Tag: Pediatrics

Overweight and obesity in 3- and 4-year-olds has decreased after the pandemic

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The prevalence of overweight and obesity in the group of 3- and 4-year-olds in Sweden has decreased after the pandemic. The increase during the pandemic thus appears to have been temporary. These are the findings of a study conducted at the University of Gothenburg and Uppsala University.

The study, published in the journal JAMA Pediatrics, is based on data on 50,833 children aged 3-5 years. Healthcare data about the children are sourced from regular check-ups at pediatric healthcare centers, BVC. Participating regions were Dalarna, Jönköping County and Sörmland.

The researchers have previously been able to demonstrate increased overweight and obesity during the pandemic among 3- and 4-year-olds in Sweden. According to the current study, today’s 3- and 4-year-olds are at about the same levels as 3- and 4-year-olds before the pandemic. The group of 5-year-olds has not had similar weight changes.

The studied time periods are before the COVID-19 pandemic (up to and including April 2020), early pandemic (May 2020-May 2021), late pandemic (June 2021-March 2022) and post-pandemic (from April 2022).

Increasing and decreasing BMI

In the group of 3-year-olds, the proportion with obesity increased from 2.4 percent before the pandemic to 3.4 percent during the early pandemic, and then decreased to 2.3 percent during the late pandemic. After the pandemic, the proportion of 3-year-olds with obesity was 2.6 percent.

The development of overweight in 3-year-olds follows the same pattern. The proportion of overweight children went from 11.6 to 13.2 percent, followed by a decline to 11.3 during the late pandemic. After the pandemic, the proportion of overweight 3-year-olds was 11.9 percent.

In the group of 4-year-olds, BMI (body mass index) also changed significantly. The obesity rate increased from 2.6 percent before the pandemic to 3.7 percent during the early pandemic, then declined to 3.1 percent during the late pandemic and to 2.5 percent after the pandemic.

The proportion of overweight in the group of 4-year-olds rose from 10.3 percent before the pandemic to 11.7 percent during the early pandemic, and then decreased to 9.9 percent during the late pandemic and after the pandemic.

Unhealthy weight can regress

Globally, weight gain in young children during the pandemic has been explained by changes in dietary habits and reduced physical activity as a result of social restrictions and closed preschools. In Sweden, preschools were up and running, but the weight trend remained the same as in other countries, which, according to the researchers, may be due to the fact that many children missed out on nutritious food and regular outdoor activity.

The fact that the weight trend has now been broken is also of great importance in the long term. Childhood obesity increases the likelihood of continued obesity in adulthood, with an increased risk of cardiovascular disease, cancer, and lower quality of life.

Responsible for the study are Anton Holmgren, Pediatrician at Halland Hospital, who conducts research in pediatrics at Sahlgrenska Academy, University of Gothenburg, and Anna Fäldt, Researcher at Uppsala University within pediatric health and parenthood.

The fact that the proportion of overweight and obese 3- and 4-year-olds has decreased indicates that the weight gains were related to the pandemic, and that an unhealthy weight status can be reversed. This also applies at the individual level, a significant proportion of the children where we had repeated measurements dropped to a lower BMI class after the pandemic.”

Anton Holmgren, Pediatrician at Halland Hospital

Source:

University of Gothenburg

Journal reference:

Fäldt, A., et al. (2024). Childhood Overweight and Obesity During and After the COVID-19 Pandemic. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2024.0122.

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March 25, 2024
Chicago’s children face widespread lead exposure in drinking water

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In a recent study published in JAMA Pediatrics, researchers assess the distribution and prevalence of lead exposure through drinking water for children below six years of age in Chicago, Illinois.

Study: Estimated childhood lead exposure from drinking water in Chicago. Image Credit: bakhistudio / Shutterstock.com

Lead exposure through contaminated water

Since discovering the toxic effects associated with lead exposure, large-scale efforts have been implemented throughout the United States to reduce exposure to this heavy metal from previously common sources like gasoline and paint. Although the installation of new lead pipes was banned in 1986, the contamination of drinking water from existing pipes remains an urgent public health concern.

According to the United States Environmental Protection Agency (EPA), no level of lead in drinking water is considered safe for consumption. Chronic exposure to low levels of lead-contaminated water can increase blood lead levels (BLLs), which increases the risk of various adverse health effects, particularly among children. These effects may include, but are not limited to, development deficits, cardiovascular complications, chronic kidney disease, and neurotoxicity.

Like many other cities throughout the U.S., Chicago, Illinois, continues to have lead service lines in its water system. In fact, current estimates indicate that over 400,000 lead pipes remain in use in Chicago, which is much greater than in any other U.S. city. Although efforts have been made to identify and replace lead service lines, only 0.007% of lead pipes were replaced in Chicago between 2020 and 2022.

About the study

Lead testing data was obtained from 38,385 tests provided by the Chicago Department of Water Management to households throughout Chicago between January 2016 and September 2023. Each test assessed lead concentrations in water that had been kept stagnant for at least six hours, water after two minutes of flushing, and water after five minutes of flushing.

Lead measurements, provided in parts per billion (ppb), were analyzed computationally to estimate childhood lead exposure at the city scale using machine learning algorithms and microsimulation studies. Risk-adjusted logistic regression analysis also determined racial disparities in lead exposure levels.

Study findings

Lead contamination in drinking water was present in 75% of the blocks. While at least one ppb was present in 70% of samples, 33% contained five ppb or more of lead.

Thus, almost 70% of Chicago’s nearly 130,000 children under six years of age are exposed to lead-contaminated drinking water. About 20% of study participants reported drinking unfiltered tap water most of the time, which increased BLLs after three months.

The geographical location, population, and number of buildings for each block most accurately predicted the risk of lead exposure. The risk of exposure declined with the population; however, this risk rose with the number of buildings for each block. Blocks in Chicago’s south and west neighborhoods had the highest contamination rates and lowest screening rates.

Although Black and Hispanic blocks were much more likely to be exposed to lead in drinking water, they were significantly less likely to complete at-home lead testing. For each increase of ten percentage points in block-level Black and Hispanic populations, the likelihood of lead testing declined by 3% and 6%, respectively, whereas the risk of lead-contaminated drinking water rose by 3% and 11%, respectively.

With a ten-percentage point increase in White populations, the likelihood of lead screening rose by 24%, even while the risk of contamination declined by 5%. This may reflect the increased use of drinking bottled water, rather than tap water, among White households compared to households of other ethnicities. However, lead contamination may also occur through bottled water, as the Food and Drug Administration (FDA) sets five ppb as the upper limit for lead in bottled water.

Implications for lead exposure

The study findings demonstrate widespread exposure to lead in drinking water among children in Chicago. While exposure rates were markedly higher among Blacks and Hispanics, they were also tested at much lower levels.

Lower screening rates, lower consumption of tap water, and higher levels of lead exposure among predominantly Black and Hispanic blocks may indicate mistrust toward water sources or lack of community engagement from relevant authorities.”

Chronic low-level lead exposure has the potential to affect humans of all ages by reducing mean IQ levels and increasing the rate of preterm births. Thus, there remains an urgent need to correct racial and ethnic inequities in childhood lead exposure. These efforts may include, but are not limited to, contacting these populations to improve access to lead testing, replacing lead pipes, filtering out lead, and using anti-corrosion agents to arrest lead leaching into tap water.

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March 22, 2024
Thriving early environments boost brain and cognitive development in children

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In a recent study published in the journal JAMA Pediatrics, researchers evaluated how fundamental environmental supports, encapsulated as a thrive factor (T-factor), during the first year of life significantly influences brain, cognitive, and socioemotional development by age 3.

Study: Basic Environmental Supports for Positive Brain and Cognitive Development in the First Year of Life. Image Credit: Monkey Business Images / Shutterstock

Background

Nearly half of the world’s children under 5 in lower-income countries fail to reach developmental milestones due to the poverty situation aggravated in the United States (US), where child poverty worsened after the Child Tax Credit discontinuation in 2023. Research highlights the need for environmental and psychosocial support for infants’ healthy brain and cognitive development, including safe shelter, supportive caregivers, and adequate nutrition. Further research is needed to explore the mitigation potential of psychosocial supports in early childhood, aiming to counteract the significant developmental setbacks caused by poverty and provide a foundation for global policy improvements in child development.

About the study

The present study involved mother-infant pairs, part of the Early Life Adversity Biological Embedding and Risk for Developmental Precursors of Mental Disorders (eLABE) project, a longitudinal investigation into how early life adversity affects neurodevelopment and the risk of mental disorders. These pairs were selected during pregnancy from a cohort within the Prematurity Research Center at Washington University in St. Louis. Eligible participants were those pregnant women who, despite exposure to adversities, did not use alcohol or substances other than tobacco or marijuana during pregnancy and had no known complications or congenital issues affecting their pregnancy. This recruitment led to 395 pregnant women joining the study, resulting in 399 singleton births, with four women having two singleton births across the study period.

The study focused on English-speaking women over 18 who were expecting a single child. Exclusions were made for congenital infections in the mother and known fetal abnormalities. Consent was obtained from all participating mothers, with the study receiving approval from the Washington University institutional review board and adhering to Enhancing the Quality and Transparency Of Health Research (EQUATOR) guidelines.

The study quantified prenatal social disadvantage (PSD) and the impact of a T-factor -including environmental stimulation, nutrition, safety, caregiving, and sleep- on children’s neurodevelopment and mental health. Cognitive, language, and behavioral outcomes were evaluated using the Bayley Scales of Infant Development and behavior assessments, considering variables like infant sex, birth weight, gestational age, and maternal cognitive abilities.

Magnetic resonance imaging (MRI) scans were conducted at 24 and 36 months to examine brain volumes and cortical folding, aiming to identify structural correlates of the environmental influences captured by the T-factor. The study used multiple imputations to handle missing data and applied stepwise linear regression to explore the relationships between the T-factor, PSD, and child development outcomes, including cognitive abilities, psychopathology, and brain structure.

Study results

In the study, researchers revealed that PSD and the T-factor, a composite measure reflecting key environmental supports, showed a strong negative correlation, suggesting that higher levels of social disadvantage were associated with lower levels of environmental support, yet each maintained unique contributions to the models.

Cognitive abilities and language development at age 3 showed significant positive associations with the T-factor, even after accounting for factors like child sex, birth weight, and PSD. These associations indicate environmental supports’ critical role in early cognitive and language development. Interestingly, the impact of the T-factor on cognitive and language abilities was found to be dependent upon the level of PSD, with positive effects diminishing as social disadvantage increased.

Socioemotional outcomes, specifically externalizing and internalizing symptoms, were inversely related to the T-factor. This relationship suggests that better environmental supports can reduce negative socioemotional symptoms in children, a finding particularly pronounced for internalizing symptoms in contexts of higher PSD.

In terms of brain structure, the study found a significant positive association between the T-factor and cortical gray matter volume, underscoring the influence of early environmental conditions on brain development. This association persisted even when controlling for PSD, highlighting the T-factor’s independent contribution to brain structure.

Mediation models further clarified these relationships, showing that the T-factor mediated the impact of PSD on cognitive abilities, socioemotional outcomes, and cortical gray matter volume. These findings suggest that enhancing environmental supports could buffer the adverse effects of social disadvantage on child development.

Conclusions

To summarize, the study highlights that early environmental quality, measured by the T-factor, significantly influences early childhood development, enhancing cognitive, emotional, and brain outcomes. The T-factor’s positive effects on development extend beyond the impact of PSD, particularly benefiting cognitive and language skills in children with lower PSD levels. Conversely, it effectively reduces internalizing symptoms in highly disadvantaged settings. These findings suggest the critical role of enriching environments in early development and advocate for interventions that enhance environmental quality, especially for children facing adversity, to improve overall developmental trajectories and reduce the risks of early psychopathology.

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March 20, 2024
Lower grades for students who use both tobacco and cannabis, California survey reveals

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Several reports have raised the issue of increasing absenteeism and lower grades in American public schools after they reopened following the coronavirus disease 2019 (COVID-19) pandemic. These predict higher rates of mental illness and dropout from high school. Substance use is also linked to poor outcomes, including vaping, tobacco, and cannabis, perhaps because of their effects on the developing brain.

Study: Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students. Image Credit: Solid photos/Shutterstock.com

A recent study published in The Journal of Pediatrics examines the odds of these outcomes when tobacco and cannabis are co-used after compensating for other risks. With the rise in legalized cannabis, there has been an increase in the national (but not California) proportion of young people who vape, from 11% to 21% over the period 2017 to 2022. Again, the proportion of cannabis users went up from 5% to 15%.

The current study sought to dissociate this risk in a sample of high school students in California surveyed in 2020-21, immediately after post-COVID school reopening.

About the study

The study utilized the California Healthy Kids Survey (CHKS), performed by the WestEd, the California Department of Education, and the Department of Health Care Services, on students in grades 9 and 11 in California. Only public school students were included, numbering about 353,000, who responded to survey questions about tobacco and cannabis use during the 30 days just before the survey and were attending school in person.

The sample was equally split between males and females, grades 9 and 11, and those with highly educated parents vs others. Almost half were Hispanic, a quarter non-Hispanic White, and 15% Asian. Over one in three said they had felt depressed sometime in the past year, while 6% reported feeling endangered at school.

Almost a tenth used alcohol, while 2% used tobacco alone. About 4% used cannabis, and the same proportion used both substances. Almost double these numbers were reported as having used these substances at any time.

Co-use of both substances was linked to 35% absenteeism vs 29% in cannabis-only users, 26% among tobacco-only users, and 17% among those who used neither. Risk factors for absenteeism and/or poor grades that needed to be adjusted for included bullying, poor health, and change of residence if the student is a caregiver for others or comes from a family with food insecurity. Unsafe school conditions or poor educational climates at school also play a role in this phenomenon.

After adjustment, co-users had a 40% higher risk of absenteeism, the highest among all categories. Compared to tobacco-only users, co-use and cannabis-only users both were ~20% and 15% more likely to report absenteeism, respectively. Similar findings were obtained among ever-users, too.

The mean grade was 6.16, that is, mostly Bs. Co-use was associated with a mean grade of 5.08 vs 5.61 for tobacco-only users, 5.54 for cannabis-only users, and 6.24 among non-users. If using tobacco only was the reference group, co-users, and cannabis-only users had a decrease of 0.39 points, but it fell by a mean of 0.87 points when co-users were matched to non-users. Cannabis-only and tobacco-only users had no difference in their mean grades.

Dangers of absenteeism

School funding suffers when students are absent. Thus, co-use has roughly cost the school $300 per absent student on average.

With over 8,000 students reporting substance use, absences may potentially have cost the school almost $2.5 million in annual funding, provided all of these absences were due to substance use, though this is an unlikely event.

What are the implications?

The drop in grades by almost one category, from Bs to Bs and Cs, associated with co-users compared to non-users, is an important adverse effect. This was accompanied by 40% higher odds of absenteeism (being absent three or more days within the past month) in the co-user group vs non-users and 20% higher odds than among tobacco-only users.

This novel study supports the hypothesis that substance abuse, especially the dual use of tobacco and alcohol, worsens educational outcomes. Several mechanisms have been speculated about. For instance, these substances could affect cognitive processing and disrupt learning and memory pathways.

Cannabis heightens nicotine addiction when used during adolescence, making quitting very difficult. Also, the use of either or both of these substances can cause illness, physical or mental, resulting in skipping school. Co-use has been linked to changes in the sleep pattern.

Finally, vaping at school may distract students, reducing their ability to learn. Another possibility is that vaping or co-use may result in suspension from school. The occurrence of such events is mirrored in the list of reasons for absenteeism, such as illness, anger, sadness, stress, or inadequate sleep.

Future studies should assess potential interventions to improve educational outcomes with the help of full-spectrum efforts to reduce or eliminate substance use among students.

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March 18, 2024
Gut bacteria-derived serotonin promotes the development of immune cells in newborns

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Weill Cornell Medicine investigators discovered that unique bacteria colonize the gut shortly after birth and make the neurotransmitter serotonin to educate gut immune cells. This prevents allergic reactions to food and the bacteria themselves during early development.

The preclinical study, published in Science Immunology on Mar. 15, showed that bacteria abundant in the guts of newborns produce serotonin, which promotes the development of immune cells called T-regulatory cells or Tregs. These cells suppress inappropriate immune responses to help prevent autoimmune diseases and dangerous allergic reactions to harmless food items or beneficial gut microbes.

The gut is now known as the second human brain as it makes over 90 percent of the neurotransmitters in the human body. While neurotransmitters such as serotonin are best known for their roles in brain health, receptors for neurotransmitters are located throughout the human body.”

Dr. Melody Zeng, study’s senior author, assistant professor of immunology in the Gale and Ira Drukier Institute for Children’s Research and the Department of Pediatrics at Weill Cornell Medicine

Gut bacteria in babies provide a helping hand

The researchers observed that the neonatal mouse gut had much higher levels of neurotransmitters, including serotonin, than the adult gut. “So far, almost all studies of gut neurotransmitters were conducted in adult animals or human subjects, where a specific gut cell type called enterochromaffin cells produce neurotransmitters,” said Dr. Zeng. “However, we discovered that this isn’t the case in the newborn gut where most of the serotonin is made by bacteria that are more abundant in the neonatal gut.”

This was also confirmed in babies through a human infant stool biobank that the Zeng lab has established in collaboration with the Neonatal Intensive Care Unit in the NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns. These samples were obtained with parental consent and deidentified.

The study results suggest that before the neonatal gut is mature enough to make its own neurotransmitters, unique gut bacteria may supply neurotransmitters that are needed for critical biological functions during early development.

“We found that gut bacteria in young mice not only directly produce serotonin but also decrease an enzyme called monoamine oxidase that normally breaks down serotonin, thus keeping gut serotonin levels high,” said the study’s lead author Dr. Katherine Sanidad, postdoctoral associate in pediatrics at Weill Cornell Medicine.

The high serotonin levels shift the balance of immune cells by increasing the number of Tregs, which helps prevent the immune system from overreacting and attacking gut bacteria or food antigens. “The neonatal gut needs these serotonin-producing bacteria to keep the immune system in check,” Dr. Sanidad added.

Healthy immune system helps later in life

Dr. Zeng noted that this work underscores the importance of having the right types of beneficial bacteria soon after birth. Babies in developed countries have better access to antibiotics, less exposure to diverse microbes in their clean environments and potentially unhealthy diets that may significantly impact the abundance of serotonin-producing bacteria in their intestines.

As a result, these babies may have fewer Tregs and develop immune reactions to their own gut bacteria, or allergies to food. This may be one reason food allergies have become increasingly common in children, particularly in developed countries. “If educated properly, the immune system in babies would recognize that things like peanuts and eggs are okay, and it doesn’t have to attack them,” she said. This may also have an impact on developing autoimmune diseases-;when the immune system attacks the body’s own healthy cells-;later in life.

The team next plans to look at bacteria in human infant stool samples to measure their production of serotonin, other neurotransmitters and molecules that may help train the immune system to prevent future immune-related diseases, such as allergies, infections and cancer.

“It’s essential to understand how the immune system is trained during early life, but this is understudied in newborns and children. Further studies of these developmental periods may hopefully lead us to mitigation approaches to reduce the risk of inflammatory diseases like food allergies and inflammatory bowel disease later in life,” Dr. Sanidad said.

Source:

Journal reference:

Sanidad, K. Z., et al. (2024). Gut bacteria–derived serotonin promotes immune tolerance in early life. Science Immunology. doi.org/10.1126/sciimmunol.adj4775.

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March 15, 2024
For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants

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Extremely preterm birth is a high-risk condition affecting both short- and long-term health. They may require intensive neonatal care. Whether the level of care they receive depends on the social status of the mother is a question recently explored in a study that appeared online in JAMA Pediatrics.

Study: Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm. Image Credit: Ratchat/Shutterstock.com

Background

Redirection of care for the extremely preterm infant indicates a shift in goals, such as from long-term survival to withholding or withdrawing treatment intended to sustain life. In one US hospital, one in five such infants died because their care was withheld from 1970 to 1972, and another reported that removing mechanical ventilation was the cause of death for over 40% of their infants in the special nursery.

The extent to which parental discussions on redirection of care are influenced by maternal social determinants of health (SDOH) is largely unknown. Drawing on prior studies on racial differences in the experiences of people at the end of life, it appears that poorer and Black children with chronic illnesses are more likely to have intense interventions and to die in hospital rather than at home, compared to White children.

Scientists at the National Institute of Child Health and Human Development Neonatal Research Network (NRN) have found similar rates of illness and in-hospital deaths among different races but higher levels of redirection of care for White non-Hispanic infants vs Black or Hispanic infants. Children with high-risk maternal SDOH were also more likely to be neurodevelopmentally impaired compared to those born to low-risk mothers.

Study aims

The current study is based on the hypothesis that structural racism, interpersonal racism, or mistrust of medical professionals may manifest in different outcomes for White vs Black infants. The researchers also followed up with neurodevelopment impairment (NDI) and mortality rates at two years to better understand the range of possible outcomes.

The investigators looked for data on documented discussions with the parents on redirection of care and for withdrawal, limitation, or withholding of treatments to prolong life. These included intubation or ventilation, nutrition and hydration, and medication.

About the study cohort

The study followed a prospective design, including all preterm infants born before 29 completed weeks of gestation during the period from April 2011 to December 2020 at several designated centers in the USA. They were followed up between January 2013 and October 2023.

The researchers aimed to identify whether infant care was redirected based in any way on the maternal social determinants. They also assessed the rates of death and impaired neurodevelopment at the age of 22 to 26 months, based on the age calculated from the actual gestational age at birth.

The cohort was classified as White or Black only since very few belonged to other races. The mothers were categorized by education (high school graduate or less), insurance type (none, private or public), race, and ethnicity (Hispanic vs non-Hispanic).

Redirection of care

The cohort included about 15,600 infants, the mean gestational age being 26 weeks. They were equally divided between male and female infants. About 2,300 infants (15%) were subjects of discussions about redirection of care.

These infants were less likely to be born after maternal steroid administration, were more premature, and were more likely to have one or more neonatal illnesses such as severe intracranial bleeds, late-onset sepsis, or severe retinopathy of prematurity (plus disease). All these conditions occurred in at least a third of infants. In almost 75%, the mothers had at least one SDOH.

Social factors and redirection of care

The unadjusted analysis failed to show any difference in the number of discussions about redirection of care between White and Black infants. After controlling for maternal and infant factors, infants of Black mothers had 16% lower odds of such a discussion compared to infants of White mothers.

Hispanic mothers were almost 30% less likely to have such discussions about redirection of care than non-Hispanic mothers. There was no difference by type of insurance – public, private, or none – or by level of education.

Redirection of care occurred less often among Black or Hispanic infants, with the odds being 25% and 35% lower, respectively. Maternal education and insurance type did not influence this event either.

Outcomes at two years

At the corrected age of 22 to 26 months, the researchers found that 90% of infants whose parents had documented redirection of care discussions had died before this date, almost all during their birth hospitalization, and 97% of survivors continued to need special care at two years.

Among those of the whole cohort who survived and were discharged, 76% were followed up. While over 80% and 90% of White and Hispanic infants were followed up, the rate was somewhat lower at 71% and 73% for Black and non-Hispanic infants, respectively.

Of the survivors, 85% had NDI, including nearly 95% of infants born to Black mothers vs 80% of those born to White mothers. Death occurred for 91% of infants of non-Hispanic mothers vs 85% among infants of Hispanic mothers.

What are the implications?

“For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants.” The type of analysis performed rules out the possibility that race and ethnicity acted as a proxy for educational and insurance type differences.

While the underlying reasons require further exploration, previous research indicates a greater risk of death and NDI among survivors for whom such discussions have occurred beforehand. Depending on the social and other background, the costs and emotional impact of providing long-term special care for these children may vary significantly.

This study emphasizes the need to consider the social and demographic attributes of patients in research on healthcare practices and outcomes. Different SDOHs have separate impacts on the way physicians and patients interact and on the type and duration of neonatal intensive care. This merits further study.

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March 12, 2024
Inexpensive liquid works as well as dental sealants to keep tooth decay at bay

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An inexpensive, cavity-fighting liquid called silver diamine fluoride (SDF) works as well as dental sealants to keep tooth decay at bay in a school cavity prevention and treatment program, according to a new study by researchers at NYU College of Dentistry.

The study, which followed more than 4,000 elementary school students for four years and is published in JAMA Pediatrics, shows that SDF is an effective alternative to sealants, and can increase access to dental care while reducing costs.

Dental cavities are the most prevalent chronic disease in children and can lead to pain, school absences, and lower academic performance. To prevent cavities, especially among children less likely to see a dentist, the Centers for Disease Control and Prevention (CDC) supports the use of school sealant programs. In sealant programs, dental professionals visit schools to apply a thin, protective coating to the surface of teeth that hardens and safeguards against decay.

SDF has emerged as another promising treatment for fighting cavities. Originally approved by the FDA for treating tooth sensitivity, the solution is brushed onto the surface of teeth, killing decay-causing bacteria and remineralizing teeth to prevent further decay.

A growing body of research shows that SDF-;which is quicker to apply and less expensive than sealants-;can prevent and arrest cavities, reducing the need for drilling and filling.”

Richard Niederman, DMD, professor of epidemiology & health promotion at NYU College of Dentistry and study’s senior author

SDF in schools

Researchers at NYU College of Dentistry led CariedAway, the nation’s largest school-based cavity prevention study, to compare the use of SDF and traditional sealants. The study included approximately 4,100 children in New York City elementary schools; more than a quarter of kids had untreated cavities at the start of the study.

At each school visit, a team of health professionals examined children’s teeth and applied either sealants or SDF followed by fluoride varnish, depending on which treatment the school was randomly assigned to receive. Sealants were administered by dental hygienists, while SDF was applied by either dental hygienists or registered nurses, all under the supervision of a dentist. Starting in 2018, the team visited each school twice a year, although the COVID-19 pandemic and school closures led to missed visits.

The researchers reported last year in the journal JAMA Network Open that a single treatment of either SDF or sealants prevented 80% of cavities and kept 50% of existing cavities from worsening two years later. The team continued their study for another two years, and in their study published in JAMA Pediatrics, found that SDF and sealants prevented roughly the same number of cavities after children were followed for a total of four years. Moreover, both sealants and SDF reduced the risk of decay at each follow-up visit.

“Our longitudinal study reaffirms that both sealants and SDF are effective against cavities. SDF is a promising alternative that can support school-based cavity prevention-;not to replace the dental sealant model, but as another option that also prevents and arrests decay,” said Ryan Richard Ruff, PhD, MPH, associate professor of epidemiology & health promotion at NYU College of Dentistry and the study’s first author.

“Most research shows that SDF can stop a cavity from progressing further. Our study demonstrated that SDF can prevent cavities from happening in the first place,” said Tamarinda Barry Godín, DDS, MPH, associate program director and supervising dentist for CariedAway, research scientist at NYU College of Dentistry, and the study’s coauthor.

An “untapped” oral health workforce

Embracing SDF for cavity prevention and treatment in schools could keep kids from needing fillings, saving families and the healthcare system money. Yet these programs can only succeed if there are enough health professionals to provide care.

The NYU researchers found that children who had SDF applied by dental hygienists and registered nurses had similar outcomes, suggesting that nurses-;including school nurses-;could play a crucial role in cavity prevention programs.

“Nurses may be an untapped resource for addressing oral health inequities,” added Ruff. “Our results suggest that nurses can effectively provide this preventive care, which could dramatically improve access, given the role of school nurses and the size of the nursing workforce.”

This research was funded by the Patient-Centered Outcomes Research Institute (PCS-160936724). The CariedAway cavity prevention model is currently being used in three New Hampshire school districts, supported by Northeast Delta Dental.

Source:

Journal reference:

Ruff, R. R., et al. (2024). Noninferiority of Silver Diamine Fluoride vs Sealants for Reducing Dental Caries Prevalence and Incidence: A Randomized Clinical Trial. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2023.6770.

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March 4, 2024
Exposure to neighborhood violence linked to unmet health needs and increased care utilization in children

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A new collaborative study between Boston Medical Center, Brigham and Women’s Hospital, Boston Children’s Hospital, Hennepin Healthcare Research Institute, University of Pennsylvania, and Children’s Hospital of Philadelphia finds exposure to neighborhood violence among children was associated with unmet health needs and increased acute care utilization. Published in the American Journal of Preventive Medicine and based on nationally representative data on violence exposure and gold standard access to care measures from the National Health Interview Survey, this study shows that evidence-based interventions to improve access to care in communities impacted by violence are needed to mitigate long-term physical and mental health consequences for children.

Millions of children in the U.S. are exposed to violence in their homes or communities. Research has shown that children exposed to violence have worse school performance in childhood, increased rates of substance use disorder in adolescence, increased rates of anxiety, depression, and post-traumatic stress disorder in adulthood, and increased risk of developing chronic medical conditions throughout their lives. Exposure to violence also deepens child health inequities, particularly in marginalized communities disproportionately exposed to violence due to systemic racism across generations.

This study helps examine violence exposure at the population level as both a direct driver of health inequities and as a consequence of fundamental causes like racism, poverty, and other structural risk conditions. The researchers found that, even after controlling for the effects of other important factors like family income and insurance status, children exposed to neighborhood violence face unmet physical and mental health care needs, cost-related barriers, decreased access to prescription drugs, increased urgent care and emergency department utilization, and decreased access to preventive care, mental health care, and medications.

The study also identified an association between exposure to neighborhood violence and mental health symptoms, including increased rates of depression and anxiety, which was consistent with multiple previous studies. Researchers also found that children exposed to violence have higher rates of delayed and forgone mental health care despite experiencing more mental health symptoms. Prior research shows how early access to care can mitigate the mental health consequences of violence exposure; improving access to high-quality, affordable mental health care services remains critical in communities impacted by neighborhood violence.

Researchers call attention to built-in environment reforms like neighborhood greening and cleanup, poverty alleviation interventions like the expanded Child Tax Credit, insurance coverage protections like continuous Medicaid enrollment, and hospital-based violence prevention programs as opportunities to take action.

Our findings highlight the profound impacts of limited access to care in communities affected by violence. We also identify specific opportunities for evidence-based clinician, health system, and policy actions that can reduce the incidence of neighborhood violence and mitigate its health consequences.”

Rohan Khazanchi, MD, MPH, lead author, resident in the Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women’s Hospital, Boston Children’s Hospital, and Boston Medical Center

“To improve health outcomes for the millions of children in the United States affected by neighborhood violence, we have to invest in their families and communities,” said senior author Aditi Vasan, MD, MSHP, a pediatrician at Children’s Hospital of Philadelphia and Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. “Our findings underscore the need for both upstream policy interventions, like the expanded Child Tax Credit, which would provide essential economic support for families in low-income communities impacted by violence, and downstream health system interventions focused on improving access to high-quality, trauma-informed care for these children and their families.”

Source:

Journal reference:

Khazanchi, R., et al. (2024) Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. American Journal of Preventive Medicine. doi.org/10.1016/j.amepre.2024.01.009.

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February 28, 2024
Innovative online tool aims to lower SIDS risk through personalized sleep plans

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A new web-based baby sleep planner, developed by researchers at the University of Bristol, could help save babies lives from sudden infant death syndrome or SIDS, a study suggests. The sleep planner tool is a new way to find out about babies risks and help keep them safe whilst sleeping. Although SIDS is rare, with one death in 3,000 to 4,000 births in England, this new tool, funded by the National Institute for Health and Care Research (NIHR), could help reduce unexplained infant deaths.

The study, published in JMIR Pediatrics and Parenting, found the sleep planner tool, which combines risk assessment and safety planning, has the potential to improve the uptake of life-saving advice for families with infants at increased risk of sudden unexpected death in infancy (SUDI). The sleep planner tool, using advice from the Lullaby Trust, UNICEF and NICE, provides a baby’s SUDI risk assessment at birth and a downloadable sleep plan for families.

While rates of SUDI declined steeply in the 1990s and and to a lesser extent since, families living in the most deprived neighborhoods continue to experience a disproportionately higher rate. Last year, Bristol’s National Child Mortality Database (NCMD) found that 42% of SUDIs occurred in deprived neighborhoods, compared with 8% in the least deprived.

The prototype baby sleep planner tool was tested by 22 health professionals, including health visitors, midwives and family nurses; 20 of whom were interviewed. The health professionals reported the tool allowed at-risk families to be identified for further support and improved their communication about risk with families. The testers suggested expanding the tool’s use to include information during pregnancy and for it to be available in different languages.

The health professionals used the planner tool with 58 families. Twenty parents were interviewed by the research team about their experiences with the tool. Families were positive about the tool, appreciated the trustworthy information and felt it was useful, appropriate and the individual baby sleep plans would be of benefit to them and other family members.

The study found the sleep planner tool, which combined risk assessment and safety planning, could improve the take up of life saving advice. Following the study’s findings, improvements have been made to the tool, which will be evaluated in a larger study – opening shortly. If successful the tool could be rolled out to families with infants at increased risk of SUDI.

Dr Anna Pease, Research Fellow in the Bristol Medical School: Population Health Sciences (PHS), and the study’s corresponding author, said: “Our web-based tool identifies babies who may be at increased risk of SUDI. This risk assessment can be done at birth, to help health professionals know who to focus on with more safer sleep support. The tool also empowers families to understand their baby’s needs and make a plan to keep them safe, which can be downloaded and shared with friends and family.

“Our study found health professionals and family members thought the tool was useful. Health professionals said it helped them to have better conversations about safer sleep and families said it helped them to understand why safer sleep was important and how it could keep their babies safe.”

We know the ‘safer sleep’ campaigns have saved the lives of thousands of babies. Although SIDS is rare, we know that many babies who have died in recent years have at least one known risk present in the sleep environment, and that most of the babies who die are born into families experiencing the effects of poverty.

We wanted to develop a web-based tool to help families follow safer sleep advice, especially for those families with babies at increased risk. We hope our baby sleep planner tool can support families with babies at risk and help save lives.”

Peter Blair, Professor of Epidemiology and Statistics in Bristol Medical School: (PHS)

The research was funded by the NIHR Research for Patient Benefit scheme and supported by the NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board (BNSSG ICB).

The research team would like to thank the health professionals and families who took part in this study, and the midwives at the Royal United Hospitals Bath, and Sirona Health and Care.

Source:

Journal reference:

Pease, A., et al. (2024). A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner. JMIR Pediatrics and Parenting. doi.org/10.2196/49952.

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February 27, 2024
Study finds sharp increase in antidepressant dispensing among adolescents and young adults during COVID-19 pandemic

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Antidepressant dispensing to adolescents and young adults increased sharply after the COVID-19 pandemic began – particularly among females – a new study finds.

While a growing number of young people ages 12 to 25 were receiving antidepressants before the pandemic, the antidepressant dispensing rate rose nearly 64% faster after March 2020, according to Michigan Medicine led findings in Pediatrics.

Antidepressant dispensing to adolescents and young adults was already high and rising before March 2020. Our findings suggest these trends accelerated during the pandemic.”

Kao Ping Chua, M.D., Ph.D., lead author, pediatrician and researcher at University of Michigan Health C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center

Researchers analyzed data from a national database reporting 92% of prescriptions dispensed in U.S. pharmacies. They found that the increase in the antidepressant dispensing rate during the pandemic was driven by females.

After March 2020, this rate increased 130% faster among female adolescents ages 12-17 years and 60% faster among female young adults ages 18-25 years.

“Multiple studies suggest that rates of anxiety and depression among female adolescents increased during the pandemic,” Chua said. “These studies, coupled with our findings, suggest the pandemic exacerbated a pre-existing mental health crisis in this group.”

In contrast to females, the antidepressant dispensing rate changed little among male young adults after March 2020 and declined among male adolescents, which Chua found surprising.

“It’s hard to believe this decline reflects improved mental health,” he said.

He believes a more likely explanation is that male adolescents may have skipped physicals and other health care visits during the pandemic, decreasing opportunities to diagnose and treat anxiety and depression.

The transition away from in-person learning, he notes, may have also decreased opportunities for teachers and other school staff to detect mental health problems in male adolescents.

Chua said the overall rise in antidepressant dispensing to adolescents and young adults may not only be related to worsened mental health. Long waitlists for psychotherapy, for example, may have also played a role.

“In my primary care clinic, I often heard from patients and families that they were facing 6-9 month wait lists for therapy during the pandemic. In those situations, it didn’t make sense to withhold antidepressants and recommend a therapy-only approach,” he said.

Further studies, Chua says, should identify which interventions can best promote the mental health of adolescents and young adults.

Source:

Michigan Medicine – University of Michigan

Journal reference:

Chua, K-P., et al. (2024) Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022. Pediatrics. doi.org/10.1542/peds.2023-064245.

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February 26, 2024