Diapers’ Contents Could Change Way Of Finding Intestinal Disease
A medical test initially researched for aging adults also could be helpful for premature babies, according to scientists with Texas AgriLife Research.
The procedure, which uses fecal samples rather than the oft-dreaded colonoscopy, was developed by Dr. Robert Chapkin and his colleagues, who have been studying the noninvasive technique at the genetic level for more than a decade.
“Babies have many, many intestinal conditions that can threaten their lives, such as necrotizing enterocolitis, or NEC, in premature infants,” said Chapkin, a nutritional scientist. “Our test, we believe, may have utility for determining a baby’s risk, and then would allow a physician to take different strategies in order to abate or prevent the possibility of this life threatening disorder.”
Necrotizing enterocolitis can be fatal, Chapkin noted, and it’s very difficult to determine which babies in the premature baby intensive care unit are going to develop the disease.
The researchers examined the fecal samples of 20 healthy babies in collaborative research with clinicians at the University of Illinois-Urbana.
Just as in the original research, in which the scientists detected genetic fingerprints from adult stools as a predictor of colon cancer, the study with babies found that genetic markers in their stools could also provide a picture of medical condition of an individual baby’s intestines.
The study used fecal samples from 10 human babies that were exclusively breast-fed and 10 human babies that were exclusively formula-fed, Chapkin said.
“I think that all doctors would agree that the breast is best. But why? What is in the breast milk? How does it affect developmental biology, why are infections and complications in the intestine lower in a breast-fed baby than a formula-fed baby?” Chapkin said. “The only way to deal with that is to have a molecular signature of the intestinal cells from that baby and to follow it over time.”
The team was able to identify genetic signatures from each baby, noninvasively, he said. In other words, each baby’s diaper was the source of the samples.
Though it is early in the research, Chapkin said, the scientists found genetic pathways that appear to be induced differently by the breast milk than by formula.
“This may unlock a gold mine, allowing us to understand how that little baby’s intestine is changing and developing and whether or not that formula is meeting those needs,” Chapkin said. “That would allow formula companies to further enrich their formulas with essential molecules so that the two worlds – breast milk and formula – look very similar at some point in time.
“We have a long way to go to validate these markers, but we show it’s feasible, it can be done,” Chapkin said. “We have genetic signatures that are different in these babies’ intestines.”
The finding comes on the heels of the long-term study of colon cancer. The team had created a way to “noninvasively assess the status of a human being’s intestine,” Chapkin noted.
Adults, who at age 50 have a higher risk for developing colon cancer, have to be anesthetized while their colons are probed.
“A colonoscopy is absolutely essential as part of a surveillance process to assess your risk (for colon cancer),” Chapkin said. “Yet, many people would rather avoid the test and run the risk of developing the disease or not catching the disease early, because that test is so distasteful and unappealing to the public.”
The test Chapkin’s team developed and patented isolates the genetic material in a fecal sample focusing on the RNA to get a gene expression or signature.
“Humans have 20,000 or so of these genes. We look at them all and look for those that are informative, telling us what is going on. We’re looking for a needle in a haystack,” he said.
He said such a test, which is not yet available, might be as simple as an at-home kit. A person would put a fecal sample into a tube, seal the tube and return it to the lab, which would then use the RNA analysis developed by Chapkin’s team.
In addition to colon cancer, the test might also reveal other inflammatory bowel diseases which affect millions of people in the U.S., he said.
“We could determine if these people have a signature that could point to when they are about to flare up or they are in the process of developing a clinical symptom,” Chapkin explained. “And that might allow the doctor to intervene very early in the process and nip it in the bud, so to speak. It’s a tool for monitoring intestinal processes.”
The test could be performed periodically, much like the blood tests that people now take to see if there are changes that need further examination.
Both studies – that of the infants and the aging adults – have preliminary findings but need additional resources to pursue further. He said both need more people to enlarge the data set and prove the authenticity of the results across a larger number. That, he added, would require millions in funding.
“We think we can really revolutionize this field of noninvasive detection, in this case targeting the gastrointestinal tract in everything from a baby all the way up to an adult in determining risk for cancer or normal intestinal development,” Chapkin said.
Collaborating with Chapkin on the project at Texas A&M University are Drs. Laurie Davidson, Joanne Lupton, Edward Dougherty and Ivan Ivanov, along with Dr. Sharon Donovan at the University of Illinois-Champaign/Urbana and Dr. Nancy Colburn from the National Institutes of Health.
Source:
Kathleen Phillips
Texas A&M AgriLife Communications
Cyberbullying – A Growing Problem That Can Be More Serious Than Conventional Bullying
Around 10 percent of all adolescents in grades 7-9 are victims of internet bullying.
‘This type of bullying can be more serious than conventional bullying. At least with conventional bullying the victim is left alone on evenings and weekends’, says Ann Frisen, Professor of Psychology at the University of Gothenburg.
‘Victims of internet bullying – or cyberbullying – have no refuge. Victims may be harassed continuously via SMS and websites, and the information spreads very quickly and may be difficult to remove. In addition, it is often difficult to identify the perpetrator.’
Ann FrisГ©n’s research concerns body image, identity development and different types of bullying among children and adolescents. She is also part of an EU network of researchers studying cyberbullying and is since 1 January the national coordinator of this type of research.
What is cyberbullying?
‘Cyberbullying occurs when new technologies such as computers and mobile phones are used to harass or bully somebody. The perpetrators often use SMS, e-mail, chat rooms and Facebook to spread their message.’ One example of this is the Facebook group ‘Vi som hatar Stina Johansson’ (Those of us who hate Stina Johansson).
‘This Facebook group was very difficult to remove. It took Stina’s parents almost one whole month’, says FrisГ©n.
A clear link to school life
Who are the victims? ‘Around 10 percent of all adolescents in grades 7-9 are victims of cyberbullying. There is a clear connection to school life – it usually calms downs in the summer.
The perpetrator is almost always from the same school as the victim. ‘It is a lot easier to be a perpetrator on the internet since it enables you to act anonymously. This also makes it possible for a weaker person to bully a stronger, which is uncommon in conventional bullying’, says FrisГ©n.
Blurring of boundaries is another important factor:
‘In these contexts, people take liberties they normally wouldn’t. For example, nobody would ever think of starting a magazine called “Those of us who hate Stina Johansson”‘. So how can cyberbullying among children and adolescents be prevented?
Parents have an important role, according to FrisГ©n:
‘Adults shouldn’t be so naive about what they put out about themselves on the internet, for example pictures. Kids get inspired by what adults do. In addition, it’s good if parents show interest and ask their children to show them which sites they like to visit. But it’s usually not a good idea to forbid them from visiting certain websites; they should instead teach them how to act when they are there.
‘It is also important not to blame victimised children, since it’s really not their fault. Our job is instead to help them end the harassment.’ FrisГ©n feels that people in Sweden generally are a bit naive when it comes to these issues:
‘All school children in the UK are taught to “zip it, block it and flag it” – don’t share information, block contacts and tell an adult!’
Source:
Lena Olson
University of Gothenburg
Sebelius Awards $100 Million To 10 States To Test Innovations In Children’s Health Care
Health and Human Services Secretary Kathleen Sebelius today announced $100 million in federal grant funds to 10 states to improve health care quality and delivery systems for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
The grants, which will be awarded over a five year period, were funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives.
“We all have a stake in the health of our nation’s children,” said Sebelius. “Exploring new technologies and initiatives will help ensure our kids get the high quality care they need and deserve.”
The grants are totally federally funded and are designed help establish a national quality system for children’s health care through Medicaid and CHIP.
“These grants will test the most current theories of how to improve the quality of care delivered to children,” said Cindy Mann, director of the Center for Medicaid and State Operations within CMS. “These awards will help create the foundation for a more responsive and effective national system of high quality health care for children.”
Awardees represent both single-state projects and multi-state collaborations. Grantees working in multi-state partnerships will share award funds with those partners with funding ultimately distributed among 18 states in total.
Eight of the 10 grantees will test a new set of child health quality measures, and seven of the ten states will use the funds to implement health information technology (HIT) strategies with two states specifically planning to develop a new pediatric electronic health record format.
More information about CHIP can be found at InsureKidsNow.
Source
HHS
Helping Children To Walk Using Treadmill Training
Using a treadmill could help infants with prenatal complications or who were injured at birth walk earlier and better, according to a University of Michigan researcher.
Prenatal injuries can often result in self-correcting or fixable neuromotor delays, but sometimes toddlers get a more serious diagnosis, such as cerebral palsy, says Rosa Angulo-Barroso, associate professor of movement science at the U-M School of Kinesiology. Some of those diagnoses may come much later, or in mild cases, never, she says.
Angulo-Barroso and colleagues followed 15 infants at risk for neuromotor delays for two years and tested their changes in physical activity and treadmill-stepping in their homes. The infants were assisted using the treadmill by their parents.
The researchers looked at the frequency of steps and also the decrease in toe-walking over the two-year period. For those infants who were still not walking, they followed up by calling families to see if infants were walking by age 3.
They found that kids with neuromotor delays using the treadmill were on the same improving trajectory as normal kids. Of the 15 children, six were diagnosed with cerebral palsy.
“We found that in those with neuromotor delays, the pattern of development through time was parallel (but less) than normal kids.” said Angulo-Barroso, who is also a research associate professor at the U-M Center for Human Growth and Development. “We also found less toe-walking, so foot placement improved.”
The study also suggests a critical intervention window. Both children without a diagnosis and kids with cerebral palsy improved the most between 10 months and 18 months.
So what does this mean for parents of children at risk for neuromotor delays?
“We are putting words of caution here,” Angulo-Barroso said. “This is a feasibility study only and the results show it seems viable to do treadmill intervention.”
A feasibility study merely shows that it warrants more work to see how much treadmill intervention helps. However, Angulo-Barroso stresses that in the meantime, parents should take other interventions seriously.
“Early interventions are really, really critical, so at this point I wouldn’t tell them to go find a treadmill, but I would say make sure you get a good physical therapist and work with the physical therapist to see if your kids would be a good candidate for that kind of (treadmill) intervention,” said Angulo-Barroso, who noted that the next study is a randomized sample of children to see how they respond to a formal treadmill intervention.
The current study, “Treadmill Responses and Physical Activity Levels of Infants at Risk for Neuromotor Delay” appears in the journal Pediatric Physical Therapy.
Source:
Laura Bailey
University of Michigan
Certain Perils Of Adolescence Could Result From Increased Neural Sensitivity To Teens’ Feelings And Surroundings
While the otherworldly behavior of teenagers is well documented, University of Pittsburgh researchers have taken a significant step toward finally unraveling the actual brain activity that can drive adolescents to engage in impulsive, self-indulgent, or self-destructive behavior. Published in the current edition of Behavioral Neuroscience, the Pitt study demonstrates that adolescent brains are more sensitive to internal and environmental factors than adult brains and suggests that the teenage tendency to experiment with drugs and develop psychological disorders could stem from this susceptibility.
Lead researcher Bita Moghaddam, a professor in the Department of Neuroscience in Pitt’s School of Arts and Sciences, said that although the exact mechanics of the adolescent brain’s reaction need further investigation, the current study is a starting point in mapping the neural path from stimuli to behavior in the adolescent brain. Pitt neuroscience doctoral student David Sturman was the “Behavioral Neuroscience “report’s lead author, conducting the study with Moghaddam and Pitt research assistant Daniel Mandell. The project was supported by the National Institute of Mental Health.
“Adolescence is a period of volatility and vulnerability with tendencies toward interpersonal conflict, emotional reactivity, and risk behavior, but we know very little about the brain mechanisms that promote this state,” Moghaddam said. “We want to know how the adolescent brain interacts with the environment at the brain-cell level, when the neural signals are firing. Once we identify how certain factors trigger teenage behavior, we might better understand-and possibly address-the origin of the risk taking and psychological disorders such as depression and schizophrenia that occur during this period.”
The researchers trained adolescent and adult rats to respond to a visual light cue by rewarding them with sugar pellets. Previous research has shown that adolescent rats and mice exhibit behavioral differences from adults similar to those of adolescent humans, including greater impulsiveness, impatience, and vulnerability to psychological problems, the authors wrote. The rats were placed in front of three holes with the light behind the middle hole. If a rat poked its nose into the center hole when the light was activated, it received a pellet; if it explored the right or left hole, it got nothing. The researchers found that the adolescents responded to the light cue at least as readily as adult rats, suggesting a similar or slightly better capacity for learning.
After six days, the rats no longer received a reward for choosing the center hole. They were divided into four test groups, each with an equal number of adults and adolescents: rats that were given 20 percent less food between sessions and received the light cue; rats that received the light cue but could eat as much as they liked between sessions; a group that received less food and no light cue; and a group that could eat between sessions but was not shown the light cue during the experiments.
Moghaddam and her team found that adolescents tended to return to the center hole far more often than the adults although they received no reward and continued going to the hole long after the adult rats stopped altogether. Such doggedness was even more prominent in adolescents who received the light cue and had a restricted diet before the experiment. This group nosed the center hole 30 times, twice as often as adults under the same circumstances and as adolescents with less food and no light cue. Adolescents that received the cue and had free access to food made for the center hole only a third as often.
Thus, rats experiencing internal and external stimuli-hunger and the light cue-compulsively sought the earlier reward long after the other rats realized it no longer existed. These results suggest that human teenagers can similarly behave irrationally and compulsively when faced with certain feelings and settings, Moghaddam said. “A scenario could range from the relatively mundane, such as hungry teenagers being more likely than adults to buy fast food immediately after seeing an advertisement, to despair and relationship problems eliciting thoughts of suicide,” she said.
For the project’s next phase, the Pitt group will repeat the experiments while monitoring activity in the emotion and cognition centers of the adolescent and adult rats’ brains, Moghaddam said. This information will help Moghaddam and her colleagues grasp how brain cells encode the behavioral signals sent in response to stimuli.
Source:
Morgan Kelly
University of Pittsburgh
Are Latino Teens Sexual Risk Takers? It’s Complicated, Researcher Says
A University of Illinois researcher advises caution when trying to characterize gender roles and sexual behavior among this country’s Latino adolescents and young adults.
“When a recent documentary about U.S. Latinos featured two teen mothers in a 90-minute program, the Latino students in my classes thought it was an unbalanced portrayal of their community – and they were right!” said Marcela Raffaelli, a U of I professor of human and community development and co-author of a recently published chapter on Latino teen sexuality.
National surveys do show that Latino young people as a group are less likely than their non-Latino peers to use condoms and birth control and are more likely to become pregnant and have a child. But these statistics hide a much more complicated picture, she said.
For one thing, Latinos represent more than 20 different groups, and they live in very different situations in the United States.
“For example, Cuban immigrants who moved to the United States when Castro came to power tended to be very wealthy, and they created an entrepreneurial, successful enclave in Miami. Compare them with Central American immigrants who may be refugees from a civil war in the 1980s. Language, religion, and some aspects of culture are apt to be the same, but socioeconomic status is probably very different, and that’s a big predictor of early sexual activity and teen pregnancy,” Raffaelli said.
When you adjust for socioeconomic status and other demographic factors, the difference in adolescent sexual behavior between Latinos and other groups largely disappears.
Attempts to understand sexuality among Latino teens are also complicated in that researchers don’t have the data to draw conclusions about how cultural factors influence sexuality. “People talk a lot about Latino culture and sexuality, but they typically don’t measure cultural variables, such as adherence to cultural norms and attitudes, in their studies,” she said.
So what do we know about Latino sexuality and risk taking among teenagers? For one thing, no one really knows how much the traditional gender role attributes of machismo and marianismo – idealizing the Virgin Mary – actually influence today’s Latino adolescents.
“In traditional Latin cultures, machismo dictates that men be virile and strong and provide for their family. In the United States, when we say macho, often we mean someone’s a male chauvinist, but in most Latin cultures, this idea encompasses such positive behavior as being responsible for your family and taking care of your household,” she said.
The female ideal of marianismo includes being self-sacrificing, pure, and silent. But the researcher emphasized that few studies have tried to measure the extent to which Latinos adhere to these traditional gender roles and whether cultural beliefs are linked to sexual behavior.
“Also, most research on Latino gender roles and sexuality doesn’t take into account that Latin cultures have changed tremendously over the last 20 years as a result of globalization, migration, and changing norms,” she added.
Immigrant status also plays a role in teens’ sexual risk taking. “For first-generation Latinos, recent immigration seems to be a protective factor. Families tend to bring the practices they had in their home country, and over time there’s a shift as they become acculturated. For girls, being an immigrant is protective because Latin American countries are typically more conservative about sexuality than the United States is,” she said.
For boys, the opposite pattern may be true because in many Latin American countries men have more freedom to explore their sexuality. In the United States, they might shift to a more conservative pattern, she said.
Scholars in multiple disciplines have described a pattern called the “immigrant paradox” in which immigrants have better outcomes than their U.S.-born counterparts despite their more challenging situations.
“First-generation teens do better in school, get into less trouble, have fewer early pregnancies, and so on, but by the second or third generation, that protective effect dissipates. A lot of immigrant families have tremendous optimism. They think, our life here is difficult, but we’re here to improve our children’s chances and, besides, things may be worse back home,” she said.
“By the third generation, things often look very different – maybe because of discrimination, bad schools, or socioeconomic factors,” she said.
Raffaelli said that she and other researchers are working to update what is known about American Latino families. “Cultural ideals provide general guidelines, but we need recent research to tell us whether people believe in these ideals and how much those beliefs affect behavior,” she said.
Raffaeli and co-author Maria I. Iturbide of the University of Nebraska at Lincoln wrote the chapter “Sexuality and Sexual Risk Behaviors Among Latino Adolescents and Young Adults” for the Handbook of U.S. Latino Psychology.
Source:
Phyllis Picklesimer
University of Illinois at Urbana-Champaign
Immigrating To North America May Foster Smoking In Children: New Study Published In Journal Of Adolescent Health
Moving to Canada could be hazardous for the health of young immigrants. A new study published in the Journal of Adolescent Health has found that over time, immigrant children from multiethnic, disadvantaged, inner-city neighbourhoods are up to 3.5 times more likely to smoke. The findings are important since an estimated 45,000 school-aged children immigrate to Canada with their parents each year.
Several reasons prompt new Canadians to light up, says lead author Jennifer O’Loughlin, a professor at the UniversitГ© de MontrГ©al’s Department of Social and Preventive Medicine. “Smoking may be more visible than in their countries of origin, especially if they settle in low-income, inner-city communities where smoking prevalence is high,” says Dr. O’Loughlin, who is also a scientist at the Research Centre of the Centre hospitalier de l’UniversitГ© de MontrГ©al (CRCHUM). “Many of their new friends may smoke, adult smoking may be more visible, smoking may be more apparent in media and there may be increased or easier access to cigarettes.”
Dr. O’Loughlin, who collaborated with McGill University colleagues, studied 1,959 Montreal children aged 9 to 12 years old. Among participants, 23 percent were Canadian born, 42 percent had one parent born outside Canada and 35 percent were immigrants born in another country.
“With each passing year in Canada, young immigrant children are at an increased risk for smoking,” warns Dr. O’Loughlin. “Communities where immigrant families chose to live may have an impact on whether their children smoke. Scientists need to better understand the acculturation of immigrant children and develop intervention programs to prevent unhealthy behaviours such as smoking among these kids.”
About the study:
The paper, “Does the ”Healthy Immigrant Effect” Extend to Smoking in Immigrant Children?,” published in the Journal of Adolescent Health, was authored by Jennifer O’Loughlin of the UniversitГ© de MontrГ©al and the Research Centre of the Centre Hospitalier de l’UniversitГ© de MontrГ©al, Katerina Maximova, Keely Fraser and Katherine Gray-Donald of McGill University.
Partners in research:
This study was supported by the Canada Research Chair in Early Determinants of Adult Chronic Disease, Canadian Institutes of Health Research, the Quebec Population Health Research Network and the National Cancer Institute of Canada.
Source:
Sylvain-Jacques Desjardins
University of Montreal
Need To Address Hemophilia In Developing World Highlighted By Research
When modern medicine finds a way to treat a medical condition, people often think that the problem is solved. But we also have to find ways to get that treatment into the hands of those who need it. For example, new research from North Carolina State University shows that much more needs to be done to help get existing treatment to hemophilia patients in the developing world, and that the current lack of treatment there is costing lives.
“This research illustrates international disparities in treatment for a disease that we know how to address,” says Dr. Jeff Stonebraker, an assistant professor of business management at NC State and lead author of two new studies on hemophilia prevalence and treatment. “What we’ve found highlights the work that needs to be done by governments, health officials and pharmaceutical manufacturers to address the needs of those suffering with hemophilia in the developing world.”
Type A hemophilia is a hereditary bleeding disorder that affects about 400,000 people – predominantly men – around the world. The disorder prevents blood from clotting normally, creating the risk of serious bleeding or internal bleeding. Ultimately, the disorder can result in severe pain, joint deformities and death in childhood or young adulthood. But the condition can be treated by replacing the missing clotting factor VIII, which enables those suffering from hemophilia A to live relatively normal lives. Unfortunately, the treatment is expensive and new research shows that access to that treatment is severely limited.
“This is the best data there is on a relatively small global population,” says Mark Skinner, president of the World Federation of Hemophilia. “It will be incredibly useful to our members, to manufacturers of treatment products, ministries of health and researchers. These two very important papers help us see where progress is being made and how we can learn lessons that will help us continue to improve care and work toward our goal of treatment for all.”
In the first study, the researchers found that prevalence of hemophilia A in high-income countries was approximately 12.8 per 100,000 males. The prevalence in lower-income countries was approximately 6.6 per 100,000 males. “The medical community tells us that the incidence of hemophilia A – or the number of people born with the condition – is the same around the world,” Stonebraker explains, “so the difference in prevalence – or the number of people living with the condition at any given moment – appears to be due to much higher mortality in developing countries.”
The study also showed that prevalence of hemophilia has increased over the past 30 years, as treatments for the disorder have improved. In other words, better treatment is helping those with hemophilia A live longer. For example, the United Kingdom had a prevalence of 9.3 per 100,000 in 1974, but it had risen to 21.6 per 100,000 by 2006.
In a second study, Stonebraker and his colleagues found that decreased mortality related to hemophilia A is tied to a willingness – by government health-care agencies or private insurers – to pay for treatment. Correspondingly, the consumption of factor VIII drugs has increased significantly in developed countries – and that trend appears poised to continue, with high-income countries expected to consume more and more factor VIII drugs in the future.
Stonebraker says the two studies should be incredibly helpful as budget-planning tools for insurance companies and those countries that provide national health care, as well as for pharmaceutical companies that will want to project the amount of factor VIII drugs they will need to make to meet market demand. But, Stonebraker says, “the studies also show how much more needs to be done to address hemophilia in the developing world.”
The first study, “A study of variations in the reported hemophilia A prevalence around the world,” was co-authored by Stonebraker, Paula H.B. Bolton-Maggs of the Manchester Royal Infirmary, J. Michael Soucie of the U.S. Centers for Disease Control and Prevention, Irwin Walker of McMaster University and Mark Brooker of the World Federation of Hemophilia. The second study, “A study of reported factor VIII use around the world,” was co-authored by Stonebraker, Brooker, Robert E. Amand of the Biotherapeutic Modeling Group, Inc., Albert Farrugia of the Plasma Protein Therapeutics Association and Alok Srivastava of Christian Medical College. Both studies will be published in a forthcoming issue of Haemophilia.
Source: Matt Shipman
North Carolina State University
Startling New Childhood Asthma Data Released By George Washington University
Researchers from The George Washington University, School of Public Health and Health Services (GW) have said that asthma, a largely manageable and chronic disease, is on the rise in America and released new data on the magnitude of the asthma crisis, the surging cost of treatment, and the more than 1 million children with asthma who are uninsured.
A new report from GW, Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes, found that asthma adds about 50 cents to every health care dollar spent on children with asthma compared to children without asthma. Those most at risk – low income, medically underserved, and African-American and Hispanic children – have the least access to preventive care and the most visits to the ER.
“Childhood asthma presents one of the nation’s starkest examples of what is wrong with the health care system. Even as more than 1 million children with asthma lack coverage, the nation is squandering health care dollars on costly treatment while missing key prevention opportunities,” said Sara Rosenbaum, JD, Chair of GW’s, Department of Health Policy and co-lead author of the new report. “To date, the knowledge, programs and infrastructure America has amassed about childhood asthma is like an unassembled puzzle. We have the pieces; it’s time that we put them together.”
The report, supported by the Merck Childhood Asthma Network, Inc., (MCAN) and the RCHN Community Health Foundation (RCHN CHF), is the result of a year-long investigation into America’s childhood asthma problem to discover why the country has not benefitted more from what is known about asthma, the single most common chronic disease among children.
GW researchers found that of the 1.17 million children with asthma estimated to be uninsured, 600,000 are estimated to be eligible but not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Another 180,000 children with asthma would be eligible for coverage if all states were to increase coverage to 300 percent of the federal poverty level, as seven states already do. With these two simple steps, America could reduce the number of uninsured children with asthma by 75 percent.
“The good news is that significant improvements in childhood asthma could result from better use of existing programs,” said Dr. Floyd Malveaux, Executive Director of MCAN and former Dean of the College of Medicine at Howard University. “For those children most at risk, stable and continuous health insurance could lead to greater access to care, controlled health spending and improved overall health.”
GW identified community health centers as another resource that can be deployed to improve asthma management for children – one in every three of whom is poor.
“Located in medically-underserved and low income communities, health centers report that 20 percent of the children they serve have asthma,” said Feygele Jacobs, MPH, MS, Executive Vice President/Chief Operating Officer of the RCHN CHF. “Community health centers could be the front door to better disease management for children with asthma.”
GW identified five essential elements that are key to improving asthma outcomes and provided practical and evidence-based recommendations about how to bring these elements to life to improve childhood asthma outcomes:
Stable and continuous health insurance
Make continuous Medicaid and CHIP enrollment a part of every eligible child’s asthma treatment plan developed by the child’s health care provider team.
Encourage all states to expand Medicaid and CHIP to at least 300 percent of the federal poverty level and to adopt new options to fully cover legally resident children.
Encourage all states to adopt Medicaid and CHIP enrollment and retention reforms, especially reforms aimed at making enrollment and retention activities possible through community health care providers, schools, and other locations where children and families can easily apply for and renew coverage.
Make enhanced asthma treatment and management a specific focus of quality performance improvement in Medicaid and CHIP.
Provide high quality clinical care and case management for children whose asthma is hard to manage or control, and reach all children regardless of whether they have health insurance coverage
Create an HHS-led, cross-agency, Administration-wide national plan for changing childhood asthma outcomes, involving: CMS, HRSA, CDC, IHS, ONCHIT, ED, HUD and EPA.
Make performance improvement in childhood asthma a key program aim for community health centers and the Indian Health Service, which together are health care homes for over 7.5 million of the nation’s most at risk children.
Continuous information exchange and monitoring, using heath information technology (HIT) as much as possible
Enhance asthma monitoring through model registries and target use of comprehensive integrated HIT systems to promote clinical reporting as well as coordination and communication among care providers, public health agencies and schools.
Asthma trigger reduction in homes and communities
Encourage public health agencies, housing authorities and environmental agencies to promote evidence-based interventions and services that are essential to reducing the many environmental asthma triggers that lie beyond the control of any one family and fall outside of traditional “health care” interventions.
Learning what works and increasing knowledge
Promote a strengthened and diversified Administration-wide research agenda to include basic, clinical and translational/ implementation investigations.
“For the first time, we have a national plan that turns decades of research and lessons learned from on-the-ground programs into recommendations that will improve outcomes,” said Rosenbaum. “It’s time to aim higher for the millions of children with asthma and their families.”
About Childhood Asthma
Asthma is the single most common chronic condition among children. In 2008, 1 in every 7 children – 10.2 million – had asthma, a number that has grown steadily over the 1997-2008 time period. It is also costly. The nation spends $8 billion alone on treating childhood asthma, more than almost any other childhood condition. It costs another $10 billion in indirect costs related to school absenteeism and missed work. Although asthma is nationwide, low income and minority children bear the heaviest burden of asthma and its consequences, including death. Compared with white non-Hispanic children asthma is 60 percent higher among African-American children and nearly 300 percent higher among Puerto Rican children.
Source:
Kimberly Wise
The Merck Childhood Asthma Network, Inc.
Experts Call For Acceleration Of Research And Interventions For Prematurity And Stillbirth
A new report identifies the enormous global impact of preterm birth and stillbirth – and what can be done to decrease it. Globally, an estimated 13 million babies are born preterm each year. Newborn deaths now account for more than 42 percent of mortality in children under the age of five, a rise from 37 percent in the year 2000. Additionally, an estimated 3.2 million are stillborn each year, and many of these losses are linked to maternal deaths.
The Global Report on Preterm & Stillbirth, published with the BMC Pregnancy and Childbirth’s latest supplement (biomedcentral/bmcpregnancychildbirth/), identifies known causes and 21 proven interventions that could now be widely used to improve these extremely distressing yet under-addressed outcomes. Additionally, it outlines the urgent need for increased focus and attention on research. This is crucial for understanding the magnitude, causes, and consequences of preterm birth and stillbirth, and for speeding up the development of diagnostics, treatment and prevention strategies.
The report, led by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), and supported by the Bill & Melinda Gates Foundation and Seattle Children’s, is a collaborative effort undertaken by an interdisciplinary team of maternal, newborn and child health experts from around the globe.
“We can save more lives, but we urgently need more action and resources to better understand the causes of prematurity and stillbirth, and to guide development of cost-effective interventions,” said Dr. Craig E. Rubens, executive director of GAPPS. “For the first time ever, experts from around the world have agreed to a comprehensive, evidence-based approach to solving these global tragedies.”
“Tremendous progress has been made toward saving the lives of children under 5, except in the early neonatal period, the first week of life, when about 3 million newborns die each year, many with complications of prematurity,” said Gary Darmstadt, director of the Family Health Division at the Bill & Melinda Gates Foundation. “Attention to this crucial stage of life will help make progress toward the Millennium Development Goals of reducing child mortality and improving safe motherhood, because maternal, newborn and child health is so intertwined, and a healthy start to life sets the stage for lifelong health.”
Preterm Birth and Stillbirth Affect all Countries
Although the impact of preterm birth and stillbirth is most widely felt in low- and middle-income countries, preterm birth rates are also rising in high-income countries. Preterm birth is the number one cause of newborn deaths worldwide, and those who survive can experience serious short- and long-term health problems. One million stillbirths occur each year during childbirth that could be reduced with existing interventions.
In the United States, great disparities exist between racial and ethnic groups: the preterm birth rates in 2005 vary from 18.4% among African American women to 11.7% among non-Hispanic white women and 10% among Asian and Pacific Islander women. An even larger disparity exists between costs and research. In the United States, for example, preterm birth is the 7th leading U.S. health care expenditure ($26B), yet perinatal health research ranks 63rd in NIH funding.
“BMC Pregnancy and Childbirth is pleased to present this important report,” said Melissa Norton, Editorial Director (Medicine) at BioMed Central. “To date there has not been enough attention given to preterm births and stillbirth, and this report will contribute considerably in reducing the 13 million preterm births and 3.2 million stillbirths worldwide.”
“Preterm births and stillbirths are major health issues in rich and poor countries alike, a private loss to many families that should be on the public’s priority list,” said Dr. Joy Lawn of Save the Children’s Saving Newborn Lives program and a co-author of the report. “With greater understanding of the causes of preterm birth and stillbirth, we can prevent many losses, and make every birth count.”
New Repository of Tissue Samples will Contribute to Global Research
Researchers lack access to quality specimens linked with phenotypic data, which has been a major impediment to solving the complex problems of preterm and stillbirth. To better understand and reduce the numbers of preterm births and stillbirths worldwide, GAPPS is establishing the GAPPS Repository (click here), a unique large collection of prospective data and specimens from diverse populations of pregnant women and their newborns. This will serve as a critical resource for researchers to develop projects that strive to understand and prevent preterm birth and stillbirth.
GAPPS is partnering closely with hospitals, universities and research institutes in the United States and internationally to establish the repository. This resource, which has great potential for furthering advances in medical and public health research, will include a large pool of samples collected from a network of global sites in a systematic and scientifically standardized manner. This will enable the study of multiple factors at different points throughout pregnancy, necessary for predicting adverse outcomes and their relation to gestational age.
The GAPPS Repository will drive discovery science research on these important health issues and accelerate biomarkers that can lead to predicting, treating, and ultimately preventing preterm birth and stillbirth. The repository will also serve as a resource for studies aimed at understanding other poor birth outcomes and fetal origins of adult disease, both acute and chronic. The GAPPS data and samples will be available to researchers worldwide.
Global Action Agenda
The BMC report outlines the first-ever comprehensive review on preterm births and stillbirths. It also includes a Global Action Agenda that was developed by more than 200 stakeholders at the 2009 International Conference on Prematurity and Stillbirth. Global leaders outlined collaborative strategies to achieve four key goals:
Increase awareness and understanding of the magnitude of the problem
Global health leaders typically are unaware of the magnitude of the health problems caused by preterm birth and stillbirth, and their relationships to maternal, child and adult health. Other global health leaders have been aware of the problem, but have not known what to do.
Close the research gaps
The biology of pregnancy and childbirth is poorly understood, as are the causes of preterm birth and stillbirth. Additionally, it is difficult to calculate the magnitude of the problem as there are no global standards for data collection.
Support the discovery, development and delivery of interventions
More research is needed to determine which interventions are most effective. Effective interventions that are already available in low-resource settings should be promoted for scale-up. Effective interventions that are only available in high-income countries should be adapted and evaluated for effectiveness in low-resource settings.
Increase resources for research and implementation
Significant funding, commitment and a coordinated effort are needed to reduce preterm births and stillbirth.
“This call to action presents a unique opportunity to move the prematurity and stillbirth agenda forward,” said Dr. Rubens. “GAPPS is forging a collaborative effort toward achieving common goals to prevent preterm birth and stillbirth. There is significant momentum and we look forward to raising visibility for these critical issues so that we can fuel investments, accelerate innovative research and interventions, and promote effective health policies that will improve maternal, newborn and child health worldwide.”
Source:
Gretchen Sorensen
Seattle Children’s