial suppression of the mutations in vitro using commercial aminoglycosides. The same result was achieved ex vivo, in cultured cells.

Despite these promising results, the most serious problem with aminoglycosides is their toxicity to the kidney and to the inner ear, which causes limitation in their use, says Ms Rebibo Sabbah. We worked with Professor Baasov, from the Chemistry Faculty at Technion, to try to develop a new compound based on aminoglycosides which will have reduced toxicity.

The scientists tested more than forty new compounds for ones which had the same efficacy as aminoglycosides, but with significantly reduced toxicity. We found a very promising new compound, called NB30, says Ms Rebibo Sabbah. After testing its toxicity in cells, we tried it in mice. In both models the toxicity was significantly reduced compared to the current commercially available aminoglycosides, and we could also see the suppressive activity of NB30 in the cultured cells.

This is the first time that this therapeutic strategy has been tried in Usher syndrome, the scientists say. Their next step will be to look at another USH1- related gene (CDH23) and its nonsense mutations in both humans and mice.

Our final aim is to prove that a nonsense mutation underlying Usher syndrome is capable of being suppressed in vivo in a mouse model by commercial aminoglycosides, and also by NB30, and that this will have a positive effect on retinal function, says Ms Rebibo Sabbah. We will also continue to look for new compounds with improved characteristics.

The researchers hope that their work will lead to therapy to delay the progression and, indeed, the onset, of vision loss in patients with USH1. Because it is recessively inherited, this is a particularly invidious disease, says Ms Rebibo Sabbah.

In most cases, parents have normal hearing and vision and are not aware that they are carriers of Usher syndrome. But if they have a child with another carrier, they will have a one in four chance of having a child with the condition at each birth. We need urgently to find an effective treatment.

Prenatal biochemical screening only detects half of chromosomal abnormalities

Sun, 01 Jun 2008 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Prenatal biochemical screening tests are widely used to look for chromosomal abnormalities in the fetus which can lead to serious handicap, or even death during gestation or in the first few days after birth. But these tests are only able to detect fewer than half of the total chromosomal abnormalities in the fetus, a scientist will tell the annual conference of the European Society of Human Genetics tomorrow (Monday 2 June) Dr. Francesca R. Grati, of the TOMA Laboratory, Busto Arsizio, Italy, says that these findings mean that women should be better informed on the limitations of such diagnostic tests.

The researchers studied 115,576 prenatal diagnoses carried out during the last fourteen years. 84,847 were amniocenteses, usually carried out around the 16th week of pregnancy, and 30,729 chorionic villus samplings, which can be undertaken from 12 weeks into the pregnancy. Both these tests carry an increased risk of miscarriage, so the decision on whether or not to undertake them can be difficult to weigh up. Since our sample included a large number of women aged less than 35 who underwent invasive prenatal diagnosis without any pathological indication to do so, we felt that the results could be useful in helping to inform pre-test counselling of such women, says Dr. Grati. Up until now, the information we had came from smaller studies which only looked at the performance of these tests in detecting a limited number of chromosomal abnormalities.

After analysing the results of the chromosomal abnormalities from their own dataset, the researchers combined them with the official detection rates for these abnormalities published by SURUSS and FASTER consortia. These are multi-centre research groups involved in the investigation of screening and diagnostic tests performed in pregnancy, whose results are being used to optimise prenatal care for pregnant patients. They found that current screening procedures were only able to detect half the total chromosomal abnormalities in women both younger and older than 35.

The TOMA laboratory is particularly suited to carry out this kind of research, says Dr. Grati, because it was among the first in the world to deal with prenatal diagnosis, and has a vast number of prenatal diagnostic samples at its disposal.

Current tests do not detect all fetal chromosomal abnormalities, but only trisomies 21 (Down syndrome), 18 (Edward's syndrome), and 13 (Patau syndrome), monosomy X (Turner syndrome), and triploids (conceptuses with 69 chromosomes instead of 46). These are common vital chromosomal abnormalities, but there are many others which are not picked up by these tests, says Dr. Grati. And the tests do not even detect 100% of the common abnormalities.

At conception, 23 chromosomes from each parent combine to create a fetus with 46 chromosomes in all its cells. Trisomy occurs when the fetus has one additional chromosome (47 instead 46). The extra genetic material from the additional chromosome causes a range of problems of varying severity.

In Down syndrome, for example, where the fetus has three copies of chromosome 21, babies are usually born with impaired cognitive ability and physical growth, cardiac defects and a characteristic facial appearance. Unlike many other such abnormalities, however, babies born with Down syndrome are able to lead relatively normal lives and their life expectancy is around 50 years.

Other than trisomy, the fetus can also have the loss of genetic material (deletions) or chromosomal abnormalities in a non-homogeneous form, where there is a mixture of two cell lines, one normal and the other abnormal. Some of these disorders are relatively common in the fetus, which may have as much chance of surviving as children who are born with Down syndrome, and it is worrying that current biochemical tests are not always able to detect them says Dr. Grati. Our research confirms that it is fundamental for doctors to counsel patients about the limitations of current screening methods, so that they can make an informed decision on whether or not to undergo invasive diagnostic testing.

NIH researchers find that Rett syndrome gene is full of surprises

Thu, 29 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) A study funded by the National Institutes of Health (NIH) has transformed scientists' understanding of Rett syndrome, a genetic disorder that causes autistic behavior and other disabling symptoms. Until now, scientists thought that the gene behind Rett syndrome was an off switch, or repressor, for other genes. But the new study, published today in Science*, shows that it is an on switch for a startlingly large number of genes.

Rett syndrome is caused by a deficiency of the MECP2 gene. It occurs almost exclusively in girls, robbing them of language, cognitive and fine motor skills around the time they are learning to walk. Having extra copies of MECP2 can also cause Rett-like symptoms.

By manipulating the number of copies of the MECP2 gene in mice, the authors of the new study found that it controls thousands of other genes, suppressing some, but activating most. The research was funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), both part of NIH.

This study simultaneously upends prevailing ideas about the disease process in MECP2-related disorders, and hints at new therapeutic strategies, says NIH Director Elias Zerhouni, M.D.

Rett syndrome occurs predominantly in girls because the MECP2 gene is located on the X chromosome. In boys, who have only one X compared to girls' two, a deficiency of MECP2 tends to cause death during infancy. Girls with Rett syndrome tend to develop normally until about one year of age, and then regress in their language, cognitive and motor skills. They lose the words they have learned, as well as their skilled hand movements, which become replaced by repetitive wringing and clapping. Other common features include seizures, stunted growth and small brain size, mood disturbances, and sleep problems.

Duplications of MECP2 have been linked to another syndrome, which can cause Rett-like symptoms, and sometimes severe mental retardation, in boys.

MECP2's dual roles in gene repression and activation were a total surprise, says the lead author of the new study, Huda Zoghbi, M.D., a professor at Baylor College of Medicine in Houston and an investigator of the Howard Hughes Medical Institute. Dr. Zoghbi led the team that first linked MECP2 deficiencies to Rett syndrome in 1999, also an NIH-funded effort. Many lines of evidence pointed to the MeCP2 protein as a gene repressor, and that is how experts in the field, including Dr. Zoghbi, have defined its function for the past 10 years.

Dr. Zoghbi did not intend to question that definition. She was interested in comparing Rett syndrome and MECP2 duplication syndrome, and in adding to the list of the few genes known to be regulated by MECP2.

Iron supplements might harm infants who have enough

Mon, 05 May 2008 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich.---A new study suggests that extra iron for infants who don't need it might delay development -- results that fuel the debate over optimal iron supplement levels and could have huge implications for the baby formula and food industry.

Our results for 25 years of research show problems with lack of iron. For us to find this result is a big deal, it's really unexpected, said Dr. Betsy Lozoff, University of Michigan research professor at the Center for Human Growth and Development, and the study's principal investigator.

U.S. infant formulas typically come fortified with 12 mg/L of iron to prevent iron-deficiency anemia. Europe generally uses a lower amount. In infants, iron-deficiency anemia is associated with poorer development, and during pregnancy it contributes to anemia in mothers, contributing to premature birth, low birth weight and other complications.

I thought that behavior and development would be better with the 12 mg formula, said Lozoff, also professor of pediatrics in the U-M Department of Pediatrics and Communicable Diseases at the Medical School and C.S. Mott Children's Hospital

The U-M study of 494 Chilean children showed that those who received iron fortified formula in infancy at the 12 mg used in the U.S. lagged behind those who received low-iron formula in cognitive and visual-motor development by age 10 years. Lozoff stressed that most children who received the 12 mg formula did not show lower scores. But the 5 percent of the sample with the highest hemoglobin levels at 6 months showed the poorest outcome. Your body needs iron to make hemoglobin, a substance in red blood cells that enables them to carry oxygen. High hemoglobin generally indicates sufficient iron.

Adversely affected children scored 11 points lower in IQ and 12 points lower in visual-motor integration, on average; the average overall score on both tests was 100. A similar pattern was observed for spatial memory and other visual-motor measures.

Lozoff noted that not many infants in Chile had high hemoglobin levels at the time since there was no iron-fortification program for infants and that more than 5 percent of U.S. infants might have high hemoglobin levels in early infancy.

In this randomized study, healthy infants without iron-deficiency anemia were given formula with either 12 mg or 2.3 mg iron from 6 to 12 months and followed to 10 years. The next step is to test the participants again at age 16, Lozoff said, who says that no such study has been conducted in the United States or elsewhere.

Iron deficiency occurs because babies grow so quickly they often grow out of the amount of iron they are born with. Breast milk is thought to contain the iron a baby needs for 4-6 months, Lozoff said. Other important sources of iron for infants include iron-fortified infant formulas and cereals, iron drops and meat.

Infants are typically not tested for hemoglobin or iron levels before 9-12 months. It would be premature to recommend earlier testing or to avoid supplemental iron based on the study's results, Lozoff said. She expects parents to be concerned, but stressed that results must be reproduced in other studies.

At this point there's no basis for changing practice, but it's really important that we have continued research on this issue, she said.

Deadly genetic disease prevented before birth in zebrafish

Thu, 20 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) By injecting a customized genetic patch into early stage fish embryos, researchers at Washington University School of Medicine in St. Louis were able to correct a genetic mutation so the embryos developed normally.

The research could lead to the prevention of up to one-fifth of birth defects in humans caused by genetic mutations, according to the authors.

Erik C. Madsen, first author and an M.D./Ph.D. student in the Medical Scientist Training Program at Washington University School of Medicine, made the groundbreaking discovery using a zebrafish model of Menkes disease, a rare, inherited disorder of copper metabolism caused by a mutation in the human version of the ATP7A gene. Zebrafish are vertebrates that develop similarly to humans, and their transparency allows researchers to observe embryonic development.

Children who have Menkes disease have seizures, extensive neurodegeneration in the gray matter of the brain, abnormal bone development and kinky, colorless hair. Most children with Menkes die before age 10, and treatment with copper is largely ineffective.

The research is published this month in the Proceedings of the National Academy of Sciences' advance online edition.

The development of organs in the fetus is nearly complete at a very early stage. By that time, the mutation causing Menkes disease has already affected brain and nerve development.

Madsen and Bryce Mendelsohn, also an M.D./Ph.D. student at the School of Medicine, wondered if they could prevent the Menkes-like disease in zebrafish by correcting genetic mutations that impair copper metabolism during the brief period in which organs develop. Both students work in the lab of Jonathan D. Gitlin, M.D., the Helene B. Roberson Professor of Pediatrics at the School of Medicine and director of Genetics and Genomic Medicine at St. Louis Children's Hospital.

The researchers used zebrafish with two different mutations in the ATP7A gene, resulting in a disease in the fish that has many of the same characteristics of the human Menkes disease. Madsen designed a specific therapy to correct each mutation with morpholinos, synthetic molecules that modify gene expression. The zebrafish embryos were injected with the customized therapy during the critical window of development, and the researchers found that the zebrafish hatched and grew without any discernable defects.

This method of copper delivery suggests that the prevention of the neurodegenerative features in Menkes disease in children may be possible with therapeutic interventions that correct the genetic defect within a specific developmental window, Madsen said.

The genetic mutations Madsen and the researchers worked with are caused by splicing defects, or an interruption in genetic code. The morpholinos prevent that interruption by patching over the defect so the gene can generate its normal product.

Consider the genetic code as a book, and someone has put in random letters or gibberish in the middle of the book, Madsen said. To be able to read the book, you have to ignore the gibberish. If we can make cells ignore the gibberish, or the splicing defect, the fetus can develop normally.

Up to 20 percent of genetic diseases are caused by splicing defects, Madsen said, so this treatment method could potentially be used for many other genetic diseases.

The idea is that we can modify the treatment to target a specific mutation and design molecules to alter gene function in the same way the morpholino oligonucleotides can, Gitlin said.

The work is an important step toward personalized medicine, which can tailor treatment to an individual's genetic makeup.

Eventually we would like to know each person's genome sequence so we know what mutations each person has that may lead to disease, Gitlin said. That way, you don't get a drug for cancer that works against any kind of cancer, you get a drug for the specific mutation that causes your cancer. That's what personalized medicine is all about.

$2.1 million NIH grant advances U-Iowa child health research

Wed, 12 Mar 2008 03:59:37 PST

( from http://www.rxpgnews.com ) The University of Iowa Department of Pediatrics has been awarded a five-year, $2.1 million grant from the National Institute of Child Health and Human Development, part of the National Institutes of Health (NIH), to continue a mentorship project that helps junior faculty members embark on research careers.

The grant renews support that has been in place since 1990 and resulted in the training of 26 UI clinician-scientists in pediatrics. They learn research skills to study the underlying mechanisms of conditions such as prematurity, heritable disorders such as hemophilia and cystic fibrosis, and adult-onset diseases that are thought to have fetal origins. Known as scholars, the trainees also gain the skills needed to ultimately secure their own grant funding.

Science is more complicated and challenging than ever before, so the program is essential to developing the next generation of leaders in pediatric science and health, said Michael Artman, M.D., physician-in-chief of University of Iowa Children's Hospital and principal investigator for the grant.

Research increasingly requires more resources, technical knowledge, expense and interdisciplinary understanding. We need to keep up with this changing environment and by extension, the changing clinical care environment, while capitalizing on existing resources, Artman said. In particular, the program involves experts across departments and colleges who serve as research mentors for the scholars. We are excited that the grant will renew efforts to help physicians, who are clinically trained, to develop the skills necessary to succeed as clinician-scientists.

The grant is titled Molecular and Cellular Research to Advance Child Health and emphasizes developmental biology, applied genetics and genomics, animal models of human disease and translational research. In addition to taking advantage of strengths of UI Health Care and UI colleges and centers, the training funded by the grant will involve the new UI Institute for Clinical and Translational Science. The program also involves eight UI internal advisors and three external advisors at other institutions.

Each scholar comes in with a unique set of interests that are matched up from a broad list of more than 30 mentors, said the grant's program director Brian Schutte, Ph.D., UI associate professor of pediatrics, who has also served as a mentor. These scholars are exceptionally smart and creative. If they come into your lab and do research, you will learn from them as they learn from you.

Nineteen of the 26 scholars remain at the UI -- some are now mentors themselves -- while seven are building research efforts at other institutions, according to records kept by Donna Friel, grant administrator and a contracts administrator for UI Children's Hospital. This program is a launching pad for many clinician-scientists, Friel said. We track the grant funding these researchers go on to secure.

In addition to providing a mentored research process, the program funds protected research time and resources for young faculty members. Funding is tighter than ever, Schutte said. A trainee 'graduates' from the program when they are able to secure their own funding for research.

One individual who made that transition is Fred Lamb, M.D., Ph.D., UI professor of pediatrics and director of the Pediatric Intensive Care Unit. Lamb was a scholar from 1994-1997 and has been a mentor for nearly 10 years.

Without the program, it would be hard to find an environment that is so nurturing. We do a lot of collaboration, and I like to work and think in groups. You get more done by involving others, Lamb said. The program allowed me to work on a topic that interested me and get trained in new techniques without feeling like I was taking up someone else's productivity.

Lamb entered the program with a background in physiology and electrophysiology and then developed molecular biology and molecular genetic skills, as well as improved his ability to secure grants on his own. Working primarily with Schutte, he studied the ClC-3 chloride channel and made a mouse model that lacked this channel. He continues to work on chloride channels.

Understanding CLC-3 is very important in understanding inflammation because the chloride channel plays a critical role in producing free radicals, he said.

Lamb has since mentored others, including Robert Roghair, M.D., UI assistant professor of pediatrics, who recently completed the scholar program himself and is studying fetal origins of disease.

It's been fun to see the next generation of clinician-scientists develop and build their careers, Lamb said.

Mouse model tightly matches pediatric tumor syndrome, will speed drug hunt

Sat, 01 Mar 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Frustrated by the slow pace of new drug development for a condition that causes pediatric brain tumors, a neurologist at Washington University School of Medicine in St. Louis decided to try to fine-tune the animal models used to test new drugs.

Instead of studying one mouse model of the disease causing the brain tumors, the laboratory of David Gutmann, M.D., Ph.D., the Donald O. Schnuck Family Professor of Neurology, evaluated three. They auditioned the three models to see which was the best match for neurofibromatosis 1, a genetic condition that increases the risk of brain tumors and afflicts more than 100,000 people in the United States.

Animal models have long been used to explore the basic physiology underlying disease and to tentatively try out new remedies, but Gutmann believes that creating a tighter match between the animal models and the human disorder will allow more extensive and more accurate preclinical testing of potential therapies.

If you think of how we move drugs from testing in the laboratory to testing in humans, this is an exciting step that's likely to speed the translation from bench to bedside, says Gutmann, the senior author of a report in the March 1 Cancer Research. With more extensive preclinical testing in the mice, we can make sure a new drug is reaching its target protein in tumor cells, we can learn whether the drug is killing tumor cells or shutting off their growth, and we can get some indication of whether the drug is likely to have an adverse effect on the developing brain.

Gutmann is director of the Washington University Neurofibromatosis Center, which facilitates multidisciplinary neurofibromatosis research and is dedicated to developing better treatments to improve the lives of patients affected by the disorder. Fifteen to 20 percent of children with neurofibromatosis 1 develop brain tumors called gliomas that arise from brain cells known as glial cells. Gutmann's lab has studied a mouse model of neurofibromatosis 1 for several years to gain a better understanding of how defects in the NF1 gene cause gliomas.

For the new study, Gutmann and colleagues Joshua Rubin, M.D., Ph.D., assistant professor of pediatrics, neurology and of neurobiology, and Joel Garbow, Ph.D., research associate professor of radiology, compared three mouse brain tumor models of neurofibromatosis 1. One of the models was the line his lab has previously used to study basic tumor biology.

To compare the mouse lines to the human disorder, researchers analyzed where the mice developed tumors, determined how quickly the tumor cells were dividing, and assessed when the tumors ceased growing. Based on these criteria, they learned that the model they had used earlier most faithfully reproduced the important features of the human condition. Researchers hope that this means the model will also give them the most accurate picture of how human patients are likely to respond to new treatments.

To test this theory, they gave the mice doses of a chemotherapy agent, temozolomide, currently in use clinically. Temozolomide slowed the growth and reduced the size of tumors in the mice, as it does in human patients.

Next researchers gave the mice rapamycin, an experimental drug currently in clinical trials as a treatment for other cancers. They found the drug was not killing tumor cells but preventing them from growing while the mice received regular doses of the drug. Higher doses could shut off tumor growth in a more long-lasting fashion, but also produced harmful side effects.

Because the trials were in mice, researchers could use a variety of invasive techniques to learn additional details about the effects of the drugs. For example, brain development is ongoing in young children, making the introduction of drugs that kill cells or stop their replication cause for significant concern. The mouse model let researchers look at developmental hotspots in the brain to see if temozolomide or rapamycin was adversely affecting the creation of new brain cells. They found that neither drug was.

Gutmann plans to use the mouse model in a new collaborative network funded by the Children's Tumor Foundation. His group and four other labs will test a variety of compounds against specific tumor types found in individuals affected with neurofibromatosis 1.

We want to learn if these new drugs work the same in all aspects of the disease, Gutmann says. We will be using what we learn to provide an efficient, rigorous pipeline for moving promising new drugs from the laboratory to clinical trials.

Financial struggles plague families of children with autism

Fri, 29 Feb 2008 04:59:37 PST

( from http://www.rxpgnews.com ) COLUMBIA, Mo. - The information that a child has been diagnosed with autism often throws parents into an emotional tailspin. A new study from a University of Missouri researcher says most people don't immediately consider the major financial struggles that follow. She suggests more outreach is needed to help families plan and cope with the profound financial life changes they may face.

As a parent, the diagnosis of autism upends your world, said Deanna Sharpe, associate professor of personal financial planning in the MU College of Human Environmental Sciences and whose own son was diagnosed with the disorder. It is important for us to hear the voices of families who have financial struggles. There is strong pressure to do everything you can for your child. However, there is a great potential for families to spend a lot of money on therapy or new ideas that may be ineffective. Careful evaluation of therapies is important.

Some of the costs include specialized child care, speech and language therapy, other types of one-on-one therapy, special interventions, and costly food or drug supplements. Applied Behavior Analysis (ABA), a widely respected and recommended behavioral intervention, can be expensive. This intervention requires children to work one-on-one with a trained therapist for 30 to 40 hours each week. In the study, some parents reported paying as much as $30,000 a year for ABA therapy. Parents whose child with autism was destructive also reported paying compensation and replacements costs for items that were destroyed.

Some families quoted in the study reported skipping meals to be able to afford therapy for their children. Others talked about robbing their future by depleting savings, emptying their 401K plans, selling stocks and even filing for bankruptcy. More costs are added to some families who need counseling and medication for themselves in order to cope with the stress of raising a child with autism, further straining the family budget.

Sharpe says it is important to begin financial planning as soon as a diagnosis is made. She suggests financial planners need to help direct families to available resources and help them think seriously about the implications of spending all their retirement money on various therapies or having one parent step out of the job force to care for a child when other options could be available.

Autism has a startlingly huge impact on society, Sharpe said. We know early intervention can influence how well a child will do later in life. It's a human capital investment that can prevent or reduce the need for public support when a child with autism becomes an adult. However, it is costly to obtain this intervention.

Teenage fathers are more likely to have babies affected by birth problems

Fri, 08 Feb 2008 16:59:37 PST

( from http://www.rxpgnews.com ) Teenage fathers are at increased risk of having babies born with birth problems ranging from pre-term delivery or low birth weight, through to death in or near to the time of delivery, according to new research published on (Thursday 7 February).

In contrast, the study also found that older fathers, aged 40 and over, were not at increased risk of having babies affected by these problems. The results were independent of the age of the mother or other maternal factors that might be expected to have an impact on birth outcomes.

Breastfeeding now safer for infants of HIV-infected mothers

Tue, 05 Feb 2008 20:29:37 PST

( from http://www.rxpgnews.com ) An antiretroviral drug already in widespread use in the developing world to prevent the transmission of HIV from infected mothers to their newborns during childbirth has also been found to substantially cut the risk of subsequent HIV transmission during breast-feeding.

In a study presented Feb. 4 at the 2008 Conference on Retroviruses and Opportunistic Infections in Boston, an international team of AIDS experts reports that nevirapine given once daily to breast-feeding infants from 8 to 42 days old decreased by almost half the rate of HIV transmission via breast-feeding at 6 weeks of age. The decrease occurred in comparison to a single dose of nevirapine given to infants at birth, the current standard of care. At 6 months of age, the risk of postnatal HIV infection or death in infants who received the six-week regimen was almost one-third less than the risk for infants given only a single dose. The study was led by three teams of investigators at The Johns Hopkins University in collaboration with investigators in Ethiopia, India and Uganda.

Breast-feeding remains a leading route of HIV transmission in the developing world. The United Nations World Health Organization estimates that approximately 150,000 infants are infected through breast-feeding each year. In the United States each year, fewer than 150 newborns are infected with HIV at birth, mostly to mothers who did not know they were HIV positive.

Anemia treatment may be a double-edged sword

Wed, 30 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Erythropoietin has so far been known to doctors as a hormone that boosts red-blood-cell production. Now, a mouse study led by Lois Smith, MD, PhD, an ophthalmologist at Children's Hospital Boston, shows it also keeps blood vessels alive and growing in the eye. The findings not only add a new function to the hormone, but also give doctors a reason to pause before prescribing it to patients with diseases affected by abnormal blood-vessel growth, such as retinopathy and cancer.

The study, published in the February issue of the Journal of Clinical Investigation (online January 24), also found that whether the hormone is a risk or benefit depends on the timing of administration.

Smith and first author Jing Chen, PhD, worked in mice with retinopathy, an eye disease that begins when healthy blood vessels nourishing the retina die. Numerous vessels then grow in, but they are deformed. Ultimately, the deformed vessels may pull the retina off the back of the eye, causing blindness.

The researchers measured erythropoietin produced in the retina as the disease progressed. Production was 3 to 10 times below normal during early-stage retinopathy, when healthy blood vessels died, and 12 to 33 times above normal during late-stage retinopathy, when deformed blood vessels grew into the retina. The researchers concluded that erythropoietin helps blood vessels survive and grow in the retina, with effects that may be healthy or harmful.

Next, the team examined whether giving erythropoietin could treat retinopathy. They injected erythropoietin into the bloodstream either early, as the mice lost healthy blood vessels, or later, when deformed blood vessels began to invade--then compared them with untreated mice.

Boosting erythropoietin early slowed the disease. The mice lost half as many healthy blood vessels, causing about 30 percent fewer deformed vessels to grow in. Raising erythropoietin levels later, when deformed blood vessels were present, appeared to accelerate the disease--slightly more deformed blood vessels grew in.

If similar effects are found in humans, and its use is properly timed, then giving erythropoietin early could slow loss of healthy blood vessels in retinopathy, says Smith. Right now, there is very little out there to treat blood vessel loss in patients with retinopathy. However, further studies on the restoration of normal levels of erythropoietin are needed to translate these results to patients.

In other diseases, like cancer, in which doctors need to slow blood vessel growth, the hormone could be blocked, although clinical trials would need to confirm this idea, she adds.

But given at the wrong time, erythropoietin may make blood vessels grow in an unhealthy way, says Smith. For example, because it boosts red blood cells, erythropoietin is often prescribed to premature babies and diabetic adults for anemia. Some of these patients also have retinopathy. Giving the hormone at the wrong time might help anemia, but worsen the eye disease.

We're not saying, 'don't do it.' We're saying, 'think about it,' says Smith. Physicians should look at the state of the eye before giving erythropoietin to patients with retinopathy. They should consider not giving it to patients with full-blown retinopathy, in which abnormal vessels are present, because our work suggests it may accelerate the disease. However, if a patient is early on in the disease, then our work suggests erythropoietin may be beneficial.

Cancer patients, who often take erythropoietin for anemia, face a similar potential risk, says Smith. Since erythropoietin has the potential to make blood vessels in tumors grow, it could make tumors worse, although a clinical trial is required to know if this is true in humans.

Overall, Smith says her mouse studies are a reason for doctors to think and researchers to investigate, not for patients to panic.

Pollution shrinks fetus size: Brisbane study finds

Sun, 06 Jan 2008 04:59:37 PST

( from http://www.rxpgnews.com ) Exposure to air pollution significantly reduces foetus size during pregnancy, according to a new study by Brisbane scientists.

Queensland University of Technology senior research fellow Dr Adrian Barnett said the study compared the foetus sizes of more than 15,000 ultrasound scans in Brisbane to air pollution levels within a 14km radius of the city.

The study found that mothers with a higher exposure to air pollution had foetuses that were, on average, smaller in terms of abdominal circumference, head circumference and femur length, Dr Barnett said.

The 10-year study, which was undertaken by Dr Barnett, Dr Craig Hansen (US Environmental Protection Agency) and Dr Gary Pritchard (PacUser), has been published in the international journal Environmental Health Perspectives.

Dr Barnett, who is based at QUT's Institute of Health and Biomedical Innovation, said the study looked at foetuses between 13 and 26 weeks duration.

To our knowledge this is the first study of its kind as it uses ultrasound measurement as a direct estimate of growth, rather than using birth weight as a delayed measure of growth, Dr Barnett said.

When analysing scans from women at different distances to monitoring sites, we found that there was a negative relationship between pollutants such as sulphur dioxide found in diesel emissions, and ultrasound measurement.

If the pollution levels were high the size of the foetus decreased significantly.

Dr Barnett said with research showing that bigger babies were healthier in childhood and adulthood, foetus size during pregnancy was important.

Birth weight is a major predictor of later health, for example, bigger babies have been shown to have higher IQs in childhood and lower risk of cardiovascular disease in adulthood, he said.

While some people may think there is no air pollution in Brisbane because the air looks so clean, you have to remember that most air pollutants are not visible to the naked eye, people do have a very outdoor lifestyle, and homes are designed to maximise airflow.

So although the actual levels of pollution are low our exposure to whatever is out there is relatively high.

This is particularly a problem for people who live near major roads.

Dr Barnett said it was wise for pregnant women to try to reduce their exposure to air pollution, most of which in Brisbane was caused by vehicles.

While we need to get more data from individual mothers before we can be more certain about the effects of air pollution on fetal development, we would recommend that where possible pregnant women reduce their exposure to air pollution.

Constipation most common cause of children's abdominal pain

Mon, 17 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) A new study led by a University of Iowa researcher showed that acute and chronic constipation together accounted for nearly half of all cases of acute abdominal pain in children treated at one hospital.

The study also suggests that physicians should do a simple rectal examination for constipation when trying to determine the cause of abdominal pain in children. The findings, which were based on medical records of 962 children ages 4 to nearly 18, appear in the December issue of the Journal of Pediatrics.

Earlier studies have shown that constipation can contribute to abdominal pain in children, but no specific recommendations for diagnosing this contributing factor were made, said Vera Loening-Baucke, M.D., professor of pediatrics at the University of Iowa Carver College of Medicine and the study's lead investigator.

Constipation can be overlooked as the cause of severe or intermittent abdominal pain, as a reporting of symptoms alone does not always establish that a child has constipation, she said. Our study helps to show that constipation frequently causes acute abdominal pain and that a physician should not just ask the parent if the child is constipated because the parent may have not been able to see all the signs of this condition.

Constipation signs include fewer than three bowel movements per week, one or more episodes of stool incontinence per week, passing of stools so large that they obstruct the toilet, retentive posturing (withholding behavior) and painful defecation.

The doctor should perform an abdominal examination and a rectal examination to see if the child is retaining stool, said Loening, who sees patients at University of Iowa Children's Hospital.

Loening said that some doctors shy away from the rectal examination, which involves digitally checking for impacted stool in the lower colon, because they believe it may cause a child mental or physical discomfort. However, the test can be performed safely and explained to children so that they understand its purpose.

It's important for doctors to do a thorough evaluation for abdominal pain, as there are many causes. In addition to constipation, having a cold or sore throat can also cause abdominal pain, for example, Loening-Baucke said.

The study found that 83 (9 percent) of 962 children who had received at least one well-child visit during a six-month period in 2004 at University of Iowa Children's Hospital or University of Iowa Hospitals and Clinics reported acute abdominal pain at that visit or another clinic or emergency visit. Significantly more girls (12 percent of the 962) reported such pain, compared to only 5 percent of boys.

Of the 83 children with acute abdominal pain, 72 were seen in a primary care clinic and 11 were examined after hours in the emergency department. Together, acute constipation (lasting eight or fewer weeks) and chronic constipation (lasting eight or more weeks) accounted for 48 percent of the cases (40 children), making it the most common cause of the pain.

Only 2 percent of the children with pain had a surgical condition such as appendicitis. In addition, doctors could not determine causes for 19 percent of the patients with pain.

While most of the patients reviewed in the study were Caucasian, individuals from all other races were included.

Children with sickle cell disease, silent strokes show some relief with blood transfusions

Mon, 10 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) A group of children who have sickle cell disease and who experience silent strokes showed some relief from the silent strokes with blood transfusion therapy, researchers at Washington University School of Medicine in St. Louis have found.

The study's results will appear in a future issue of Pediatric Blood and Cancer but are available for review in its advance online publication.

In a Phase II study of 10 children with sickle cell disease who also had multiple silent strokes, or cerebral infarcts, the majority of families were committed to having their children receive blood transfusions for two years, showing that the therapy was feasible. In addition, the blood transfusion therapy helped to shrink the lesions on the brain caused by the infarcts and eliminated one lesion completely, said Allison A. King, M.D., a pediatric hematologist at St. Louis Children's Hospital and a researcher at Washington University School of Medicine. Lesions are small areas of damaged tissue thought to be due to blockage of small arteries in the brain.

Silent strokes are strokes that don't show the classic symptoms of overt strokes, such as numbness, tingling, headache or slurred speech. Blood transfusion therapy has been shown to be effective in preventing overt strokes in patients with sickle cell disease, but its effectiveness and the willingness of families to participate in long-term treatment to prevent silent strokes had not been tested.

Sickle cell disease is an inherited blood disorder affecting red blood cells that contain hemoglobin, a substance that carries oxygen from the air in the lungs to all parts of the body. In patients with this disease, red blood cells contain an abnormal type of hemoglobin that causes the normally round, flexible red blood cells to become sickle- or crescent-shaped. The sickle cells can't pass through tiny blood vessels, preventing blood from reaching the body's tissues, which can result in tissue and organ damage, pain and stroke.

Sickle cell disease affects about 70,000 people in the United States. It occurs in about 1 of every 500 African-American births and 1 of every 1,000 to 1,400 Hispanic-American births. While there is no cure for the disease, blood transfusions and bone marrow transplants have been shown to be effective treatments by replacing short-lived sickle cells with longer-lived healthy red blood cells, although bone marrow transplants have a 10 percent mortality rate because of the possibility of rejecting the bone marrow, complications such as seizures and a high risk of infection.

In the study, brain lesions in six patients shrank after two years of regular blood transfusions, and no new silent strokes occurred. One patient had a lesion disappear, however, that patient did not continue with further blood transfusions, and the lesion returned at more than three times its original size, suggesting the need for prolonged transfusions. A lesion grew larger in the seventh patient.

Many of the lesions occur in the frontal lobe of the brain, which controls the cognitive function or problem-solving area, or in the occipital lobe, which controls the visual processing center, King said. Neuroradiologists can locate the lesions using magnetic resonance imaging (MRI).

Because these lesions are usually in the frontal lobe, it is important to do cognitive testing on these children to determine any impairment, King said. We hope that by preventing further lesions through blood transfusions that we can preserve their ability to think and learn.

A total of 71 percent of the school-aged children in the study were receiving special education services and 57 percent had failed a grade in school. Previous School of Medicine research shows that 80 percent of students with silent strokes perform poorly in school.

King said the results of the trial were encouraging to health-care professionals treating children with sickle cell disease.

What we found in this trial is that families and children with sickle cell disease and who experience silent strokes are willing to commit to blood transfusion therapy for this condition, King said. If these children are left untreated, their risk for an overt stroke is very high, but if we use blood transfusion therapy, they may have a lower risk for overt stroke and no evidence of new silent infarcts on an MRI.

Results of this Phase II trial spearheaded a larger, Phase III study that is evaluating 1,800 children in the United States, Canada and Europe. That trial, called the Silent Cerebral Infarct Multi-Center Clinical Trial, is headed by Michael R. DeBaun, M.D., professor of pediatrics at the School of Medicine. Through it, researchers will further determine the effectiveness of blood transfusion therapy to prevent silent strokes in children with sickle cell disease and to prevent further cerebral injury.

Cord blood viable option for kids with life-threatening metabolic disorders

Mon, 10 Dec 2007 04:59:37 PST

( from http://www.rxpgnews.com ) DURHAM, N.C. -- Children born with inherited metabolic disorders that cause organ failure and early death can be treated successfully with umbilical cord blood transplants from unrelated donors and, in some cases go on to live for many years, according to a study led by Duke University Medical Center researchers.

Umbilical cord blood transplant may confer advantages over bone marrow transplant, which has been the traditional method for treating these disorders, the researchers said.

During the past 25 years, children with these disorders, which include Hurler disease and Krabbe leukodystrophy, have been treated successfully with bone marrow transplants but only if a matched donor was available, said Vinod Prasad, M.D., a pediatric hematologist/oncologist at Duke and lead investigator on the study. Umbilical cord blood transplant can be done successfully from a mismatched donor, so it opens the possibility of treatment to many patients who otherwise would succumb to their disorders.

The researchers presented their findings on Dec. 10 at the American Society of Hematology meeting in Atlanta. The study was funded by the National Institutes of Health and Hunter's Hope Foundation, an organization founded in memory of former NFL quarterback Jim Kelly's son Hunter, who died from Krabbe disease, an inherited metabolic disorder that affects the nervous system.

These disorders are rare when taken individually -- some of them occur in only one in a million births -- but if you put them together they have a sizeable incidence, maybe 1 in 10,000 births, Prasad said. What these patients have in common is that they have some type of gene defect that causes them to lack a critical enzyme, required for the development of a vital organ, such as the heart or the brain or the nerves.

Without successful intervention, many of these children die before their first birthday, he said. Bone marrow and umbilical cord blood transplant work in these patients in much the same way -- by replacing missing enzymes and allowing the affected organs to develop more normally.

For this study, researchers looked at 159 children with inherited metabolic disorders who received unrelated cord blood transplants at Duke between 1995 and 2007.

We saw that there were advantages to the unrelated cord blood transplant, Prasad said. For instance, cord blood is more readily available than bone marrow and there was a decreased risk of complications, including a lower incidence of serious and potentially fatal graft-versus-host disease, which occurs when donor cells perceive a recipient's tissues and organs as foreign.

The study also suggests that when patients are transplanted while they are still relatively healthy, they have better outcomes than their counterparts who received bone marrow transplants.

Research team finds link between asthma and depressive disorders

Tue, 06 Nov 2007 04:59:37 PST

( from http://www.rxpgnews.com ) Young people with asthma are about twice as likely to suffer from depressive and anxiety disorders than are children without asthma, according to a study by a research team in Seattle. Previous research had suggested a possible link in young people between asthma and some mental health problems, such as panic disorder, but this study is the first showing such a strong connection between the respiratory condition and depressive and anxiety disorders. The findings appear in the November issue of the Journal of Adolescent Health.

The study was conducted by researchers at the University of Washington School of Medicine, Group Health Cooperative, and Seattle Children's Hospital Research Institute. The researchers interviewed more than 1,300 youths, ages 11 to 17, who were enrolled in the Group Health Cooperative health maintenance organization. Of the participants, 781 had been diagnosed with or treated for asthma, and the rest were randomly selected youths with no history of asthma.

About 16 percent of the young people with asthma had depressive or anxiety disorders, the researchers found, compared to about 9 percent of youth without asthma. When controlling for other possible variables, youth with asthma were about 1.9 times as likely to have such depressive or anxiety disorders.

Researchers tested for several depressive and anxiety disorders, including depression, a mood disorder called dysthymia, panic disorder, generalized anxiety disorder, separation anxiety, social phobia, and agoraphobia. These disorders are somewhat common in youth, and are associated with high risk for school problems, early pregnancy, adverse health behaviors like smoking or lack of exercise, and suicide.

Young people with depressive and anxiety disorders often find it harder to manage their asthma and describe more impaired physical functioning because of the combination of asthma and a depressive or anxiety disorder, the researchers said. Youth with asthma and one of the disorders are also more likely to smoke, making their asthma more difficult to treat.

Physicians treating young people with asthma should realize that those children are at a greater risk of depressive and anxiety disorders, and should try to educate patients and their families about this increased risk, said Dr. Wayne Katon, professor and vice-chair of psychiatry at the UW School of Medicine, and corresponding author of the study. The primary care system is correctly identifying only about 40 percent of the cases in which children with asthma also have a psychiatric disorder. We should improve our screening for these disorders, and develop effective treatment programs for affected patients that address both asthma and the depressive or anxiety disorder.

In addition to exploring the link between asthma and depressive and anxiety disorders, researchers found other variables that further increase the risk of such disorders. Female respondents were at a greater risk of depressive and anxiety disorders, as were youth living in a single-parent household, those who had been diagnosed with asthma more recently, and those with more impairment in asthma-related physical health.

Medical College of Wisconsin receives FDA grant

Thu, 25 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The Food and Drug Administration (FDA) has awarded the Medical College of Wisconsin in Milwaukee a three-year, $1 million Orphan Products Development grant to study infantile hemangiomas � a vascular tumor of the skin or internal organs.

The unique, interdisciplinary, and multi-institutional study is led by co-principal investigators Beth Drolet, M.D., professor of dermatology and pediatrics, at the Medical College and medical director of the vascular anomalies and dermatology program at Children�s Hospital of Wisconsin; and Michael E. Kelly, M.D., Ph.D., assistant professor of pediatrics - hematology/oncology.

�This is a major achievement for Drs. Drolet and Kelly to receive an FDA grant to study a neglected but important health issue in infants,� says Dean and Executive Vice President Michael Dunn, M.D. �Dr. Drolet noted the increase in incidence of this disease and found a way to fund research to develop better treatment options.�

The new research builds on earlier Medical College studies supported by Children�s Hospital and Health System Foundation, the Dermatology Foundation, Children�s Research Institute, the Greater Milwaukee Foundation, and the NOVO Foundation.

�Partnering with Children�s Hospital, Children�s Research Institute, our patient families, and private donors in the community was truly inspiring,� says Dr. Drolet. �Their generosity and support has empowered our center to create a vision for our research that will change the way infants with this disorder are cared for around the country.�

In 2004, Children�s Hospital and the Medical College created the Birthmarks and Vascular Anomalies Center to better care for infants with hemangiomas and other vascular anomalies. This interdisciplinary program, composed of surgeons, oncologists, radiologists, and pathologists, treats patients from around the country.

�Our preliminary studies show that the increased incidence of hemangiomas may be related to the increase in the rate of low birth weight infants in the United States,� says Dr. Drolet. �We are treating more of these infants while uniform guidelines for therapy and methods used to measure response to treatment of infants with hemangiomas are lacking.�

Infantile hemangiomas are a common, yet poorly understood vascular tumor. Most hemangiomas are found in the skin, but sometimes, they occur in other organs in the body such as the liver, spleen, intestine, airway, lungs and the central nervous system. Unlike most birthmarks, cutaneous hemangiomas are tumors that undergo cellular proliferation. They are either absent or barely evident at birth proliferating in the first few weeks to months of life, followed by a phase where they tend to decrease in size over several months to years.

Although most hemangiomas eventually resolve, many infants will suffer complications such as permanent disfigurement, ulceration, bleeding, loss of vision, airway obstruction, congestive heart failure and even death. Since hemangiomas can behave in vastly different ways and affect many different areas of the body, even physicians who are knowledgeable about hemangiomas and have access to diagnostic resources often find caring for affected infants challenging.

Drs. Drolet and Kelly will study infants diagnosed with large, complicated hemangiomas to determine and compare the effectiveness and safety of steroids in the current standard of care with a drug currently used for cancer.

Fifty infants with large and complicated hemangiomas will be randomly assigned to receive daily oral corticosteroid, prednisolone, or weekly IV vincristine for up to six months. The diagnostic, therapeutic and response criteria determined in this study may be used as a framework for future multi-institutional clinical trials to treat hemangiomas.

The study will provide answers as to which drug is more effective while at the same time providing opportunities for several additional investigators at the Medical College and at the Children�s Research Institute to examine pathogenesis of hemangiomas and genetic factors that influence disease susceptibility and response treatment. These unique partnerships should help develop even better and safer treatment options for these infants.

Gauging parent knowledge about teens' substance use

Wed, 24 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- New research results from the University at Buffalo�s Research Institute on Addictions (RIA) suggest that most parents are aware of and accurately evaluate the extent of their teenager�s cigarette smoking, marijuana use, drinking and overall substance use.

Researchers also found that in cases where parents provided lower estimates of substance use, parents were nearly twice as likely to underestimate frequency of marijuana use and quantity of alcohol use. Parents also were less likely to be aware of extent of use by younger teens and of their children�s use if they themselves had personal problems or were using alcohol more frequently.

What is novel about these findings is that for the first time, detailed statistics are available about parental knowledge of teen substance use for families in which the teen�s substance use is causing the parent stress, but the teen is not necessarily in treatment. Previous studies have been restricted to families with a teen in substance-buse treatment or families with no current substance use issues.

For a six-month reporting period, 82 percent of parents accurately evaluated the presence of teen cigarette smoking; the parents� reports corresponded with the teens� reports of their own smoking. Eighty-six percent of parents accurately evaluated the presence of teen alcohol use, and 86 percent accurately reported the presence of teen marijuana use. However, only 72 percent of the parents in the RIA study accurately reported the presence of illicit drug use (other than marijuana) by teens.

According to lead researcher Neil B. McGillicuddy, Ph.D., �This study begins to dispel the notion that parents don�t know the extent to which their teens are using cigarettes, alcohol and illicit drugs. It seems that, despite a few exceptions, many parents do know the extent of their teenager�s substance use. Parents can use this knowledge to help themselves cope with teenage substance use and the resulting stress on the family, as well as to begin conversations with their teen about making changes.�

McGillicuddy is a research scientist at RIA with extensive background in treatment interventions for parents of substance-abusing adolescents, interventions for partners of addicted persons and treatment for alcohol and drug-abusing adolescents.

This research was funded by the National Institute on Drug Abuse and published in the most recent issue of the Journal of Child and Adolescent Substance Abuse.

For this study, 75 parents and their teenagers were interviewed separately about the teens� recent use of cigarettes, alcohol, marijuana and other illicit drugs. Parent-participants were, on average, female (85 percent), 39 years of age with 13 years of education. Teen-participants were, on average, male (61 percent), 16 years of age and not receiving substance abuse treatment (76 percent).

When parents� and teens� reports were discrepant, parents provided lower estimates of substance use than teens. That is, teens tended to report greater frequency and amount of substance use. Although some of these discrepancies were small (for instance regarding how often teens drank alcohol), others were substantial (parents were nearly twice as likely to underestimate the frequency of marijuana use and the quantity of alcohol use).

In addition, McGillicuddy and colleagues set out to find factors that might explain the discrepancies in parent-teen reports of teen substance use. Parents were less aware of the extent of the teen�s substance use if the teen was younger (about 14 or 15), and if the parents did less monitoring of what their teens were doing after school, during the evening and on weekends. Together, these findings suggest that parents need to consider increasing their monitoring of how teens spend their time and begin thinking about substance use at a significantly younger age.

Lastly, parents who are caught up in their own issues or problems, whether stressed, feeling depressed or using alcohol more frequently, also made less accurate reports.

�What we would hope that people come away with from this study, is that parents can be more aware of their teen�s substance use,� McGillicuddy explained, �by reducing their own alcohol use, giving more attention to what their teen is doing 24/7, particularly if the teen is younger, and taking steps to reduce their own psychological distress. Participation in parenting programs, especially those geared toward coping with an adolescent�s substance use, can give the parent important skills to deal with teen behavior and have been found to reduce the parent�s distress.�

Getting fathers involved in children's ADHD treatment programs

Tue, 23 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- While working with parents of children with attention deficit hyperactivity disorder (ADHD) at the University at Buffalo, Gregory A. Fabiano noticed something was missing: the fathers. Fabiano, an assistant professor in the Graduate School of Education, made the discovery while still a graduate assistant at the UB Center for Children and Families, which runs a summer treatment program that has helped more than 2,500 children with behavioral, emotional and learning problems. The program uses sports as a way to teach children peer-relationship skills, Fabiano said.

�I knew a lot of the dads in that program, because they would show up early to watch their kids on the soccer fields or the softball fields and we�d chat it up when we were out there,� recalled Fabiano, who teaches in the counseling, school and educational psychology department.

�But then they would take their child and go home in the one car, and then the mom would drive up in another car and go to the parenting group,� he added. �I thought �There is something wrong with this picture.��

To find out why fathers of children with ADHD weren�t participating in treatment programs, or why some initially participate, but then drop out soon after, Fabiano turned to research literature on the subject and found�nothing.

�I was surprised to find there were no studies on dads with kids with ADHD and so I thought this would be a good area in which we could try to do something. My dissertation was trying out a parenting program specifically for fathers, using sports as a kind of hook to get the dads interested and the kids too,� Fabiano said.

His new research program, designed for children 6-12 years of age, includes two formats: a control group of fathers and children who receive traditional, evidence-based treatments for ADHD families and another group that receives the same, plus a sports element, in this case, soccer games. This second group is dubbed COACHES, or Coaching Our Acting-Out Children: Heightening Essential Skills.

Traditional treatments include teaching parents strategies to deal with the disruptive behaviors that are hallmarks of the disorder. Adding the COACHES element, Fabiano hoped, would result in increased participation for the fathers and improved relationships with their children.

�We thought for a chronic disorder like ADHD where these fathers aren�t going to be dealing with these problems for a couple weeks or a couple months, but for the child�s entire life, the treatment has to be well-liked, palatable and engaging,� Fabiano explained.

The results, he said, have been remarkable.

�We had huge differences on things like drop-out rates for both the dad and the child. The dads in the COACHES group were more likely to try out the homework, which was a pretty big accomplishment,� Fabiano said. �They also rated the treatment as better.�

Another surprise was the lack of tension between fathers and players, and between the fathers themselves, when it came to controversies on the playing field.

�We were a little nervous about the dads, because you read the newspaper and you see fathers getting into fights with the referee. But we have not had that. The dads seem to be genuinely enjoying the activities, perhaps because the children have struggled in other settings and are successful in this one,� Fabiano said.

Also, the children themselves seemed to be tension-free while playing, a sharp contrast to their previous experiences with sports, he said.

�Families with children with ADHD tell us lots of horror stories about their children failing at team sports because they weren�t paying attention when the ball is coming toward them or they have a low frustration threshold, so they stomped off the field if they made an error,� Fabiano said.

The best result by far was the sense of community that the program offered the fathers.

�In groups, the dads said things like �I didn�t realize other dads had kids like this,� so there is sense of isolation among these parents. Maybe putting fathers together who have children challenged in sports takes things in a positive direction as opposed to a negative direction that makes a father defensive because he sees his child struggling when other kids aren�t,� Fabiano said.

At each meeting, while the children practice soccer skills, the fathers meet to learn parenting skills, such as �how to pay attention to the child�s good behaviors, give clear commands, use time outs well,� Fabiano said.

Now recruiting families for another session of COACHES funded by the National Institutes of Mental Health, Fabiano said the program will stick with soccer for now because �it spreads the kids out so the dads can get right out on the field and monitor their kids very well. There�s also lots of action, unlike baseball, where you might be standing by yourself for 20 minutes and not have anything come your way.�

Success on the field means a greater chance of success at home and school. �Soccer engages the kids, who we want to be behaving well when the parents are trying out new skills. We don�t want parents trying out a skill during a child�s most difficult-to-manage behavior,� he said. �If they succeed, they are more likely to try it out at home, when the kids are doing homework or are supposed to clean their rooms.�

Exercise improves thinking, reduces diabetes risk in overweight children

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Just three months of daily, vigorous physical activity in overweight children improves their thinking and reduces their diabetes risk, researchers say.

Studies of about 200 overweight, inactive children ages 7-11 also showed that a regular exercise program reduces body fat and improves bone density.

�Is exercise a magic wand that turns them into lean, healthy kids? No. They are still overweight but less so, with less fat, a healthier metabolism and an improved ability to handle life,� says Dr. Catherine Davis, clinical health psychologist at the Medical College of Georgia and lead investigator.

All study participants learned about healthy nutrition and the benefits of physical activity; one-third also exercised 20 minutes after school and another third exercised for 40 minutes. Children played hard, with running games, hula hoops and jump ropes, raising their heart rates to 79 percent of maximum, which is considered vigorous.

�Aerobic exercise training showed dose-response benefits on executive function (decision-making) and possibly math achievement, in overweight children,� researchers write in an abstract being presented during The Obesity Society�s Annual Scientific Meeting Oct. 20-24 in New Orleans. �Regular exercise may be a simple, important method of enhancing children�s cognitive and academic development. These results may persuade educators to implement vigorous physical activity curricula during a childhood obesity epidemic.�

Functional magnetic resonance imaging studies, which show the brain at work, were performed on a percentage of children in each group and found those who exercised had different patterns of brain activity during an executive function task.

�Look what good it does when they exercise,� says Dr. Davis. �This is an important public health issue we need to look at as a nation to help our children learn and keep them well.�

Unprecedented obesity and inactivity rates in America�s children are impacting health, including dramatic increases in the incidence of type 2 diabetes, a disease formerly known as adult-onset diabetes. Overweight children also have slightly lower school achievement, on average.

�We hope these findings will help persuade policymakers, schools and communities that time spent being physically active enhances, rather than detracts, from learning,� says Dr. Davis.

�There have been several studies that have shown that exercise produces kind of a selective effect, particularly with older adults, in cognitive tasks that require regulation of behaviors,� says Dr. Phillip D. Tomporowski, experimental psychologist at the University of Georgia and a key collaborator.

For this study, researchers gave the children tests that look at their decision-making processes. In the first such studies in children, the researchers found small to moderate improvements in children who exercised as well as a hint of increased math achievement.

�We have a number of studies conducted with animals that examined what influence physical activity has on blood flow, metabolic activity, brain function, glucose regulation, and they all demonstrate the same theme: that physical activity done on a regular basis has a protective effect,� says Dr. Tomporowski. �It doesn�t take too much to make the leap that it might influence developing children as well.�

Looking at the children�s insulin resistance, a precursor of type 2 diabetes in which it takes more insulin to convert glucose into energy, researchers found levels dropped 15 percent in the 20-minute exercise group and 21 percent in the 40-minute group. The control group stayed about the same.

�Increasing volume of regular aerobic exercise shows increased benefits on insulin resistance in overweight children, indicating reduced risk of type 2 diabetes, regardless of sex or race,� they write.

�We also know that if you stop exercising, you lose all the benefits,� adds Dr. Davis. �Exercise works if you do it.�

Adult studies have yielded comparable findings regarding exercise�s impact on insulin resistance and cognition.

The researchers tested oral glucose tolerance, measuring insulin response after children drank a small amount of glucose, before and after the studies. �Once your glucose levels start to rise, it�s called impaired glucose tolerance and that is a precursor of diabetes. It�s called pre-diabetes now,� says Dr. Davis, noting that overweight children typically have higher insulin resistance than their leaner peers. Insulin resistance is an early sign of diabetes risk that appears before glucose levels start to rise. Growth associated with puberty can temporarily increase insulin resistance, Dr. Davis notes, so because some of the children were beginning puberty, they made adjustments for the level of sex hormones.

DEXA scanning, which uses a small amount of radiation to quantify bone, tissue and fat, was used to accurately assess body composition. Executive function was measured using the Cognitive Assessment System and math skills using the Woodcock Johnson Test of Achievement III.

�If physical education were ideal, which it�s not � it�s not daily and it�s not active � then children could achieve this within the school day,� Dr. Davis says, pointing to benefits derived by children exercising just 20 minutes a day. �We are not there. To achieve maximum benefit, we were able to show it will take more than PE.�

Scientists find predisposition to bronchiolitis in some babies

Fri, 19 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) LIVERPOOL, UK � 19 October 2007: Scientists have found that a large proportion of infants who suffer from bronchiolitis have an inherent pre-disposition to the disease.

The disease is the most prevalent acute wheezing disorder in infants and is the most common cause of admission to hospital in the first year of life in the developed world. Around 25 in every 1,000 babies are admitted to hospital for bronchiolitis - needing oxygen and help with feeding - and of these, 10% need the support of a ventilator.

Bronchiolitis frequently develops in infants suffering from respiratory syncytial virus (RSV) infection. Although most infants infected with RSV have only mild symptoms such as a cough and wheeze some develop potentially life-threatening bronchiolitis. Babies born prematurely are particularly susceptible to the condition but what has puzzled scientists is that the majority of babies admitted to hospital are previously healthy and have not had an obvious reason for becoming so ill.

A new study by University of Liverpool scientists, based at Alder Hey Children�s Hospital, has found that previously healthy babies with severe disease have a different immune response to those with only mild symptoms. The study involved nearly 200 infants under two years old admitted to Alder Hey over a five-year period. On admission to hospital, those with severe disease were taking more than 50 breaths per minute and their blood oxygen levels were dangerously low.

The study found that those with severe bronchiolitis had lower levels of interferon-gamma and substance P in their airway secretions. Gamma interferon is an important substance made in the body which is used to fight viral infections. The role of substance P is less understood but is thought to be involved in the local inflammatory response in many parts of the body.

Dr Calum Semple, Senior Lecturer in Child Health at the University of Liverpool and Consultant Respiratory Paediatrician based at Alder Hey, said: �This work helps to explain a common observation about children who had bronchiolitis as babies. Parents often tell us that every time their child gets a cold �it goes straight to his chest� and many parents and doctors believe that bronchiolitis in infancy is the cause of these chest problems in childhood.

�This study shows that it is the difference in the child�s ability to fight viruses that predisposes them to bronchiolitis in the first place. That poor ability to fight the condition is an innate feature of their immune system. Bronchiolitis just happens to be the commonest respiratory virus around and therefore the first virus a baby is likely to come across.

�Because the gamma interferon response is an important feature of the immune system in these children, they won�t handle subsequent respiratory viruses very well either. The association between bronchiolitis in babies and �chestiness� in childhood is not causal or consequential but due to a common immune predisposition and is probably genetic.�

St. Jude identifies the specific cell that causes eye cancer, disproving long-held theory

Thu, 18 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Investigators at St. Jude Children's Research Hospital have identified the cell that gives rise to the eye cancer retinoblastoma, disproving a long-standing principle of nerve growth and development. The finding suggests for the first time that it may one day be possible for scientists to induce fully developed neurons to multiply and coax the injured brain to repair itself.

A report of this work appears in the Oct. 19 issue of the journal �Cell.� Michael Dyer, Ph.D., an associate member in the St. Jude Department of Developmental Neurobiology, is the report�s senior author.

Retinoblastoma arises in the retina�the multi-layered, membrane lining the back of the eye that responds to light by generating nerve impulses that are carried into the brain by the optic nerve.

The immediate importance of the St. Jude finding is that it unexpectedly showed that retinoblastoma can arise from fully matured nerves in the retina called horizontal interneurons. This disproves the scientific principle that fully formed, mature nerves cannot multiply like young, immature cells, Dyer said. Human neurodegenerative disorders such as Alzheimer�s disease can occur when differentiated nerves in the brain try to multiply, and in the process, trigger a self-destruct program called apoptosis. Differentiation is the process by which cells lose their primitive, stem-cell-like properties that include the ability to grow and multiply, and instead develop specialized shapes and functions.

�For the past 100 years, it�s been ingrained among scientists that differentiated mature nerves are so elaborate that they can�t divide, and if they try to divide, they undergo apoptosis,� Dyer said. �There was no exception to this rule until now. This is the first time that anyone has shown that under certain conditions, a fully mature and differentiated nerve can undergo cell division and multiply.�

The discovery that fully differentiated horizontal interneurons can multiply to form retinoblastoma also challenges the established scientific belief that cancer cells are most aggressive when they are undifferentiated, Dyer said. For example, the leukemic cells of chronic myelogeneous leukemia (CML) are much less aggressive when they are differentiated; and it is generally not aggressive until the tumor cells sustain mutations that block differentiation.

�On the contrary, we showed that when certain genes are inactivated in the retina, horizontal neurons that are already differentiated and fully integrated into the brain can start multiplying rapidly and produce a very aggressive cancer,� Dyer said. �This opens an exciting new chapter in the study of neurons and brain tumors.�

An important implication of this finding is that if researchers were able to alter the activity of certain genes in fully developed neurons, they might be able to trigger them to multiply temporarily and replace the neighboring neurons that were lost as a result of neurodegenerative diseases such as Alzheimer�s, Dyer said. �Having nerves duplicate themselves might be more efficient than trying to stimulate nerve replacement by inserting stem cells into the brain, since the existing nerves would already be in the right place to restore missing brain cells,� he said. �However, there is still a lot of research required to determine if it is possible to control gene activity to make this approach practical.�

Dyer�s group made their discovery by developing different populations of mice whose retinas lacked one or more members of the Rb family of genes that include Rb, p107 and p130. This family of related genes is critical to the ability of an immature cell to stop dividing and begin to differentiate so it acquires certain specific characteristics required to do its job in the body.

The St. Jude researchers showed that when the mouse retina had reduced Rb family function, fully differentiated horizontal neurons could multiply while retaining all of the differentiated features of normal horizontal neurons.

As part of the study, the St. Jude team conducted microscopic and biochemical studies to prove that the multiplying cells were horizontal interneurons. Using such techniques, the researchers showed that as the horizontal interneurons multiplied their numbers up to 50-fold, they maintained their normal position in the retina as well as their normal connections to other cells.

If the horizontal interneuron cell division was allowed to proceed unchecked, highly differentiated tumors formed that resembled normal horizontal neurons. Unexpectedly, these tumors were aggressive and spread rapidly.

The investigators concluded that the Rb family�s only task is to prevent mature horizontal interneurons from multiplying as they did when they were immature cells.

Massive microRNA scan uncovers leads to treating muscle degeneration

Wed, 17 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Researchers have discovered the first microRNAs � tiny bits of code that regulate gene activity � linked to each of 10 major degenerative muscular disorders, opening doors to new treatments and a better biological understanding of these debilitating, poorly understood, often untreatable diseases. The study, to be published online this week by the Proceedings of the National Academy of Sciences, was led by Iris Eisenberg, PhD, of the Program in Genomics at Children�s Hospital Boston. Louis Kunkel, PhD, director of the Program in Genomics and an investigator with the Howard Hughes Medical Institute, was senior investigator.

The disorders include the muscular dystrophies (Duchenne muscular dystrophy, Becker muscular dystrophy, limb girdle muscular dystrophies, Miyoshi myopathy, and fascioscapulohumeral muscular dystrophy); the congenital myopathies (nemaline myopathy); and the inflammatory myopathies (polymyositis, dermatomyositis, and inclusion body myositis). While past studies have linked them with an increasing number of genes, it's still largely unknown how these genes cause muscle weakness and wasting, and, more importantly, how to translate the discoveries into treatments.

For instance, most muscular dystrophies begin with a known mutation in a �master gene,� leading to damaged or absent proteins in muscle cells. In Duchenne and Becker muscular dystrophies, the absent protein is dystrophin, as Kunkel himself discovered in 1987. Its absence causes muscle tissue to weaken and rupture, and the tissue becomes progressively nonfunctional through inflammatory attacks and other damaging events that aren�t fully understood.

�The initial mutations do not explain why patients are losing their muscle so fast,� says Eisenberg. �There are still many unknown genes involved in these processes, as well as in the inflammatory processes taking place in the damaged muscle tissue.�

She and Kunkel believe microRNAs may help provide the missing genetic links. Their team analyzed muscle tissue from patients with each of the ten muscular disorders, discovering that 185 microRNAs are either too abundant or too scarce in wasting muscle, compared with healthy muscle.

Discovered in humans only in the past decade, microRNAs are already known to regulate major processes in the body. Therefore, Eisenberg believes microRNAs may be involved in orchestrating the tissue death, inflammatory response and other major degenerative processes in the affected muscle tissue. The researchers used bioinformatics to uncover a list of genes the microRNAs may act on, and now plan to find which microRNAs and genes actually underlie these processes.

The findings raise the possibility of slowing muscle loss by targeting the microRNAs that control these �cascades� of damaging events. This approach is more efficient than targeting individual genes.

The team also defined the abnormal microRNA �signatures� that correspond to each of the ten wasting diseases. They hope these will shed light on the genes and disease mechanisms involved in the most poorly understood and least treatable of the degenerative disorders, such as inclusion body myositis.

�At this point, it�s very theoretical, but it�s possible,� says Eisenberg.

Obese children show early signs of heart disease

Wed, 17 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Children who are obese or who are at risk for obesity show early signs of heart disease similar to obese adults with heart disease, a study by researchers at Washington University School of Medicine in St. Louis has found.

�Based on this study, these subtle markers can help us predict who could be at risk for heart disease and heart attacks,� said Angela Sharkey, M.D., associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children�s Hospital.

The study was published in the Winter 2007 issue of the Journal of Cardiometabolic Syndrome.

Childhood obesity in the United States is an epidemic -- nationwide, 19 percent of children ages 6 to 11 and 17 percent of those 12 to 19 are overweight, according to the Centers for Disease Control and Prevention (CDC). Those who are overweight during childhood also have an increased risk of obesity in adulthood and are at greater risk for complications such as diabetes, high blood pressure and heart disease, because obesity increases total blood volume, which leads to extra stress on the heart.

Sharkey and Steven M. Lorch, M.D., a former fellow at the School of Medicine now at University of Texas Health Science Center at Houston, analyzed data from 168 children ages 10 to 18 who had been referred to them for cardiac ultrasound with symptoms including heart murmur, chest pain, acid reflux or high blood cholesterol. Based on CDC guidelines for body mass index for age (BMIA), 33 patients were found to have a BMIA as obese, or the 95th percentile or above for their age; 20 had a BMIA that classified them as at risk for obesity, or between the 85th and 94th percentile; and 115 were considered normal, or below the 85th percentile.

To analyze the hearts of the obese children and those at risk, Sharkey and Lorch used a new tissue Doppler imaging technique called vector velocity imaging which tracks the movement of the heart�s muscular wall. Any changes in the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion.

�In the patients who are obese, the rate of motion of heart muscle changed,� Sharkey said. �As a child�s BMIA increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were assumed to be from long-standing obesity, but it may be that these changes start much earlier in life than we thought.�

As vector velocity imaging becomes more broadly available, Sharkey said, it could potentially help pediatric cardiologists follow these children more closely over time to see if changes in the heart progress.

�We may be able to determine whether we could intervene in the process, such as focusing the families on understanding the importance of regular exercise and dietary modifications for weight loss and prescribing statin drugs for high-blood cholesterol,� she said.

Sharkey said the results of the study give more ammunition to physicians to use in counseling pediatric patients and their parents about the risks of obesity and the need to attain a healthy weight.

�Even in teenagers, obesity leads to decreased myocardial performance and abnormal diastolic function,� she said.

Further study is needed to determine how soon the changes in the heart set in after a child becomes obese and whether those changes are reversible with weight loss.

Septic survival

Wed, 17 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) While survival rates for sepsis have increased over the past two decades, children under four and those in adolescence remain highly susceptible to the condition. Researchers in The Netherlands have now demonstrated that age and to a lesser extent, gender, are critical factors in whether or not a child sufferer will develop a more severe disease state and survive or not. These findings could help to improve the treatment of sepsis and improve survival rates further still.

Writing in the online open access journal Critical Care, Jan Hazelzet and colleagues at the Erasmus MC-Sophia Paediatric Intensive Care Unit (PICU) in Rotterdam describe their study of almost 300 children admitted with sepsis and purpura (red patches caused by bleeding under the skin) between 1988 and 2006. The researchers recorded the age, gender, ethnic origin, severity of condition, therapy, and survival of the patients. They then pooled the data and analyzed the outcomes retrospectively.

The results showed that the fatality rate from sepsis and purpura was 15.7%. However, during the study period, they observed a marked improvement in the numbers of children surviving sepsis. Nevertheless, they found that younger children were affected more severely and fatality rate was higher (4.3 times) for those under the age of three years. They found no difference in fatality rates between boys and girls, but boys were admitted to the PICU for longer periods and had more severe symptoms. The team found that the course of sepsis and purpura was not related to a child's ethnic origin.

In almost all cases, the infection that led to sepsis was Neisseria meningitidis, the bacterium commonly known as meningococcus. The team also reports how the drugs used to treat sepsis changed during the course of the study. There has been a marked reduction in the use of dopamine and a concomitant increase in the use of dobutamine, norepinephrine and corticosteroids to treat sepsis. The finding of the important influence of young age and to a lesser extent gender can lead to a better understanding of the disease, which in turn can lead to better therapy, says Jan Hazelzet.

Sepsis is a serious medical condition triggered by infection, which leads to body-wide inflammation, fever, increased pulse and breathing, and potentially organ failure and death. Each year, more than 750,000 people in the USA will develop severe sepsis, and more than 215,000 will die from the condition. In the UK, sepsis kills around 30,000 people annually.

Reunion with patient inspires follow-up study on treatment for DiGeorge syndrome

Tue, 16 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) More than 20 years ago, doctors at Mattel Children's Hospital UCLA performed a successful bone marrow transplant on a baby girl who was born without a thymus gland and was suffering from severe immune deficiency. It marked the first time a bone marrow transplant, rather than a thymic transplant, had been used to treat the genetic condition known as DiGeorge Syndrome (DGS).

The doctors lost track of the young girl when her family moved away but were reunited with her when she returned to UCLA for heart treatment in 2005. Upon rechecking the young woman's immune system, they were pleased to learn that she continued to do well.

Inspired by her positive long-term outcome � along with a handful of other DGS bone marrow transplant patients worldwide � UCLA researchers embarked on a study to follow up on the benefits of bone marrow transplant treatment. Their findings are published in the October 2007 issue of the peer-reviewed Journal of Allergy and Clinical Immunology.

Overall, the researchers found that survival with bone marrow transplant was greater than 75 percent, similar to thymic transplantation.

We believe that this long-term follow-up study indicates that bone marrow transplant is a good procedure � and more readily available than thymic transplantation � for complete DiGeorge syndrome, said co-author Dr. E. Richard Stiehm, professor of pediatrics in the division of immunology, allergy and rheumatology at Mattel Children's Hospital UCLA. This also suggests that the thymus may not be necessary for immune development after birth, or that other tissues, such as the skin, may serve as a thymus equivalent.

DiGeorge syndrome is a common genetic immunodeficiency that occurs in one out of every 2,000 people. The syndrome includes thymic and parathyroid deficiency, chromosome abnormalities, low calcium levels and decreased immunity. Patients often have heart problems and developmental delay, which bone marrow or thymic transplants do not correct. Only a few patients have the severely deficient immune systems characteristic of complete DGS, which is similar to severe combined immunodeficiency (also known as bubble boy syndrome) and is fatal if untreated.

In this first report of extended survival in patients with complete DGS who were treated with bone marrow transplant with long-lasting immune reconstitution, researchers described the medical history and current immune function of two DGS patients who received transplants more than two decades ago. Now in their 20s, both patients lead normal lives free of serious infections and have preserved immune function.

The study also reviewed nine additional cases from other centers internationally and assessed the current status of all patients but one.

The thymus produces hormones that stimulate the production of certain infection-fighting cells. It is also of central importance in the maturation of T-cells (thymic cells), which help build immunity.

According to Stiehm, the thymus gland is the university of the immune system.

Stem cells must go there to be educated before entering the circulation to fight organisms, he said. The thymus continues to put out T-cells for a lifetime. It puts out naive T-cells that are then exposed to microbes to become memory T-cells. It was previously thought that the body needs a continuous supply of new naive cells to keep the immune system functioning, but now we think that maybe it's not necessary, since the memory cells from the donor may serve for a lifetime.

The significance is that adult memory cells from bone marrow, or peripheral blood, can persist in the circulation for several decades and keep the patient well, even though new naive T-cells from the thymus are not produced.

A bone marrow transplant works by replacing the patient's marrow with healthy marrow from a matched donor. Ultimately, the new marrow helps the patient produce normal blood cells.

A thymic transplant is an effective but complicated procedure that involves transferring the thymus tissue of another infant undergoing heart surgery, culturing it, and then surgically implanting it in the patient. It then takes several months for the thymus gland to grow and allow the patient to develop a functioning immune system.

Thymus transplantation is available in the U.S. only at Duke University's medical center. By contrast, bone marrow transplant is a standard procedure available at many large medical centers across the country and internationally.

UD named a regional research participant in National Children�s Study

Mon, 15 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The University of Delaware has been named a regional research participant in the National Children's Study--the largest long-term study of children's health ever conducted in the United States.

The study, which is funded by the National Institutes of Health, will follow an estimated 100,000 children in communities across the United States, from before birth to 21 years of age. It will seek information to prevent and treat some of the nation's most pressing health problems, including autism, birth defects, diabetes, heart disease and obesity.

Over the next two decades, researchers from UD's Center for Disabilities Studies, the School of Nursing and the Department of Individual and Family Studies, in partnership with Christiana Care Health System and the Nemours/Alfred I. duPont Hospital for Children, will monitor the health of 1,100 children in New Castle County, Del., which is one of 105 study sites selected for the nationwide initiative. The Delaware study site is part of a regional collaboration managed by the Children's Hospital of Philadelphia and Drexel University College of Medicine.

�We are excited to launch this long-term research partnership that will ultimately impact the health of our children as well as federal and state policy decisions,� said Bethany Hall-Long, associate professor of nursing in UD's College of Health Sciences and the Delaware study center's principal investigator. Hall-Long also holds a joint appointment as an associate policy scientist in the Health Services Policy Research Group in the College of Human Services, Education and Public Policy.

�Here at UD, we will be busy with project management, community outreach, home visits and child health assessments. It is an honor to be part of such a terrific team,� Hall-Long noted.

Deborah Amsden, a researcher at UD's Center for Disabilities Studies in the College of Human Services, Education and Public Policy, is the project director. She will oversee day-to-day operations, from recruiting field staff to monitoring the extensive data on children and the environment that will be collected during the 25-year effort.

Martha Buell, professor, and Christine Ohannessian, associate professor, both in UD's Department of Individual and Family Studies, also will play an integral role in the Delaware study center's operation.

A major objective of the study is to examine how environmental inputs and genetic factors interact to affect the health and development of children, Amsden said.

�We'll be collecting a great deal of information on environmental quality, including air and water samples from where these children live,� Amsden noted. �There will be opportunities for faculty and student involvement from across the University in this interdisciplinary project, which will provide access to a national protocol for collecting data on children and their environment over a long period of time.�

The study will officially launch in 2008, with the first data to be collected in 2009. Two hundred fifty children will be identified for the first phase of the study, with successive groups of children to be added each year for five years.

The study is being conducted in 105 U.S. locations that together are representative of the nation's population. A national probability sample was used to select the counties in the study, which took into account such factors as race and ethnicity, income, education level, number of births and babies born with low birth weights.

Programs show short-term benefits in helping children maintain weight loss

Tue, 09 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Children who lost weight were able to keep it off more effectively by participating in maintenance treatment programs that emphasized behavioral skills or social facilitation, although the effectiveness lessened over time, according to a study in the October 10 issue of JAMA.

The prevalence of overweight among children in the United States has tripled in recent decades and related health care costs have nearly quadrupled, according to background information in the article. �Lifestyle interventions remain the most well-established interventions for overweight 7- to 12-year-olds. Although some evidence supports long-term efficacy, maintaining weight loss remains a challenge, with most interventions marked by considerable relapse,� the authors write.

Denise E. Wilfley, Ph.D., of Washington University School of Medicine, St. Louis, and colleagues evaluated the effects of two interventions following standard family-based behavioral weight loss treatment: a behavioral skills maintenance (BSM) and a social facilitation maintenance (SFM) intervention, compared to no intervention.

The BSM approach is based on the premise that specific strategies are needed for weight loss maintenance, emphasizing self-regulation behaviors and relapse-prevention strategies. The SFM approach is based on the premise that relapse results from the absence of a social environment supportive of continued weight control. This approach also targets peer (e.g., teasing) and self-perceptual (e.g., body image) factors identified as barriers to overweight children�s physical activity.

The randomized controlled trial, conducted between October 1999 and July 2004 in a university-based weight control clinic, included 204 healthy 7- to 12-year-olds, 20 percent to 100 percent above median (midpoint) body mass index (BMI) for age and sex, with at least one overweight parent. Children enrolled in five months of weight loss treatment and 150 were randomized to one of three maintenance conditions: control group or four months of BSM or SFM treatment. Follow-up assessments occurred immediately following maintenance treatments and 1 and 2 years following randomization.

The researchers found that children receiving either BSM or SFM maintained relative weight significantly better than children assigned to the control group from randomization to postweight maintenance. Active maintenance treatment effectiveness relative to the control group declined during follow-up, but the effects of SFM alone and when analyzed together with BSM were significantly better than the control group when examining certain BMI score outcomes from baseline to 2-year follow-up. Baseline child social problem scores moderated child relative weight change from baseline to 2-year follow-up, with low social problem children in SFM vs. the control group having the best outcomes. There were no significant differences in child weight outcomes between BSM and SFM in either the short-term or long-term.

�The alarming prevalence of child overweight necessitates the development of more effective long-term intervention strategies. Our study demonstrated that extended treatment contact with either a continued BSM focus or a novel SFM focus improves weight loss maintenance in a childhood overweight population in comparison with a weight loss program alone at least in the short-term, with some evidence for sustained long-term efficacy among more socially adept children receiving an SFM treatment,� the researchers write.

(JAMA. 2007;298(14):1661-1673. Available pre-embargo to the media at

Virtual game helps children escape realities of burn unit

Mon, 08 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) COLUMBUS, Ohio -- Nurses and physicians at Nationwide Children�s Hospital are using the latest technology to help young burn victims endure the extreme pain of dressing changes and wound care. Instead of traditional distraction devices, such as books and music, Nationwide Children�s Hospital Burn Center is now using virtual reality games to distract patients while nurses attend to the patients� burn wounds.

�It�s long been known that the actual treatment for a burn is far worse than the actual injury. Initially, the wound has to be cleaned and the dressing applied, and that can be a very painful and lengthy procedure,� said Dr. Catherine Butz, PhD, a psychologist at Nationwide Children�s Hospital and an Assistant Professor at The Ohio State University College of Medicine.

Following this initial treatment, patients must endure subsequent wound care procedures, some of which can be both extensive and painful, depending on the extent of the burn. During these procedures, anxiety often plays a major role in the patient�s pain level.

�Research shows a very strong connection between anxiety and pain,� said Dr. Butz. �Distraction does a great job in decreasing any kind of anxiety that might be associated with the anticipated procedures, so by distracting patients and keeping anxiety at a minimum, procedures tend to go much more smoothly and be much less painful for the child.�

The device, made possible by a donation from the Aladdin Shriner�s Hospital Association for Children, allows patients to escape into a computer-generated world complete with its own environment, creatures and sounds. Patients wear a virtual reality helmet, and once in this new world, they interact in the virtual environment with the help of child life specialists, trained to assist kids through stressful medical treatments.

Since Nationwide Children�s Hospital began using the device in May 2007, it has already resulted in positive feedback from burn patients. Burn nurses report several patients have noticeably improved in terms of their ability to tolerate dressing changes.

In order to better understand the effect on pain, doctors at Nationwide Children�s have launched a study to compare the results of virtual reality pain distraction with traditional distraction techniques, such as watching television, listening to music, counting and deep breathing. Patients will be randomly assigned to receive virtual reality or another pain distraction technique. Following the procedure, they will be asked to gauge their level of pain on a scale of zero to 10. The study will also assess the perspectives of parents and nurses in terms of the child�s pain and level of distress.

The burn program�s goal is to be able to better engage the child in a distraction activity which will hopefully have a beneficial affect on the procedure. An added benefit for patients may be a decrease in the amount of pain and anxiety medications needed. However doctors point out that pain is a very individual experience, and the benefits of virtual reality distraction as well as the level of medication must be determined on a case by case basis.

How pitching changes little leaguers' shoulders

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) At this year's Little League World Series, new rules for the first time forced players to limit the number of times pitchers could throw the ball, and coaches had to strategize how pitchers were used more carefully.

Under the old system, a pitcher age 12 and under could throw up to six innings per week and six innings per game. But in response to an increase in reported cases of young pitchers experiencing arm and shoulder problems, this year the Little League instituted pitch limits rather than innings limits, and required specific rest periods when a pitcher reached the threshold of pitches delivered in a day. Under the new rules, anyone who throws more than 20 pitches in a day needs to rest a day before he can pitch again. If pitchers throw 85 pitches in a day, they must rest at least three days before pitching again.

When Dr. Scott Mair and colleagues at the University of Kentucky began research into what throwing really does to young arms and shoulders seven years ago, they had many questions about those physical changes since most research until then had focused only on adult players. Now that their research is complete, Mair has those answers, along with one surprising finding.

To evaluate these adaptive changes, the study followed 32 male baseball players between 13 and 21 years of age for six years to study changes in the shoulder's range of motion and strength, along with any growth plate changes shown by X-ray images.

What the researchers found was that repeated pitching does cause changes in the upper arm bone and soft tissue in the shoulders of young baseball players, but that these types of changes generally help protect players from injury, so it's not necessarily a bad thing. Mair said these changes may actually allow for better throwing velocity and less injuries to the shoulder.

However, he cautioned, pitching too much and playing year-round can push those adaptive changes to the point of injury. Young men in particular may be prone to injury, because some play the game year-round, and because the bones and muscles in their arms are still growing and changing.

One surprise finding in the study was that X-rays showed changes in the growth plate in the throwing shoulder in almost all of the kids. In the past it had been thought that these types of changes only occurred when there was a problem and resulted in pain with throwing.

Overall, Mair said parents of young baseball players shouldn't be overly concerned about their children's shoulders. Throwing is fine as long as it's in moderation and the parents and child use common sense, he said. A 10-year-old pitcher shouldn't be throwing through pain to win a Little League game, for example.

Young players do need a break from throwing, Mair said. In the old days kids played baseball in the summer and then played basketball or football in the winter. That was better for growing children because varying the sports used different muscles and movements, he said. But now, some children play only baseball year-round, and that can be a problem. It can cause shoulder changes that go beyond normal adaptation, and can lead to pain and even growth plate injuries.

Kids that are pitching in three different leagues and pitching 12 months of the year tend to get growth plate problems that turn into a source of pain, Mair said.

Jim Madaleno, a senior athletic trainer for the UK Department of Athletics and father of a 14-year-old son who was part of Mair's study, knows all too well about the variety of pain that can come with playing sports. Aches and pains are a part of it, but when an ache and a pain become significant enough that it alters how you're doing your everyday activity, then you should consult a physician, he said.

Now that this part of the research is complete, Mair said there's still a lot of work to be done in finding out how the growth plate responds to throwing, how to keep kids from being injured, determining pitch counts and days of rest needed, and in educating kids, parents and coaches.

Both Mair and Madaleno agree children shouldn't be pushed to play a sport just because they may be better at it than others. There needs to be time put aside to let the kids be kids, and not just kids who are in a sport, Madaleno said.

UMass Medical School awarded National Children's Study contract

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) WORCESTER, Mass.�The National Institute of Child Health and Human Development (NICHD) announced today that the University of Massachusetts Medical School (UMMS) was awarded a competitive contract to participate in the landmark National Children�s Study (NCS), the largest study to be conducted in the United States to assess the effects of environmental and genetic factors on child and human health. The study will follow 100,000 children from before birth to age 21, seeking information to prevent and treat some of the nation�s most pressing health problems, including autism, birth defects, diabetes, heart disease and obesity.

�This is a watershed moment for UMass Medical School as the Commonwealth�s research institution,� said Terry R. Flotte, MD, executive deputy chancellor of UMMS and dean of the School of Medicine. �We have long held public health as our passion and our obligation, and we are exceptionally proud to be chosen as one of a select few to make such an important contribution to the body of knowledge related to child health and development. This contract award is a testament to the Medical School�s demonstrated ability to conduct exceptional public health and epidemiological research and our capacity to engage the community in this study.�

�UMMS is uniquely positioned to accept this charge from the NICHD in part because of the partnerships we have established throughout the community and the trust we have earned over decades of caring for families and children,� said Marianne E. Felice, MD, chair of pediatrics for UMMS and physician-in-chief of UMass Memorial Children�s Medical Center. Felice is the principal investigator of the UMMS arm of the NCS, which will be known as the Massachusetts Children�s Health Indicators and Life Determinants study (MassCHILD). �Many of our faculty are already recognized in the community for the important public health research they have conducted, and we believe parents will work enthusiastically with us on this study. We�re delighted that families of Worcester County will be able to contribute to the health of the nation for generations to come. Furthermore, by being participants in this prestigious study, we may be able to identify solutions to issues of children�s health that are important to us in this area, such as infant mortality.�

UMMS is one of 22 new study centers of the NCS, which began in response to the Children�s Health Act of 2000, when Congress directed the NICHD and other federal agencies to undertake a national, long-term study of children�s health and development in relation to environmental exposures. Through the NCS, contracted centers will collect a broad range of biological and environmental samples and data to generate a comprehensive database of material that will provide researchers, health care providers and public health officials with information from which to develop preventive strategies and health and safety guidelines. Data will be collected in 105 specific previously designated counties in the U.S. There are only two counties in Massachusetts that qualify for the NCS �Worcester and Bristol counties�but the current funding is only designated for Worcester County. The 105 counties were selected through a national probability sample that took into account factors such as race and ethnicity, income, education level, number of births, and number of births of low birth weight babies, and together are representative of the entire U.S. population.

The Medical School�s contract represents more than $16 million for the first five-year phase, during which UMMS will begin recruiting and training the equivalent of 88 full-time staff and working with community leaders in preparation for opening enrollment into the study in the summer of 2009. Funding for the 22 study centers and the study�s initial phase is a result of a $69 million appropriation from Congress in fiscal year 2007. Funding is expected to increase for subsequent phases over the life of the study. Additional contracts are to be awarded at a later date, but will probably total no more than 35 to 40 centers to collect data from all 105 counties. UMMS will work with faculty from Clark University for their expertise in geographic information systems, which will be instrumental in household selection for the survey. Each study site, or county, is expected to enroll 1,000 participants in four years, which will likely require identification of more than 13,000 households in which there may be pregnant women in the first trimester of pregnancy or women who could become pregnant in the next year. In fact, 25 percent of the children are to be identified before they are even conceived.

Additional UMMS faculty serving as co-investigators on the MassCHILD team are Thomas McLauglin, ScD (Co-Principal Investigator); Onesky Aupont, MD, PhD (Operations Manager and Co-Investigator); Katherine Luzuriaga, MD (Co-Investigator); Janet Hardy, PhD (Co-Investigator); Tiffany Moore-Simas, MD, MPH (Co-Investigator); and Judith Ockene, PhD, MEd, MA (Co-Investigator).

In addition to UMMS, 21 other study centers were named today, representing 25 other study locations: Brown University (Providence, R.I.); Children�s Hospital of Philadelphia (Schuylkill, Pa., and New Castle, Del.); Emory University (DeKalb and Fayette Counties, Ga.); Johns Hopkins University (Baltimore, Md.); Michigan State University (Wayne County, Mich.); Mount Sinai School of Medicine (Nassau County, N.Y.); Northwestern University (Cook County, Ill.); St. Louis University (Macoupin County, Ill., and St. Louis, Mo.); University of California, Davis (Sacramento County, Calif.); University of California, Irvine (San Diego County, Calif.); University of California, Los Angeles (Los Angeles County, Calif.); University of Hawaii at Manoa (Honolulu County, Hawaii); University of Minnesota (Ramsey County, Minn.); University of Mississippi (Hinds County, Miss.); University of New Mexico (Valencia County, N.M.); University of North Carolina at Chapel Hill (Rockingham County, N.C.); University of Pittsburgh (Marion County, W.Va., and Westmoreland County, Pa.); University of Texas Health Science Center at San Antonio (Bexar County, Texas); University of Utah (Cache County, Utah); University of Washington (King County, Wash.); and Yale University (New Haven County, Conn.).

UCLA to lead local study center in landmark government study of child health

Thu, 04 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The UCLA Center for Healthier Children, Families and Communities has been selected as one of 22 new study centers for the National Children�s Study, a nationwide project designed to assess the effects of environmental and genetic factors on children�s health in the United States. The study center will manage local participant recruitment and data collection for the largest study of child health ever conducted in the United States.

The National Children�s Study is a collaborative effort between the U.S. Environmental Protection Agency and the Department of Health and Human Services (including the National Institute of Child Health and Human Development, the National Institute of Environmental Health Sciences at the National Institutes of Health, and the Centers for Disease Control and Prevention).

�This study is big science and it will be one of the most important generators of new knowledge on child and adult health and development ever attempted,� said principal investigator Dr. Neal Halfon, professor of pediatrics, public health and public policy at UCLA and director of the UCLA Center for Healthier Children, Families and Communities. �It will help children across the U.S. and shape child health guidance, interventions and policy for generations to come.�

The National Children�s Study will eventually follow a representative sample of 100,000 children from before birth to age 21, seeking information that will help prevent and treat some of the nation�s most pressing health problems, including autism, birth defects, diabetes, heart disease and obesity. To better understand the impact of exposures on the developing fetus, infant and child, the study will recruit pregnant women, as well as women who are likely to become pregnant, in order assess environmental health influence during the pre-pregnancy and prenatal period.

The UCLA Center for Healthier Children, Families and Communities is an internationlly distiguished leader in child health research and policy. The grant will be housed within the division of child health policy and community pediatrics at Mattel Children�s Hospital UCLA. The UCLA-based team of scientific investigators will be joined by collaborating investigators from Cedars-Sinai Medical Center, the University of Southern California, Charles R. Drew University of Medicine and Science, the Los Angeles Department of Public Health, First 5 Los Angeles County, the Ventura County Public Health Department, First 5 Ventura County, the Research Triangle Institute and the Rand Corp.

The NIH has approved $47.9 million to launch the study and enroll 5,000 children in Los Angeles and Ventura counties, in waves of 1,000. The first installment of funding, $14.7 million, will cover the establishment of the study center, a 22-month planning phase and a 38-month enrollment of the first 1,000 children. Actual data collection for this first wave is scheduled to begin in the late summer of 2009.

The National Children�s Study is on a par with other major scientific projects like the Human Genome Project and the Women�s Health Study, and the NIH estimates that the study�s price tag the over the next 30 years will reach the $3 billion mark. At this point, Congress has yet to authorize the full amount needed for the study and has chosen to provide incremental funding.

�While $3 billion is a lot of money, over this 30-year period it will represent less than 1 percent of the NIH annual research budget,� said Dr. Michael Lu, associate professor of obstetrics and gynecology and public health at UCLA and a lead investigator for the study.

Supporters of the study further argue that six of the health conditions the study will target � asthma, obesity, schizophrenia, autism, learning disabilities and injuries � currently cost the nation more than $600 billion dollars a year. If knowledge resulting from the study was to reduce expenditures for these conditions by 1 percent, the study would pay for itself many times over.

The University of California is well-represented in the study and will contribute much-needed expertise. In addition to UCLA, other new study centers were awarded to UC Irvine (for San Diego and San Bernardino counties, to go along with the existing Vanguard Center for Orange County) and UC Davis (for Sacramento and San Mateo counties). With the collaboration between the lead UC centers and additional sites, it is projected that more than 10,000 Californians will be enrolled in the study.

When fully funded, the study will be conducted in 105 study locations across the United States. A national probability sample was used to select the counties in the study, which will be representative of the U.S. population as a whole.

The National Children�s Study began in response to the Children�s Health Act of 2000, when Congress directed the National Institute of Child Health and Human Development and other federal agencies to undertake a long-term national study of children�s health and development in relation to environmental exposures. A group of more than 2,000 scientists from across the U.S. have been designing and planning the study for the past six years.

Today�s announcement of the new study centers follows earlier study milestones, including the 2004 announcement of the 105 study locations and the establishment of the seven Vanguard centers in 2005.

�We urge the public to watch out for future announcements about the National Children�s Study and opportunities to enroll children from Los Angles County starting in 2009 and Ventura County at a later date,� said co-principal investigator, Dr. Calvin Hobel, who is vice chair of the department of obstetrics and gynecology at Cedars-Sinai Medical Center and holds the Miriam Jacobs Chair in Maternal-Fetal Medicine. �This is a historic and once-in-a lifetime opportunity that will advance our understanding of the causes and prevention of some of the common and rare disorders of childhood.�

UT Southwestern investigating hypothermic technique in treating pediatric head injuries

Wed, 03 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) DALLAS � Oct. 3, 2007 � UT Southwestern Medical Center has been selected to take part in an $11.5 million multicenter clinical trial that is examining the effectiveness of induced hypothermia as a therapy for brain swelling in children who have suffered severe traumatic brain injuries.

The 12 centers that are participating in the trial are expected to enroll a total of 340 children up to age 16 in the five-year trial, which is being funded by the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health. Children�s Medical Center Dallas, which has a Level I pediatric trauma center, will serve as the local coordinating site. The study is being led by Children�s Hospital of Pittsburgh.

Pediatric patients who are eligible for the trial must have severe brain injury caused by blunt trauma. This excludes patients who have suffered injuries that penetrate the skull such as gunshot wounds.

Those patients selected to receive hypothermia therapy will be cooled to between 32 and 33 degrees Celsius (89 to 90 degrees Fahrenheit), using special cooling blankets and/or cooled saline given intravenously. In addition to normal emergency care, they will remain cooled for 48 hours while being closely monitored in the intensive care unit. Children will be tracked by researchers for one year to record outcomes, with a battery of tests being conducted at six and 12 months following the injury.

�Trauma is the leading cause of death and disability in children, more than all other causes combined,� said Dr. Pam Okada, associate professor of pediatrics at UT Southwestern and lead investigator of the Dallas trial. �Previous studies have shown hypothermia is not only safe in children following severe traumatic brain injury, but may improve their chance of survival.�

It had been thought that children had better outcomes than adults following traumatic brain injury, Dr. Okada said. In fact, it has been demonstrated that younger children (those younger than 4) actually have worse outcomes. Problems that develop with motor, behavior, learning, memory and other higher-level functions are common even in children with only �moderate� or �mild� concussions or injuries, she said.

�In head injuries where the skull remains intact there is little room for swelling,� Dr. Okada said. �This causes diminished blood flow resulting in brain damage. Cooling the body may reduce the swelling and possibly prevent continuing damage. If this therapy proves effective, it would be a major breakthrough in the treatment of traumatic brain injuries.�

According to federal and state laws, those who participate in a clinical research study must provide or, in the case of a child, have a guardian provide informed consent. Because of the nature of this trial and the fact that hypothermia must be induced within six hours of injury, it may be sometimes impossible to obtain consent at the time of brain injury.

For this reason, researchers are notifying the public that informed consent will be waived. Every attempt to contact family members to provide notification and obtain consent for continued participation will be made as soon as possible after enrollment.

UAB wins $5.7M neurofibromatosis grant

Tue, 02 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) BIRMINGHAM, Ala. � A team of UAB geneticists, doctors and biostatisticians has received $5.7 million from the U.S. Department of Defense to study and test new treatments for neurofibromatosis, or NF.

UAB is the lead research center in a nine-institution group called the NF Consortium. The coalition formed more than two years ago to design and manage multiple clinical trials held across the nation looking at new and more effective therapeutic options for adults and children diagnosed with NF.

The $5.7 million award will be shared among the NF Consortium members, with UAB�s research team serving as the operations center and distribution point for the government funds.

Bruce Korf, M.D., Ph.D., chair of the UAB Department of Genetics and an internationally recognized expert in neurofibromatosis type 1, said the goal of the consortium is to streamline and improve the way clinical trials are performed for this disease, and to break down past barriers to discovering and testing cutting-edge NF treatments.

�We expect results from the NF Consortium studies to provide a wider range of therapeutic options for patients with the goal of reducing the rates of tumor growth, and improving quality of life,� Korf said.

�By monitoring not only the clinical outcomes, but the effects of therapies on molecular targets, it will be possible to better understand NF as a disease,� he said.

The other eight participating institutions are Children�s Hospital Boston, Children�s Hospital of Philadelphia, Children�s National Medical Center in Washington, D.C., Cincinnati Children�s Hospital Medical Center, Washington University in St. Louis, the University of Chicago, the University of Utah in Salt Lake City, and the National Cancer Institute in Bethesda, Md.

Often diagnosed in childhood, NF is a hereditary condition that causes tumors to grow on nerve tissue that affects many bodily systems. As the tumors grow, they can press on vital areas and lead to deformities, high blood pressure, scoliosis, speech impairment, early or delayed puberty, blindness and other medical problems. About 10 percent of NF type 1 cases lead to cancer.

The recent $5.7 million grant is in addition to $2.9 million awarded two years ago to start the NF Consortium. The recent award will be used to put the group�s scientific plans into action, said Jeannette Y. Lee, Ph.D., a biostatistician and professor in the UAB School of Medicine. Lee directs the NF Consortium operations center and serves as the grant�s overall principal investigator.

Lee said three clinical trials will be the focus of the consortium�s first studies. These include:

Childhood TV viewing a risk for behavior problems

Mon, 01 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Daily television viewing for two or more hours in early childhood can lead to behavioral problems and poor social skills, according to a study of children 2.5 to 5.5 years of age conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The Hopkins researchers found that the impact of TV viewing on a child�s behavior and social skills varied by the age at which the viewing occurred. More importantly, heavy television viewing that decreased over time was not associated with behavior or social problems. The American Academy of Pediatrics recommends that children under age 2 watch no television while children age 2 and older are limited to no more than two hours of daily viewing. The study is published in the October 2007 issue of Pediatrics.

�A number of studies have demonstrated negative effects of heavy television viewing. However, timing of exposure is an important consideration as reducing viewing to acceptable levels can reduce the risk of behavioral and social problems,� said Kamila Mistry, MPH, lead author of the study and a doctoral candidate in the Bloomberg School�s Department of Population, Family and Reproductive Health.

For the study, the research team analyzed data for 2,707 children collected from the Healthy Steps for Young Children national evaluation. Parents were surveyed about their child�s television viewing habits and behavior at 2.5 and at 5.5 years of age.

Sixteen percent of parents reported that their children watched two hours or more of television daily at 2.5 years of age (early exposure), while 15 percent reported that their children watched two hours or more of television daily at 5.5 years of age (concurrent exposure). One in five parents reported that their children watched two hours or more of television daily at both 2.5 years and at 5.5 years of age (sustained exposure). Sustained exposure to television was associated with behavioral problems. However, early exposure that was subsequently reduced was not a risk for behavior problems. Concurrent viewing was associated with fewer social skills, while sustained and early viewing had less of an impact on social skill development.

The study also found that having a television in the child�s bedroom at 5.5 years of age was associated with behavioral problems, poor social skills and poor sleep. Forty-one percent of the children included in the study had a television in his or her bedroom.

�Children who reduced their viewing by 5.5 years of age were not at greater risk for behavior and social problems,� said Cynthia Minkovitz, MD, MPP, senior author of the study and associate professor with the School�s Department of Population, Family and Reproductive Health. �It is vital for clinicians to emphasize the importance of reducing television viewing in early childhood among those children with early use.�

More reports of children having trouble falling asleep than maintaining sleep

Mon, 01 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) WESTCHESTER, Ill. � Children have more difficulty initiating sleep than maintaining sleep. Further, parents tend to underestimate their children�s sleep problems. This highlights the importance of having treatment options available to help a child overcome a sleep disorder, according to a study published in the October 1 issue of the journal SLEEP.

The study, authored by Leonie Fricke-Oerkermann, PhD, of the University of Cologne in Germany, centered on 832 children and their parents, who were surveyed using questionnaires three times on an annual basis. The average age of the children was 9.4, 10.7 and 11.7 years at the three assessments.

According to the results, in child and parental reports, about 30 to 40 percent of the children had problems falling asleep at the first assessment. One year later, the child and parental reports indicated that about 60 percent of those children continued to have difficulties initiating sleep.

One of the striking results of the study, notes Dr. Fricke-Oerkermann, is the difference between the children and their parents in the assessment of the children�s sleep problems. Children described significantly more difficulties initiating and maintaining sleep than what their parents reported on their behalf. For example, in the parental reports, four to six percent of the children �often� had difficulties initiating sleep, whereas up to five to 10 percent of the children reported difficulties initiating sleep. About 40 percent of the children reported difficulties initiating sleep which occur �sometimes�, compared to 25 to 30 percent of what the parents reported for their children. Sleep onset problems in all surveys were present in 13.5 percent of the children according to their parents and 24 percent of the children according to the children�s ratings.

These findings are supported by other studies, and imply that in epidemiological studies and in practical work, the inclusion of children�s and adolescent�s self-reports is necessary. It might be that parents are not informed about the sleep problems by their child, Dr. Fricke-Oerkermann speculates. On the other hand, it might be that children in this age range have difficulties estimating the severity of their sleep problems.

Difficulties maintaining sleep are less common, with three percent (parent-reported) versus six percent (child-reported). These results indicate that children of this age group have a higher risk of developing difficulties initiating sleep than difficulties maintaining sleep after one year, adds Dr. Fricke-Oerkermann.

�Sleep problems in childhood and adolescence are a frequent phenomenon,� says Dr. Fricke-Oerkermann. �Sleep problems decrease only marginally with age. Sleep problems might become chronic, requiring medical treatment.�

It is recommended that children in pre-school sleep between 11-13 hours a night, school-aged children between 10-11 hours of sleep a night, and adolescents about nine hours a night.

The American Academy of Sleep Medicine (AASM) offers some tips to help your child sleep better:

Combination of medication and psychotherapy appears most effective for treatment of depressed teens

Mon, 01 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) The combination of the antidepressant medication fluoxetine and cognitive behavior therapy appears more effective than either strategy alone for the long-term treatment of adolescents with depression, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Major depressive disorder affects approximately 5 percent of adolescents, causing difficulties for patients and their families and increasing the risk for suicide, according to background information in the article. To improve the treatment of depression in teens, the National Institute of Mental Health (NIMH) in 1999 funded the Treatment for Adolescents with Depression Study (TADS). TADS is a randomized controlled trial evaluating short- and long-term effectiveness of three treatments: fluoxetine alone; cognitive behavior therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events; and a combination of the two.

The TADS team randomly assigned 439 adolescents with depression to one of the three treatments or to placebo pills for 12 weeks. At that point, patients receiving placebo were offered active treatment and the remaining 327 patients (average age 14.6) were asked to continue their assigned therapy through 36 weeks. Fluoxetine was initially prescribed at a dose of 10 milligrams per day; the dosage was increased or decreased at various points during the study based on whether patients responded to treatment or experienced adverse effects. Patients receiving cognitive behavioral therapy had fifteen one-hour sessions during the first 12 weeks, then less frequently, with exact timing dependent on how they responded to treatment.

After 12 weeks, 73 percent of patients receiving combination therapy, 62 percent of those receiving fluoxetine only and 48 percent of those undergoing cognitive behavior therapy only responded to treatment, as measured by two clinical scales. At the end of 36 weeks, 243 (74.3 percent) of the 327 patients remained in the study. Response rates were 86 percent for combination therapy, 81 percent for fluoxetine and 81 percent for cognitive behavioral therapy.

Throughout treatment, researchers monitored patients for suicidal thoughts and behaviors. At the beginning of the study, 42 of 106 (39.6 percent) of those in the combination therapy group, 28 of 107 (26.2 percent) of those in the fluoxetine group and 27 of 107 (25.2 percent) of those in the cognitive behavior therapy group warranted prompt evaluation for suicidal tendencies. By week 12, patients treated with fluoxetine alone reported more clinically significant suicidal thoughts and behaviors than those in either of the groups receiving cognitive behavior therapy. After 36 weeks, two of 79 (2.5 percent) combination therapy patients, 10 of 73 (13.7 percent) taking fluoxetine alone and three of 76 (3.9 percent) receiving cognitive behavior therapy reported experiencing significant suicidal thoughts and behaviors.

Suicidal events�defined as suicidal attempts, thoughts and behaviors or preparatory actions toward suicide�occurred in 10 percent of patients in the study, mostly early in treatment. �Patients treated with fluoxetine alone were twice as likely as patients treated with combination therapy or cognitive behavior therapy to experience a suicidal event, indicating that cognitive behavior therapy may protect against treatment-emergent suicidal events in patients taking fluoxetine,� the authors write. �After taking benefit and risk into account, we conclude that the combination of fluoxetine and cognitive behavior therapy appears superior to either monotherapy [single treatment] as a long-term treatment strategy for major depressive disorder in adolescents.�

Babies raised in bilingual homes learn new words differently than infants learning one language

Fri, 28 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Infants who are raised in bilingual homes learned two similar-sounding words in a laboratory task at a later age than babies who are raised in homes where only one language is spoken. This difference, which is thought to be advantageous for bilingual infants, appears to be due to the fact that bilingual babies need to devote their attention to the general associations between words and objects (often a word in each language) for a longer period, rather than focusing on detailed sound information. This finding suggests an important difference in the mechanics of how monolingual and bilingual babies learn language.

These findings are from new research conducted at the University of British Columbia and Ottawa. They appear in the September/October 2007 issue of the journal Child Development.

Immigration, official language policies, and changing cultural norms mean that many infants are being raised bilingually. Because nearly all experimental work in infant language development has focused on children who are monolingual, relatively little is known about the learning processes involved in acquiring two languages from birth.

The researchers sought to determine whether the demands of acquiring more sounds and words lead to differences in language development. An important part of language development is the ability to pay attention to native speech sounds to guide word learning. For example, English learners expect that the nonsense words �bih� and �dih� refer to different concepts because �b� and �d� are different consonant categories in English. By 17 months of age, monolingual English infants use native-language speech-sound differences to guide them as they learn words. Do bilingual infants show a similar developmental pattern?

The study revealed that bilingual infants follow a slightly different pattern. Researchers tested bilingual children ages 14, 17, and 20 months on their ability to associate two words that differed in a single consonant sound with two different objects. Experiment 1 included a heterogeneous sample of bilingual babies (i.e., those exposed to English and another language). Experiment 2 tested two homogeneous groups of bilingual infants (English-French and English-Chinese). In both experiments, infants were repeatedly presented with a crown-shaped object that was called �bih� and a molecule-shaped object called �dih.� They were then tested on their ability to notice a switch in an object�s name (for example, the molecule-shaped object being called �bih� instead of �dih�). In all of the groups, the bilingual infants failed to notice the minimal change in the object�s name until 20 months of age, whereas monolingual infants noticed the change at 17 months.

This later use of relevant language sounds (such as consonants) to direct word learning is due to the increased demands of learning two languages, the researchers suggest. Ignoring the consonant detail in a new word may be an adaptive tool used by bilingual infants in learning new words. Outside the laboratory, there is little cost to overlooking some of the consonant detail in new words, as there are few similar-sounding words in infants� early vocabularies. By paying less attention to the detailed sound information in the word, bilingual infants can devote more cognitive resources to making the links between words and objects.

Extending this approach to word learning for a few months longer than monolinguals may help bilinguals �keep up� with their peers. Indeed, previous research has shown that bilinguals and monolinguals achieve language-learning milestones (such as speaking their first word) at similar ages and have vocabularies of similar sizes when words from both languages are taken into account.

�Through studies with bilingual infants, we can gain a deeper understanding of language development in all infants,� according to Christopher T. Fennell, assistant professor of psychology at the University of Ottawa and the lead author of the study. �In addition, the findings emerging from such studies will have practical implications for parents who are raising their children in a bilingual environment by revealing how young bilinguals acquire language.�

Study finds post-traumatic stress symptoms in adolescent children of cancer patients

Wed, 26 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: A new study by Dutch researchers has found that adolescents may suffer from severe symptoms of post-traumatic stress when a parent is recently diagnosed with cancer and that parents tend to underestimate the problems.

A cancer diagnosis is among those life experiences that can be so stressful that it is traumatic. While only a fraction of people who develop post-traumatic stress symptoms (PTSS) go on to develop post-traumatic stress disorder (PTSD), the symptoms can cause emotional problems later in life. Much is known about the psychological effect that cancer has on a patient and a spouse, but the consequences of a parent�s cancer on children are more poorly understood.

The study, presented today (Wednesday) at the European Cancer Conference (ECCO 14) in Barcelona, is the first to examine PTSS over time in adolescent children of cancer patients.

Dr Gea Huizinga, a health scientist and research fellow at the University Medical Center in Groningen, The Netherlands, examined the prevalence of PTSS, emotional and behavioural problems in 49 adolescents during the first year after a parent�s cancer diagnosis. The children and each of their parents completed questionnaires three times over the year � within four months after the diagnosis and at six and twelve months after the first survey.

�At the first assessment, 29 percent of the children reported clinically elevated PTSS, which means they needed psychological help, but the proportion suffering symptoms dropped to 16 percent at the second assessment and then to 14 percent at the third,� Huizinga said.

�PTSS levels shortly after the parent�s diagnosis appeared comparable to those seen in our earlier study of adolescents surveyed one to five years after their parent�s diagnosis,� Huizinga added. �The two studies together suggest that PTSS related to parental cancer fluctuate over time, decreasing during the first year after diagnosis and resurging during the years following.�

One of the most important findings of the latest study concerned how aware parents were of the magnitude of the effect the cancer had on their children.

�It appeared that parents were under the impression that children with more severe PTSS experienced problems in fewer emotional, behavioural and cognitive areas than the children themselves reported,� Huizinga said. �The results could indicate that the level of emotional and behavioural problems of children with more severe PTSS is underestimated by the ill parents and even more so by their partners.�

The study found that ill parents were more able to pick up on their children�s distress if the PTSS was particularly severe, but they still reported fewer problems than the adolescents themselves did.

Spouses did not observe any problems in their children in the period shortly after the diagnosis, although they noticed slightly more later in the year.

�It seems that ill parents were better able to judge the situation. They may be more alert to changes in their children�s behaviour than spouses because of a sense of guilt over their illness,� Huizinga suggested. �It may also be that spouses were less sensitive to their children�s functioning because they were often working outside the home, or more focused on the wellbeing of the partner with cancer, their own emotions and on increased household tasks.�

�Our study also found that children with more PTSS had more emotional and behavioural problems, and vice versa. This suggests that children who already have psychosocial problems have more difficulty in coping with their parent�s cancer than children who are doing well,� Huizinga said.

Emotional problems consist of withdrawal, physical complaints and anxiety or depression. Behavioural problems consist of actions that are aggressive or delinquent. Post-traumatic stress symptoms include recurrent and intrusive distressing memories of the event and avoidance of thoughts, feelings or conversations associated with it. Behavioural problems in adolescents with more PTSS were evident in the beginning of the study, but tended to disappear as time went on, while emotional problems seemed to persist.

Healthcare professionals should be made aware of the prevalence of PTSS in children of a parent with cancer, Huizinga said, adding that parents, particularly the spouses of the cancer patients, may benefit from information on children�s reactions and how to seek professional help, if necessary.

New chemotherapy regimen prolongs survival in difficult-to-treat childhood brainstem gliomas

Tue, 25 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Barcelona, Spain: Childhood brainstem gliomas (BSGs) are rare but can be very difficult to treat successfully and they tend to have poor survival rates. However, a team of Spanish researchers have found that a chemotherapy regimen of irinotecan and cisplatin (I/C) produced rapid clinical responses and shrank the tumours by more than 20 percent in all six children enrolled in a clinical trial.

Dr Jaume Mora told the European Cancer Conference (ECCO 14) in Barcelona today (Tuesday) that this was the first time that such a response had been achieved in children with high grade gliomas, while in low grade gliomas the response was comparable with the best achieved by other chemotherapies. All six children were still alive at one year, although the disease had progressed in three children with the most life-threatening tumours. The usual average survival rate for BSGs is between 4-15 months.

Dr Mora, who is head of the department of paediatric oncology at Hospital Sant Joan de Deu, Barcelona, Spain, explained: �The main treatment for BSGs is radiotherapy. Surgery is not really an option because of the way the tumour is situated in life-threatening anatomical structures situated in the brain stem. However, for children the long-term adverse consequences of radiotherapy have meant that doctors have looked to clinical trials to see if chemotherapy could be substituted for radiotherapy. However, most of these trials have failed; at present, many centres use radiation therapy for high-grade gliomas and diffuse intrinsic pontine tumours, the deadliest of all BSGs. For low-grade gliomas in children few combination regimens have shown significant changes in the long-term natural history of this disease: vincristine and carboplatin is the current protocol and was pioneered by the Duke�s University group in the USA. The Italians have tested cisplatin and VP-16 with very good results for low-grade gliomas.�

BSGs are rare, but are amongst the commonest cancers to occur in children aged between about six and ten years old. The cause is unknown and the survival rates are poor: high-grade BSGs (diffuse and non-diffuse intrinsic tumours) are uniformly fatal, while children with low-grade gliomas have a more prolonged survival.

Dr Mora and his team enrolled six children out of 22 with BSGs in their trial. Four children had high-grade gliomas (two diffuse and two non-diffuse) and two had low-grade, mid-brain tumours. Irinotecan and cisplatin was given once a week for four weeks for a total of four cycles. Children with the high-grade tumours were also given anti-angiogenic therapy (bevacizumab) and radiotherapy.

Dr Mora said: �All patients had complete and rapid clinical responses to the I/C regimen. Remarkably, the I/C regimen achieved a reduction in tumour size greater than 20 percent in all the children at the end of the therapy, including those with the worst BSGs, the intrinsic diffuse BSGs. No chemotherapy has ever achieved this grade of early response in high-grade BSGs.�

Between nine and twelve months after the therapy, three of the high-grade tumours started to progress again.

Dr Mora said: �This early response is promising but the high-grade patients eventually progress regardless of the maintenance therapy we have given them. We need to rethink these results and find out how to consolidate better these initial responses.�

The other 16 children with BSGs had received different treatments by the start of the trial and they made up the historical cohort. After an average of 25 months, ten of them (65 percent) were still alive. These results cannot be compared directly with the results from the clinical trial but give an indication of how difficult it is to prolong survival for this disease.

Consumption of omega-3 fatty acids associated with decreased risk of type 1 diabetes

Tue, 25 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Preliminary research suggests that in children at increased risk for type 1 diabetes, dietary intake of omega-3 fatty acids was associated with a reduced risk of pancreatic islet autoimmunity, which is linked to the development of diabetes, according to an article in the Sept. 26 issue of JAMA.

�Type 1 diabetes mellitus is an autoimmune disease that is characterized by the destruction of insulin-producing beta cells in the pancreatic islets. Although it is not yet known what initiates the autoimmune process, it is likely that both genetic background and environmental factors contribute to the disease process,� the authors write. Certain dietary factors have been associated with the onset of type 1 diabetes as well as the autoimmune process that leads to the disease.

Jill M. Norris, M.P.H., Ph.D., of the University of Colorado at Denver and Health Sciences Center, Denver, and colleagues examined whether consumption of omega-3 and omega-6 fatty acids are associated with the development of pancreatic islet autoimmunity (IA; development of antibodies against the cells in pancreas that produce insulin) in children. The study, conducted between 1994 and 2006, included 1,770 children at increased risk for type 1 diabetes, defined as either possession of a high diabetes risk HLA (human leukocyte antigen) genotype or having a sibling or parent with type 1 diabetes. The average age at follow-up was 6.2 years. Islet autoimmunity was assessed in association with reported dietary intake of polyunsaturated fatty acids starting at age 1 year. Fish is the primary source of marine polyunsaturated fatty acids. Childhood diet was measured using a food frequency questionnaire (FFQ).

A case-cohort study (n = 244) was also conducted in which risk of IA by polyunsaturated fatty acid content of erythrocyte membranes (outer portion of the red blood cell) was examined.

Fifty-eight children became positive for IA during follow-up. Adjusting for HLA genotype, family history of type 1 diabetes, caloric intake, and total omega-6 fatty acid intake, total omega-3 fatty acid intake was inversely associated with IA risk (a 55 percent reduced risk). The association was strengthened when the definition of the outcome was limited to those positive for two or more autoantibodies. In the case-cohort study, omega-3 fatty acid content of erythrocyte membranes was associated with a 37 percent decreased risk of IA.

�Our study suggests that higher consumption of total omega-3 fatty acids, which was reported on the FFQ, is associated with a lower risk of IA in children at increased genetic risk of type 1 diabetes,� the researchers write.

Parents' participation in medical decisions linked to self-efficacy

Wed, 19 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) ANN ARBOR, Mich. � The majority of parents feel they play a significant role in making medical decisions for their child, according to researchers at the University of Michigan C.S. Mott Children�s Hospital.

In a new study published in the October issue of the Journal of Pediatrics, 86 percent of parents report that they participate in decisions made about their hospitalized child�s medical care. Researchers also found that parents who feel confident communicating with physicians � as well as those parents whose child has been previously hospitalized � are more likely to participate in medical decisions.

The role of parents as participants in medical decisions may significantly affect the child�s health, says study lead author Beth A. Tarini, M.D., clinical lecturer and member of the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics at Mott. She notes that previous research has shown that in adult patients, shared decision- making � between patients and health care providers �improves health outcomes.

�Medical care has become more complex, and it behooves us to get parents more involved in that care,� says Tarini. �Ultimately, parents are responsible for the care of their child once they leave the hospital. When parents feel informed and empowered, they�re likely to be better prepared to care for their child.�

For the study, Tarini and her colleagues surveyed parents of children admitted to the general pediatrics ward of a children�s hospital in Seattle during a two-month period. All parents surveyed had children younger than 18, and were given the survey within 24 to 48 hours of admission to the hospital, after the parents had met with physicians and other medical staff to discuss their child�s care.

The self-administered survey, available in English and Spanish, asked 130 parents general questions about their hospital experience in order to evaluate their participation in medical decision-making during their child�s hospitalization.

The study revealed that parents� ability to make medical decisions about their child was strongly linked to self-efficacy, or confidence in their ability to interact and communicate with physicians.

Additionally, researchers also found that parents of previously hospitalized children were more involved in medical decision-making. Tarini says this finding suggests that the hospital may be �a learned experience� for parents.

�While this study is only the first step to learning more about parental participation in medical decisions, it is a reminder to physicians of the potential modifiability of parents� involvement in their child�s medical care,� says Tarini.

According to Tarini, the next phase of research on this topic will involve working to determine if parental participation in medical decisions improves medical outcomes for the child.

Childhood vaccination may protect adult eyes

Wed, 19 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Childhood vaccination for the rubella virus may have also almost entirely eliminated an inflammatory eye disease from the U.S.-born population, according to a study by researchers at the University of Illinois at Chicago.

The study is published in the September issue of the American Journal of Ophthalmology.

Fuchs heterochromic iridocyclitis, or FHI, is a chronic inflammatory disease of the eye that causes cataract and glaucoma and can lead to blindness. There is no effective treatment.

We don't know what causes FHI, says Dr. Debra Goldstein, associate professor of ophthalmology and visual sciences at UIC. But we were seeing changes in the incidence of the disease and in the makeup of the patient population with the disease -- fewer American-born FHI patients, and those we did see were older.

Although not able to establish the cause of FHI, earlier studies had found antibodies for rubella in the eyes of patients with FHI, suggesting that the rubella virus might be involved. The UIC researchers looked for epidemiological evidence that might link childhood vaccination for rubella, commonly known as German measles, with the decrease in the incidence of FHI they had observed.

We hypothesized that if there was a relationship between rubella and FHI, then the proportion of FHI cases we were seeing at UIC would decrease after the institution of the national rubella vaccination program and that an increasing percentage of the FHI cases would be in patients coming from countries without a vaccination program, Goldstein said.

Patients with FHI and two other types of inflammatory eye disease who were seen at UIC between 1985 and 2005 were grouped by the decade of their birth to determine whether the percentage with FHI decreased relative to the two other inflammatory eye diseases. The percentage of foreign-born versus U.S.-born patients with FHI and the two control groups was also compared.

For U.S.-born patients born before rubella vaccinations (1919-1958) the percentages of FHI and two other eye inflammatory diseases were about equal. But there was a 69 percent drop in FHI in patients born the following decade (1959-1968) and a further 40 percent drop in patients born from 1969 to 1978. Only one FHI patient born during the decade 1979-1988 was seen.

Over the same periods, the percentage of foreign-born patients with FHI increased compared with the controls.

Rubella vaccination was implemented in the United States in 1969. By 1977, an estimated 60 percent of children had been vaccinated, with an 80 percent decline in cases.

Currently, children commonly receive two doses of the vaccine by the time they are six years old. As a result of the vaccination program, the majority of U.S. rubella cases now occur in foreign-born individuals.

The vast majority of eye inflammatory diseases have no known cause, according to Goldstein. Although this kind of study has its limitations, it's exciting to find convincing epidemiological support for earlier research implicating the rubella virus as a cause of FHI, she said.

Children's Hospital of Pittsburgh psychiatrist receives prestigious NIH award

Wed, 19 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Children�s Hospital of Pittsburgh of UPMC psychiatrist Eva M. Szigethy, MD, PhD, is among a select group of researchers who have been chosen by the director of the National Institutes of Health (NIH) to receive a prestigious New Innovator Award.

NIH director Elias A. Zerhouni, MD, announced today that 41 researchers from across the country � many of them in the early stages of their careers, including Dr. Szigethy � will receive five-year grants totaling more than $105 million. Dr. Szigethy is one of only 29 recipients of the NIH Director�s New Innovator Award (selected from more than 2,100 applicants), and there are 12 recipients of the Pioneer Award.

Pioneer Awards support scientists at any career stage, while New Innovator Awards are reserved for new investigators who have not received an NIH regular research or similar grant. This is the first group of New Innovator Awards and the fourth group of Pioneer Awards. Both programs are part of an NIH Roadmap for Medical Research initiative that tests new approaches to supporting novel research.

Dr. Szigethy is the medical director of the Coping Clinic, part of the Inflammatory Bowel Disease (IBD) Center at Children�s Hospital. She also is an assistant professor of psychiatry and pediatrics at the University of Pittsburgh School of Medicine. By working with young patients who have been diagnosed with Crohn�s disease or ulcerative colitis, Dr. Szigethy is investigating the interactions among the brain, gut and immune system in how adolescents cope with chronic disease. She will work with Robert Noll, PhD, chief of the Division of Developmental and Behavioral Pediatrics at Children�s, and Ronald Dahl, MD, the Staunton Professor of Psychiatry and Pediatrics at the University of Pittsburgh to coordinate this multi-faceted research effort.

�Novel ideas and new investigators are essential ingredients for scientific progress, and the creative scientists we recognize with NIH Director�s Pioneer Awards and NIH Director�s New Innovator Awards are well-positioned to make significant � and potentially transformative � discoveries in a variety of areas,� Dr. Zerhouni said in announcing the award recipients.

Dr. Szigethy�s NIH award will allow her to use functional magnetic resonance imaging to study regions of the brain responsible for emotional and cognitive processing in patients with IBD with and without depression. She also will study the relationship between depressive symptoms and brain, immune and gastrointestinal functioning, as well as the effectiveness of cognitive behavioral therapy in treating patients with IBD who are depressed. The integration of behavioral health into comprehensive medical care represents a paradigm shift within medicine in treating children with chronic physical illness.

�The early identification and treatment of depression in children and adolescents with chronic physical illness such as IBD is an understudied area. Given the significant risk of emotional and physical harm to physically ill adolescents who are depressed, the development and implementation of effective preventive interventions is crucial,� she said. �The early data from our research examining the effects of a cognitive behavioral therapy shows promising effects in improving depressive symptoms in adolescents with IBD.�

Hazards of using crib bumper pads outweigh their benefits

Tue, 18 Sep 2007 03:59:37 PST

( from http://www.rxpgnews.com ) St. Louis, Sept. 18, 2007 -- Although bumper pads are theoretically designed to prevent injury to a baby while in the crib or bassinet, the risk of accidental death or injury to an infant from using them outweighs their possible benefits, according to a new study by pediatric researchers at Washington University School of Medicine in St. Louis.

In the study, which appears in the September 2007 issue of The Journal of Pediatrics, the researchers reviewed three U.S. Consumer Product Safety Commission databases for deaths related to crib bumpers and crib-related injuries from 1985-2005. They found 27 accidental deaths reported by authorities of children from 1 month old to 2 years old that were attributed to suffocation or strangulation by bumper pads or their ties. They also found 25 non-fatal injuries in infants attributed to bumper pads.

Of the deaths in which there was a formal investigation, 11 infants likely suffocated when their face rested against the bumper pad, 13 infants died from being wedged between the bumper pad and another object and three infants died from strangulation by a bumper tie.

Many infants lack the motor development needed to free themselves when they become wedged between the bumper pad and another surface, said Bradley Thach, M.D., professor of pediatrics and staff physician at St. Louis Children's Hospital who researches infant apnea and Sudden Infant Death Syndrome. They are likely to suffocate because they are rebreathing expired air or their nose and mouth are compressed.

Thach said both soft or firm bumper pads pose risks. If the pads are too soft, the baby's nose or face can get pressed up against it, and the baby suffocates, he said. If they are too firm, the baby can climb up on the pads and fall out of the crib.

The researchers examined 22 retail crib bumpers for features that could be hazardous to infants. They graded the bumpers for softness and measured the potential space between the bottom of bumper and mattress, the width of the bumper pads and the length of the fasteners that attach the bumper to the crib. Current manufacturing standards state that bumper pads should not have ribbons, strings or ties longer than 9 inches, but the researchers found two with fasteners longer than 9 inches.

Thach said all of the retail bumper pads they examined were hazardous because they all potentially leave a space between the pad and the mattress where babies can get their heads wedged.

The researchers indicated that their study is limited because of underreporting of cases and lack of a consistent protocol of scene investigations and autopsies.

Thach recommends that parents not use bumper pads in cribs or bassinets.

I don't think bumper pads are doing any good, he says. Although the deaths and injuries may be rare events, they are preventable by eliminating the use of bumper pads.