Hi all,
I am making a single thread for each and every medical topic, with news and research corresponding to it.
So this thread shall contain all Pediatrics research news.
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all over the world A consensus statement on childhood obesity was published today in The Journal of Clinical Endocrinology & Metabolism, one of the four journals of The Endocrine Society.
Child Health News
Published: Tuesday, 8-Mar-2005
The consensus statement reflects the conclusions from an international summit held in Israel last year and includes a controversial recommendation to classify obesity as a disease. This landmark statement reviews the available research evidence on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity.
Pediatric obesity is now recognized as a major medical and health problem all over the world. Researchers have found that children who are obese have a higher risk for adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased health risks. Approximately 14-15 percent of all 15-year-olds in the United States can be classified as obese. The statement notes that, between the years 1980 and 2000, the prevalence of overweight children doubled among children aged six to 11 and tripled among those aged 12-17. The U.S. ranked among the highest of 15 countries in the study in terms of prevalence of overweight and obese boys and girls.
"Our goal is to emphasize the safest means for primary care physicians to manage obese patients," says Dr. Henry Anhalt, a participant of the Obesity Consensus Working Group and physician at Saint Barnabas Medical Center in Livingston, New Jersey. "These recommendations should provide incentive for the public and private sectors to mobilize resources to stem the tide of increasing body mass in children and adults."
By classifying obesity as a legitimate disease, the consensus statement paves the way for public funding and insurer's reimbursement for obesity treatment programs and spurring further research to more effectively prevent and treat obesity. With health care costs of patients whose body mass index (BMI) is greater than 35 reaching 44 percent more than those of non-obese patients, the need for a consensus among physicians and health professionals is necessary. These recommendations not only provide a platform for future corrective action but encourage early intervention at the onset of obesity.
Without proper intervention, serious health risks will likely begin to appear in obese adolescents and children as they grow older. These may include diabetes, metabolic syndrome, hyperandrogenism (hormomal perturbations place the obese adolescent girl at a high risk of menstrual disorders and early onset of polycystic ovarian syndrome), heart disease, hypertension, respiratory factors and sleep disorders, among many others. Obese children are also at greater risk of anxiety and depression.
The following is a partial list of recommendations in the statement that can be implemented by parents, schools, healthcare providers and government and regulatory agencies to help prevent the onset of childhood obesity:
Normalize the mother's body mass index prior to pregnancy
Maintain moderate exercise during pregnancy
Breast feed for up to three months
Eat meals as a family in a fixed place and time
Do not skip meals, especially breakfast
Use small dishes and keep serving dishes away from the table
Eliminate school fundraisers with candy and cookie sales
Install water fountains in schools
Give age-appropriate expectations for body weight in children
Classify obesity as a legitimate disease for treatment and insurance purposes
Make exercise programs tax deductible
The statement also includes evidence from previous findings that have shown the adverse impact obesity has on existing endocrine and metabolic disorders such as cardiovascular risk, diabetes and hypertension. Including the classification of obesity as a disease in the recommendations is a critical part of helping the medical community better evaluate and determine the best treatment for obese children and lessen their health risks as they grow older.
Main Category: Hypertension News
Article Date: 03 Aug 2007 - 2:00 PDT
Infants whose mothers smoke during pregnancy have substantially higher blood pressures in their first months of life, Dutch researchers reported in Hypertension: Journal of the American Heart Association. A study of 456 infants in The Netherlands showed that, by age 2 months, babies born to mothers who smoked had higher systolic blood pressures compared to those whose mothers didn't smoke and weren't exposed to smoke during pregnancy. "Our findings indicate maternal smoking during pregnancy has a direct substantial impact on systolic blood pressure in early infancy and is another reason for women not to smoke during pregnancy," said Caroline C. Geerts, lead author of the study and a doctoral student at Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht in The Netherlands. "This association appears to occur in utero and doesn't appear to be due to the postnatal environment of the infant."
Infants born to mothers who smoked during pregnancy had 5.4 millimeters of mercury (mm Hg) higher systolic blood pressure levels than babies whose mothers were not exposed to tobacco smoke during pregnancy. This estimate was obtained after controlling for birth weight, infant age, gender, nutrition and age of the mother -- all factors that could affect the blood pressure of the infant, researchers said.
Systolic blood pressure (SBP), the larger of the two numbers that make up a blood pressure reading, represents the blood pressure when the heart is fully contracted.
For years, women have been advised against smoking during pregnancy, which can result in intrauterine growth retardation, insufficient fetal growth that leads to low birth weight.
In the study -- Wheezing Illnesses Study Leidsche Rijn (WHISTLER) -- researchers assessed parents of newborns living in a residential area of Utrecht. Participating mothers were asked if they had smoked during pregnancy, did not smoke but were exposed to secondhand smoke or were not exposed to smoke during pregnancy. Infants of the participants had their blood pressure, heart rate, chest and lung function measured before 2 months of age.
Only 6.6 percent of the mothers (30 subjects) reported smoking during pregnancy; another 13.8 percent (63 subjects) reported they did not smoke, but were exposed to smoke; and 79.6 percent of mothers (363 subjects) said they were not exposed to smoke during pregnancy. The overall blood pressures of the mothers weren't significantly different among these groups.
However, researchers found an association between maternal smoking and newborn systolic blood pressure, although they didn't find significant difference between smoke exposure and newborn diastolic blood pressure and heart rate. The diastolic pressure is the lower number of a blood pressure reading and occurs when the heart relaxes. The researchers discovered male infants were more likely to have higher systolic blood pressures if their mothers smoked. Male offspring of smoking mothers had 8.6 mmHg higher systolic blood pressures than infants not exposed to tobacco smoke in utero.
"We can only speculate on the reason for this," said Geerts, adding that it has been shown that male infants react significantly different in response to pain with an increase in systolic blood pressure. "Perhaps gender is a modifier of stress responses including smoke exposure."
The researchers also found that newborns of mothers who smoked in pregnancy were significantly lighter, shorter and had a smaller chest circumference than other offspring.
Mothers who smoked in pregnancy were also less inclined to breastfeed their infants. However, the researchers said that birth weight, infant age, gender, infant nutrition or maternal age did not explain the systolic blood pressure findings.
"We aren't sure that the increases in systolic blood pressure will continue in time," Geerts said. "It is unknown if our findings will have an impact on blood pressure later in life." The researchers plan to follow the children for at least four to five years to see if the increase in systolic blood pressure continues. Geerts said it's important to study infants and children to obtain a better insight into cardiovascular disease that occurs later in life.
"There is increasing evidence that later-life ischemic cardiovascular diseases originate in early childhood," she said. "Childhood cardiovascular risk factor profiles, including overweight, smoking and sedentary lifestyles, are increasing health problems with substantial future consequences. From a prevention point of view, it is important to determine these early life risk factors, to know at what age they exert vascular damage, and ultimately whether childhood interventions lead to actual cardiovascular risk reduction."
The first study to examine brain activity patterns in severely traumatized children showed their brains function differently than those of healthy children, say researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital.
The study hints at the biological underpinnings of the disorder called PTSD, or post-traumatic stress disorder. It also provides a valuable benchmark with which to assess the effectiveness of potential therapies.
"Now we can see some real neurological reasons for the impulsivity, agitation, hyper-vigilance and avoidance behaviors that children with untreated PTSD often exhibit," said Victor Carrion, MD, child psychiatrist at Packard Children's. "The fact that their brains appear to be working differently may indicate a deficit for which other areas of the brain are trying to compensate."
Some children with PTSD, for example, cut or burn themselves as a way of coping with their feelings. The researchers found that affected children who had also cut or otherwise injured themselves exhibited unique patterns of activation in a portion of the brain involved in the perception of pain and emotions.
It's not yet clear whether the brain differences are caused by the interpersonal trauma, such as sexual or physical abuse, experienced by the children or if pre-existing differences make some children more susceptible to developing PTSD after traumatic events than their more resilient peers.
Carrion, who is also associate professor of Psychiatry
and behavioral sciences at the Stanford School of Medicine, is the lead author of the research, which was recently published online in the journal Depression and Anxiety.
The researchers used an experimental technique called functional magnetic resonance imaging, or fMRI, to compare brain activation patterns in 16 children with symptoms of PTSD with the patterns seen in 14 age- and gender-matched non-traumatized children as they performed a simple decision-making task. The fMRI analysis detects changes in blood flow and oxygenation that correlate with increased neuronal activity in different regions of the brain.
To conduct the test, study subjects were placed inside the fMRI machine - a body-sized, narrow, hollow tube -- and then asked to push a button each time a letter other than X flashed on a screen in front of them. Because Xs were introduced only after a string of non-Xs, the test is a good way to measure what's known as response inhibition, or a subject's ability to suppress the natural tendency to push the button as soon as any letter appears. Response inhibition is often difficult for children and adults with PTSD.
MRI tests can leave some people feeling claustrophobic and frightened and the experience can be particularly difficult for children already struggling with past trauma. Carrion and his colleagues used a special "mock MRI" machine at Packard Children's to familiarize the study participants to the sights and sounds of the imaging procedure before conducting the real experiment.
The researchers found that, although the two groups accomplished the task equally well, they used different parts of their brains to do so. The children with PTSD symptoms showed less activity than their non-traumatized peers in the left middle frontal cortex, an area known to be involved in response inhibition, and more activity in several other areas of the brain including a region involved in emotional awareness known as the insula.
"We found that affected kids who injured themselves-a subgroup of our study sample-had more activity in the insula than did kids who did not injure themselves," said Carrion. "What's more, we found a very good correlation between the levels of activation of this structure and the severity of PTSD symptoms experienced by the child."
People with PTSD often have trouble paying attention and responding appropriately to experimental tasks, perhaps due to heightened physiological arousal arising from their traumatic experience. As a result, many children with PTSD symptoms are diagnosed with attention-deficit hyperactivity disorder, or ADHD. But it's difficult to tell whether the two disorders are truly related, or if they simply have overlapping symptoms. Functional imaging like fMRI may allow researchers to finally solve the mystery. More importantly, it may help doctors devise better therapies.
"It may be possible to redirect the brain's altered processing functions," said Carrion. "Ideally we will one day be able to compare brain images from before and after treatment to determine what works, or doesn't work, for kids with PTSD. All is not lost.
Main Category: Cervical Cancer / HPV Vaccine News
Article Date: 03 Aug 2007 - 9:00 PDT
Ontario is to offer Gardasil, a vaccine to protect against cervical cancer, to all Grade 8 girls, even though the Canadian Medical Association Journal indicated that it is perhaps too early to offer the vaccine on a universal basis. The program will be free and voluntary and will be offered to approximately 84,000 girls and young women. The vaccine will be offered in schools.
The program will cost Ontario CAN[no ads please]
117 million over three years.
Sandra Pupatello, Minister for Women's Issues, Ontario, said that all Grade 8 girls will get the vaccine if they so choose by the end of this school year. Pupatello added "There has never been an issue around women's health that has had this level of unanimity. It wasn't a difficult decision."
Public health nurses will administer Gardasil. Parents will be given consent forms, plus information, well before the vaccines are offered. Nova Scotia started offering Gardasil to girls in July, 2007.
Older females will not get the vaccine free-of-charge. The full course, involving three injections over six months, costs around CAN[no ads please]
600.
What is cervical cancer?
It is cancer of the cervix, the lower part of the uterus that connects to the vagina. Certain types of HPV (human papillomavirus) cause abnormal cells to develop in the lining of the cervix. If these abnormal cells are not treated early enough they may become pre-cancers, and eventually cancer. HPV does not go away on its own.
Why Gardasil?
Gardasil helps protect a woman against diseases caused by HPV Types 16 & 18. These two types are responsible for 70% of all cervical cancer cases. Gardasil also protects women against HPV Types 6 & 11, the cause of 90% of genital warts.
Gardasil does not protect everyone, it does not prevent all cervical cancer types. It is important for women who have received Gardasil to continue having regular cancer screenings.
According to the Gardasil web site, the three-injection six month course may cause swilling, itching, redness at injection site, raised temperature, nausea and dizziness.
How does one become infected with HPV?
-- Anyone who has sexual activity with a person infected with HPV can become infected. An infected person may have no symptoms and not know he/she could be it on. Sexual activity does not exclusively involve sexual intercourse.
-- HPV infection affects both men and women.
-- According to the Centers for Disease Control and Prevention (CDC), about 20 million people in the USA were infected with HPV in 2005. The CDC adds that the only fully-guaranteed way of never becoming infected with HPV is to avoid any sexual activity.
Main Category: Cardiovascular / Cardiology News
Article Date: 03 Aug 2007 - 0:00 PDT
Cardiac-gated CTA radiation doses can vary and be as high as 28.4 mSv (10 times the annual natural background radiation) in children, according to a recent study conducted by researchers from Duke University Medical Center in Durham, NC and Stanford University Medical Center in Palo Alto, CA.
"This investigation evaluated the potential radiation dose of coronary CT angiography in pediatric patients," said Caroline Hollingsworth, MD of Duke University Medical Center, lead author of the study. "Since often adult technologies and techniques are simply applied to children, we were interested in assessing what the dose could be," she said.
"Technical advances in multidetector CT angiography have lead to increased utilization of this technology for evaluation of the coronary arteries in adults. However, this technology lacks systematic assessment in children," said Dr. Hollingsworth. "Due to concerns for potentially large radiation doses from this type of CT evaluation, we were interested in assessing standard gated coronary CTA techniques in a pediatric phantom. Dosimetry information is important since optimal techniques for this type of coronary assessment are still under evolution as this technology becomes increasingly utilized," she said.
For the study, an ECG-gated cardiac CTA simulating scanning of the heart was performed on a phantom of a 5-year-old child on a 16-MDCT scanner. The highest doses were of the breast (3.5-12.6 cGy), lung (3.3-12.1 cGy) and bone marrow (1.7-7.6 cGy). To put these numbers into perspective, 12 cGy is equivalent to about 50 two-view screening mammograms.
"The results of this investigation support that coronary CTA doses vary substantially with different parameters and can provide very high radiation doses to children when adult-type parameters are utilized," said Dr. Hollingsworth. "Optimal techniques in children have yet to be developed and the results of this study show that gated CTA should be used cautiously in the pediatric population while further evaluation of newer techniques (modulation), applications and outcomes are evaluated," she said.
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e272-e282 (doi:10.1542/peds.2006-3037
Sonia Hernández-Díaz, MD, DrPHa,b, Linda J. Van Marter, MD, MPHc, Martha M. Werler, ScDa, Carol Louik, ScDa and Allen A. Mitchell, MDa
a Slone Epidemiology Center at Boston University, Boston, Massachusetts
b Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
c Division of Newborn Medicine, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
OBJECTIVE. Persistent pulmonary hypertension of the newborn, a clinical syndrome that results from the failure of the normal fetal-to-neonatal circulatory transition, is associated with substantial infant mortality and morbidity. We performed a case-control study to determine possible antenatal and perinatal predictors of persistent pulmonary hypertension of the newborn.
METHODS. Between 1998 and 2003, the Slone Epidemiology Center enrolled 377 mothers of infants with persistent pulmonary hypertension of the newborn and 836 mothers of matched control subjects. Within 6 months of delivery, study nurses interviewed participants regarding demographic, medical, and obstetric characteristics.
RESULTS. Factors that were independently associated with an elevated risk for persistent pulmonary hypertension of the newborn were infant male gender and black or Asian maternal race compared with white race. High prepregnancy BMI (>27 vs <20) was also associated with persistent pulmonary hypertension of the newborn, as were diabetes and asthma. Compared with infants who were delivered vaginally, the risk for persistent pulmonary hypertension of the newborn was higher for those who were born by cesarean section. Compared with infants who were born within 37 to 41 gestational weeks, the risk was higher for those who were born between 34 and 37 completed weeks and for those born beyond 41 weeks. Compared with infants within the 10th and 90th percentiles of birth weight for gestational age distribution, the risk was higher for infants above the 90th percentile.
CONCLUSIONS. Our findings suggest an increased risk for persistent pulmonary hypertension of the newborn associated with cesarean delivery; late preterm or postterm birth; being large for gestational age; and maternal black or Asian race, overweight, diabetes, and asthma. It remains unclear whether some of these factors are direct causes of persistent pulmonary hypertension of the newborn or simply share common causes with it; however, clinicians should be alert to the increased need for monitoring and intervention among pregnancies with these risk factors.
Low HDL-C predicts the onset of transplant vasculopathy in pediatric cardiac recipients on pravastatin therapy
Hedman M, Pahlman R, Sundvall J, Ehnholm C, Syvänne M, Jokinen E, Jauhiainen M, Holmberg C, Antikainen M. Low HDL-C predicts the onset of transplant vasculopathy in pediatric cardiac recipients on pravastatin therapy.
The levels and protein/lipid compositions of major lipoprotein particles of 19 pediatric cardiac transplant recipients (4-18 yr of age) were studied in this prospective, open clinical follow-up study before and at one yr of pravastatin therapy (10 mg/day). The recipients were grouped into those with (n = 6; group A) and those without (n = 13; group B) angiographically detectable vasculopathy. Twenty-one pediatric non-transplant controls were studied at baseline. At baseline, the group A recipients had 29% lower HDL-C concentrations (p = 0.031) and 29% higher apoB-100/apoA-I ratios (p = 0.034) than the group B recipients. At one yr of pravastatin, the respective figures were 29% (p = 0.013) and 33% (p = 0.005). Compared with the healthy pediatric controls, the transplant recipients had significantly higher serum TG before pravastatin [median (range): 1.3 mmol/L (0.6-3.2) vs. 0.7 mmol/L (0.3-2.4), p = 0.0002] and at one yr [1.3 mmol/L (0.5-3.5) vs. 0.7 mmol/L (0.3-2.4), p = 0.0004]. The baseline apoB-100/apoA1 ratios of the recipients were 33% higher (p = 0.005). In conclusion, low HDL-C and high apoB-100/apoA-I ratio were associated with angiographically detectable vasculopathy. Even though pravastatin effectively lowered the TC and LDL-C and improved compositional properties of LDL and HDL2 particles, it failed to normalize the elevated TG and, in some patients, to prevent the progression of transplant vasculopathy.
Keywords: Pediatric heart transplantation; transplant vasculopathy; lipoproteins; HDL; apoB; Pravastatin
Document Type: Research article
DOI: 10.1111/j.1399-3046.2007.00690.x
Affiliations: 1: Hospital for Children and Adolescents 2: National Public Health Institute 3: Division of Cardiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Main Category: Sports Medicine / Fitness News
Article Date: 06 Aug 2007 - 1:00 PDT
Every year, Fred Mueller compiles a sports list, but unlike popular pre-season picks or a glamorous hot-recruit sheet, nobody envies him this task. Some years the list is longer than others, but, Mueller said, there's no reason any kid should be on it.
It's a list of boys who died playing or practicing football, kids whose body temperatures rose so high and so fast under the summer sun that their brains couldn't keep up, couldn't regulate their cores, and the boys died.
"When something is preventable ...," Mueller said, shaking his head. "Those kids could be alive today."
Five young athletes, from 11 to 17 years old, died of heat stroke in 2006. The trend was declining. The last time there were more than five was 1972, when there were seven. In five of the past 16 years there were none. But, Mueller said, there have been 31 since 1995, and all of them could have been avoided.
Seven other players died last year of 'heart-related' deaths that might or night not have been related to heat or exertion. "And we don't know the number of kids who had heat exhaustion," Mueller said.
With summer practice about to swing into high gear, Mueller said it's time to remember these kids, and to keep in mind how heat-related deaths can be prevented.
* Require each athlete to have a physical and know if an athlete has a history of heat-related illness; these kids are more susceptible to heat stroke. Overweight players are also at higher risk.
* Acclimatize players to the heat slowly; North Carolina mandates that the first three days of practice be done without uniforms.
* Alter practice schedules to avoid long workouts in high-humidity.
* Provide cold water before, during and after practice in unlimited quantities.
* Provide shaded rest areas with circulating air; remove helmets and loosen or remove jerseys; some schools have plastic outdoor pools filled with ice for cool-downs after practice.
* Know the symptoms of heat illness: nausea, incoherence, fatigue, weakness, vomiting, muscle cramps, weak rapid pulse, visual disturbance. Contrary to popular belief, heat stroke victims may sweat profusely.
* Have an emergency plan in place; parents should inquire about emergency plans for their kids' teams.
Heat-related deaths are compiled as part of the Annual Survey of Football Injuries, research that began in 1931; Mueller took the reins in 1980. The survey tracks major injuries and deaths in 1.8 million football players from sandlot (organized, non-school affiliated teams), middle school, high school, college and professional teams.
There were a total of 20 deaths in 2006; two sandlot players, three in college, 13 middle and high schoolers. Only one death was directly related to the game; a 17-year-old high school player who received a spinal cord injury when tackled in a practice drill.
Rules against 'spearing,' or leading blocks and tackles with the helmet or face mask, have drastically reduced the number of direct injuries, Mueller said.
The heat-related injuries warrant special attention because they are preventable, he said. These and other 'indirect' deaths and injuries were the highest since 1936, when there were 18.
Mueller said there still exists a hard-core mentality in some football circles, where kids feel pressured from coaches or parents not to complain about feeling ill during practices or games.
But machismo doesn't affect Physiology
. Physical activity raises players' temperatures higher than normal, Mueller said. When body temperatures rise to 103 or 104, the brain's hypothalamus loses its ability to regulate the heat. The heart beats faster to increase blood flow to the skin to aid in evaporation, leaving less blood in the heart and other muscles. Brain death begins around 106 degrees, but death from heat stroke can be gradual, taking three or four days while organs begin to fail.
"Coaches, athletes and parents should be aware that all fall sports could lead to heat-related deaths if precautions aren't taken," Mueller said. "Every year we have to get the word out."
A team of scientists in Canada
has suggested that raising children on diet foods and drinks could inadvertently turn them into obese adults. They said that children's bodies learn to connect the taste of different foods and drinks with whether they are high or low in calories, and if they only have diet food and drink this connection becomes distorted leading them to overeat as they develop into adults.
The study will be published in the journal Obesity and is the work of sociologist Dr David Pierce and colleagues from the University of Alberta.
"Based on what we've learned, it is better for children to eat healthy, well-balanced diets with sufficient calories for their daily activities rather than low-calorie snacks or meals," said Pierce.
He and his team showed that feeding young rats low calorie substitutes of food and drink led them to overeat, whether they were lean or genetically obese. Eating too many calories is more of a health risk for obese animals.
However, older, adolescent rats that were also fed low calorie substitutes of their regular food and drink did not overeat. The researchers concluded that the older rats did not overeat because by this age they had learned to assess the calorific value of different foods and drinks using their sense of taste, and this regulated their intake. They called this process "taste conditioning".
Pierce said that:
"The use of diet food and drinks from an early age into adulthood may induce overeating and gradual weight gain through the taste conditioning process that we have described."
The authors suggest taste conditioning could explain what has been puzzling scientists who have conducted studies in this area. For instance one particular study at the University of Massachusetts found drinking diet soda in childhood was linked to higher risk of obesity, diabetes and heart disease.
The scientists said more research was needed especially in older animals and using a range of taste-related cues.
However, Pierce wished to make clear that this research has shown that:
"Young animals can be made to overeat when low-calorie foods and drinks are given to them on a daily basis, and this subverts their bodies' energy-balance system."
"Parents and health professionals should be made aware of this and know that the old-fashioned ways to keep children fit and healthy, ensuring they eat well balanced meals and exercise regularly, are the best ways. Diet foods are probably not a good idea for growing youngsters," he added.
A pediatric endocrinologist and childhood obesity expert, Dr Katherine Morrison, said in an interview for CBS News Consumer Life that she found the study "intriguing". She said she welcomed it because it helps scientists to understand more about how "we become full and what is it that encourages us to eat".
Morrison told CBS News she encourages parents to give children healthy foods such as vegetables, fruit or sa
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