Category Archives: Pediatrics
While more than 30 million children receive free or reduced-cost meals through the U.S. Department of Agriculture’s (USDA) National School Lunch Program during the school year, only about 3 million of those kids sign on for summer meals through the USDA’s Summer Food Service Program, according to agency statistics. While not all 30 million need the summer meals—many are enrolled in summer programs that offer food or have parents that are able to take responsibility for providing meals—USDA and hunger experts know that millions are going hungry each summer, impacting their day-to-day lives, the learning gains of the previous year and learning readiness for the next grade.
“Most of the reason eligible kids aren’t getting meals in the summer is simply because parents don’t know about them,” said Audrey Rowe, head of the USDA’s Food and Nutrition Service, which runs the meal programs.
Last year, USDA made increasing the number of kids getting summer meals (sites typically serve one meal and a snack or two meals) a top priority, according to a the report Summer Doesn’t Take a Vacation, published by the Food Research and Action Center (FRAC), a Washington, D.C.-based nonprofit aimed at ending child hunger. According to the report, the summer of 2013 marked the first major increase in the number of low-income children eating sponsored summer meals in 10 years, and the program grew last year to serve nearly three million children, an increase of 161,000 children or 5.7 percent from 2012. This represents the largest percentage increase since 2003.
To reach those increases, the USDA worked with organizations including FRAC, Feeding America, Share Our Strength, the YMCA and other national, state and local stakeholders to target states with high rates of poverty, food insecurity and low participation rates in summer food programs. Efforts ran from high-level conversations with state governors—some of whom had known nothing about summer meal programs—to dozens of webinars to teach officials and private partners the nuts and bolts of running the programs. For example, sites are eligible in communities where more than half the area children receive subsidized school meals.
Study: Low-income Teens in Better High Schools Engage in Fewer Risky Behaviors
Low-income teenagers attending “high-performing” high schools are less likely than their peers in lower-performing schools to engage in risky behaviors such as carrying a weapon, binge drinking, using drugs other than marijuana and having multiple sex partners, according to a new study in the journal Pediatrics. Researchers analyzed 521 students who were accepted into a high-performing charter school; when compared to 409 students who also applied to top charter schools but were not selected in a random lottery, the kids in the high-performing schools were less likely to engage in at least one of the identified “very risky” behaviors—36 percent, compared to 42 percent. There was no statistical difference for more common risky behaviors, such as lighter drinking and smoking cigarettes. Read more on education.
Too Few People At Risk for Heart Disease are Receiving Recommendations for Aspirin Therapy
Despite the important role it can play in preventing heart disease, only 40 percent of the people who are at high risk of cardiovascular disease reported receiving a doctor’s recommendation for aspirin therapy, according to a new study in the Journal of the American Heart Association. Approximately one-quarter of people at low risk received the recommendation. “Cardiovascular disease is a significant problem in the United States and the appropriate use of prevention strategies is particularly important,” said Arch G. Mainous III, PhD, the study’s lead investigator and chairman of the department of health services research, management and policy at the University of Florida’s College of Public Health and Health Professions, in a release. “Aspirin has been advocated as a prevention strategy but only for certain patients. There are health risks associated with the treatment. It is important that doctors are directing the right patients to get aspirin for cardiovascular disease prevention.” The U.S. Preventive Services Task Force recommends aspirin use to prevent heart attack and stroke in men ages 45-79 and women ages 55-79. Read more on heart health.
Study: Coping Skills Programs for Mothers of Children With Autism Helps All Involved
Mothers of children with autism who participated in coping skills programs saw reduced stress, illness and psychiatric problems—all of which they are at higher risk for—while also improving their connections with their children, according to a new study in the journal Pediatrics. Such programs also benefit their children, as these risk factors are associated with poorer health outcomes for the children. Researchers entered 243 mothers of children with disabilities (two-thirds of which were autism) into six weeks of either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice), finding that both reduced stress and other negative impacts. Read more on mental health.
Earlier this month, following the heatstroke death of a Georgia toddler who was left in a sweltering car for hours, Tennessee became the first state in the nation to pass a law that specifically protects people from liability for forcibly breaking into cars and rescuing kids they think are at risk of heatstroke. The law requires those individuals to call 911 first and follow instructions.
Many states have Good Samaritan laws that may protect people in such instances, but the specifics vary from state to state, according to Cristina M. Meneses, JD, MS, a staff attorney with the Network for Public Health Law’s Eastern Region. A recent Today show poll found that 88 percent of the 44,000 people asked would break into a car to rescue a child they thought was in danger, but specific laws can increase the response—and potentially remove penalties—while raising awareness of the issue. More such laws could soon follow. Janette Fennell, founder and head of KidsAndCars, a nonprofit based in Kansas City, Mo., which advocates for laws that will protect kids from heat in vehicles, said she’s received inquiries from two states about those laws since Tennessee’s law was passed. Another set of laws that KidsAndCars tracks are those that penalize adults for leaving kids in cars. Nineteen states currently have such laws on the books.
“It’s a good deterrent for anyone who might think, ‘Oh, I’ll just leave them in the car for a minute,’” said Fennell, “because it’s often that minute that turns into much longer and results in injury or death.”
According to the National Highway Traffic Safety Administration (NHTSA), more than 40 kids—often under age 2—die each year of “vehicular heatstroke.” Seventeen U.S. kids have died after being left or trapped in car since the beginning of 2014. Fennell and other experts say many people just don’t realize how quickly temperatures can climb in a car, even if the window is cracked open a bit—when outside temperatures are in the low 80's, the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Children's bodies, in particular, overheat easily; and infants and children under four years old are at the greatest risk for heat-related illness.
NHTSA research shows that heatstroke deaths and injuries often occur after a child gets into an unlocked vehicle to play without a parent or caregiver's knowledge. Other incidents can occur when a parent or caregiver who is not used to transporting a child as part of their daily routine inadvertently forgets a child sleeping in the back.
Last week, KidsAndCars launched a petition drive to encourage NHTSA to require technology in all cars that would remind a driver that there is a child in the back. There are devices parents can install, but a 2012 study by NHTSA found that none that the agency studied were consistently effective.
“You get a warning if you don't buckle your seatbelt, leave a car door open, your gas is low or you leave your headlights on,” said Fennell. “If a child is left behind then you absolutely need a warning.”
Guidelines from NHTSA and other safety experts aimed at never leaving a child unattended in a car include:
- Make a habit of looking in the vehicle—front and back—before locking the door and walking away
- Ask childcare providers to call if a child doesn't show up for care as expected
- Put items in the back seat you’ll have to retrieve such as a purse or briefcase, or put a stuffed animal in sight of the driver to indicate there’s a child in the car.
Study: Common Asthma Treatment Suppresses Growth in Children
A common treatment for asthma may suppress growth in children, according to a new review of two studies that was published in The Cochrane Library journal. The studies included 45 trials on corticosteroid drugs, which are delivered via inhalers to both children and adults with asthma and generally used as first-line treatments for persistent asthma. "The evidence... suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment," said Linjie Zhang at the Federal University of Rio Grande in Brazil, according to Reuters. "But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma." The World Health Organization estimates that there are approximately 235 million people living with asthma. Read more on pediatrics.
Study: Busiest ERs Often Provide the Best Care
People with life-threatening emergencies have better odds of survival when treated at busier emergency departments, according to a new study in the Annals of Emergency Medicine. The study found that patients admitted to a hospital after an emergency had a 10 percent lower chance of dying in the hospital if they initially went to one of the nation's busiest emergency departments; that people with sepsis had a 26 percent lower death rate at the busiest emergency centers; and that lung failure patients had a 22 percent lower death rate. The researchers behind the study estimate that if all emergency patients received the level of care provided by the busiest emergency departments then approximately 24,000 fewer people would die each year. "It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said Keith Kocher, MD, MPH, the lead author of the new study and a University of Michigan Health System emergency physician, in a release. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter." Read more on health disparities.
HHS: $11M Toward Integrating HIV Services into Primary Care
As part of the ongoing National HIV/AIDS Strategy, the U.S. Department of Health and Human Services is making $11 million available for the integration of HIV services into primary care services in Florida, Massachusetts, Maryland and New York. The funds will go toward innovative partnerships between health centers and those states’ health departments. They are part of Partnerships for Care: Health Departments and Health Centers Collaborating to Improve HIV Health Outcomes, a multi-agency project that includes the U.S. Centers for Disease Control and Prevention and the Health Resources and Services Administration. Read more on HIV/AIDS.
RWJF Analysis of ACA Effects Finds No Increase in New Patient Visits
A new report, ACAView, from the Robert Wood Johnson Foundation (RWJF) and athenahealth, finds that in the first five months of 2014 there was no increase in new patient visits, when compared to the same time last year. The ACAView initiative was created to measure the impact of the Affordable Care Act (ACA) on providers, patients and physicians from 2014 through 2016. The report focuses on the provider perspective, showcasing how the ACA affects the practice patterns and economics of physicians and other care team members around the country. Potential reasons for the lack of an increase in visits include the newly insured being unfamiliar with the health care system, or even the winter weather. Read more on the Affordable Care Act.
Study: Nickel in an iPad Linked to Boy’s Allergic Skin Reaction
An ever-increasing reliance on consumer electronics may also mean rarer allergies are becoming more common, according to researchers who linked an 11-year-old boy’s allergic skin reaction to the nickel found in a first-generation Apple iPad. The study was published in the journal Pediatrics. Previous studies have linked the nickel in computers, smartphones and other electronics to allergic reactions; other common sources of nickel include ear piercings, clothing fasteners and dental work. “With the increasing prevalence of nickel allergy in the pediatric population, it is important for clinicians to continue to consider metallic-appearing electronics and personal effects as potential sources of nickel exposure,” according to the study. Read more on pediatrics.
Study: Changing Generic Pill Color, Shape Can Decrease Prescription Adherence
In addition to known considerations such as side effects and cost, the change in the appearance of prescription medications may also lead some people to stop taking their prescriptions, according to a new study in the Annals of Internal Medicine. In a study of more than 11,000 patients, researchers determined that a change in pill color would increase the odds that a patient would stop taking their heart medication by 34 percent, while a change in pill shape would increase the chances by 66 percent. This adds another wrinkle to the series problem of medication adherence; the American Heart Association estimates that three out of four Americans do not take their medication as directed. Read more on prescription drugs.
CDC Closes Flu and Anthrax Labs After Serious Lapses
After two serious lapses with anthrax and avian flu virus, the U.S. Centers for Disease Control and Prevention (CDC) announced it was temporarily closing its anthrax and flu laboratories and stopping shipments of all infectious agents. Last month at least 63 CDC employees may have been exposed to live anthrax bacteria after samples were sent to laboratories that were not prepared to handle the infectious agents. Anyone possibly exposed has been offered a vaccine and antibiotics; the CDC says no one was in danger.
In the second incident, technicians in a CDC lab accidentally contaminated a largely benign flu virus with a much more dangerous H5N1 bird flu strain. A lab worker who received a shipment of the strain and realized it was more dangerous than the sample expected contacted the CDC. And, in a third incident, the CDC also announced on Friday that two of six vials of smallpox vaccine recently found stored at the National Institutes of Health since 1954 contained live virus that could have infected people.
CDC has convened an investigation with finding expected later this week, as well as:
- Established a high-level working group, reporting to the CDC Director, to help accelerate improvements in laboratory safety; review and approve—on a laboratory-by-laboratory basis—resuming transfer of biological materials; and serve as the transition group for accountability on laboratory safety.
- Established a review group, under the direction of CDC’s Associate Director for Science, to look at the systems, procedures and personnel issues that led to the events, as well as how to prevent similar events in the future.
- Plans to take personnel action regarding individuals who contributed to or were in a position to prevent this incident.
Read more on infectious disease.
Military Servicemembers at Increased Risk of Financial Abuse
Members of the military are at increased risk of financial abuse, according to a new survey from the National Foundation for Credit Counseling (NFCC), and more must be done to help servicemembers protect themselves. An NFCC survey of active duty military personnel found that:
- 77 percent of respondents have financial worries
- 55 percent feel not at all or only somewhat prepared to meet a financial emergency
- 60 percent say they had to look outside of traditional institutions and utilized alternative, non-traditional lenders to meet their financial needs
In order to answer this need, the NFCC is working to give servicemembers a deeper understanding of personal finance through its Sharpen Your Financial Focus program, which includes materials that address their particular financial literacy challenges. The program presents 10 individual lesson topics, ranging from banking to planning for retirement. “No one should be victimized by financial abuse, particularly the military,” said Gail Cunningham, spokesperson for the National Foundation for Credit Counseling (NFCC). “One way to avoid financial abuse is through financial education, as an educated consumer is always a better consumer, one more equipped to identify fraud or deception and make wise financial decisions.” Read more on the military.
Study: Confusion Over Spoon Sizes Can Lead to Incorrect Medication Doses for Kids
Confusion over and differences in spoon sizes can lead to frequent medication dosing errors for children, according to a new study in the journal Pediatrics. Researchers observed 287 parents provide medicine to their children using teaspoons and tablespoons, finding that 39 percent incorrectly measured the dose they intended and 41 percent made an error in measuring what their doctor had prescribed. The findings indicate a growing need to change how doctors prescribe medicine for children. "A move to a milliliter preference for dosing instructions for liquid medications could reduce parent confusion and decrease medication errors, especially for groups at risk for making errors, such as those with low health literacy and non-English speakers," said the study's lead author Shonna Yin, MD, an assistant professor of pediatrics at NYU School of Medicine in New York City. Poison control centers receive approximately 10,000 calls each year related to incorrect dosages of oral liquid medications. Read more on pediatrics.
HHS’ Million Hearts Initiative Launches Health Eating Resource Center
The Million Hearts initiative from the U.S. Department of Health and Human Services has launched a new online resource center to promote healthier eating by individuals and families. The Healthy Eating and Lifestyle Resource Center features lower-sodium, heart-healthy recipes and family-friendly meal plans, and emphasizes managing sodium intake. The searchable recipes include nutritional facts and use everyday ingredients. “This resource helps people see that it’s not about giving up the food you love, but choosing lower sodium options that taste great," said Tom Frieden, MD, Director of the U.S. Centers for Disease Control and Prevention. “Small changes can make a big difference. We can prevent 11 million cases of high blood pressure each year if everyone reduced their daily sodium intake to 2,300 mg.” The Million Hearts initiative was launched with the goal of preventing 1 million heart attacks and strokes by 2017. Read more on nutrition.
3-D Mammograms Improve Breast Cancer Detection Rate, Reduce Recall Rate
Tomosynthesis—also known as 3-D mammography—can increase the detection rate of breast cancer while also decreasing false positives that can lead to multiple and unnecessary re-tests, according to a new study in the Journal of the American Medical Association. Researchers analyzed the results of 454,850 examinations, finding that when 3-D mammography was combined with traditional digital mammograms the detection rate for breast cancer climbed 40 percent while there was a 15 percent decrease in the recall rate, or the percentage of women who needed additional screening due to inconclusive results. The findings come as more and more hospitals and physicians are turning to 3-D mammography. The researchers cautioned that more study was needed into the relatively new technology. Read more on cancer.
AAP: Reading to Young Kids Starting in Infancy Improves Literacy Later in Life
Read to your kids—aloud and every day—starting as early as their infancy. That’s the latest recommendation from the American Academy of Pediatrics' (AAP) Council on Early Childhood. The policy statement is set to appear in the August print issue of the journal Pediatrics. "This is the first time the AAP has called out literacy promotion as being an essential component of primary care pediatric practice," said statement author Pamela High, MD, director of developmental and behavioral pediatrics at Hasbro Children's Hospital in Providence, R.I., and a professor at Brown University. "Fewer than half of children are being read to every day by their families, and that number hasn't really changed since 2003. It's a public health message to parents of all income groups, that this early shared reading is both fun and rewarding." According to the AAP, reading proficiency in the third grade is the most important predictor of eventual high school graduation, but approximately two-thirds of all U.S. children and 80 percent of kids living in poverty finish third grade lacking in reading proficiency. Reading aloud to a young child can promote literacy while also strengthening family ties. Read more on pediatrics.
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
An American Academy of Pediatrics symposium earlier this week focused on ways to prevent “toxic stress” in children and families, including addressing mental health education and treatment early in a child’s life. In a comprehensive interview during May’s Mental Health Awareness Month, David Shern, PhD, senior science advisor at Mental Health America and a member of American Public Health Association’s Mental Health Section, addressed the importance of this approach.
“[W]e can develop strong mental health which gives us increased resilience to deal with the adversities that we experience in life, to concentrate better, to be more productive, to be more emotionally well balanced,” he said. “So it’s important that when we think about the overall health of our population, we think not only about preventing illness, which of course is critically important, but also promoting strength and well being.”
Read the full interview with the American Public Health Association.
Study: Public Transportation Policy Often Doesn’t Take Public Health into Account
Many officials and planners continue to ignore public health issues such as air pollution, crime and numerous traffic hazards when designing transportation projects, according to a new study in the Journal of Planning Education and Research. This is especially true for non-white and poor neighborhoods, which often find themselves along major roads, making this a social justice issue, as well. “The public health effects of heavy traffic are broad,” said study author Carolyn McAndrews, PhD, assistant professor at the University of Colorado Denver’s College of Architecture and Planning. “Studies have found associations between high-traffic roads and high mortality rates, lung cancer, cardiovascular disease, respiratory disease, poor birth outcomes and traffic-related injuries.” The study was based on an analysis of Verona Road near Madison, Wisconsin, which can see nearly 60,000 vehicles per day and is in a neighborhood that is home to approximately 2,500 people. Read more on transportation.
CDC Report Finds Up, Downs in Risky Youth Behaviors
The latest Youth Risk Behavior Surveillance System (YRBSS) from the U.S. Centers for Disease Control and Prevention found that while teens are smoking fewer cigarettes and getting into fewer fights, they’re still texting and driving at dangerous rates. The YRBSS—conducted once every two years—monitors an array of risky teen behaviors at the national, state and local levels. It includes data from 42 states and 21 large urban school districts.
Among the findings from the 2013 report:
- Cigarette smoking rates among high school students have dropped to 15.7 percent, meeting the Healthy People 2020 objective of reducing adolescent cigarette use to 16 percent or less
- The percentage of high school students nationwide who had been in a physical fight at least once during the past 12 months decreased from 42 percent in 1991 to 25 percent in 2013
- Fights on school property have been cut in half during the past 20 years, from 16 percent in 1993 to 8 percent in 2013
- 41 percent of students who had driven a car or other vehicle during the past 30 days reported texting or emailing while driving
- The percentage of high school students who are currently sexually active has declined from 38 percent in 1991 to 34 percent in 2013
- Among the high school students who are currently sexually active, condom use also has declined from 63 percent in 2003 to 59 percent in 2013
Read more on pediatrics.
More Active Military Personnel Seeking Mental Health Treatments
The percentage of U.S. military personnel being treated for mental health conditions more than tripled between January 2000 and September 2013, climbing from 1 percent to 3.5 percent, according to a new study in the Medical Surveillance Monthly Report. That comes out to approximately 2,698,903 mental disorder-related treatment courses during the period. In 2012, approximately 232,184 individuals with at least one "initial" mental disorder diagnosis spent a total of 18,348,668 days in mental health disorder treatment. Researchers pointed toward the mental health toll of the terrorist attacks of Sept. 11, 2001, the war in Iraq and the war in Afghanistan—as well as an increased emphasis on getting soldiers who need help into treatment—as they main reasons for the increase. Read more on the military and mental health.