Bacterial Meningitis Vaccine, Obese Children – PediaCast 066

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Topics

• FDA Expands Age Range For Bacterial Meningitis Vaccine
• Alarming Findings in Obese Children
• Watching Funny Shows Helps Children Tolerate Pain
• Maine School Hands Out Birth Control Pills–To Eleven Year Olds!
• Deterrent Effect of Drug Testing Among High School Athletes

Links

• Maine School to Offer Contraception (AP)
• Kids on Birth Control (ABC)
• Middle School Adds Birth Control Options (Portland Press Herald)

Transcription

Announcer: This is PediaCast.

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Announcer: Welcome to PediaCast, a pediatric podcast for parents, the news edition. And now direct from Bird House Studios, here's your host, Dr. Mike.

0:00:24

Dr. Mike Patrick: Hello everyone and welcome to PediaCast! It is episode 66 for Monday, October the 22nd, 2007. And how'd your weekend go? We we're busy in fact kids amazing that I'm going to show out today. Of course it's a new show, news I should say. And the news shows don't take quite as much work as some of the other ones do especially the listener one. But we had a busy weekend, again went to the Ohio State Football Game. And they did a pretty good job except for a couple of bad place and of course just a couple of minutes.

0:01:06

It could have ruined the game but they hang in there and they are still number one in the country and hopefully they'll stay there for a lot longer. It's me on knocking on wood.

0:01:19

I'm recording during the Indian's game because I'm not so sure that really deserve to win. But we'll see we'll see how that one goes. Now sports talk, this is not a sports podcast I know. After the football game yesterday we met up with some acquaintances over the internet. They live in Kentucky but they are Ohio State then. And we're setting at our section and we knew him because we're going to be on a cruise with him on a Disney cruise in April.

0:01:49

And on the disc boards they have a cruise meet thread where you can find other people who are going to be on your cruise. And so we found out that they're going to be on the football game and afterward went to go out together to a city barbecue to eat. So that was fun.

0:02:06

And then today, of course went to church and after church, nightmare before Christmas. Boy there's two things next to each other that may not make the most sense. Okay, it was nightmare before Christmas. It was 3 days and it was fun. And the fact that it was after church then that's the way it is.

0:02:26

Okay today in the news we have the FDA expands their age range for bacterial meningitis vaccine and alarming finding in obese children. Watching funny show helps children to tolerate pain, and then Maine, Portland Maine school hands out birth control pills to eleven year olds and then the deterrent effect of drug testing among high school athletes. We'll talk about that. Don't forget that if there's the subject matter that you would like us to discuss, all you have to do is go to PediaCast.org and click on the contact link. You can also email me at PediaCast@gmail.com or call the voice line at 347404KIDS that's 347045437.

0:03:15

And of course don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at PediaCast.org.

0:03:43

With that in mind we'll be back with the news parents can use right after this short break.

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0:04:18

In addition to the podcast we're also doing this particular show live on stickam, that's S T I C K A M. So if you go to stickam.com just go put PediaCast down as a friend once you sign up and most week nights, I'm going to try to shoot for between 7 and 8, somewhere around that time to record these shows. So if you'd like to come and hang with us you're more than welcome to do so. It's going to depend a little bit on my call schedule but we'll see how that works out.

0:04:48

Our news parents can use edition is brought to you in conjunction with news partner Medical News Today, the largest, independent and health medical news website. You can visit them online at medicalnewstoday.com. The US Food and Drug Administration expanded the approved age range for menactra, a bacterial meningitis vaccine that'll include children ages 2 to 10 years. Meningitis is a serious inflammation of the lining that surrounds the spinal cord and brain. It can result in death or permanent injury to the brain in nervous system. In the United States about 2600 people become ill from bacterial meningitis annually. About 10% die from the infection and another 15% suffer brain damage or limb amputation.

0:05:35

Now how do you get limb amputation? Well I'm going to pause here just to explain this. Cause this kind of interesting. The bacteria that we're talking about here is called meningococcus, it's the meningococcal type meningitis. And that particular bacterium can cause a blood clotting problem that we called DIC. And what this basically is is that your clotting system goes wacko and you can get easy bleeding plus blood clots that form both things happening at the same time.

0:06:07

And if with blood clots and easy bleeding you can have the blood supply to fingers and toes and then you know to larger vessels that go to the extremities and can cause ischemia which is lack of oxygen that leads tissue death or necrosis. So you can end up needing amputations because of that.

0:06:30

Okay moving on with the story menactra was first approved by the FDA in January 2005 for people ages 11-55 years. Previously menomune was the only meningococcal vaccine available in the United States for use in children ages 2 and older. Both vaccines offer protection against 4 groups of nicer a meningitis's, the bacterium that causes meningococcal meningitis. Approving menactra for younger children offers another option for health care providers and parents.

0:07:01

Now there are 2 vaccines available for children between 2 and 10 years of age who may be at increased risk of meningitis. So says Dr. Jessie Goodman, director of the FDA Center for Biologics Evaluation and Research. The centers for disease control and prevention advisory committee and immunization practices currently recommends meningococcal vaccination for children ages 2 to 10 years of age who are at increased risk of developing meningococcal disease such as those who have their spleen removed or whose spleen is not functioning.

0:07:35

Also those with a medical condition called terminal compliment deficiency which makes it difficult to fight infection. And those who expect to travel to areas outside of United States where the disease is common. Vaccination is also is used to control outbreaks of bacterial meningitis. Menactra's effectiveness was measure in clinical trials that it included people ages 2 to 55 years.

0:07:59

The vaccine was shown to produce an immune response one month after vaccination. The safety of menactra was evaluated in 8 clinical studies that included a total of 10,057 participants who were seen menactra and 5,266 participants who received menomune. The most common adverse events reported in the studies were pain at the injection side and irritability. Diarrhea, drowsiness and lack of appetite also were common.

0:08:27

What not observed on these children on this clinical trial Guillain-Barré syndrome and neurological disorder that causes muscle weakness was noted as a possible but unproven risk in some adolescents following immunization with menactra occurring in an estimated 1 in 1 million vaccine recipients. As a precaution, people who have previously been diagnosed with Guillain-Barré syndrome should not receive menactra.

0:08:53

The FDA and CDC will continue to monitor the safety of menactra through their jointly administered vaccine adverse event reporting system. Children who are obese or who are at risk for obesity show early signs of heart disease similar to obese adults with heart disease. A study by researchers at Washington University School of Medicine in St. Louis has found. Based on this study, the subtle markers can help us predict who could be at risk for heart disease and heart attacks, says Dr. Angelus Sharky, associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children's Hospital. The study was published in the winter 2007 issue of the journal of cardiometabolic syndrome.

0:09:40

Child with obesity in United States is an epidemic nationwide. 19% of children ages 6-11 and 17% of those 12-19 are overweight according to the Centers for Disease controlling the prevention. Those who are overweight during childhood also have an increased risk of obesity in adulthood and are a greater risk for complications such as diabetes, high blood pressure and heart disease because obesity increases total blood volume which leads to extra stress on the heart.

0:10:09

Dr. Sharky and Dr. Steven Lurge a former fellow at a School of Medicine now at University of Texas Health Science center at Houston analyzed data from 168 children ages 10-18 who had been referred to them for cardiac ultrasound with symptoms including heart murmur, chest pain, acid reflux or high blood cholesterol. Based on CDC guidelines for body mass index or BMI, 33 patients who were found to have a BMI's obese or the 95th percentile or above for their age.

0:10:41

Twenty had the BMI that classified them as at risk for obesity or between the 85h and 94th percentile and 115 were considered normal or below the 85th percentile. To analyze the hearts of the obese children and those at risk, Sharky and Lurge used a new tissue Doppler imaging technique called vector velocity imaging which tracks the movement of the heart's muscular wall. Any changes in the rate of motion of heart muscle where average with any age group compared to the normal rate of motion. And the patients who are obese the rate of motion of heart muscle change, Sharky said. As a child's BMI increases, we see the alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that's have been seen in adults were assumed to be from a long standing obesity. But it maybe these changes start much earlier in life than we thought.

0:11:37

As vector velocity imaging becomes more broadly available Sharky said, it could potentially help pediatric cardiologist follow these children more closely over time to see if changes in the heart progress. We may be able to determine whether we could intervene in the process such as focusing the families on understanding the importance of regular exercise and dietary modifications for weight loss and prescribing statin drugs for high blood cholesterol she said.

0:12:04

Sharky thinks the results of the study give more ammunition to physicians to use in counseling pediatric patients and the parents about the risk of obesity and the need to attain a healthy weight. Even in teenagers, obesity leads to decrease heart muscle performance and abnormal blood pressure for their study is needed to determine how soon the changes the heart set in after a child becomes obese and whether those changes are reversible with weight loss.

0:12:33

Watching comedy shows helps children tolerate pain for longer periods of time. Suggesting that humorous destruction could be used in clinical settings to help children and adolescents better handle painful procedures. According to a study which team UCLA's Jonssons Comprehensive Cancer Center with the non-profit organization are ex laughter. Laughter has long been viewed as good medicine although there are many programs that bring humor into pediatric hospitals. Little research has been done on utility of humor for children or adolescents undergoing stressful or painful procedures such as blood draws and treatments for cancer.

0:13:10

RX Laughter, an organization interested in using humor for healing founded by former television executive Sharey Doney Hilber work with UCLA researchers on the study which was funded by a grant from comedy central. Participants watched funny classic and contemporary films in television series before, during and after a standardized pain task.  In this case placing their hands in icy cold water said Dr. Margaret Stuber, a researcher in the Johnson Cancer Center and the first author of the study.

0:13:45

The group demonstrated significantly greater pain tolerance while viewing the funny shows according to the study published in the October issue of the journal evidence based complementary and alternative medicine. Stuber said researchers documented participant's appraisal of the pain and noted submersion times and examine them in relation to two humor indicators the number of laughs or smiles and the children's ratings of how funny Hershey perceived each show. We found that viewing funny videos increased the tolerance of pain for children but did not change their ratings of the severity of the pain.

0:14:23

So Dr. Stuber although they kept their hands in the water longer they didn't describe the test as any less painful than when they weren't watching the videos. However this may mean that it simply too long for the pain to become severe enough to remove their hand. The number of laughs recorded was not related to either pain tolerance or appraisal, Stuber said. 18 healthy children aged 7-16, 12 boys and 6 girls with a mean age of 12 participated in the study.

0:14:51

An ice chest was fitted with a plastic mesh screen to separate crushed ice from a plastic mesh arm rest placed in 50-degree water, it's Fahrenheit. Water was circulated through the ice by a pump to prevent local warming. Participants placed the hand and in the cold water to adapt the 2 inches above the wrist for up to 3 minutes maximum. Hands were warmed between tests with warm tiles. Researchers took a base line measure of submersion duration before the video was viewed and measure them after and one well participant watched the video.

0:15:26

The children left their hands in the icy water significantly longer when watching the funny shows. Researchers say further studies needed to explore the specific mechanism of increased pain tolerance. According to Dr. Stuber, since we did not test any other types of destructors, it could be that something equally destructing but not funny would also be effective. However the results do support the types of intervention being done at children's hospitals across the United States.

0:15:53

A school in this State of Maine is to make birth control pills available to middle school children as young as 11 through its health center. According to an associated press report, the decision was made in a school committee meeting last week following a request from the school's health center to make the pills available to children of high school age who are still attending middle school. Officials from King Middle School in Portland Maine defended the decision saying it was aimed at a handful of sexually active students.

0:16:25

The decision means King will be the first middle school in Maine to offer a full range of contraception to students' age from 11 to 15 or grade 6-8 said the Portland Press Herald. Amanda Rose, school nurse coordinator of the Portland Public School told ABC news there's nowhere else for students to get protection. I see students' everyday whose lives could be ruined by an unwanted pregnancy or are having sexual intercourse and who need protection.

0:16:55

Principal of King Middle School Mike McCarthy added that there were some occasions when they had to protect kids from risky behavior than some cases they are not talking to their parents about. According to the Associated Press only 5 of the 134 children to visit the school's health center last year reported being sexually active, only 5.

0:17:17

Seven pregnancies have been reported among school girls attending Portland's 3 Middle Schools in the last 4 years. It helps the official told the associated press correcting earlier reports that said this figure with 17, so 7 pregnancies in the last 4 years. School children will need a permission from a parent to attend the health center however under state law the health center is required to keep the treatment confidential. Which means parents will not know whether the children are getting contraceptive pills.

0:17:46

The decision to make the pills available to the children was carried by a 72 vote by the school committee with the posing voices raising concerns about violations to parents' rights. One parent that spoke to ABC news said that she would rather see a kid being able to get birth control than to get pregnant. And a 12-year old child attending the school said she was aware she now had the right to ask for birth control but she wasn't about to.

0:18:13

A committee member and parent of an 8th grade student at the school told the Portland Herald she supported the decision even though she was not comfortable about it. She said that there maybe some kids without strong parental support at home with nobody to turn to. And even though she felt she had done her job as a parent, there may times when her daughter might not feel comfortable coming to her mother.

0:18:35

The decision extends the range of contraception options available to the children who are already able to get condoms at the health center but not birth control pills. It will not be easy for a child to just walk in or get hold of birth control pills when school committee member told the press there would be an extensive counseling in children who had not reached puberty would not qualify. Another committee member disagreed saying that some kids would know how to quote navigate the system.

0:19:04

Principal McCarthy told ABC news that he had a few complains about the decision from Portland residence yeah until it was on ABC. Fewer than 30 people showed for the committee meeting that made the decision. This compares with a turn out 3 times that number for budget meetings. McCarthy said he had received far more complains by email from people outside Portland. McCarthy said he was sympathetic to people worried about the decision but implied, it had to be considered in context.

0:19:35

There was one pregnancy at the school last year and several students reported being sexually active. While the health center could give out condoms it could not suspend birth control pills and referred students to a Planned Parenthood center outside the school. But many of the kids weren't going to the outside center, said McCarthy.

0:19:54

The decision highlights the careful path that health professional caring for children needs to thread. On the one hand there is a duty to give sexually active children advice in education and health care and a confidential setting and on the other hand is a legal obligation to report any cases of abuse against minors.

0:20:12

What about the abuse against common sense? That's my question. According to the Maine Youth risk behavior study, 23% of school students in Maine reported having sexual intercourse in 1997. The latest figure for 2005 is 13%, a drop of 10% in an 8-year period. So there's been a significant reduction in the number of kids having sex. The Middle Schools' now averaged just 1 or 2 pregnancies a year so they solved this problem by offering prescription drugs to 11-year olds without parental support.

0:20:44

Now my question is this Portland, first why do you have health clinics in your school? I mean we had a nurse when I went to school and there was a cat that you might lay on. But I mean it wasn't a full bloom clinic. I mean are these girls getting pap smears? I mean they're no need on birth control pills you need to be getting pap smears, are they doing that? Are they even seeing a doctor? I mean these are prescription medicines. Is it just a nurse that's given the pills away? Is there nurse practitioners? Is there physicians seeing the children? And who's paying the doctor who's paying the nurse and who's paying for the pills?

0:21:16

You know shouldn't public schools spend their times in resources on something like education? Look Portland you elected the officials. You're the ones who didn't show up to the meeting and it's your taxes that are supporting this lunacy so I guess you're getting what you pay for literally.  And people ask why we are home school?

0:21:35

I do have some links in the show notes for the Associated Press report, the ABC news report and the report in the Portland Press Herald. All the links to those sources will be available in the show notes at PediaCast.org.

0:21:50

Random drug and alcohol testing doesn't not reliably keeps student athletes from using. In fact the mere presence of drug testing increases some risk factors for future substance use or again Health and Science University researchers report. Their findings are published in the November issue of the journal of adolescent health. The study named Saturn for student athletes testing using random notification are the first ever prospective randomized clinical trial to assess the deterrent effects of drug and alcohol testing among high school athletes.

0:22:26

Prior to the study there was a little research and no randomized trials to establish whether student athlete drug and alcohol testing is an effective deterrent said Dr. Linn Goldberg, principal investigator and head of the division of public promotion and sports medicine at the Oregon Health and Science University School of Medicine.

0:22:45

As a result of this study, drug testing is better understood. Drug testing did not appear to reduce school sports participation as some had just suggested it would. But it also did not reduce drug and alcohol use. Armed with this information parents, schools and policy makers now can make evidence based cause-effect of decisions about how best to protect the health and well being of young athletes. This was a state of the art collection and testing program that exceeded the standards used by most schools.

0:23:16

If this did not show significant deterrent effects, less sophisticated programs are not likely to be more successful. So Dr. Diane Elliot, co-investigator and certified doping control officer for the United States Anti Doping Agency. I didn't even know there was such a thing. The 2-year study was conducted in 11 high schools with 150 miles or Portland Oregon. Participating schools were randomly assigned 1 of 2 study groups.

0:23:45

Schools that designed and implemented a drug and alcohol testing policy and schools that had designed the policy but agreed to defer their own testing until the study had concluded. Athletes at drug and alcohol testing schools were at risk for random testing throughout the academic year.

0:24:03

If an athlete tested positive for drug use, the results were reported to the parents or guardians and counseling was mandatory. Did you hear that Maine? In Oregon's Portland they informed parents about health issues affecting children. Before the study began, I couldn't resist, before the study began researchers obtained voluntary consent from students and parents so that students could complete confidential questionnaires at the beginning and end of each school year.

0:24:31

The questionnaires ask about alcohol and drug use and student attitudes about drug testing. After 2 complete years with surveys collected 5 times, the researchers found that drug and alcohol use did not differ, did not differ among student athletes among schools with drug and alcohol testing and those schools without it.

0:24:51

So as drug testing at public schools really worth the expense the researchers conclude two things. First, more studies are needed. Have you noticed researchers always reach that conclusion? It's called job security. They also concluded that it might be time for schools to re-examine their policies on drug test for student athletes.

0:25:12

Alright that concludes this week's news parents can use and we'll be back to wrap up the show, if I haven't got myself into too much trouble, right after this.

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0:25:53

Alright thanks go out to Medical News Today and also to Catharine Paddock for writing some of the news stories for us. Also vlad over vladstudio.com. Vlad is the Russian artist who the art work for the website so please visits him at vladstudio.com. Don't forget if one of the biggest favors that you can do for me is to tell your friends and family and co-workers about PediaCast. There's really you know we don't really have a huge advertising budget here and really we rely on word of mouth to spread the news about the show. So make sure you let people know. Explain to them how you can get to the website, just listen there or they can subscribe as a podcast through any type of feed catcher such as iTunes. But there are other ones as well.

0:26:40

So if you could please help spread the word about PediaCast that would be most helpful. We have an exciting announcement on a new sponsor that's going to come on board but the details are still being worked on but I was excited and just wanted to mention there is going to be news coming up about that. So stay tuned. It's a really a great organization to have involved with the show. Also reviews in iTunes are helpful. The PediaCast shop is open if you'd like to buy a T-shirt. We do not make any money off the T-shirt so there's no mark-up above what they cost us. We just like you to get them to help you spread the good news about the show.

0:27:21

So we have another great week ahead for you. We have more answers to your questions. We'll have more news for you and an interview with another pediatric specialist. Later in the week we're going to have a pediatric pulmonologist by to talk about the difference between asthma and this thing called vocal cord dysfunction. So that's going to be coming up later on in the week and until tomorrow, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So on everybody.

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