Parental Guidance: Urgent care vs. emergency room: how to decide

BY BETH WHITEHOUSE

NewsdayMay 13, 2014

Q: How should parents decide whether to take a child to a pediatric urgent care center or an emergency room?

A: First, parents should try to reach their child’s pediatrician; after office hours, doctors usually have a pediatrician on call, says Dr. Jahn Avarello, who says he “sits in both seats” as the doctor in charge of the pediatric emergency room and the pediatric urgent care center of the Cohen Children’s Medical Center in New Hyde Park, N.Y. “Often there are nuances that the primary care provider can detect by phone,” Avarello said. The pediatrician can help recommend the appropriate and reputable venue, he said.

If the pediatrician can’t be reached, or time is of the essence, parents should act based on the severity of the situation, Avarello said. With abdominal pain, a severely broken bone or respiratory distress, a child should be taken to an ER, which can do CT scans and ultrasounds, he said.

In a less acute situation, a pediatric urgent care center may have a lower insurance co-payment and be able to address the problem more quickly because of the elimination of adult patients vying for attention, he says. Avarello recommends pediatric urgent care centers rather than general centers because they are more likely to have pediatricians or pediatric emergency medicine specialists on duty at all times. Many have X-ray equipment; many are festively decorated. “It’s a lot more comforting of an environment and a lot less likely that the child is going to be scared,” he says.

(Email Beth Whitehouse at beth.whitehouse@newsday.com.)eprint of this story

Read more here: http://www.mercedsunstar.com/2014/05/13/3646031/parental-guidance-urgent-care.html#storylink=cpy

Stem Cells to Treat Lung Disease in Preterm Infants – Journal of Pediatrics

Cincinnati, OH, February 6, 2014 — Advances in neonatal care for very preterm infants have greatly increased the chances of survival for these fragile infants. However, preterm infants have an increased risk of developing bronchopulmonary dysplasia (BPD), a serious lung disease, which is a major cause of death and lifelong complications. In a new study scheduled for publication in The Journal of Pediatrics, researchers evaluated the safety and feasibility of using stem cell therapies on very preterm infants to prevent or treat BPD.

Won Soon Park, MD, PhD, and colleagues from Samsung Medical Center and Biomedical Research Institute, Seoul, Republic of Korea, conducted a phase I, single-center trial of intratracheal transplantation of human umbilical cord blood-derived mesenchymal stem cells to nine very preterm infants (24-26 weeks gestational age) who were at high risk of developing BPD.

All patients who received the treatment tolerated the procedure well without any immediate serious adverse effects. Thirty-three percent of treated infants developed moderate BPD and none developed severe BPD, and 72 percent of a matched comparison group developed moderate or severe BPD. Another serious side effect of very preterm birth, retinopathy of prematurity requiring surgery, tended to occur less often in treated infants. Overall, all nine treated infants survived to discharge, and only three developed moderate BPD.

This phase I study suggests that intratracheal administration of mesenchymal stem cells is safe and feasible. According to Dr. Park, “These findings strongly suggest that phase II clinical trials are warranted to test the efficacy of mesencymal stem cell transplantation, which could lead to new therapies to prevent or cure BPD.” Dr. Park and colleagues are currently conducting a long-term safety and follow-up study of these nine preterm infants (ClinicalTrials.gov: NCT01632475).

http://www.jpeds.com/content/JPEDSChangPark

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Measles outbreak in New York City, health officials warn

By RYAN JASLOW/CBS NEWS

America’s biggest city has a measles outbreak on its hands.

New York City health officials warned unvaccinated New Yorkers that they should get shots after identifying 16 cases of measles in Manhattan and the Bronx.

Nine of the cases are children, and seven are adults. Four people have been hospitalized as a result of the outbreak, according to the New York City Department of Health and Mental Hygiene.Measles is a highly contagious disease that is spread easily through the air and typically has symptoms that begin within seven to 14 days of infection. Symptoms include a blotchy rash, fever, cough, runny nose, sore throat aches, tiny white spots found inside the mouth and red, watery eyes.

About 30 percent of measles cases lead to serious complications including pneumonia, ear infections and diarrhea, the Centers for Disease Control and Prevention adds.

Brain inflammation, hospitalization and even death are possible complications.

The health department is urging anyone who has not been vaccinated to get an MMR vaccine, especially children. Adults who are unsure whether or not they’ve received the shot could get revaccinated or take a blood test to see if they are immune.

Babies should get the vaccine at 12 months of age, so the best way to protect really young toddlers is to have older children get vaccinated. Two doses are required for full protection, with the second shot administered at 4 to 6 years old.

Side effects are typically mild and include soreness at the site of the shot, the health department added.

The CDC warned in December that once-eliminated measles had come back in elevated numbers — about 175 cases in 2013, compared to the typical 60 each year. Anti-vaccination beliefs were suspected to be behind the rate increases, including an oft-debunked link perpetuated by a British researcher whose since-retracted study found a link between the MMR vaccine and autism risk.

The disease is more common in Europe, Asia, Africa and the Middle East, so international travelers who have not been vaccinated may transmit the disease.

© 2014 CBS Interactive Inc. All Rights Reserved.

http://www.cbsnews.com/news/measles-outbreak-in-new-york-city-health-officials-warn/

BPA, Phthalates Linked to Pediatric Health Risks

Scientific research into health effects of chemical exposures from food packaging and plastics may have taken 2 steps forward and 1 step back this week.

Two research articles published online August 19 in Pediatricsadd to evidence that bisphenol A (BPA) and phthalates may be associated with increased health risks for children and adolescents, but an accompanying commentary casts doubt on the articles because of the measure of exposure used in the studies.

BPA and BMI

In the article on BPA exposure, Donna S. Eng, MD, from the Division of Pediatric Endocrinology, University of Michigan School of Public Health, Ann Arbor, and colleagues analyzed data from the National Health and Nutrition Examination Survey 2003-2010 to assess associations between urinary BPA and obesity and chronic disease risk factors.

They found that higher levels of urinary BPA in children and adolescents aged 6 to 18 years were associated with higher odds of obesity and abnormal waist circumference-to-height (WC-to-height) ratio but did not find significant associations between BPA levels and other chronic disease risk factors.

Of 10,990 children in the survey, 3370 had both body mass index (BMI) and BPA data recorded. When the researchers categorized BPA levels into quartiles and performed logistic regression analysis, they found an increase in the odds of obesity with increasing quartiles of BPA, with those in the highest-concentration quartile having twice the risk as those in the lowest-concentration quartile (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36 – 2.98; P = .001). They found a similar association for increased odds of abnormal WC-to-height ratio between the highest and the lowest quartiles (OR, 1.55; 95% CI, 1.12 – 2.15; P = .01).

“Our work provides additional evidence of an association between BPA and excess levels of body fat in children, as measured by BMI and WC-to-height ratio,” the researchers write. The results are similar to other studies in the United States and China that have linked higher urinary BPA levels to higher odds of obesity in adults, they write, although reverse causation cannot be ruled out. “It is possible obese individuals store BPA differently than nonobese individuals, thus leading to higher concentrations of BPA in the urine.”

Read more: http://www.medscape.com/viewarticle/809612

Many U.S. Adults Not Getting Key Vaccines: CDC

By Margaret Farley Steele

HealthDay Reporter

THURSDAY, Feb. 6, 2014 (HealthDay News) — Many U.S. adults are skipping recommended vaccinations that could protect them from serious or life-threatening diseases, according to figures released by federal health officials Thursday.

Modest increases were seen for Tdap vaccinations, which prevent whooping cough, from 2011 to 2012, according to the report from the U.S. Centers for Disease Control and Prevention. More seniors also got vaccinated against shingles, whileHPV vaccinations picked up slightly among young women hoping to avoid cervical cancer.

However, Americans aren’t taking full advantage of other routinely recommended vaccines, including those for pneumonia and hepatitis, the CDC said in its Feb. 7 issue of the Morbidity and Mortality Weekly Report.

Vaccination rates for diseases other than flu are well below target levels, and troubling racial/ethnic disparities persist, with whites more likely than blacks and Hispanics to have coverage, the agency said. Flu vaccine rates are published separately.

The data in the report came from the 2012 National Health Interview Survey, which includes a nationally representative sample of the U.S. population.

Coverage for most adult vaccines remains “depressingly low,” said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. “This is a discussion I have daily with patients, who see vaccination recommendations posted in the examination room.”

Patients have a myriad of reasons to refuse the vaccines, Horovitz noted. “Mythology surrounding vaccination is the greatest obstacle,” he said. “In spite of all the press about the rise of whooping cough, for instance, patients still may refuse vaccination.”

Those “myths” include fears that vaccines might cause autism, a concern that has been widely discredited, or lead to illness or severe reactions.

To boost vaccination rates, the CDC said health care providers should review adult patients’ vaccination histories and offer needed vaccines at routine visits. Reminder-recall systems might help in this regard, the agency added. Also needed: publicity about the benefits of vaccines and expanded access to vaccination, the agency said.

Read the rest of the article here: http://www.webmd.com/vaccines/news/20140206/many-us-adults-not-getting-key-vaccines-cdc

Number of kids with autism may drop under new criteria

The number of U.S. children estimated to have autism could decline as a result of new criteria to diagnose the condition, a new study suggests.

The findings show that 81 percent of children in the study diagnosed with autism under the old criteria would still be classified as having the condition under the new criteria, which were released last year in the new edition of the psychiatric handbook called the DSM-5.

Before the release of the DSM-5, some people were concerned that the new criteria would exclude some children who previously would have been diagnosed with autism, leaving these children without access to educational services available to children with autism.

The new findings should be reassuring to parents, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children’s Medical Center of New York, who was not involved in the study.

“The overwhelming majority of children” who met the old criteria will continue to meet the new ones, Adesman told LiveScience.

In addition, it is likely that many children who fall short of a diagnosis of autism under the new DSM-5 criteria will qualify for services under a different psychiatric diagnosis, Adesman said. [The 10 Most Controversial Psychiatric Disorders]

According to Autism Speaks, an advocacy organization that funds autism research, no one previously diagnosed with an autism spectrum disorder (including Asperger’s syndrome) will “lose” their diagnosis. “If you have a diagnosis for ASD, you have a diagnosis of ASD for your life and should be entitled to appropriate interventions for the rest of your life,” the organization says on their website.

 Read More at Fox News: http://www.foxnews.com/health/2014/01/23/number-kids-with-autism-may-drop-under-new-criteria/

SSRI use in pregnancy doesn’t raise autism risk

By: MARY ANN MOON, Pediatric News Digital Network

A mother’s use of selective serotonin reuptake inhibitors during pregnancy doesn’t appear to raise the risk of autism spectrum disorders in her offspring, according to a report published online Dec. 18 in the New England Journal of Medicine.

In a cohort study of all 626,875 singleton live births that occurred in Denmark between 1996 and 2005, fetal exposure to maternal SSRI use did not significantly increase the risk that the child would be diagnosed as having an autism spectrum disorder during 5-14 years of follow-up, said Dr. Anders Hviid of the department of epidemiology research, Statens Serum Institut, Copenhagen, and his associates.

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Pregnant women who use SSRIs did not significantly increase the risk that the child would be diagnosed as having an autism spectrum disorder, experts said.

This large nationwide study had the statistical power to rule out all but a small increase in relative risk, they noted.

Dr. Hviid and his colleagues undertook this study because a recent California case-control study reported that the risk of autism spectrum disorder increased by a factor of two among offspring of women who used antidepressants, particularly SSRIs, during pregnancy, and that this risk was increased by a factor of more than three if the woman used an SSRI during the first trimester (Arch. Gen. Psychiatry 2011;68:1104-12). Evidence from other studies also seemed to bolster this association.

In addition, a causal association is biologically plausible, because people with autism spectrum disorders are known to have increased levels of circulating serotonin, and because serotonin appears to play an important role in early brain development. “Manipulation of serotonin homeostasis can alter neuroanatomical and neurophysiological development and produce enduring behavioral changes in animal models,” Dr. Hviid and his associates said.

The investigators analyzed data from the Danish national birth registry, national prescription registry, and national registry of psychiatric diagnoses to assess the 626,875 children, including those who were born to 6,068 mothers who used SSRIs during pregnancy. A total of 3,892 cases of autism spectrum disorder were diagnosed.

In an initial analysis, autism was strongly associated with maternal psychiatric diagnoses and with the use of drugs other than SSRIs during pregnancy. This suggested possible confounding by indication, meaning that any association found between SSRI use and autism might be due to the mother’s underlying psychiatric disorder rather than to the medication she took for it.

During 42,400 person-years of follow-up, there were 52 cases of autism spectrum disorder among the offspring of women who took SSRIs during pregnancy. “In unadjusted analyses, we did find a significantly increased risk of autism spectrum disorder in association with the use of SSRIs during pregnancy.

“In fully adjusted analyses, however, the risk was no longer significant. This was primarily due to adjustment for a number of psychiatric diagnoses [in the mother], which is consistent with the presence of confounding by indication in the unadjusted analysis,” the investigators said (N. Engl. J. Med. 2013;369:2406-15 [doi:10.1056/NEJMoa1301449]).

Read more at Pediatric News… –>

Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. [Study]

Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB.

Source

Center for Health Research-Southeast, Kaiser Permanente, Atlanta, Georgia 30305, USA. rbednar@emory.edu

Abstract

OBJECTIVE:

Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity-related clinical outcomes after adolescent vaccination.

METHODS:

We conducted a retrospective cohort study utilizing longitudinal electronic data from a large managed care organization. Girls enrolled in the managed care organization, aged 11 through 12 years between July 2006 and December 2007, were classified by adolescent vaccine (HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; quadrivalent meningococcal conjugate) receipt. Outcomes (pregnancy/sexually transmitted infection testing or diagnosis; contraceptive counseling) were assessed through December 31, 2010, providing up to 3 years of follow-up. Incidence rate ratios comparing vaccination categories were estimated with multivariate Poisson regression, adjusting for health care-seeking behavior and demographic characteristics.

RESULTS:

The cohort included 1398 girls (493 HPV vaccine-exposed; 905 HPV vaccine-unexposed). Risk of the composite outcome (any pregnancy/sexually transmitted infection testing or diagnosis or contraceptive counseling) was not significantly elevated in HPV vaccine-exposed girls relative to HPV vaccine-unexposed girls (adjusted incidence rate ratio: 1.29, 95% confidence interval [CI]: 0.92 to 1.80; incidence rate difference: 1.6/100 person-years; 95% CI: -0.03 to 3.24). Incidence rate difference for Chlamydia infection (0.06/100 person-years [95% CI: -0.30 to 0.18]) and pregnancy diagnoses (0.07/100 person-years [95% CI: -0.20 to 0.35]), indicating little clinically meaningful absolute risk differences.

CONCLUSIONS:

HPV vaccination in the recommended ages was not associated with increased sexual activity-related outcome rates.

http://www.ncbi.nlm.nih.gov/pubmed/23071201

East Houston Regional Medical Center

East Houston Regional Medical Center serves as a campus of Bayshore Medical Center and is part of the HCA Gulf Coast Division, which owns and manages more than 169 hospitals and 113 outpatient surgery and endoscopy centers across 19 states and England. The establishment offers comfortable and convenient healthcare to residents nestled in the heart of the historic land where Texas gained its independence. A full-service acute care hospital, East Houston Regional Medical Center features 131 beds, as well as 400 people in staff members and 250 board-certified doctors. The Center has a Level IV emergency center which represents the only such facility in the region, allowing the hospital to offer care for trauma cases, reduced wait times, and quick diagnosis.

For more information about East Houston Regional Medical Center, please visit http://easthoustonrmc.com/.