Is Congress listening? Experts urge funding for Native American kids
Filed under: Type 2, Drugs, Daily News, Support
An issue in dire need of attention - climbing rates of Type 2 diabetes amongst Native Americans - has made it to Washington. Experts on diabetes and its impact on Native Americans went to Washington Thursday to basically beg for money to continue with the treatment and prevention programs currently in place.Charles Grim, head of the Indian Health Service, testified yesterday to the Senate Indian Affairs Committee (SIAC) about the disastrous impact diabetes is having in Native American (aka American Indian) and Alaska Native communities. "In some communities, the prevalence rate is as high as 60 percent among adults," said Grim. But the scariest thing is how fast diabetes is spreading amongst younger people. According to the Indian Health Service, diabetes grew by 128 percent amongst teenagers between 1990 and 2004. It also affected many more younger children, but not as badly: the rate of increase for the same period was 77 percent for kids younger than fifteen.
In addition to the testimony of Grim, two North Dakota physicians also spoke at the hearing, urging the SIAC to renew funding for prevention and treatment programs that are currently due to expire next year. Said one of the docs, "We don't want history to repeat itself." The other, Dr. Biron Baker of Bismark, ND, was openly critical of ongoing efforts to stem the spread of diabetes, saying "Administrative ineptitude within the Indian Health Service is a glaring problem."
I guess the answer to the question "Is Congress listening?" is yes. Problem is, those in government who want to help have to come up with money for these programs. Then there are those who take a more cautious approach before they'll approve treatment and prevention programs. People like Wyoming Republican Craig Thomas, who was quoted as saying he wants to see evidence that current programs are effective before throwing his weight behind proposals to improve services. Funny how the money is always available for other pet projects and disastrous wars, but not for stuff like public health programs...
[RESEARCH] Side effects of phenobarbital and carbamazepine in childhood epilepsy: randomised controlled trial
Objective To compare the behavioural side effects associated with two commonly used antiepilepsy drugs--phenobarbital and carbamazepine--in children in Bangladesh.
Design Prospective randomised controlled single centre trial.
Setting Specialist children's hospital in Dhaka, Bangladesh.
Participants 108 children aged 2-15 with generalised tonic-clonic (n=51) or partial and secondary generalised seizures (n=57).
Main outcome measures Seizure control and behavioural side effects.
Results 91 children were followed up for 12 months. Six required a change of antiepilepsy drug. Side effects were compared in 85 children. In the last quarter of the 12 month follow-up, 71 children were seizure free after one year's treatment. Thirty two in the phenobarbital group and 39 in the carbamazepine group had no seizures in 74 and 102 days after randomisation, respectively. Ten children had increased behavioural problems, which were unacceptable in four (one in the phenobarbital group and three in the carbamazepine group). Independent t tests, however, showed no difference between the two trial drugs.
Conclusion There was no excess in behavioural side effects with phenobarbital in children with epilepsy in a country with limited resources.
Trial registration NCT00381537.
Avandia controversy stirs Congress to investigate FDA
Filed under: Type 2, Adult Onset, Drugs, Research, Daily News
Remember learning about "checks and balances" in U.S. History class? When state leaders gathered in 1787 to draft the Constitution, they established three branches of government (legislative/executive/judicial) to protect individual freedom and prevent government from abusing its own power. Now, Congress is questioning the balance of powers over at the Food and Drug Administration (FDA).
Republicans and Democrats in the House and Senate have called for an investigation into the FDA in the wake of the New England Journal of Medicine study which suggests the popular diabetes medication, Avandia, significantly increases the risk of heart attacks. A House hearing is set for June 6.
Original trials by the drug's maker, GlaxoSmithKline, revealed twice the rate of ischemic heart disease for patients taking Avandia versus recipients of placebos. The medical reviewer for the FDA initially expressed concern, but determined the risk was more benign following further analysis.
Internally, the FDA has one set of officials who approve drugs and another set who track the safety of drugs after approval. But there is an unequal balance of power between the safety and approval offices. Congressional investigators report the safety group recommended months ago Avandia receive its severest warning. The review group disagreed. Here's the catch -- the reviewers hold more power than the safety officials.
Senator Charles E. Grassley, Republican of Iowa and others in Congress have pushed for a separation of the approval and safety offices, and increased power for the safety group. Just this month, Senator Grassley proposed such a split, but it failed by one vote. House staffers believe the Avandia case re-ignites Senator Grassley's proposal as the House is soon entering debates to change the drug agency. Here is a previous post covering the Avandia concerns and the full story on the FDA.
High percentage of children having surgery are overweight or obese
Filed under: Diet, Research, Obesity, Nutrition
Researchers from the University of Michigan Health System just released a report in the new issue of the National Medical Association, stating that a very high proportion of children having surgery are overweight or obese.
Examining a database of over 6,000 pediatric surgeries at the University of Michigan Hospital from 2000 to 2004, the researchers found that almost 32 percent of the patients were overweight or obese (with more than half of that 32 percent being obese). One of the major concerns, aside from the clear relationship to a nationwide rise in overweight and obese children, is that these children -- just like overweight and obese adults who undergo surgery -- are more likely to develop infections in their wounds.
The research also suggests that overweight and obese children have a greater likelihood of requiring particular types of surgery. Most frequently, overweight or obese children had to have their tonsils and adenoids removed. Additionally, overweight and obese children were more apt to require surgeries related to breathing problems and sleep apnea; orthopedic surgeries to mend broken bones; and procedures for dealing with gastrointestinal problems.
As stated, the marked increase in the number of overweight and obese children is not limited to Michigan alone, but applies to the entire nation. Over the past two decades, overweight and obesity in children has nearly tripled, just as it has concurrently risen in adults. This surgery related discovery is one of many associated health problems.
Mary Tyler Moore champions research for kids with type 1 diabetes
Filed under: Type 1, Childhood, Research
I have always loved Mary Tyler Moore. I remember snuggling on the couch with my mom one night a week to watch the Mary Tyler Moore show. I don't know what was more comical -- the humor of the storyline or hearing my mom's roaring laugh each Saturday.
I found out years ago Moore has type 1 diabetes. Right away, it comforted me. Maybe it was because I admired her acting skills and love her warm smile. My young brain logic went something like this, "If Mary Tyler Moore has type 1, then maybe it's not so bad my older brother has juvenile diabetes." Whatever the reason, I did some research to catch up on Moore's activities these days.
Born in 1936, Moore turns 71 this year. Her activism in support of the Juvenile Diabetes Research Foundation International (JDRF) is remarkable. As JDRF's International Chairman, Moore has regularly testified before Congress for juvenile diabetes research. She is heading to Washington D.C. later this month to testify once again at Children's Congress 2007. Moore and over 100 kids with type 1 diabetes will meet with top U.S. Government officials to advocate for the cause. These pioneering delegates represent all 50 states and the District of Columbia.
I applaud Mary Tyler Moore for her efforts on behalf of type 1 diabetics worldwide. Watch for future posts on Children's Congress 2007 -- this influential event only comes around every two years.
Men: Smoking can harm your unborn children
Filed under: Smoking, Men Heart Health
In a recent post on our sister blog, That's Fit, Jonathon Morgan wrote a post on the fact that male smokers can damage the genetic makeup of their offspring. I am always happy to see research done in equal measures on both males and females. So often, only men (as in a large number of heart attack studies) or only women (as in the effects on unborn children) are used in studies.It takes two to tango, so to speak, and it just makes sense that what men do translates to their babies. Doing studies on the effects that fathers have on their offspring is welcome. There have been studies that show that men who drink a lot can affect their unborn children. What we do very rarely affects only ourselves in real life. Knowing that smoking can affect their offspring might get some men, who are not taking the warnings of harming their own health seriously, to quit smoking. I believe that there are many men out there who truly believe that they are invincible, and do not heed warnings about the effects of smoking. I also believe that a large number of those men will think twice about lighting up when it can harm their children.
We are, of course, assuming that men who smoke can "make" babies in the first place. Men should also remember that smoking can lead to impotence. Men who started smoking in their teens can be impotent in their 30s or 40s. So, guys, if you want to make healthy babies, butt out!
[RESEARCH] Objectively monitored patching regimens for treatment of amblyopia: randomised trial
Objectives To compare visual outcome in response to two prescribed rates of occlusion (six hours a day and 12 hours a day).
Design Unmasked randomised trial.
Setting Research clinics in two London hospitals.
Participants 97 children with a confirmed diagnosis of amblyopia associated with strabismus, anisometropia, or both.
Interventions: 18 week period of wearing glasses (refractive adaptation) followed by occlusion prescribed ("patching") for six or 12 hours a day.
Main outcome measures Visual acuity measured by logMAR letter recognition; objectively monitored rate of occlusion (hours a day).
Results The mean age of children at study entry was 5.6 (SD 1.5) years. Ninety were eligible for occlusion but 10 dropped out in this phase, leaving 80 children who were randomised to a prescribed dose rate of six (n=40) or 12 (n=40) hours a day. The mean change in visual acuity of the amblyopic eye was not significantly different (P=0.64) between the two groups (0.26 (95% confidence interval 0.21 to 0.31) log units in six hour group; 0.24 (0.19 to 0.29) log units in 12 hour group). The mean dose rates (hours a day) actually received, however, were also not significantly different (4.2 (3.7 to 4.7) in six hour group v 6.2 (5.1 to 7.3) in 12 hour group; P=0.06). The visual outcome was similar for those children who received three to six hours a day or more than six to 12 hours a day, but significantly better than that in children who received less than three hours a day. Children aged under 4 required significantly less occlusion than older children. Visual outcome was not influenced by type of amblyopia.
Conclusions Substantial (six hours a day) and maximal (12 hours a day) prescribed occlusion results in similar visual outcome. On average, the occlusion dose received in the maximal group was only 50% more than in the substantial group and in both groups was much less than that prescribed. Younger children required the least occlusion.
Trials registration Clinical Trials NCT00274664.
[RESEARCH] Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials
Objective To review the published literature on the effectiveness of interventions to promote physical activity in children and adolescents.
Design Systematic review.
Data sources Literature search using PubMed, SCOPUS, Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006.
Review methods Two independent reviewers assessed studies against the following inclusion criteria: controlled trial, comparison of intervention to promote physical activity with no intervention control condition, participants younger than 18 years, and reported statistical analyses of a physical activity outcome measure. Levels of evidence, accounting for methodological quality, were assessed for three types of intervention, five settings, and three target populations.
Results The literature search identified 57 studies: 33 aimed at children and 24 at adolescents. Twenty four studies were of high methodological quality, including 13 studies in children. Interventions that were found to be effective achieved increases ranging from an additional 2.6 minutes of physical education related physical activity to 283 minutes per week of overall physical activity. Among children, limited evidence for an effect was found for interventions targeting children from low socioeconomic populations, and environmental interventions. Strong evidence was found that school based interventions with involvement of the family or community and multicomponent interventions can increase physical activity in adolescents.
Conclusion Some evidence was found for potentially effective strategies to increase children's levels of physical activity. For adolescents, multicomponent interventions and interventions that included both school and family or community involvement have the potential to make important differences to levels of physical activity and should be promoted. A lack of high quality evaluations hampers conclusions concerning effectiveness, especially among children.
[RESEARCH] At what age can schoolchildren provide effective chest compressions? An observational study from the Heartstart UK schools training programme
Objective To determine at what age children can perform effective chest compressions for cardiopulmonary resuscitation.
Design Observational study.
Setting Four schools in Cardiff.
Participants 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14).
Interventions Participants were taught basic life support skills in one lesson lasting 20 minutes.
Main outcome measure Effectiveness of chest compression during three minutes' continuous chest compression on a manikin.
Results No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines (38-51 mm). 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies. Compression depth showed a significant relation with children's age, weight, and height (P<0.001). Multivariate analyses showed that, if the age and weight of the children were both known, the height (which is closely related to both) was no longer significant (P=0.95). No association was found between pupils' age, sex, weight, or height and the average rate of chest compressions over the three minute period. Similarly, no relation was found between year group and ability to place the hands in the correct position. During the three minutes' compression, compression rate increased and depth decreased.
Conclusions The children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. Young children who are not yet physically able to compress the chest can learn the principles of chest compression as well as older children.
[RESEARCH] Long term prognosis in preschool children with wheeze: longitudinal postal questionnaire study 1993-2004
Objectives To follow a population of preschool children with and without parent reported wheeze over a period of 6-11 years to determine prognosis and its important predictive factors.
Design Longitudinal series of five postal surveys based on the international study of asthma and allergies in childhood questionnaire carried out between 1993 and 2004.
Setting Two general practice populations, south Manchester.
Participants 628 children aged less than 5 years at recruitment and those with at least six years’ follow-up data.
Main outcome measures Parent completed questionnaire data for respiratory symptoms and associated features.
Results Of 628 children included in the study, 201 (32%) had parent reported wheeze at the first observation (baseline), of whom 27% also reported the symptom on the second occasion (persistent asthma). The only important baseline predictors of persistent asthma were exercise induced wheeze (odds ratio 3.94, 95% confidence interval 1.72 to 9.00) and a history of atopic disorders (4.44, 1.94 to 10.13). The presence of both predictors indicated a likelihood of 53.2% of developing asthma; if only one feature was present this decreased to 17.2%, whereas if neither was present the likelihood was 10.9%. Family history of asthma was not predictive of persistent asthma among children with preschool wheeze.
Conclusion Using two simple predictive factors (baseline parent reported exercise induced wheeze and a history of atopic disorders), it is possible to estimate the likelihood of future asthma in children presenting with preschool wheeze. The absence of baseline exercise induced wheeze and a history of atopic disorders reduces the likelihood of subsequent asthma by a factor of five.