Children without insurance are 60 percent more likely to die than their insured peers, according to a new study from Johns Hopkins researchers that argues that health care reform must protect the nation's most vulnerable.  

The findings, published in the Oct. 30 issue of the Journal of Public Health, offer another sobering statistic: lack of insurance might have contributed nearly 17,000 deaths among children in the United States over the last two decades.

Researchers analyzed more than 23 million hospital records from 37 states between 1988 and 2005, comparing the risk of death in children with and without health coverage. When comparing death rates taking into account underlying disease, uninsured kids had a higher risk of dying regardless of their medical problems, researchers found.

The uninsured rate for children has been rising steadily for two decades causing some lawmakers to fight for expansion of the public insurance to low-income kids through the Children Health Insurance Program, which President Obama signed into law earlier this year. Last year, the rate and the number of uninsured children dipped to their lowest since 1987. Still, advocates are quick to point out, some 7.3 million children lack insurance nationwide.

Confronting the issue is a moral imperative, said researchers.

"Thousands of children die needlessly each year because we lack a health system that provides health insurance. This should not be," said Dr. Peter Provonost, director of Critical Care Medicine at Hopkins, in a statement. "In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue."

Continue reading "Uninsured children and a rising death toll" »

Posted by Kelly Brewington at 7:13 AM | Permalink | Comments (3)
Categories: Pediatrics
        

A CDC advisory panel has said the HPV-vaccine Gardasil should not be used routinely in men and boys. The panel's advice, which the CDC usually follows, comes on the heels of the vaccine winning approval for boys by the Food and Drug Administration.

The panel said it's OK to give the vaccine to males who want it, but stopped short of adding it to the list of routine recommended vaccines for boys.

Supporters of the vaccine's use in boys had hoped recommending the vaccine to them would lead to greater protection for girls and women from the sexually transmitted virus (HPV) that can cause cervical cancer. But members of the panel questioned whether this was cost effective. The vaccine isn't cheap -- a series of three injections runs upwards of $300.

Others hoped that the approval would signal gender parity in the war against sexually transmitted diseases. After all, it takes two doesn't it? If girls can contract HPV from sex, shouldn't their partners help protect them from the virus?

The vaccine would also protect boys from genital warts. While genital warts may not be as severe as cervical cancer, the costs associated with its treatment could be reason enough to vaccinate boys, some experts say.

"It’s embarrassing, but it does not cause cancer," Dr. Maura Gillison, an oncologist at Ohio State University told me recently. "But it does cause a heck of a lot of money for the American health care system. For that, there is no question."

Continue reading "Federal panel does not recommend Gardasil in boys... now what?" »

Posted by Kelly Brewington at 7:39 AM | Permalink | Comments (4)
Categories: Pediatrics
        

The level of mercury in the blood of autistic children is no different than that of their typically developing peers, according to new research that takes aim at the theory held by some parents that one trigger -- mercury in vaccines -- causes autism.

Several studies have ruled out that vaccines cause autism. Nevertheless, the issue sparks controversy in some circles at just the mention of a possible link.

The new study by researchers at the University of California Davis' MIND Institute, looks directly at blood-mercury levels and finds they are virtually no different a group of 452 children 2 to 5-year olds, 249 of whom were diagnosed with autism. The study examined a wide range of sources of mercury in the children's environments, from dental fillings to fish consumption. The research, published in the journal Environmental Health Perspectives, comes from a long-range study to identify causes of autism, a wide spectrum of disabilities marked by impaired communication and social interaction.

It's important to note that while the study is among the first to examine the blood mercury levels of children with autism, researchers cautioned that they did not probe whether mercury is a factor in the cause of autism.

Still, researchers point to it as evidence that a host of research is necessary to identify what is likely a complex web of causes for a very complicated set of neurobiological disorders.

Continue reading "Mercury levels no different in children with autism" »

Posted by Kelly Brewington at 7:03 AM | Permalink | Comments (1)
Categories: Pediatrics
        

Back when I was in school -- no need to specify when -- lunches consisted of a rectangular block of pizza and milk (chocolate if it was Friday!). On some days I don't recall a single vegetable on my plate.

School lunches have improved since then, but they have a ways to go as far as nutrition is concerned, according to a new study by the Institute of Medicine, that urges new dietary standards. The current guidelines -- which set the standard for school lunches for some 30.5 million children and breakfasts for another 10.5 million -- haven't been changed since 1995, the report states. 

The report recommends that lunches have more fruit, vegetables and whole grains and less saturated fat and sodium. Right now, there are no requirements for whole grains and fruit and veggies are counted in the same category. While the current guidelines set minimum calories needed, there is no maximum set.

The current guidelines don't specify limits for sodium, either. Right now, a typical high school lunch contains about 1,600 milligrams of sodium. The new recommendations say the limit should be more than half that amount at 740 milligrams.  

Continue reading "Study: healthier school lunches needed" »

Posted by Kelly Brewington at 3:00 PM | Permalink | Comments (3)
Categories: Pediatrics
        

We've written a good deal here at Picture of Health about racial and ethnic health disparities. But here's an issue of unequal access that's news to me: gaps in care among children with brain tumors.

Hispanic children who have been diagnosed with brain tumors are less likely to receive high-quality treatment in specialty hospitals than their peers of other ethnicities, according to a recent paper by Johns Hopkins researchers.

The findings, published in a recent issue of the journal Pediatrics, found that out of a study over 18 years of 4,421 children with brain cancer, Latino children had the worst access to quality care.

You might think this is a matter of access to good health insurance. But researchers found that coverage didn't play a role in where a patient was treated. Rather, even after adjusting for socioeconomic status, Latino children received top-notch care at one-third of the rate of other children, researchers found.

The gaps in care were shocking to researchers. Despite recent studies and industry efforts pushing to provide quality care for all, the gaps remain, they said. The reasons for the gaps are unclear. Perhaps Hispanic kids are less likely to live near to-notch institutions? Or maybe something else is at play? Researchers also found disparities were higher in communities with high numbers of immigrants and fewer neurosurgeons, which makes sense.

Continue reading "Hispanic kids less likely to get top-notch brain cancer care" »

Posted by Kelly Brewington at 7:21 AM | Permalink | Comments (0)
Categories: Pediatrics
        

So much about autism is a mystery to scientists -- no one knows what causes it and there is no cure. But in recent years one aspect of the puzzling neurobiological disorder appears clear: more children are being diagnosed with autism.

New research suggests that previous estimates of the number of children with autism are too low. As many as 1 in 100 children may have autism -- higher than the 1 in 150 estimate widely cited.

The findings come from the journal Pediatrics and an unpublished paper from the Centers for Disease Control and Prevention.

The Pediatrics study was based on a phone survey of some 78,000 parents of children ages 3 to 17 and asked if they had been told by a health care provider that their child had autism, Asperger disorder or a related disorder. The results showed 1 in 91 children had received such a diagnosis. Parents who answered yes were asked about the severity of the disorder.

For years, researchers have been trying to understand the causes of autism and whether there is a true increase in its prevalence. Some specialists think genetics are its main cause while others see environmental factors. And other experts attribute some of the growth to better diagnosis and a broadening of autism's definition.

Now researchers think the figures might reflect a real rise in cases.

"The concern here is that buried in these numbers is a true increase," said Dr. Thomas Insel, director of the National Institute of Mental Health told the Associated Press. "We're going to have to think very hard about what we're going to do for the 1 in 100."

Continue reading "Autism diagnoses on the rise " »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (6)
Categories: Pediatrics
        

Pregnant women have access to more prenatal tests than ever before with numerous options available to determine the likelihood of genetic disorders. What if those tests slowly led to fewer babies being born with Down syndrome and if the disorder eventually disappeared?

Well, it's happening, according to new research.

Between 1989 and 2005 there was a 15 percent decrease in births of babies with Down syndrome, according to new study by Dr. Brian Skotko, a genetics fellow at Children's Hospital Boston.

It's a striking finding, considering that more women are waiting longer to have children -- a factor that increases the chance of Down syndrome. If there were no prenatal testing, researchers would have expected the opposite - a 34 percent increase, not a decrease, Skotko found. Instead, women are finding out the diagnosis of Down syndrome and choosing not to continue the pregnancy.

The research, appearing in the latest issue of the journal Archives of Disease in Childhood, raises some interesting questions about how doctors and patients should navigate such a diagnosis. As it is now, doctors do a poor job explaining Down syndrome and discussing the diagnosis with soon-to-be parents, Skotko says. This could only get tougher in the future.

Continue reading "Will babies with Down syndrome disappear?" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Pediatrics
        

The CDC is considering promoting circumcision of all infant boys as a way to reduce HIV transmission. (Warning: this, ahem, delicate, issue always seems to inspire sharp remarks from both sides.)

So far, data from Africa about whether circumcision reduces the spread of HIV is somewhat promising. Several large clinical trials in Uganda showed circumcision reduces a man's risk of getting HIV by more than half. Still, another trial was stopped recently when it showed circumcision does little to reduce the virus' transmission to a female partner. And circumcision doesn't appear to protect men who have sex with men from contracting the disease, a separate study found. It’s unclear how those studies might translate to reducing the HIV risk here.

The CDC isn't close to deciding whether or not to recommend the practice yet debate is already raging about it all over the web.

Continue reading "CDC weighs circumcision policy " »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (29)
Categories: Pediatrics
        

The University of Maryland is still looking for some itty bitty volunteers to take part in its swine flu vaccine trial: babies 6 to 35 months.

Investigators have had no problem recruiting adults and older children in the trails, which started in adults earlier this month and in children last week. In fact, they had so many 18-64 year olds try to volunteer, they had to use a lottery to make the final cut. Even older children, many of whom were signed up by their doctor parents, have been an easy find.

But the smallest of all test subjects have proved a challenge for researchers. Officials say it isn't because parents are reluctant to test the experimental inoculation on their wee ones. They've had great response from all age groups. Rather, it seems babies' recommended -- and rigorous -- vaccine schedule might be getting in the way. From 12 to 18 months alone, children can receive various vaccines from shots against measles, mumps and rubella to hepatitus A. But the swine flu study requires that babies have not had recent inoculations and will not be vaccinated soon after they receive the H1N1 shot.

If you are interested in volunteering your tot and want to know if your child qualifies, call the University of Maryland's Center for Vaccine Development for details: 410-706-6156. Vaccinations are taking place now at the University of Maryland's Ambulatory Pediatric Center in Baltimore and at clinics in Annapolis and Frederick. The university, one of a handful of vaccination sites across the nation, hopes to test 40 children in the 6 to 35 month old range.   

Continue reading "Wanted: tiny testers" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Pediatrics, Swine flu/H1N1
        

Poison control centers have seen a sharp increase in the number of calls about teen misuse of attention-deficit drugs, suggesting "a rising problem with abuse of these medications," according to a new study out today.

The calls came from emergency room doctors, parents and school officials asking for advice for how to deal with apparent abuse of the increasingly common medications. The severity of the calls has increased over time and four deaths were reported in the study.

Teens, who many times use the drugs to get high, may not realize that there can be serious consequences to using what are, after all, prescription medications. Sales data of attention-deficit drugs suggest that abuse of the medications reflects an increased availability of the prescriptions, which have also been rising. The calls about ADHD medication rose 76 percent over an eight-year period, a pace outstripping calls for victims of substance abuse generally and teen substance abuse.

Continue reading "Teens abusing ADHD medication, study finds" »

Posted by Stephanie Desmon at 12:00 PM | Permalink | Comments (1)
Categories: Pediatrics
        

There is no question that properly installed infant car seats save lives.

But a study today in the journal Pediatrics finds that even healthy newborns may not be getting enough oxygen when they spend too much time in those cozy and convenient carriers.

The study, done with 200 two-day-old babies in Slovenia, showed that infants placed in cribs got more oxygen than those who spent prolonged periods of time in either car seats or in car beds, which are designed for tiny or premature babies.

Among the findings: The percentage of time the babies spent with oxygen saturation levels below 95 percent was, on average, significantly higher for those in car seats (23.9 percent) compared to those in cribs (6.5 percent).

The moral here is not to dump your car seat. Instead, the authors note, parents should limit the their babies spend in those carriers to when they are on the road.

Continue reading "Infant car seats can cut off air to babies" »

Posted by Stephanie Desmon at 7:55 AM | Permalink | Comments (2)
Categories: Pediatrics
        

Now this might sound counterintuitive: Giving children small quantities of milk over time may ease their allergic reaction to it.

Allergy experts at Johns Hopkins started following a small group of children in 2008, giving them higher doses of milk over time in an attempt to train their immune systems to tolerate it. It worked. In a recent follow-up, all 18 children with a history of severe milk allergy saw their allergy eased or disappear within 17 months, researchers report in the Journal of Allergy and Clinical Immunology.  

Given the extremely small sample size, there are a number of caveats. Researchers are still learning about milk allergy and ways to possibly overcome it. What works for one child may not work for another. And these patients were given milk under the close supervision of a doctor. So a word of caution to parents -- don't try this at home.

Still, researchers are encouraged by the findings: regular dairy use could help children become more tolerant and remain so.

Continue reading "Got milk allergies? Drink more milk" »

Posted by Kelly Brewington at 12:00 PM | Permalink | Comments (4)
Categories: Pediatrics
        

Two new studies shed light on the safety of the vaccine to protect women from cervical cancer and call into question the ethics behind the marketing of the shot.

Gardasil, the blockbuster vaccine to combat the human papillomavirus (HPV), which can cause cervical cancer, is linked to complications, including 32 deaths, according to an analysis in today's Journal of the American Medical Association. But researchers note that the rate of side effects is low and the safety record is not out of line from other similar vaccines. The most common side effects are fainting, nausea and dizziness at a rate of about 40 to 80 cases per 1 million girls vaccinated.

Raising more eyebrows, however, is an accompanying JAMA article revealing that the makers of Gardasil, Merck & Co, provided grants to professional medical associations to help promote the vaccine.

"However, much of the material did not address the full complexity of the issues surrounding the vaccine and did not provide balanced recommendations on risks and benefits," the authors note.

Continue reading "HPV vaccine promoted with drug company money" »

Posted by Kelly Brewington at 12:22 PM | Permalink | Comments (5)
Categories: Medical studies, Pediatrics
        

Twice as many kids are overdosing on what's in the medicine cabinet as what's underneath the sink, according to a new study.

More than 70,000 kids each year in the U.S. are treated in emergency room for unintentional medication overdoses -- 80 percent of them from unsupervised ingestion of drugs. Many are getting sick after they get their hands on commonly available over-the-counter medications. The four most frequent culprits: acetaminophen (Tylenol), cough and cold medicine, antidepressants and non-steroidal anti-inflammatory drugs (Ibuprofen).

The rate of hospitalizations for medication overdoses, according to the study in this month's American Journal of Preventive Medicine, was four times that for poisonings from non-pharmaceutical products like cleaning sprays, pesticides and shampoos.

Continue reading "Calling Mr. Yuk" »

Posted by Stephanie Desmon at 7:07 AM | Permalink | Comments (0)
Categories: Pediatrics
        

In recent years, childhood depression has received a lot of attention as researchers have tried to unravel how the disorder affects kids. But little is known about if, and how, depression strikes very young children. A new study suggests that children as young as 3 can be diagnosed with depression and that the disorder is often a chronic condition.

The study, which appears in the August issue of the Archives of General Psychiatry, is sure to raise eyebrows among people who question if children that young are emotionally mature enough to be depressed. The study's authors say that despite skepticism, a growing body of research suggests that depression does exist among preschoolers and they launched the study to better understand it.

The authors studied 306 children 3 to 6 years old, including 75 of them diagnosed with depression, and evaluated them for up to two years. Preschoolers with depression at the beginning of the study were four times more likely to have depression 12 or 24 months later  than children who were not depressed at the study's start. 

Continue reading "Depression in preschoolers" »

Posted by Kelly Brewington at 7:08 AM | Permalink | Comments (2)
Categories: Mental health, Pediatrics
        

A new study out today suggests that 7 out of 10 children in the U.S. have low levels of vitamin D, raising their risk for bone and heart disease.

The findings, in what appears to be largest study to date of children and vitamin D, seemed to surprise even the researchers. In sheer numbers, the study published online in the journal Pediatrics suggests that 7.6 million children have a vitamin D deficiency while 50.8 million more have levels considered insufficient.

The American Academy of Pediatrics recently recommended that children take vitamin D supplements of 400 IU a day.

Continue reading "Study: 7 in 10 kids need more vitamin D" »

Posted by Stephanie Desmon at 7:00 AM | Permalink | Comments (0)
Categories: Pediatrics
        

For a while now, parents, physicians and researchers have debated whether children with autism have more digestive problems than their non-autistic peers. As parents search for therapies for a mysterious disorder with no cure, many have placed their children on gluten-free and other restrictive diets.

But little research has been done on the diets or the link between gut problems and autism. Until now.

A new study out of the Mayo Clinic finds that autistic children don't have more gastrointestinal problems than other kids. And researchers warn that children should not be put on such restrictive diets unless appropriate tests are done that discover a digestive issue. 

Continue reading "Study raises doubts about link between autism and digestive problems" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (6)
Categories: Pediatrics
        

The teen pregnancy rate increased in 2006 and again in 2007, after 14 years of declines, according to a report released today from the Centers for Disease Control and Prevention.

It's among a string of worrisome statistics released today that indicate after recent years of improvements, some trends are getting worse. Among the findings in the CDC's analysis of youth sexual and reproductive health: 

+   The rate of AIDS diagnoses in young men (15-19 years old) is on the rise, nearly doubling from 1.3 cases per 100,000 population in 1997 to 2.5 cases per 100,000 population in 2006.

+   In 2006, about 1 million teens and young adults had chlamydia, gonorrhea or syphilis. And the rates of syphillis, for men and women, are on the rise.

+   The humanpapillomavirus, or HPV, is widespread. Between 2003 and 2006, nearly a quarter of girls 15-19 years old had an HPV infection. That figure was 45 percent for young women ages 20-24.

Continue reading "Sobering statistics on teen pregnancy and STDs" »

Posted by Kelly Brewington at 12:53 PM | Permalink | Comments (1)
Categories: Pediatrics
        

Most warnings about bathtub safety focus on making sure the water isn't too hot to scald children and that someone is always watching the kids to be sure they don't drown.

Turns out, the more common danger to kids in the tub or shower is slipping and falling. In fact, tens of thousands of children end up in the emergency room each year after being hurt in the tub or shower, according to a study published today in the online issue of the journal Pediatrics. Eighty-one percent of tub or shower injuries are slips and falls. And more than half of the injuries occur in children under the age of 4.

The researchers from the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio say that scalding and drownings have gotten the most attention because of the severity of these injuries. Legislation and educational efforts have helped make strides in those areas. But, the study's authors write, "bathtub slips and falls should not be overlooked."

Continue reading "Bathtub dangers for kids" »

Posted by Stephanie Desmon at 12:30 PM | Permalink | Comments (1)
Categories: Pediatrics
        

Medication errors happen. They can and do occur at every step of the way from calculating dosages to prescribing, dispensing and giving drugs not only to adults but to children. Take one of the more famous cases: Actor Dennis Quaid's newborn twins who somehow survived being given a blood-thinner at 1,000 times the proper dose.

A study published this week in the journal Pediatrics looked at medication errors specifically involving heart drugs dispensed to children. What they found was, er, heart-stopping. They found that in a single year, half of the errors made were in children under the age of 1 and 90 percent of those were in children younger than six months. The littlest seem to be most vulnerable because health care providers may miscalculate and give them more medication than someone of their weight can handle or they may prescribe a drug not meant for someone so young. ...

Continue reading "Infants and medication errors" »

Posted by Stephanie Desmon at 12:00 PM | Permalink | Comments (2)
Categories: Pediatrics
        

When it comes to HIV/AIDS the mantra has always been: get tested.

But some doctors warn that not all tests are created equal. Sometimes a negative test can give a false sense of security to both doctors and patients, particularly for risk-taking teenagers, said Dr. Allison Agwu, a pediatric infectious disease specialist at Johns Hopkins Children’s Center.

Rapid HIV tests are designed to pick up antibodies to the virus, not the virus itself. It can take weeks or months for someone to produce antibodies. So a rapid test can come up negative the first time, but positive some weeks or months later. False negatives often happen during the earliest and most contagious stages of the infection.

And with teens, those crucial months matter.

“The test is only as good as when you get the test,” said Agwu. “I can’t tell you the number of times I spoke to a patient, and they say, ‘Well I’m negative. And they go on to doing whatever risky behaviors they’ve been doing.”

Of the 53,000 new HIV infections diagnosed each year in the United States, 14 percent of those occurred in 13 to 25-year-olds, according to the Centers for Disease Control and Prevention.

Continue reading "Keepings teens safe from HIV" »

Posted by Kelly Brewington at 8:00 AM | Permalink | Comments (5)
Categories: HIV/AIDS, Pediatrics
        

Conventional wisdom says teenagers do crazy things because they think they’re invincible. But a new study finds that while many teens think they’ll live forever, a sizable minority is downright fatalistic about their future.

Some 15 percent of adolescents aren’t sure they’ll live past 35, and these teens are more likely to engage in risky behaviors such as doing drugs and having unsafe sex, according to a study by University of Minnesota researchers appearing in today’s Pediatrics.

The figures are even more startling among minorities and teens living in poverty. Among whites, some 10 percent said they thought they might die young. Meanwhile, that figure was 26 percent for blacks, 21 percent for Latinos, 15 percent for Asians and a staggering 29 percent for Native Americans, the study found. Among black youth on public assistance, 1 in 3 youth shared these negative views.

There’s no doubt that adolescence is a crazy, confusing time. But even researchers were troubled and surprised at the magnitude of the findings.

Continue reading "Not so invincible" »

Posted by Kelly Brewington at 1:30 PM | Permalink | Comments (6)
Categories: Pediatrics