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What Protects Our Children from the Effects of Stress?

Jul 28, 2014, 9:00 AM, Posted by Lorraine McKelvey

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.

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For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.

Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

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To Address Childhood Obesity, Companies Must Join the Fight

May 7, 2014, 4:38 PM, Posted by Risa Lavizzo-Mourey

Risa Lavizzo-Mourey, MD, MPH Risa Lavizzo-Mourey, MD, MPH

We’re seeing signs of promise in the effort to reverse the childhood obesity epidemic in the United States. Overall childhood obesity rates have leveled off—and they’ve even declined in some regions and among some age groups.

But it’s far too early to declare victory, writes RWJF President and CEO Risa Lavizzo-Mourey, MD, in a new post on the professional social networking site LinkedIn. The rate of obesity among U.S. teens, she notes, stands at a “shocking 21 percent, and Hispanic and African-American youth still have higher obesity rates than their white and Asian peers.”

To make more progress, Lavizzo-Mourey says, we need more people and organizations in the fight—particularly the business community.

So what more can be done? On Thursday, May 8, Lavizzo-Mourey and influential leaders from throughout the nation—including many from the business community—met to consider innovative approaches in a forum, “Closing the Gap in Childhood Obesity,” sponsored by RWJF and the Clinton Health Matters Initiative, in collaboration with Grantmakers in Health. The forum focused on developing solutions to the inequities that exist in childhood health and childhood obesity.

Progress, Hope, and Commitment

Feb 28, 2014, 10:55 AM, Posted by Risa Lavizzo-Mourey

Nearly seven years ago, this Foundation made a major commitment to reversing the nation’s childhood obesity epidemic. We had many reasons, but chief among them was the decades of data showing more and more young people in America facing greater challenges to growing up healthy. We, and many others, knew it was an unsustainable path. So we pledged $500 million to reverse the trend, and joined forces with a wide range of partners to address the many different facets that an effort of this magnitude would require. Big challenges require big commitments.

This week has been one of the most exciting in the last seven years. Research published Tuesday shows a major decline in the obesity rate among children ages 2 to 5 over the last eight years. This is a very real sign of progress, because we know that preventing obesity at an early age is likely to help children maintain a healthy weight into adulthood. The significant decline measured by researchers with the Centers for Disease Control and Prevention follows progress we’ve started to see over the last 18 months.

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New Hope for Treatment of Rare Pediatric Disease

Feb 25, 2014, 1:00 PM

About 19 in every 100,000 American children under the age of five suffers from an inflammatory illness called Kawasaki Disease (KD) that can cause irreversible damage to the heart. If diagnosed early, it can usually be treated effectively, and children can be returned to health in just a few days. But between 10 and 20 percent of treated patients suffer from a persistent fever, or one that recurs after treatment, and they are at elevated risk of developing coronary artery aneurysms. A new study, led by Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program Scholar Adriana H. Tremoulet, MD, MAS, and published yesterday in The Lancet, offers new hope for patients with KD.

The symptoms of KD include prolonged fever associated with a rash, swollen neck glands, red eyes, swollen red lips, a condition physicians call strawberry tongue, and swollen hands and feet with peeling skin. Current treatment is infusion of intravenous immunoglobulin (IVIG) and aspirin. The IVIG carries the pooled antibodies from the blood plasma of more than 100,000 donors, and in the KD patient, it decreases the inflammation that causes heart damage. The treatment usually works, but some patients’ IVIG-resistance puts them at greater risk and in need of further treatment.

Tremoulet, a pediatric infectious disease specialist at Rady Children’s Hospital in San Diego, conducted a Phase III trial in which a synthetic antibody called infliximab was added to the standard IVIG and aspirin treatment. While the protocol did not affect the patients’ resistance, it had important positive results. “In our study,” Tremoulet said, “we demonstrated that a single dose of infliximab is safe in children with Kawasaki Disease and that this treatment reduced the inflammation in the body overall as well as in the arteries of the heart faster than just using standard treatment with intravenous immunoglobulin.”

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Protecting Infants from Whooping Cough

Jan 6, 2014, 9:00 AM, Posted by Katherine A. Auger

Katherine A. Auger, MD, MSc, a pediatrician in the Division of Hospital Medicine, Department of General Pediatrics at Cincinnati Children’s Hospital Medical Center, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.

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A 2006 recommendation from the Centers for Disease Control and Prevention (CDC) that all adolescents receive vaccines for pertussis, also known as whooping cough, is having a positive impact. A new study that I led shows it is associated with lower rates of infant hospitalizations for the respiratory infection than would have been expected had teens not been inoculated.

The study, published in Pediatrics, found that the CDC recommendation led not only to a significant increase in vaccination rates among teens, but also to a reduction in severe pertussis-related hospitalizations among infants, who often catch the disease from family members, including older siblings.

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In the Right Place at the Right Time: RWJF Scholar Saves Choking Toddler

Dec 30, 2013, 8:38 AM

Quick thinking and a lucky coincidence saved a toddler’s life, and the incident is serving as a powerful reminder about the need to train parents and other caregivers about what to do when children choke.

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Maja Djukic, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and assistant professor at the New York University College of Nursing, was rollerblading near her home in Connecticut this fall when she heard screaming. Djukic raced to the scene to find a one-year-old boy limp and turning blue. The boy’s father was calling 9-1-1 while him mother tried, unsuccessfully, to clear his air passages. Djukic was able to do so; she had the child breathing by the time an ambulance arrived. He has fully recovered.

In “Keeping Little Breaths Flowing,” Jane E. Brody of the New York Times wrote about the incident, noting that “few parents of newborns are taught how to prevent choking and what to do if it occurs.” Brody’s two-part piece on cardiopulmonary resuscitation (CPR) concludes with “How CPR Can Save a Life,” in which she focuses on resuscitating adult victims of cardiac arrest.

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A Remedy for What Ails the Urban City

Dec 27, 2013, 9:00 AM

By Santa J. Ono and Greer Glazer

Santa J. Ono, PhD, is president of the University of Cincinnati. Greer Glazer, PhD, is dean and Schmidlapp professor of nursing at the University of Cincinnati College of Nursing, and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This piece first appeared in the Cincinnati Enquirer; it is reprinted with permission from the newspaper.

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The children of poor Cincinnati neighborhoods are 88 times more likely to require hospitalization to treat asthma than their peers across town. That’s an urban health disparity born of unequal access to the kind of consistent, attentive, high-quality health care that renders asthma a controllable condition.

In academic medicine, we chart the credentials of our staff and the test scores of our students. We tout the wizardry of the medical technology we bring to bear on exotic maladies. But too often we lose sight of the fact that the ultimate test of an academic medical center isn’t what’s inside the building, it’s what’s outside. If we are improving the health of the communities we serve, then we are truly succeeding.

By that score, we are falling short.

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Childhood Lead Exposure: Piling Disadvantage onto Some of the Country’s Most Vulnerable Kids

Nov 19, 2013, 9:00 AM

Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.

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Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?

Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.

We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.

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The Ripple Effect of Asthma Programming

Nov 1, 2013, 2:58 PM, Posted by Molly McKaughan

There was once a small boy. He was 5 years old, and he lived in a neighborhood of Washington, D.C., in an environment that was rife with potential triggers for asthma.

Back in 2006, we wrote about this boy in a report assessing the impact of one of our programs, Managing Pediatric Asthma.

JH, as we called him then, was enrolled in that program. And with good reason. He coughed and wheezed four days out of every seven, and had made four visits to the emergency department at Children’s National Medical Center in the previous year.

It’s been a long time since I’d thought about JH, but his compelling story came flooding back to me when I read a recent story in the Washington Post about an asthma clinic at this same hospital.  It teaches families of kids with asthma, kids like JH, how to manage the condition with medication, ultimately reducing the number of trips to the emergency room.

According to the Post article, “The clinic has had some success. ER visit rates for asthma have fallen by 40 percent, even as the prevalence of asthma continues to rise.”

Those hopeful results reminded me of JH and other kids just like him, and of RWJF’s important investment in pediatric asthma. The story demonstrates how one program can have such a ripple effect—making a big difference, not only in the life of one very small boy years ago, but in the lives of children with asthma living in Washington today.

 

Childhood Obesity Is Everybody's Problem

Aug 9, 2013, 9:59 AM, Posted by Risa Lavizzo-Mourey

Risa Lavizzo-Mourey

Why? Because, aside from the deleterious impact on the health of kids individually, childhood obesity can have an adverse effect on “our economy, our health care system, and our future,” writes RWJF President and CEO Risa Lavizzo-Mourey, MD, in a new blog post on the professional social networking site, LinkedIn.

So what can you do? Quite a bit, Lavizzo-Mourey concludes.

The rate of childhood obesity has been soaring for more than three decades. That has been cause for deep distress, and still is. All the same, she writes, there is new reason for hope, and it is to be found in the findings of an August 6 report by the Centers for Disease Prevention and Control (CDC).

The report suggests that, for the first time, obesity rates dropped in 18 states and one U.S. territory in recent years for low-income children ages 2 to 4.

The report, while not cause for complacency, suggests that—although childhood obesity is still a major health concern—there are steps we can take to arrest and reverse the epidemic.

“The diverse group of states and communities with declines have instituted a wide range of programs to help families make healthy choices where they live, learn, play, and work—programs that can be adapted and scaled up by other regions,” Lavizzo-Mourey asserts. “All of these communities have one important thing in common—they have made childhood obesity prevention a priority.”

In 2007, the Foundation pledged $500 million to meet a goal of reversing the epidemic by 2015. “We know we can do it,” Lavizzo-Mourey writes, “but we can’t do it alone.”