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PedSPAM November 2002

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

In the News

Friday, November 1: The US Centers for Disease Control and Prevention (CDC) has issued a collaborative guide developed by representatives of a broad range of organizations that gives educators six strategies to help schools manage the problems of students with asthma. The CDC's environmental health program, the National Institutes of Health, the Environmental Protection Agency and the Department of Education were among the collaborators. The CDC notes that between 1980 and 1990 the prevalence of asthma increased 74% among children 5 to 14 years of age. About 5 million children now have asthma. The disease accounts for 14 million lost school days annually. The guide is available online at www.cdc.gov/healthyyouth/healthtopics/asthma.
Monday, November 4: Another study, this one from Denmark and done in the outpatient setting, confirms the usefulness of probiotics - harmless bacteria normally present in the intestinal tract - to reduce the duration and severity of diarrheal illness in children. Probiotics are found as well to reduce the incidence of respiratory illness, including otitis media and sinusitis, and thus subsequent antibiotic use. Children with rotavirus diarrhea recover significantly faster and excrete the virus for a shorter time when treated with probiotic Lactobacillus. Pediatric Infectious Disease Journal 2002;21(5):417-419.
Tuesday, November 5: A new virus has been implicated in wheezing in infants. The new virus, metapneumovirus, was discovered last year, but has been around for at least 20 years. It can cause a bronchiolitis similar to that produced by respiratory syncytial virus (RSV) infection. Lancet 2002;360:1393-1394.
Wednesday, November 6: A rapid urine test for Streptococcus pneumoniae infection in the bloodstream promises to make the evaluation of children in the office or emergency department more accurate. The test identifies fragments of the Strep bacterium in the urine of patients with bacteremia - bacteria in the blood stream. It takes only 15 minutes to perform, versus hours to days for blood culture tests, and was very accurate in the study patients at ruling infection in or out. Further study will be necessary to determine its value in clinical use. Annals of Emergency Medicine 2002;40:399-404.
Thursday, November 7: A Finnish study of more than a half-million measles-mumps-rubella (MMR) vaccinations over the period from 1982 to 1986 found Children were monitored every three months for up to two years after vaccination. The lead investigator concluded, "Our study further ascertains the safety of MMR vaccination." Pediatrics 2002;110:957-963.
Friday, November 8: This study finds that education in allergen control and reduction of house dust mite allergens reduces the rate of dust mite sensitization in high-risk toddlers and preschoolers. Allergy to dust mites is the single best predictor for asthma, and is also seen in more than half of children with atopic eczema. In this large study, all parents were given information on allergies. Those in the intervention group were provided with mite-impermeable mattress covers and instructions on removing carpet from their child's room and various other measures to reduce mite allergen exposure. Such simple interventions might hold potential to reduce the rate of childhood asthma. Archives of Pediatrics and Adolescent Medicine 2002;156:1021-1027.
Monday, November 11: A large self-reporting survey of inner-city middle school children in Philadelphia may show the asthma incidence among them to be twice current estimates. Children were asked first if they knew they had asthma. One of four answered yes. When shown video scenes of children with asthma symptoms and asked if they had similar problems, about one third of the children said that they had symptoms suggesting asthma. Reuters Health.
Wednesday, November 13: Bicycle helmets prevent head injuries - that much is known. This Canadian study showed that provinces that adopted mandatory helmet-use laws (as opposed to voluntary use) for children on bicycles had significantly greater rates of head injury reduction than those provinces that did not pass helmet laws. Bicycle helmet laws are effective in reducing childhood head injury. Pediatrics 2002;110:e60.
Thursday, November 14: Ankyloglossia (tongue-tie) in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and nipple pain for mother. This can cause premature weaning, says this article. This study examined whether tongue clipping (frenuloplasty) of newborns with breastfeeding problems and tongue-tie was beneficial. The authors found that babies having problems latching on and whose mothers reported pain with breast feeding often had tongue-tie, and that breast feeding effectiveness and nipple discomfort were immediately improved by frenuloplasty. Pediatrics 2002;110:e63.
It bothered me a bit that the study was not blinded - the same doctor decided whether the procedure was needed and whether it worked. This contains pitfalls because of possible bias by the evaluator. However, I'll be thinking of this study the next time I have a mother with painful latching and breast feeding difficulties.
Friday, November 15: Trends in antibiotic use in children are more favorable now. A survey of antibiotic use for pediatric URI's - colds - during the period of 1995 to 1998 found that inappropriate antibiotic use dropped by 69%. Actual antibiotic choices for true bacterial infections such as ear infections improved as well, with fewer inappropriate antibiotics used. Archives of Pediatric and Adolescent Medicine 2002;156:1114-1119.
Tuesday, November 19: Here is one you may not have to worry about. Licorice is very popular among women of childbearing age in Finland as well as some other countries. Heavy licorice consumption increased the risk of preterm delivery by more than twice. Glycyrrhizin is known to affect metabolism of the hormones cortisol and prostaglandins, which probably accounts for the effects. Licorice had an even stronger effect than smoking on preterm birth.

De gustibus non disputandam est. - "There's no accounting for taste." American Journal of Epidemiology 2002;156:803-805.

Wednesday, November 20: Every winter brings outbreaks of RSV (respiratory syncytial virus). Some years seem worse than others; some cases are worse than others. Researchers have found that severity of disease varies according to the specific genotype (variations in DNA coding for the virus) of the over 100 strains identified so far.
Thursday, November 21: Accelerated schedule allergy shots (what one of our local allergists refers to as "rush" immunotherapy) achieves within a single 2.5-hour visit immunization levels that usually require 6 months of shots. Such a schedule of shots may present little risk of systemic reactions, according to this research. Concerns have been raised in the past, claiming more adverse reactions with rush immunotherapy. This analysis of 37 children between 3 and 15 years found no instances of systemic reaction. The major advantages include the fact that patients start to feel better faster, within one or two months. There was better long-term compliance with the allergy shots, as well. Reuters Health.
Friday, November 22: A year-long investigation of the use of nasal steroids in children for hay fever (allergic rhinitis) presented this week at the annual meeting of the American College of Allergy, Asthma & Immunology found no effect on growth in the treated group. The children averaged 6 years old, and were treated with either the steroid (fluticasone, Flonase®) or a placebo. Reuters Health
Monday, November 25: Three reports in the British Medical Journal find that marijuana use in adolescence and early adulthood is associated with increased risk of anxiety, depression and schizophrenia in adulthood. The reports show that marijuana use has a negative effect on mental health. The effects are dose-dependent. Men who have used marijuana more than 50 times triple their risk for schizophrenia. Most chillingly, adolescents who begin marijuana smoking before age 15 have a 10% incidence of schizophrenia by age 26. British Medical Journal 2002;325;1183-1184,1195-1201,1212-1213.
Tuesday, November 26: The American Academy of Pediatrics has developed a Òrefusal to vaccinateÓ form for parents who refuse to vaccinate their children to sign. It is intended to document informed consent by the parents about the risks of refusing to immunize their children. The form states that the physician and the parent have discussed the vaccines in question and the types of diseases that they prevent. Parents acknowledge by signing that they understand the purpose of the recommended vaccine, its risks and benefits, and the consequences of nonvaccination. The form includes all major childhood vaccines, including meningitis and influenza. A copy of the "Refusal to Vaccinate" form, can be obtained here.
Friday, November 30: Bottle feeding infants whose parents have allergies in bed (bottle propping) increased the risk of wheezing and asthma in the first five years of life in this long-term study. Each separate incidence of bottle-propping increased the subsequent risk of wheezing in the 1 to 5 year period, and increased the risk of diagnosed asthma at 5 years of age. Pediatrics 2002;110:e77.
Bottle propping is a known risk for wheezing in the first year and ear infections. Don't do it.


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