Category Archives: Pediatrics
Obese Children More Susceptible to Air Pollution-Related Asthma
Obese children are more susceptible to air pollution-related asthma, according to a new study in the journal Environmental Research. Researchers followed the health of 311 children, ages 5 and 6, in predominantly Dominican and African-American neighborhoods of New York City, finding that high exposure to polycyclic aromatic hydrocarbons (PAH)—a family of air pollutants—was only associated with asthma among obese children The study determined that obese children exposed to the PAH chemicals 1-methylphenanthrene and 9- methylphenanthrene were two to three times more likely to have asthma. PAHs are emitted by vehicles, cigarette smoke, cooking, incense, burning candles and various other indoor sources. Two possible explanations for the disparity are that obese children tend to be less active, so are more likely to be exposed to indoors sources of PAH, and that they may breathe more rapidly than children of healthier weights Better understanding of the risk factors opens the door to more targeted interventions. “These findings suggest that we may be able to bring down childhood asthma rates by curbing indoor, as well as outdoor, air pollution and by implementing age-appropriate diet and exercise programs,” said senior author Rachel Miller, MD, professor of medicine (in pediatrics) and environmental health sciences, and co-deputy director of the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health. Read more on pediatrics.
Report: Antibiotics Dangerous to Humans Still Used in Livestock
Despite knowing their risk to humans, the U.S. Food and Drug Administration (FDA) continues to allow the use of certain antibiotics as additives in animal feed and water, according to a new report from the Natural Resources Defense Council based on documents acquired under the Freedom of Information Act. In a review from 2001 to 2010 the FDA concluded that 30 such antibiotics posed a significant risk of exposing people to antibiotic- resistance bacteria. The drugs were approved for “non-therapeutic” use in farm animals, such as preventing disease or promoting growth of the animals, instead of treating specific illnesses. In December the FDA announced its intention to combat the spread of antibacterial resistance by prohibiting the use of medically important antimicrobials in food animals for food production purposes, while also adding veterinary oversight to therapeutic use of the drugs in animals. Read more on food safety.
Residents of Public Housing Developments, Rental Assistance Units See Significant Gap in Oral Health Care
People who live in public housing developments and rental assistance units are less likely to have routine preventive dental care and more likely to have suffered serious oral health issues related to tooth loss, according to a new study in The Journal of Urban Health. The study was conducted by the Partners in Health and Housing Prevention Research Center (PHH-PRC) at the Boston University School of Public Health. The researchers looked at four indicators for people living in Boston’s publicly supported housing: having had a dental visit in the last year, having had a dental cleaning in the last year, having had six or more teeth extracted, and having dental insurance. They found that people in public housing, despite being as likely to have had a dental visit in the past year, were significantly less likely to have had a cleaning. The gap in health care is especially serious for the seniors in this already vulnerable population: Compared to younger residents, seniors 65-75 years old were 30 times as likely to have had six or more teeth removed. Read more on prevention.
Study: 20 U.S. Children Hospitalized for Gunshots Each Day
Each day approximately 20 children across the United States are hospitalized for a firearm injury, with more than 6 percent—or about one child a day—ultimately dying, according to a new study in the journal Pediatrics. Researchers from the Yale School of Medicine analyzed health records for 2009, finding a total of 7,391 hospitalizations and 453 deaths for children and adolescents younger than age 20. While most hospitalizations were for assault, for children younger than age 10 the cause was unintentional or accidental injury approximately 75 percent of the time. Firearm injuries can require extensive follow-up treatment, including rehabilitation; home health care; hospital readmission from delayed effects of the injury; and mental health or social services. "These data highlight the toll of gun-related injuries that extends beyond high-profile cases, and those children and adolescents who die before being hospitalized,” said John Leventhal, MD. “Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.” Read more on violence.
Study: Integrating Vegetation into Transportation Planning Improve Air Quality, Public Health Overall
The strategic integration of trees, plants and other vegetation into transportation planning may have a positive effect on air quality specifically and public health overall, according to a new article from the U.S. Environmental Protection Agency, the U.S. Forest Service and other organizations. The study, which appeared in TR News Magazine, looked at short-term and long-term methods to reduce human exposure to pollutants along major transportation corridors. “Properly designed and managed roadside vegetation can help us breathe a little easier,” said Greg McPherson, PhD, research forester at the U.S. Forest Service’s Pacific Southwest Research Station. “Besides reducing pollutants in the air, these buffers can protect water quality, store carbon, cool urban heat islands and soften views along our streetscapes. They are essential components of green infrastructure in cities and towns.” Read more on transportation.
Quality Improvement Initiative Sees Significant Improvement in Teen Asthma Management
A quality improvement initiative from the Cincinnati Children's Hospital Medical Center has proven to significantly improve asthma outcomes for teenagers, a notoriously difficult demographic to help due to overall poor adherence to treatment. The study appeared in the journal Pediatrics. The researchers focused their efforts on 322 primary care patients with asthma, of which only about 10 percent had optimally well-controlled asthma. Starting in 2007, that percentage grew to 30 percent by 2009 and remained steady through the study’s end in 2011. The researchers also saw patient confidence in the ability to manage their asthma climb from 70 percent to 85 percent. "We were able to achieve sustained improvement in patients whose chronic asthma is not well-controlled by implementing a package of chronic care interventions,” said Maria Britto, MD, director of the Center for Innovation in Chronic Disease Care at Cincinnati Children's and senior author of the study. “These included standardized and evidence-based care; self-management support, such as self-monitoring by using diaries and journals; care coordination and active outreach among healthcare providers; linking these teens to community resources; and following-up with patients whose chronic asthma is not well-controlled." Read more on pediatrics.
Interactive Map Helps Communities Prepare for Peaks in Flu Cases
Flu season for most of the country should peak in January, according to a new website that utilizes modern weather prediction technology to turn real-time influenza estimates into 94 local forecasts of future flu activity. The website was developed by infectious disease experts at Columbia’s Mailman School of Public Health. By predicting when areas are likely to see the highest incidence of flu cases, public health officials can better manage medicine and other supplies.
The website features:
- Interactive U.S. map that displays the relative severity of seasonal flu in cities across the country flu and incidence numbers for each
- Influenza incidence predictions by city for the coming weeks
- Map that illustrates the proportion of flu cases by region
- Charts that compare the timing and severity of the four most recent flu seasons
- Exportable data for each week of the flu season (beginning in 9/29 for the 2013-2014 season)
Read more on influenza.
Minority Children Less Likely to Be in Car, Booster Seats Properly
Minority children are less likely than white children to be put into car seats and booster seats as recommended, according to a new study in the journal Pediatrics. Potential reasons for the disparity include both access to resources and social norms. "We expected that differences in family income, parental education, and sources of information would explain the racial disparities in age-appropriate restraint use and they did not," lead author Michelle L. Macy, MD, according to Reuters. According to a survey of 600 parents with kids ages one to 12, among four- to seven-year-olds, twice as many non-white kids sat in the front seat as white kids; 10 percent of the kids in that age group overall had sat in the front seat. The study also found that 3 percent of kids under age four and 34 percent ages eight to 12 had sat in the front seat, although there were no differences based on race for these groups. Read more on safety.
Study: Access to Firearms Increases Risk of Suicide and Homicide
A person with access to a gun is three times more likely to commit suicide and about twice as likely to be murdered than someone without such access, according to a new study in the journal Annals of Internal Medicine. Researchers analyzed 15 previous gun studies—13 from the United States—looking at intentional acts of violence. They also adjusted the past studies for the likelihood of mental illness. "If you have a firearm readily available and something bad has happened to you, you might make a rash, impulsive decision that will have a bad outcome," said lead author Andrew Anglemyer, a specialist in study design and data analytics in clinical pharmacy and global health sciences at the University of California, San Francisco. "These are just normal gun owners, and we are seeing that gun owners are making very bad, impulsive decisions." Each year the United States sees approximately 31,000 deaths due to firearms. Read more on violence.
New Report by RWJF Commission to Build a Healthier America Calls for Funding Changes to Help Improve the Health of the Nation
Recommendations released by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America yesterday call for three areas of change essential to improving the nation's health:
- Increasing access to early childhood development programs;
- Revitalizing low-income neighborhoods;
- Broadening the mission of health care providers beyond medical treatment to include the social problems their patients face that keep them from living healthy lives.
The Commission, which reconvened last June after four years, deliberated over the past several months and determined that these areas have the greatest potential for improving the health of the population, especially for low-income families.
The independent, non-partisan Commission was chaired by Alice M. Rivlin, PhD, former director of the Office of Management and Budget, and Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services. Commission members included journalists, physicians, academics, policymakers, public health experts and people engaged in community development.
The new recommendations are part of a new report, Time to Act: Investing in the Health of Our Children and Communities.
“We cannot improve health by putting more resources into health care alone," McClellan said. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."
"To achieve a healthier America, we must change our approach to investing in health to affect the actual determinants of health, not just the consequences of ill-health," said Rivlin. "If carried out, these recommendations will build a foundation of lifelong health for generations to come."
Speaking at the release of the recommendations in Washington, D.C., yesterday RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said, “we must join forces to foster a culture of health in which everyone—regardless of where they live, their race or ethnicity, or how poor or wealthy they may be—has the opportunity to lead a healthy life."
The Commission’s members all spoke about the findings and recommendations during panel discussions at an event at the Newseum to release the report. Suggested next steps include engaging both citizens and policymakers to advance the issues. “Often aspiring policymakers are looking for an issue and we’re trying to hand them one,” said Rivin. Anne Warhover, a member of the Commission and president and CEO of the Colorado Health Foundation, pointed out that turning the recommendations into successful actions will include helping each community determine both what it needs and what it can do, and realizing that “one size does not fit all” when it comes to these changes.
The Robert Wood Johnson Foundation, said Lavizzo-Mourey, “will make the [Commission’s report] our compass going forward to allow everyone to live a healthy life. It’s not going to stay on the shelf. We’re going to use this every day.”
- Resources created to accompany the release of the recommendations of the Commission to Build a Healthier America include video interviews with key leaders who are already helping to change the health of their communities.
Study: School Assaults Lead to Nearly 90,000 ER Visits Annually
Assaults at school account for almost 90,000 emergency-room visits annually, according to a new study in the journal Pediatrics. In a review of data on students ages 5-19, researchers determined that an average of 92,000 annual emergency visits were a result of deliberate injury, with student-on-student assault accounting for about 88,000. About 40 percent of the injuries were bruises or scratches, with few leading to later hospitalization. "[The number of injuries] appears to be concerningly high, especially when you realize that such a substantial number of injuries are occurring in the school setting, where safety measures are already in place," said lead author Siraj Amanullah, MD, an assistant professor of emergency medicine and pediatrics at Brown University's Alpert Medical School. "There is a need to continue addressing this issue at various levels—at home, at school and in the medical care setting—and there is a need to ramp up our existing prevention and safety strategies.” Read more on violence.
WHO: India Can Now Be Declared Polio-Free
With now three years passed since its last reported cased of polio—January 13, 2011—the country of India can now be declared polio-free, according to the World Health Organization (WHO). The certification process should be completed by the end of March. The country’s last victim was a two-year-old girl in West Bengal. This now leaves Afghanistan, Pakistan and Nigeria as the only countries where polio remains endemic. As part of our recent Outbreak Week, NewPublicHealth recently spoke with Sona Bari, WHO’s senior communications officer, about the efforts underway to eradicate polio globally. Read more on infectious disease.
Translation Errors Plague ACA’s Spanish-language Site, Impede Enrollment
Problems with the Spanish-language version of the Affordable Care Act’s website are making it difficult for many of the site’s users to navigate the site and enroll for coverage. In addition to launching late and sending users to English-language forms when they are clearly looking for Spanish-language content, CuidadoDeSalud.gov is also full of grammatical and other language mistakes. "When you get into the details of the plans, it's not all written in Spanish. It's written in Spanglish, so we end up having to translate it for them," said Adrian Madriz, a health care navigator who helps with enrollment in Miami. Several states with large Hispanic populations have fallen short in their goals to enroll Spanish-speakers, with critics pointing to the website as a major impediment. For example, while it’s not know how many of California’s 4.3 million residents who only speak Spanish intend to seek coverage under the Affordable Care Act, through the end of November only 5,500 had successfully enrolled. Read more on the Affordable Care Act.
Tips on Staying Warm During the ‘Polar Vortex’
As much of the country faces record lows due to a polar vortex, with many areas suffering through below-zero temperatures, experts are offering advice on how to stay warm and healthy. The first tip is staying indoors. "It's best to limit your outdoor activity as much as possible, since prolonged exposure can lead to frostbite and hypothermia," said John Marshall, MD, chair of emergency medicine at Maimonides Medical Center in New York City. "Both of these conditions can become serious, and even life-threatening if untreated." However, when you must go outside, follow these tips:
- Dress warmly — Layer clothing to retain body heat, and a non-permeable outer layer will help against strong winds.
- Protect your extremities — Wear extra socks. Also go with mittens over gloves, since fingers stay warmer when they’re next to each other.
- Wear a hat — And cover the ears and nose if possible.
- Wear properly fitted winter boots — If they’re too tight they can cut off circulation. Also go for a pair that’s insulated with treads.
- Stay hydrated — Drink fluids to replenish the energy your body spends to stay warm.
- Stay dry — Get out of wet clothing as soon as possible.
Read more on preparedness.
Study: Health Care Spending Remained Low as Economy Struggled
Health care spending has now stayed relatively steady—and low—for four consecutive years, rising by 3.7 percent in 2012 to $2.8 trillion. according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The study, published in Health Affairs, found that faster growth in hospital, physician and clinical services was somewhat offset by slower growth in prescription drug and nursing home services prices. Spending growth and growth in private health insurance for Medicaid were also near historic lows. "The low rates of national health spending growth and relative stability since 2009 primarily reflect the lagged impacts of the recent severe economic recession," said Anne B. Martin, an economist in the Office of the Actuary at CMS and the study’s lead author. "Additionally, 2012 was impacted by the mostly one-time effects of a large number of blockbuster prescription drugs losing patent protection and a Medicare payment reduction to skilled nursing facilities." Read more on budgets.
Study: Newer Antidepressant Drugs All Carry About Equal Risk of Suicidal Thoughts
New antidepressants all come with about the same level of risk for suicidal thoughts and behaviors in children, according to a new study in the journal Pediatrics. Previous studies identified the increased risk, especially within the first few weeks of treatment, but there were still questions of whether some drugs came with higher risks. The study analyzed the medical histories of almost 37,000 children, average age 14, enrolled in Tennessee's Medicaid program between 1995 and 2006. Each child was a new user of one of six antidepressants: Prozac, Zoloft, Paxil, Celexa, Lexapro or Effexor. The study found little difference in the rate of suicidal thoughts and attempts before and after they began the medications. However, they did note that children on multiple medications were at higher risk, though that could also be a result of more severe depression. Read more on mental health.
UC Santa Barbara Might Use Unapproved Vaccine to Combat Meningitis Outbreak
Health officials confirmed late last week that they are considering administering the unapproved vaccine Bexsero to halt the spread of a bacterial meningitis outbreak that has sickened four students at UC Santa Barbara. Three of the students have recovered fully, with the fourth requiring the amputation of both feet. The U.S. Centers for Disease Control and Prevention (CDC) is working with the California state and Santa Barbara County departments of public health to determine whether the vaccine would be effective against the strain; Bexsero, which is not yet approved for use in the United States, is for type B meningococcal disease. The U.S. Food and Drug Administration recently granted Princeton University permission to use the vaccine, after eight students became sick from a similar strain of what has struck UC Santa Barbara. Read more on infectious disease.
AAP Calls for Ban on U.S. Sale of Raw or Unpasteurized Milk
The risk of infection has led the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on Nutrition to not only recommend against the consumption of raw or unpasteurized milk by pregnant women, babies and kids, but to call for the complete ban of its sale in the United States. Pasteurization kills bacteria by heating the milk to a minimum of 161 degrees Fahrenheit for at least 15 seconds before cooling it quickly; at least 97 percent of U.S. dairy products are pasteurized. From 1998 through 2011 there were 148 disease outbreaks related to raw milk or raw milk products, leading to 284 hospitalizations and two deaths. "It's kind of like riding in a car with seatbelts," said Kathryn Boor, dean of Cornell University’s school’s Agriculture and Life Sciences, who was not involved in the study. "If you've got the opportunity for a safety barrier, which would be pasteurization, why wouldn't you use it?" Read more on food safety.
Study: Lack of Sleep in Kids Increases Blood Pressure
Lack of adequate sleep can lead to higher blood pressure even in children who are a healthy weight, according to a new study in the journal Pediatrics. Monitoring 143 Chinese youth in a sleep lab, the researchers determined that one fewer hour of sleep per night increased systolic blood pressure by 2 millimeters of mercury (mm/Hg) and diastolic blood pressure by 1 mm/Hg. All of the participants, ages 10-18, were normal weight and did not have sleep apnea. "Pediatricians must screen for diabetes, and [high blood pressure] in teenagers with sleep loss besides screening for snoring and sleep apnea in obese teenagers," said Sanjeev Kothare, MD, a pediatric sleep expert at NYU Langone Medical Center, who was not involved in the study. The National Sleep Foundation recommends 10-11 hours of sleep per night for children ages 5-12, and at least 8.5 hours per night for teenagers. Read more on pediatrics.
Study: Strong State Laws Can Help Curb Binge Drinking
Strong state laws can help curb binge drinking, according to a new study in the American Journal of Preventive Medicine. Binge drinking, defined as more than four or five alcoholic drinks in a two-hour period, is a factor in about half of the 80,000 alcohol-related deaths each year. Researchers analyzed and graded 29 alcohol control policies across the United States, finding that those with the better policies were one-fourth as likely as those with poorest scores to have binge drinking rates in the top 25 percent of states. They also found that rates were 33 percent higher in states in the bottom quarter of grades than those in the top quarter. "Unfortunately, most states have not taken advantage of these policies to help drinkers consume responsibly, and to protect innocent citizens from the devastating secondhand effects and economic costs from excessive drinking," said study senior author Tim Naimi, MD, an associate professor of medicine at Boston University Schools of Medicine and attending physician at Boston Medical Center. "The bottom line is that this study adds an important dimension to a large body of research demonstrating that alcohol policies matter—and matter a great deal—for reducing and preventing the fundamental building block of alcohol-related problems." Laws and policies that can help prevent binge drinking include limiting hours of sale, increasing alcohol taxes and holding those who sell alcohol legally responsible for harm inflicted by consumers who recently consumed alcohol, according to the U.S. Centers for Disease Control and Prevention. Read more on alcohol.
VP to Announce $100M to Improve Access to Mental Health Services
Vice President Joe Biden will today announce $100 million to improve access to mental health services across the country. The plan comes a year after the school shooting in Newtown, Connecticut, and Biden will make the announcement at a meeting of the families of the victims of the tragedy and mental health advocates. The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) will provide the funding. "HHS will soon issue a $50 million funding opportunity to help Community Health Centers establish or expand behavioral health services for people living with mental illness or addiction," said a White House official, according to Reuters. "Additionally, USDA has set a goal of financing $50 million for the construction, expansion, or improvement of mental health facilities in rural areas over the next three years." Read more on mental health.
Kids Who Watch Violent Movies Also Exposed to Other Risky Behaviors
Exposing kids to violent movies can also expose them to other examples of potentially harmful behavior, according to a new study in the journal Pediatrics. "Parents should be aware that youth who watch PG-13 movies will be exposed to characters whose violence is linked to other more common behaviors, such as alcohol and sex, and that they should consider whether they want their children exposed to that influence," said study lead author Amy Bleakley, a policy research scientist at the University of Pennsylvania's Annenberg Public Policy Center. The study analyzed nearly 400 top-grossing movies released from 1985 to 2010, finding that 90 percent included at least one act of violence that involved a main character, and that a main character used tobacco, consumed alcohol or engaged in sexual behavior in 77 percent of the films. Read more on violence.
HealthCare.gov: After Fixes, More Enroll in First Two Days of December than Did in All of October
The five weeks spent working on many of the problems of the HealthCare.gov website seem to have been time well spent, with more people signing up for the new health insurance in the first two days of December than were able to enroll in all of October. About 29,000 signed up for the insurance, made possible by the Affordable Care Act, on Sunday and Monday; only about 27,000 people signed up in October when the site first went live. While the final numbers have not been released, about 100,000 are estimated to have signed up via the site in November. The website is used in 36 states, with fourteen states and Washington, D.C. running their own sites. Read more on the Affordable Care Act.
Boston Adds Rentable Bicycle Helmets to Bikeshare System
Boston is working to improve the safety of people who use Hubway, the city’s popular bikeshare system, by installing the first vending machine for renting bicycle helmets. The HelmetHub street kiosk will be located at the Boylston Street and Massachusetts Avenue Hubway Station. Riders will be able to rent a helmet for 24 hours for $2, or purchase one to keep for $20; they will be sanitized and inspected after each use. The city intends for this test kiosk to be the first of many throughout Boston. Read more on safety.
Study: Social Ties, More than Biology, Responsible for Changes in Teen Sleep Times
Social ties—especially with parents and friends—may be more responsible than biology for whether a teenager gets enough sleep. While past studies have linked biological development factors to why children tend to sleep less as they age into teenagers, a new study in the Journal of Health and Social Behavior ties the trend more closely to the quality of the teen’s social ties. In an analysis of data on almost 1,000 kids ages 12 to 15—during with the average sleep time drops from 9 hours per school night to 8 hours—researchers concluded that teens who felt that they were a part of school, who were close to their friends and especially who had parents who were active in their life were more likely to get more sleep. "Research shows that parents who keep tabs on their kids are less likely to see them get into trouble or use drugs and alcohol," said David Maume, a sociology professor at the University of Cincinnati. "My findings suggest a similar dynamic with sleep. Parents who monitor their children's behavior are more likely to have kids that get adequate rest. Given that children generally get less sleep as they become teenagers, parents should be ever more vigilant at this stage.” Read more on pediatrics.
As colder weather begins to set in, a new story on the homeless from Atlantic Cities is particularly striking: According to the U.S. Department of Education, the number of homeless students in the United States has hit a record high number.
For the 2011 school year—the latest year for which the department has data—1,168,354 homeless children were enrolled in U.S. schools from nursery through 12th grade. Nationally, that is a 10 percent jump over the previous school year, and a whopping 72 percent increase since the recession began in 2008. More striking numbers: more than 40 states showed a rise in homelessness among kids and ten states saw the number of kids without a space to call their own rise more than 20 percent since 2008.
The lack of a safe home and limited access to health care leaves America’s homeless at especially high risk for a large number of health problems. According to a fact sheet from the National Health Care for the Homeless Council, “Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.”
>>Bonus link: Continue reading even after the numbers jump out at you to learn about a ten year old girl, reported by the San Jose Mercury News, who rides a bus with her father in Santa Clara County, Calif., each night since the $70 monthly pass makes it an affordable option. The fact that the young girl is having “one of her best years so far in school,” according to her father, is all the more remarkable considering they have to get off and reboard that bus about every two hours.