PedSPAM March 2003

Welcome to the PedSPAM archive for March. Here are the month's daily SPAMlets from my update reading that you might have missed:

In the News

Monday, March 3: Canadian investigators confirm that repeated short courses of oral steroids are safe in pediatric asthma treatment. In their study they found that there were no lasting effects on bone or adrenal glandular function. While the researchers found that oral steroid use was very safe, they point out that the need for repeated courses of oral steroids means that the child's asthma is not well controlled - meaning that it is time to revise and intensify the child's asthma treatment regimen. Pediatrics 2003;111:376-383.
Tuesday, March 4: School can be a headache! About 50% to 70% of adolescents report that they have headaches. Swedish researchers interviewed 10 to 14 year old school children about their headaches and found that the children consistently linked their headaches with conditions in school, "Specifically with more theoretically oriented subjects--mathematics or Swedish--a noisy and disorderly school environment, and insecure relations with classmates." Another regular theme when the children were encouraged to talk freely was insecurity or conflict in their family. British Journal of General Practice 2003;53:210-215.
Wednesday, March 5: Unfortunately, in the United States, those infants at highest risk for SIDS are least likely to be placed in the correct supine (back sleeping) sleep position. This study found that very low birthweight infants, who have the highest risk of sudden infant death syndrome (SIDS), may also be those most likely to be put to sleep on their stomachs. This greatly increases their risk of dying of SIDS. Pediatrics 2003;111:633-640.
Friday, March 7: An interactive multimedia program for the education of children about their asthma improves their knowledge and improves their health outcomes. They manage their condition better, using less medicine and having two-thirds fewer urgent care visits while experiencing 30% fewer days with asthma symptoms. "Analysis revealed that increased asthma knowledge of all 7- to 17-year-old children at visit 3 had significant correlations with fewer urgent physician visits and decreased use of quick relief medicine by these children," the investigators reported. Pediatrics 2003:111:503-510.
Tuesday, March 11: Treatment with a certain hormone (luteinizing hormone-releasing hormone (LHRH) agonist) can increase adult height in children with precocious (early) puberty. This study found that the same hormone can increase the height of short adolescents with normally timed puberty, but this treatment dramatically reduces bone mineral density (BMD), and this decreased bone mineralization will likely never be fully recovered. For this reason, the authors of this study conclude that it can not be routinely recommended for such patients. The New England Journal of Medicine 2003;348:908-917,942-944.
Wednesday, March 12: A study presented at the American Heart Association's 43rd Annual Conference on Cardiovascular Disease Epidemiology and Prevention in Miami found that eating breakfast may decrease a person's risk of obesity and insulin resistance. "In comparison to those who reported eating breakfast twice per week or less often, those reporting eating breakfast every day had 35% to 50% lower rates of developing obesity and insulin resistance syndrome," said researcher Dr. Mark A. Pereira. "This was true for white men and women, and black men, but not black women." Breakfast consumption may reduce the risk of obesity, type 2 diabetes and cardiovascular disease by controlling appetite and reducing the likelihood of overeating later in the day, Dr. Pereira explained. Reuters Health
Thursday, March 13: A study by the U.S. Institute of medicine finds no reason to believe that infant vaccines are connected in any way to sudden infant death syndrome (SIDS) and other forms of unexpected death in infants, and that there is no reason to believe that multiple vaccinations routinely given to children in the first year of life contribute to an increased risk of severe reactions leading to death. The panel reviewed four major observational studies, none of which showed a link between multiple vaccinations and SIDS. Reuters Health
Monday, March 17: Babies born with either very low or very high birth weight have increased chances of adult obesity, this study determined. A study of women between 50 and 79 found a correlation or unusually high or low birthweight with adult obesity. Women in the highest birth weight category, over 4.5 kg (9-1/2 pounds) birth weight were twice as likely as normal controls to be obese in adulthood. The investigators conclude that their findings "support the hypothesis that fetal experience may influence adult obesity with potential consequences for risk of several major cancers." International Journal of Cancer 2003;103:789-791.
Tuesday, March 18: Asthma treatment cannot simply focus on the lower airways, this researcher says. Treating upper airway disease should be considered as additional therapy in the care of patients with asthma. According to the "unified airway hypothesis," the upper and lower airways are linked together. The majority of patients with asthma have hay fever; The majority of severe asthmatics have sinusitis. Nerve responses in the nasal passages to allergens, cold temperature, or polyps directly affect bronchial reactions. Recent findings support the concept that asthmatic symptoms can be markedly improved by oral antihistamines, nasal steroids, or allergy shots in patients with concomitant allergic rhinitis. Reuters Health
Wednesday, March 19: Most American homes have detectable levels of house dust mite antigen according to this study. Dust mites are strongly linked to allergy and asthma symptoms in many children and adults. About 80% of homes surveyed had some dust mite antigen detectable; half the homes had levels that produce allergies; and almost a fourth of the homes had levels five times the threshold level for asthma. Older homes and those with high humidity in the bedroom or musty, mildewy smells were most likely to have problem levels of dust mite allergens. To lower the levels of dust mite allergen, use impermeable mattress covers, wash bedding every week in hot water and remove all non-washable items such as stuffed animals from the bed. Journal of Allergy and Clinical Immunology 2003;111:408-414.
Thursday, March 20: A study by the Kansas Medicaid agency found that expensive prophylaxis of babies against RSV was not cost effective. About 9% of 1,500 infants diagnosed with either prematurity or bronchopulmonary dysplasia received monthly palivizumab (Synagis¨) injections to prevent RSV infection. The treatments cut the risk of hospitalization by half, but did not prevent all hospitalizations; the average hospitalization length for the treated group was reduced by a half a day. The average savings in hospitalization cost was about $700; however, it cost the Medicaid program $4,700 to treat each infant. Pediatric News March 2003;37(3)
I expect insurers and state Medicaid agencies to take note of this study as funding cutbacks force us to scrutinize expenses more and more thoroughly.

Friday, March 21: Children with sickle cell anemia who have low nighttime blood oxygen levels are more likely to have painful crises, and overnight supplementation with oxygen can reduce the number of these attacks. Ninety-five patients were followed for an average of over four years; all but nine of them had painful crises requiring hospital admission for fluids and pain medications. Admission rates to the hospital were strongly correlated with lower nighttime blood oxygen levels. Blood 2003;101:846-848.
This is a great little article. Anyone who understands the pain that children and adults with sickle cell disease must endure during the attacks will see that this is possibly a real breakthrough. I am going to bring this to the attention of our local sickle cell expert right away.

Monday, March 24: Waistlines of British children, especially those of girls are rapidly expanding. The girth of 11- to 16-year-old British boys and girls over the last 20 years has increase 2.5 inches. This could raise their risk of developing heart disease, hyperlipidemia, diabetes and other illnesses later in life. Waist circumference seems to be a stronger marker for obesity-related risks than body mass index (BMI), and in Britain is increasing even faster than the average body mass index. Similar increases have been found in Spanish children. British Medical Journal 2003;326:624-626.
Tuesday, March 25: Breast feeding predominantly for the first six months and at least partially for the first 12 months confers significant resistance to respiratory illness in the first year of life, this Australian research found. In this prospective study, babies from the same birth cohort (born about the same date) were tracked over time for both breast feeding duration measures as well as respiratory illnesses, including doctor visits and admissions to the hospital. Breastfeeding for less than 6 months was a risk factor for wheezy lower respiratory illnesses requiring doctor visits or hospital admission. Archives of Diseases in Childhood 2003;88:224-228.
Friday, March 28: Gatekeeping - the restriction of access to medical services by doctors in health maintenance organizations (HMO's) - does not reduce heathcare costs. Gatekeeping arrangements were widely adopted by health insurers in an attempt to control costs in the mid-1990s. To date there have been no studies confirming that such programs actually save any significant amounts of money. This study found that children in standard health insurance plans had annual per capita expenditures of $887 vs $881 per capita for children in gatekeeper programs. The authors interpreted these data as indicating that gatekeeping is not an effective cost-containment method for children. Pediatrics 2003;111:456-460.

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