Indoor Tanning, Parents & Friends, Redesigned Well-Checks – PediaCast 291
Join Dr Mike in the PediaCast Studio for more News Parents Can Use! Topics include indoor tanning & skin cancer, diagnosing genetic disorders by photograph, parents & friends, the benefit of moral stories, redesigning the well-child visit, and nurses & immunizations.
Indoor Tanning & Skin Cancer
Genetic Disorders & Photographs
Parents & Friends
The Moral of the Story
Redesigning the Well Check
Nurses & Immunizations
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Announcer 1: this is PediaCast
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from the campus of Nationwide Children's here is your host, Dr. Mike.
Dr. Mike: Hello everyone and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio it is episode 291 for July 9, 2014. We're calling this one, "Indoor Tanning", even though it's July. 'Parent's and Friends," and "Redesigned Well Checks." I want to welcome everyone to the show. I hope all my American listeners had a happy Independence Day, also known as the 4th of July.
I feel like I have to explain because we have a significant number of folks in the audience who are not in the United States of America. So this is the time of the year when we celebrate our independence from the British Empire. And families take time off work, we watch fireworks, we have cook outs, we go swimming, play Frisbee, golf some of us. Just really get outside, spend time with family. And I hope all of you who are here in the States had time well spent with family and friends. And for my British listeners, well sorry about your luck. I know that wasn't nice. And here I have some dear listeners from the United Kingdom who are usually pretty vocal and write into the program a lot, which I love. Really I do appreciate you guys, truly I do it's just I couldn't resist. We have a news parents can use show lined up for you this week.
I'll get to the entire line-up in a moment. First don't forget about our sibling blog, 700 Children's it's at 700childrens.org. Just recently I had a post on there called "Home Made Baby Food: The Danger of Nitrates." Now this is a topic that we covered on a recent PediaCast but if you like the same information in a form of a blog post, maybe the share on Facebook. I'll put a link on the show notes page for this episode 291 over at pediacast.org. Stay tune, I'm going to have a follow up article "Home Made Baby Food and Botulism". And then a third one "Home Made Baby Food Safety Tips" all coming your way at the same location, 700childrens.org. Other recent blog topics from other physicians here at Nationwide Children's Hospital, "Physicians and Other Healthcare Professionals", "How to remove a Tick?" It's a very practical one for the summer.
"Using Brain MRI to Fight Delays and Preemies", "Changing the Future of 3D Printing", now how does that relate to pediatric medicine? Well drop by the blog to find out. And "Ten Tips for Families New to Type One Diabetes". So be sure to check out our sibling blog, 700childrens.org. Very easy to find and equally easy to digest. So click there and share, we really do appreciate it. Alright what are we talking about this week on this particular show? Indoor tanning and skin cancer. A few episodes back we talked about indoor tanning and eating disorders and at that time I said in a rather off handed manner that indoor tanning is also linked to skin cancer which everyone assumes is true. But does the scientific evidence back that up? Stay tune to find out. And then genetic disorders and photographs. Now this is an interesting story. Could facial recognition software aid in the diagnosis of rare genetic disorders?
And if so how in the world would that work? We'll explore and explain. Parents and friends, you've heard about a Mama's boy right? If a boy is too close to his Mama he might have trouble making friends with kids his age, but is that true? How does the relationship between parent and child affect friendships between peers? We'll take a look. And then the moral of the story, do moral stories really improve your child's behavior? If so are some stories better than others? See now this is another interesting one. Of course all PediaCast episodes are hopefully beneficial. But I'm really excited to share this one with you and this story in particular, it's pretty interesting. And the next one is redesigning the ell check. All parents know about well child check-ups, they've really been the same for decades and decades, really very littlest changed.
But armed with an increasing number of topics to cover and lots of new technologies to utilize, is it time for a new model? We'll explore the options and tell you what may be on the horizon at a doctor's office near you. And then finally at the end of the program, nurses and immunizations. A couple of nurse educators have some blunt words regarding childhood vaccines. Nurses tend not to pull punches. So stick around and hear what's on their mind at the end of the program. Don't forget PediaCast is your show, so if you have a topic you'd like us to talk about either in the form of just letting folks know, or really a full blown nuts and bolt show where we interview a pediatric expert on a particular topic. If you have an idea for that, write in and let us know. Also we answer your pediatric questions, we don't give medical advice for particular kids but we will entertain questions and answer from a general educational perspective.
Dr. Mike: Alright we are back. So back in PediaCast episode 286 I share the study linking indoor tanning bed use and eating disorders. Now it's not likely that indoor tanning causes eating disorders right? It's an association. If you have a negative self image you may be more likely to strive for tanner skin and a thinner waist line. And the point of talking about it was the parents and doctors who have or seen teenagers who want to tan. Well you may want to think about the possibility of eating disorders and start paying attention to certain behaviors and start to ask pointed questions if you need to. In the course of that discussion, I made it off handed remark that you shouldn't let your teenagers use tanning beds, and parents shouldn't use tanning beds either because they are linked to skin cancer.
And this time that link is probably not an association but an actual cause. Then I got to thinking, we like to keep things real around here. This is an evidence based podcast. So in case you had any doubts i want to report that Dartmouth researchers have found that early exposure to the ultra violet radiation lamps used for indoor tanning is related to an increased risk of developing basal cell carcinoma which is a type of potentially deadly skin cancer at a young age. Their findings were reported this month in the Journal Pediatrics. Since indoor tanning has become increasingly popular among adolescents and young adults, the researchers call attention to the importance of counseling young people about the risk of indoor tanning. Dr. Margaret Karagas lead author of the study and director of the Children's Environmental health and Disease Prevention research center at Dartmouth says, "Our findings suggest that teens and young adults who seek indoor tanning may be especially vulnerable to developing basal cell carcinoma, the most common form of skin cancer at a young age."
She adds, "A recent survey in New Hampshire, where our study was conducted, found that 74 percent of high schools have at least one tanning salon within two miles of the school and an additional 22 percent have easy access to a tanning salon. So we need to help young people understand these risks…. The researchers collected data on 657 participants in the New Hampshire Skin Cancer Study all under the age of 50 who had newly diagnosed cases of basal cell carcinoma and they compare this group with 452 control subjects who have not had skin cancer. Data collected included the type of indoor tanning device used such as sunlamps, tanning beds, or tanning booths, also skin sensitivity to the sun and proportion of time spent outdoors in childhood. So what did they find? A higher proportion of patients with early-onset basal cell carcinoma reported indoor tanning with a tanning lamp compared to controls, and this association was present for all types of indoor tanning devices.
Sunlamps, tanning beds, and tanning booths. The researchers also found that participants with early-onset basal cell carcinoma were re likely to burn rather than tan during the first hour of sun exposure in summer as compared to controls. The study notes that indoor tanning products can produce 10 to 15 times as much UV radiation as the midday sun, and the author support the recommendations of medical groups, including the American Academy of Pediatrics, to minimize ultraviolet exposure, including that which comes from indoor tanning. So there you have it, don't ignore my off handed remark about tanning beds and skin cancer back in episode 286 because here we have hard and recent evidence that backs up my claim. Computer analysis of photographs could help doctors diagnose which condition a child with a rare genetic disorder has, so says investigators at Oxford University.
Researchers have come up with a computer program that recognizes facial features in photographs. The software looks for similarities with facial structures for various conditions, such as Down's syndrome, Angelman syndrome, and many others and returns possible matches ranked by likelihood. Using the latest in computer vision and machine learning, the algorithm increasingly learns what facial features to pay attention to and what to ignore from a growing bank of photographs of people diagnosed with different syndromes. The researchers report their findings in the journal eLife. While many genetic disorders are each individually rare, collectively these conditions are thought to affect 1 person in 17. Of these, a third may have symptoms that greatly reduce quality of life. However, many of these patients fail to receive the correct genetic diagnosis. Dr. Christoffer Nellåker, lead author of the project and a professor with the MRC Functional Genomics Unit at the University of Oxford says, "A diagnosis of a rare genetic disorder can be a very important step."
"It can provide parents with some certainty and help with genetic counseling on risks for other children or how likely a condition is to be passed on. A correct diagnosis can also improve estimates of how the disease might progress, or show which symptoms are caused by the genetic disorder and which are caused by other clinical conditions, information which may help in choosing between treatment options." Dr. Andrew Zisserman, a professor of Engineering Science at the University of Oxford brought expertise in computer vision and machine learning to the project. He says, "It is great to see such an inventive and beneficial use of modern face representation methods." Identifying a suspected genetic disorder usually requires doctors to come to a conclusion based on facial features, laboratory test, and their own clinical experience. It's thought that 30–40% of rare genetic disorders involve some form of change in the face and skull, possibly because so many genes are involved in development of the face and head as a baby grows in the womb.
The researchers set out to teach a computer to carry out some of the same assessments objectively. They developed a software program hat… like Google, Picasa and other photo software… recognizes faces in ordinary, everyday photographs. The program accounts for variations in lighting, image quality, background, pose, facial expression and identity. It builds a description of the face structure by identifying corners of the eyes, the nose, the mouth and other features, and compares this against what it has learnt from other photographs fed into the system. The algorithm developed by the researchers analyzes photographs, sorts the pictures, and automatically clusters patients sharing the same condition together. And as the software looks at more and more pictures of people with specific syndromes it learn subtle pictures and improves its ability to suggest the correct diagnosis.
Dr. Nellåker says, "In the future, a doctor, anywhere in the world should be able to take a Smartphone picture of a patient and run the computer analysis to quickly find out which genetic disorder the person might have." He adds, "This objective approach could help narrow the possible diagnoses, make comparisons easier and allow doctors to come to a conclusion with more certainty." So why didn't I think of that? Or you for that matter? Interesting stuff and more to come in the not so distant future. What social skills does a three-year-old bring to interactions with a new peer partner? Also known as a friend. Well if he has strong bonds with his parents, the child is likely to be a positive, responsive playmate, and he'll be able to adapt to a difficult friend by asserting his needs. That's according to a new University of Illinois study published in Developmental Psychology. Dr. Nancy McElwain, a professor of human development at the University of Illinois says, "Children with secure attachments to their parents are more responsive to suggestions and requests made by a new friend."
"And their more likely to come into a new peer relationship with positive expectations." For the study, investigators assessed the security of child-mother attachment relationships for 114 children at 33 months of age, and asked the parents about their child's temperament including details on anger proneness and social fearfulness. At 39 months, children of the same gender were randomly paired with one another and observed over three laboratory visits in a one-month period. Securely attached kids were more responsive to a new peer partner the first time they met, even if the new child was prone to anger. Kids with secure attachments continued to respond favorably on the second and third visits as long as the peer partner's anger was low, but not so much when the other child's anger was high.
Dr. McElwain says, "When a child is mashed up with a peer who is quick to become frustrated or angry, the positive social expectations of a child with a secure attachment are likely not met. The securely attached child may then adapt to the situation and dampen his responsiveness to the challenging partner." In other words they go with the flow. Dr. McElwain adds, "A more securely attached child was also likely to use suggestions and requests rather than commands and intrusive behavior such as grabbing toys away during play and an anger-prone child during the first two visits. By the final visit, a child with secure parental attachment had adjusted to the controlling assertiveness of his anger-prone friend by becoming more controlling himself." The study showed that a child's level of parental attachment security, their partner's tendency to become angry, and how well the children knew each other by comparing earlier vs. later visits combined to predict a child's behavior.
Dr. Mc Elwain says, "Behavior toward a peer partner depended on the partner's temperament as much as the child's own attachment. Consideration of both factors in combination is needed to understand a child's behavior toward a new peer…. The child's own temperament also played a role in understanding his behavior toward new peer partners. Children whose parents described them as socially fearful were less assertive overall. But don't confuse a difficult temperament with an insecure attachment. Dr. Mc Elwain says, "You may have a fussy baby, but if you respond to him with sensitivity, he will develop a strong bond with his parents and will likely go on to enjoy positive, close relationships with others…. So here's another reason why a strong bond between mother and child is important especially in the first couple of years of life. A strong bond between mom and child predicts how well your child will get along with others during the toddler years and probably beyond that. And it makes sense, the child-mother bond is a relationship.
It's your child's first relationship, and it sets the tone for friendships down the road. So working moms, take heed and dads, take heeds as well. Don't rely on video screens to babysit your young child when you get home from work. Get down on the floor, play, interact, form those attachment bonds because your child's future friendships are at stake. A moral story that praises a character's honesty is more effective at getting young children tell the truth than a story that emphasizes the negative repercussions of lying. This according to research published in the journal Psychological Science. The findings suggest that stories such as "The Boy Who Cried Wolf… and "Pinocchio… may not be effective cautionary tales when it comes to inspiring honest behavior in children. Stories have long been employed to instill moral and cultural values in young children, but there is little research exploring the effectiveness of such stories.
Dr. Kang Lee, lead author of the study and an investigator with the Dr. Eric Jackman Institute of Child Study at the University of Toronto says, "We should not take it for granted that classic moral stories will automatically promote moral behaviors…. Dr. Victoria Talwar a co-author and researcher at McGill University adds, "As parents of young children, we wanted to know how effective the stories actually are in promoting honesty. Is it in one ear, out the other,' or do children listen and take the messages to heart?… To find out, investigators studied 268 children age's three to seven. Each child played a game that required guessing the identity of a toy based on the sound it made. In the middle of the game, the experimenter left the room for a minute to grab a book, instructing the child not to peek at a toy that was left on the table. For most children, this temptation was too hard to resist. When the investigator returned, she read the child a story, either "The Tortoise and the Hare,… "The Boy Who Cried Wolf,… "Pinocchio,… or "George Washington and the Cherry Tree….
Afterwards the child was asked to tell the truth about whether he or she peeked at the toy. Contrary to the researchers' expectations, "Pinocchio… and "The Boy Who Cried Wolf… — which associate lying with negative consequences, such as public humiliation and even death — were no more effective at promoting honest behavior than a fable unrelated to honesty, in this case "The Tortoise and the Hare…. Only the apocryphal tale about a young George Washington seemed to inspire the kids to admit to peeking: Children who heard the story in which the future first president of the United State is praised for confessing his transgression were three times more likely to tell the truth than their peers who heard other stories. An additional experiment indicated that the positive focus of the George Washington story was responsible for the kids' honest behavior. When the researchers changed the ending so that it took a negative turn, children who heard the story were no longer more likely to admit to peeking.
Dr. Talwar believes the original story about George Washington is effective because it demonstrates "the positive consequences of being honest by giving the message of what the desired behavior is, as well as demonstrating the behavior itself…. Dr. Lee adds, "Our study shows that to promote moral behavior such as honesty, emphasizing the positive outcomes of honesty rather than the negative consequences of dishonesty is the key. And this may apply to other moral behaviors as well…. Investigators caution that more research is necessary to determine whether moral stories influence kids' behavior long-term. Dr. Still, they have been quick to take advantage of the findings. Talwar reports a shift in her own parenting practices. She says, "It really seems to work. I use this now with my child…. So George Washington and The Cherry Tree, whether it's true or not, get it, read it and when your child tells the truth, praise her for doing so.
Well-child visits are the foundation of pediatric primary care in the United States Accounting for more than one-third of all outpatient visits for infants and toddlers, these appointments are intended to give doctors the opportunity to identify health, social, developmental and behavioral issues that could have a long-term impact on children's lives. However, several studies have shown that the current system of well-child care leaves room for improvement. One major concern is that well-child care guidelines issued by the American Academy of Pediatrics call for physicians to provide more services than can realistically be completed within a 15-minute office visit. As a result, many children do not get all of the preventive care services that they need and the problem is most glaring for low income families due to a larger likelihood of psychosocial and developmental problems and a greater need for parental education.
in a year-long study led by Dr. Tumaini Coker, an assistant professor of pediatrics at Mattel Children's Hospital UCLA, researchers developed a new design for preventive health care for children from birth through age three from low-income communities. The team partnered with two pediatric practices and a multi-site community health center in greater Los Angeles. Dr. Coker says, "The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices. Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventive care that is more family-centered, effective and efficient." Investigators created two working groups of pediatric clinicians, office staff, and parents to design the new models of care. One group included private practice, private pediatric practices, and the other a community clinic. Researchers gathered input from two sources.
First, they solicited ideas from pediatricians, parents and health plan representatives about topics such as having non-physicians provide routine preventive care and using "alternative visit formats" — meeting with health care providers in alternative locations, meeting in groups as opposed to one-on-one, or getting providers' advice electronically instead of in person. Secondly, the teams surveyed existing literature on alternative providers, locations and formats for well-child care. Using that input, the clinic working groups developed four possible new models of care that it submitted for review by a panel of experts on preventive care practice redesign. Based on the panel's rankings, the working groups selected two models to implement and test — one for the private practices and the other for the community clinic. The private practices adopted a one-on-one visit format while the community clinic used a group-visit format, but the two models shared several characteristics.
Including, one, a trained health educator, or "parent coach," at each facility who relieves the physician of some of the more routine services and provides preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns. Two, a considerably longer preventive care visit. Three, a website that enables parents to customize their child's specific needs prior to their visit. And four, scheduled text messages or phone calls enabling the health care team to communicate with parents. The next stage of research is already underway with implementation and testing of the two models to the end of 2014. Dr. Coker says, "For clinics and practices that provide child preventive health care to families living in low-income communities, the process we used to develop the new models — or the new models themselves — could help them bring innovation to their own practices." So this is really a long time coming. There's so much ground to cover during the well-child check and precious little time to do it.
I love the idea of a parent coach as a physician extender, although that person could easily become overwhelmed, you'd probably need more than one in a busy office. All these ideas are great. Let's add one more into the mix, what about podcast? What if you have a podcast that covered child health information? Maybe included news parents can use, perhaps answered some listener's questions. Maybe even included interviews of pediatric experts. Anyone know where you could find one of those? That does wrap up our new stories that I've lined up for you this week, but stick around. I have a final word from a couple of nurses, you're going to love this, on the subject of immunizations. So that's coming your way right after this.
Dr. Mike: Alright we are back. So nurses and immunizations. Concerted effort is needed to reverse the ongoing rise in pertussis, also known as whooping cough. Cases of pertussis and deaths of because of pertussis especially among children and young people. This is according to nurse educators, Emily Peake and Lisa McGuire. They say, "This effort begins with nurses, nurse practitioners and other primary care providers who educate patients and the public." They add, "The battle of pertussis is winnable through education, awareness, and vaccination." In the US and abroad we are seeing rising rates of pertussis infection and death caused by Bordetella pertussis bacteria.
In the United States, the average number of pertussis cases seen each year increased from less than 3,000 cases per year during the 1980's to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths each year making pertussis a major cause of death in infants worldwide. So why is pertussis on the rise? Well according to nurse Peake and nurse McGuire, "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks. They add, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."
Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children. Nurses should reassure parents that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions. They say, "Education is key to increasing pertussis vaccination. Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines."
Peake and McGuire say, "Waiting rooms provide a good opportunity to present videos and other educational materials." The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, they say, "Partnerships should be formed with service organizations, food banks, churches, hospitals and schools. These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations." Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime." So strong words from a couple of nurses and words I happen to agree with. By the way, if you have concerns that the MMR vaccine causes autism.
It's all available at pediacast.org. We're also on iTunes under the kids and family section of their podcast directory. You'll find PediaCast on Stitcher, TuneIn, Downcast, iCatcher, Podbay and most other podcasting apps for iPhone and android. We're also on Facebook, Twitter, Google Plus, and Pinterest. And of course we really appreciate you connecting with us there and sharing, re-tweeting, re-penning, favoriting all of our posts so you can tell your own online audience about our little show. We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or anyone who takes care of children. And as always be sure to tell your child's doctor about the program next time you're in for a sick office visit or one of those well checkups. It'll be a great opportunity to say, "Hey I hear that they're thinking about new models of well checkups for in the not too distant future." That may perk your doctor's ears up and just let them know. You can find out more at pediacast.org. And posters are also available under the resources tab. They go nicely in exam rooms, on bulletin boards, and nurseries, and daycare centers, places like that. So feel free to download and use those.
So again I appreciate all of you being a part of the program. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids. So long everybody.
Announcer 2: This program is a production of Nationwide Children's, thank you for listening. We'll see you next time on PediaCast.
your kids. So long everybody.
Announcer 2: This program is a production of Nationwide Children's, thank you for listening. We'll see you next time on PediaCast.