MRSA, Teenage Suicide, and Long-Distance Speech Therapy – PediaCast 050
- Community-Acquired MRSA
- Preparing Kids for Disaster
- Update on Teenage Suicide
- Ages and Stages Questionnaire
- Long-Distance Speech Therapy
Announcer: This is PediaCast.
Welcome to PediaCast, a pediatric podcast for parents, the News Edition. And now direct from BirdHouse Studio, here's your host Dr. Mike.
Dr. Mike Patrick: Hi, everyone, and welcome as usual to PediaCast.
It is Episode number 50. And you'll notice we have a little bit of a different introduction than you might be used to. The reason for that is, I'm trying something a little different this week.
And I'm sure I'll have good comments and bad comments about it. And I'm not sure if it's something that's going to be every week or if this is just experiment for this week only. We'll see how it goes.
I'm going to experiment with dividing our segments that we usually do as one big long hour-and-a-half episode into several shorter episodes this week.
So this is going to be our News Edition and then we'll have an interview coming up for you tomorrow so you can hear a little bit something each day, but a little on the shorter than you're used to.
We're going to aim for about 20 to 30 minutes 30 minutes max.
Now, part of this comes we've had the last couple of weeks we kind of plateaued on our news subscribers. And I have a feeling just from some other comments that I've had, that one of the problems with PediaCast is just too darn long.
I can understand that especially someone who doesn't know what PediaCast is all about. They see this new podcast. It sounds great but, my gully, an hour and a half. [Laughter] What am I going to do?
I can do it. I generally want to get involved. So I still want to present the same amount of material.
It's just my hope is that we'll be able to grow the audience a little bit more or a little quicker by having shorter episodes. So we'll see how it goes. We'll call it a trial here for a week or so.
So this is the "New Age" of PediaCast. And we'll see how long it lasts. And of course, don't be afraid to let me know what you think.
Today is our News Parents Can Use and we're going to talk about Community-Acquired MRSA, which is methicillin-resistant Staphylococcus aureus. And we're going to talk about that. Also, Preparing Kids for Disaster: An Update of Teenage Suicide; The Ages and Stages Developmental Questionnaire and Long Distance Speech Therapy.
Don't forget if you have a topic you would like us to discuss or you have a question, just get a hold of us at pediacast.org and click on the Contact link, or you can email firstname.lastname@example.org, or call the voice line at 347-404-KIDS. That's K-I-D-S.
And also, I have to remind you that 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.
And with that in mind, we'll be back with News Parents Can Use right after this short break.
[Short Break Music]
Our News Parents Can Use Edition is brought to you in conjunction with news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.
Now normally associated with hospital environments, a community-based resistant superbug that causes a deadly Staph infection is posing a growing danger to healthy people especially children across the U.S., called community-acquired or community associated MRSA, which is short for methicillin-resistant Staphylococcus aureus.
The bacterium is said to be a more virulent form than the hospital-acquired strain. MRSA also how we say, M-R-S-A, is resistant to methicillin and other common antibiotics, such as oxacillin, penicillin and amoxicillin.
And the carrier is most frequently in hospitals, nursing homes and other health care facilities, for instance, dialysis centers where patients tend to have weakened immune systems.
Now community-acquired MRSA, on the other hand, is acquired outside of these environments, in the community. And it's acquired by otherwise healthy people who have not, at least within the last 12 months, been hospitalized or had a medical procedure, such as surgery, dialysis or had a catheter inserted.
Community-acquired MRSA usually manifests as skin infections like pimples and boils. Director of Pediatric Infectious Diseases at Driscoll Children's Hospital in Corpus Christi, Texas, Dr. Jaime Fergie, who's been studying MRSA and community-acquired MRSA for over 10 years, said in a press release that "We've seen MRSA working in a community is much more virulent."
South Texas was one of the first regions in the U.S. to report community-acquired MRSA.
In 2004, Fergie published study with a colleague Dr. Kevin Purcell that said "The rise in infections grew from 5 per 10,000 in 1999 to 360 per 10,000 in 2004.
Infection routes for staff and all forms of MRSA is primarily via hands which become contaminated through contact with people who are already infected or colonized with the bacteria, touching infected body sites, or touching equipment or surfaces that have been contaminated by body fluids carrying the bacteria.
Skin-to-skin contact, crowds and poor hygiene have also been cited as infection routes, according to the Center for Disease Control and Prevention.
According to a statement from Driscoll Children's Hospital, most children infected with community-acquired MRSA present with skin and soft tissue infection but some have developed more severe symptoms and a few have even died.
The severely infected children have had to undergo multiple surgeries, including orthopedic, cardiothoracic and drainage procedures. Sometimes called community Staph, this bacteria enters the body through open wounds on the skin, emerges as a boil or abscess that looks like a bite from a spider. But it's not.
The bacteria can get into the blood stream, bones, joints, muscles and lungs.
Fergie said community-acquired MRSA can be prevented by diligent hand washing and good hygiene. He said parents should know what the symptoms are to make sure their children are diagnosed and treated early.
Incarceration has also been identified as a major risk factor for community-acquired MRSA.
A study published in the September issue of "Nature Reviews Microbiology" by Biomathematicians at the Semel Institute for Neuroscience in Human Behavior at the University of California Los Angeles reported how a computer model was used to predict the severity and potential consequences of an outbreak in jails.
Outbreaks of community-acquired MRSA occur frequently in jails around the U.S. For instance, the Los Angeles County Jail has a higher rate of community-acquired MRSA. And outbreaks have been reported on a regular basis since 2002, totaling some 8,500 cases.
Once they are released it may spread the bacteria to members of their family and the rest of the community.
According to the CDC, the best way to prevent Staph or MRSA skin infections is to practice good hygiene, such as keeping your hands clean by washing thoroughly with soap and water, or an alcohol-based sanitizer.
Clean and cover cuts and scrapes until they're healed. Don't touch other people's wounds or bandages and don't share personal items, such as towels and razors.
For more information about community-acquired MRSA from the CDC, look for the link in the Show Notes.
And I have to tell in our pediatric practice, boy, we're seeing more and more of these. And so many times, parents do think it's a spider bite infected, in fact they'll come in and say, "I wonder my kid has a spider bite. What do I do?"
Boy, when we hear that we always say, "You have to come in so we can take a look at it." And more times than not, it's a skin abscess caused by this highly resistant form of Staph.
And how do you get highly resistant forms of bacteria? Well, one of the ways is through inappropriate of antibiotics.
"Children will be better prepared mentally and emotionally for a natural or man-made disaster, if parents speak with them in advance about the threats and realistic but calm manner," says a Purdue University Child Development expert.
"Give children enough information that they empowered to know what to do in an emergency," says Judith Myers-Walls, Assistant Professor of Consumer and Family Sciences. "Don't rely on one big talk but instead look for teachable moments because you have to present these lessons repeatedly through the years."
Myers-Walls says, "It's important to increase everyone's awareness. But when preparing children to deal with threatening situations, it is vitally important to neither focus on nor feed fear."
She says, "Lessons can be incorporated into everyday life and even made into a fun and positive adventure."
"Tornado drills can be turned into a monthly picnic in the basement where the family eats emergency rations from a can, listens to a battery-powered radio and plays board games lit by flashlight," Myers-Walls says.
That's not scary and it fosters family togetherness. I don't know. I think it would've scared me as a kid.
She says, "It's not scary and it fosters family togetherness whether or not the family ever has to face that emergency."
She says, "Attempting to shield children from the frightening realities of the world by not talking about them and is counterproductive in an era where the Columbine shootings, World Trade Center attacks, Indian Ocean Tsunami, and the Virginia Tech massacre received saturated television coverage.
Children already know the world can be dangerous. Unfortunately much of what they know is only partially true or even completely misunderstood. But children know it's OK for them to ask questions and listen to what they're thinking, even if the topic is difficult or uncomfortable.
Because television is such a powerful presenter of information, Myers-Walls says, "It's important to teach children that mass media can be a helpful source of information in an emergency or it can be a fear-inducing titillation."
"Television news caters to human curiosity and dread when it repeatedly presents images of jumbled trailer parks, collapsing skyscrapers and wiped out beach resorts," she says.
Children need to know that these images in their living room are often made scarier by what shots are selected and music that is added afterwards. They should know that disaster is highly unlikely to strike their home, and if it does, the parents will do everything they can to keep the kids safe.
Myers-Walls says, "Research shows that people who depend on TV for most of their information believe that the world is a more dangerous place than do actual victims of violent crime. That kind of fear helps prompt parents and teachers to instill stranger danger into their children, making them fearful of almost anyone or anything that they do not already know."
"A man with a gun is usually not a criminal. More often he's a police officer or a national guardsman. Dark clouds bring crop-nurturing rain more often than dangerous tornadoes," Myers-Walls says.
We need to give children perspective and teach them when it is reasonable to be afraid. Myers-Walls says, "Fear is a disease focusing on the What-Ifs but by its very nature preparedness focuses on the What-Ifs as well."
She says, "The key as a parent is to know your children and how much information they can handle based on their age or temperament. Living in Indiana, I don't know much about earthquakes," she says, "but I do know if the ground begins to shake, I need to seek shelter in an open field, on a doorway or under a heavy table.
"That is the kind of practical basic information children need to know to be prepared and not afraid."
Myers-Walls says, "Providing tools and strategies for preparedness can lessen fear and increase confidence because it helps children feel more in control. Parents can help their children regain a sense of control by helping them find ways to help others who have already suffered disaster. That can include donating money or needed items or raising awareness about the victim's situations."
"Children can learn how to care for others and those acts can also help the children themselves to feel more secure and helpful. They may think that, if they helped others someone will help them, too, if a disaster ever invades their lives. That kind of hope is one of the most powerful preparedness tools."
All right. Teen suicide is often a preventable tragedy and it's an appropriate focus of research and inquiry. Two new studies focused on the issue raised both important clinical and policy questions.
In the September 2007 issue of the American Journal of Psychiatry, researchers looked at children and teen suicide rates in the United States and The Netherlands, two countries which have put major warnings on the medications to treat depression with a resulting substantial drop in medication prescriptions for children and teens.
They observed a large increase in suicide in children and teens following controversy about advisory warnings when that correlates to the drop in prescriptions for anti-depressants.
Suicide has many dimensions and medication treatment is an important one.
The study is an opportunity to begin to put key pieces together relating regulatory demands, warnings and the tragedy that is suicide.
One possibility is that the FDA block box warning on the use of anti-depressants with children and adolescence has reduced access to useful but risky, on rare occasions, treatment, with bad outcomes as a result.
It will take more study and time to fully understand the block box warnings role in the rate of rise for teenage suicide.
Also this week, the Center for Disease Control released their own report documenting a rise in the suicide rate among teenage girls. Again, this could have many causes and it will important to look more closely at the data to determine if the increase has been related to black box warnings.
OK. So what are these black box warnings all about? I think we discussed this in a prior episode, but it was quite a while ago. And the basic thought went like this that, there is an increased, according to some research, in suicide thoughts, not necessarily even actions, but just there's more thinking about suicide when kids are started on anti-depressant medication.
And so there's a black box warning, meaning that the drug insert in big bold capital letters with a thick black box around it says "Warning! Taking this can cause suicide old thoughts and so you have to be very careful".
And so because of this, and because of fear of being sued, if a doctor gives an anti-depressant to a child or teenager and then that teenager commits suicide and then the doctor is afraid or "I'm going to get sued because there is all these warnings that this could happen."
And so doctors are prescribing anti-depressant medicine less often because of this warning that's there. And you know, I guess it's not fair to say the only reason that there's been a drop is because they're afraid of getting sued. But also if they truly in their hearts feel that these studies are true and if this causes suicidal thinking, they certainly don't want their patients to commit suicide.
But now we are seeing an increase in this teenage suicide rate that correlates with this decreased in prescriptions.
So the next question, is this decrease in anti-depressant prescriptions causing this increased in the teenage suicide rate, or are there some other cause or causes and they're just there temporarily associated or associated by time? In other words, they're not related.
Can we talk about that all the time? It's going to take further research to know which is going on.
OK, let's move on. Parental Surveys, a simple questionnaire developed at the University of Oregon and requiring no more than 15 minutes of a parent's time before or after a doctor's appointment, is credited with a 224% increase in referrals of one and two-year-old children with mild developmental delays in a year-long study.
Researchers found that on doctors' observations alone, 53 of 78 referrals for special services or additional monitoring would not have been made without the ages and stages questionnaire or ASQ filled out by parents at home or in the office.
Thirty-eight children underwent further evaluation and qualified for federally funded monies in the early intervention services system and 44 others became eligible for additional monitoring. This is from a study appearing in the August issue of the Journal of Pediatrics.
"Seeing the results as a percentage was pretty shocking," says lead author Hollie Hix-Small, who this year earned a doctorate from the Early Intervention Program in the University of Oregon College of Education. She is now research associate and an independent early childhood consultant.
The 224% jump in referrals occurred despite just a 54% return rate of the survey which was given to 1,428 parents or caregivers and a 15% decrease in patient volume compared to the control group which did not use the questionnaire.
Almost certainly, the referral rate would have been higher had more forms been completed, said co-author Dr. Kevin Marks, a pediatrician at the PeaceHealth Medical Group in Eugene, Oregon.
"The study was about making quality improvements in health care delivery," Marks said. We had intuitions that physicians had difficulty identifying children with mild developmental delays, especially in the fine motor, problem solving and personal social domains.
Physicians focused mostly on milestones involving communication and gross motor skills. The data shows that when physicians suspected delay, those children are almost always eligible for early intervention services, but at the same, we have our limited powers of observation.
"Those limits," he added, "often result from busy offices, including tight scheduling and heavy patient loads."
The study also indicated that physicians had a greater difficulty identifying delays at 12 months compared to 24 months. I intuitively thought that physicians took a wait-and-see approach with younger patients with likely delays.
But the data suggests that they more often just missed those likely delayed children at the 12-month well-child visit. This finding was a noteworthy and needs to be shared with other pediatricians.
The authors noted that an estimated 12% to 16% of U.S. children have developmental delays or behavioral problems according to four studies they cited.
Research also has shown that early intervention improves the child's long-term academic and behavioral outcomes. "Many communities are struggling with getting their identification rates up," Hix-Small said.
We did think that detection rates by physicians can go up when parents use some kind of a standard parent completed tool.
The ASQ already recommended by the American Academy of Pediatrics for other targeted age groups was developed about 20 years by a team that included these studies, other co-authors, Jane Squires, Director of the University of Oregon's Early Intervention Program and Professor in the Department of Special Education, and Dr. Robert Nikkel, Professor of Pediatrics at the Oregon Health and Science University in Portland.
The ASQ covers different age intervals from 4 months to 5 years and includes 30 items and 5 questions on different areas of development.
In this study, 18 pediatricians and 2 nurse practitioners participated.
"We found that many doctors were simply missing kids and not because they were taking a wait-and-see approach on possible delays," Marks said. "We as doctors are under identifying the number of children who can benefit from intervention."
The paradox is that the children with mild delays are the same ones who often times respond well to early intervention.
I'd like to say that the brain is like a piece of hot plastic. You have to work with it and mold it before it solidifies.
"Those most likely to benefit from early intervention," he added, "are children with mild delays, children from low socioeconomic backgrounds and younger children with early signs of autism."
"The University of Oregon's Early Intervention Program now is experimenting with a Web-based version of the ASQ to streamline the process so that more parents and/or caregivers will use the form to assist their children's pediatrician," Hix-Small said.
On their website asq.uoregon.edu, parents and caregivers can complete the ASQ. Participation is free and confidential. And we'll have a link to that in the Show Notes.
Of course, my only question with this is. With all these increased referrals, is the early intervention system set up to handle the influx?
And finally, speech therapist in Australia will soon be treating children with speech, language and reading disorders by using a remote telerehabilitation system designed by researchers at the University of Queensland in Brisbane, Australia.
The system consisting of Web cams, headsets, a robotic arm and touch-screen computers allows speech pathologists to assess and treat children living in rural and remote areas via the Internet.
Speech Pathology PhD student Monique Waite said, "Preliminary results using the system were encouraging."
Ms. Waite said, "A pilot study found ratings of speech and oral motor functions made over the Internet were the same as face-to-face ratings more than 90% of the time, and ratings of language skills of 12 children online matched face-to-face ratings with almost 100% agreement."
Ms. Waite and her team need suitable volunteers to further test the system to determine if it is possible to assess and treat speech, language and reading disorders over the Internet.
She said they were seeking children with difficulties in speech language or literacy to participate including kids with delayed speech who are ages 4 to 9; kids with delayed language who are ages 5 to 9; and kids with reading difficulties who are ages 8 through 13.
Participation involves a free screening assessment conducted by a qualified speech pathologist either across the Internet or between two rooms or face to face at the University of Queensland.
The sessions will take about 90 minutes and a report of the child's results will be provided. A growing number of health professionals are using telehealth software to help children in remote areas access quality care.
For more information on this program, or to ask about participating in the study, look for the link in the Show Notes.
Of course, I think you have a better chance of being to actually participate if you're located in Australia. But I do know for a fact we have listeners down under. So you wanted to check that out [Laughter]?
All right. We will be back to wrap up this, our first short episode, right after this.
[Short Break Music]
All right, look folks, it's a shorter show but think about it this way. I'll be back tomorrow. OK? [Laughter] You can hear my voice every day this week.
All right. I do want to thank Medical News Today for being our news partner also. Of course, that may not be a good thing. I know. I know.
I also want to thank Vlad over at vladstudio.com. Be sure to visit his site and support him. He's the wonderful artist that takes care of us here, at PediaCast, and on the Pediascribe blog, with all his wonderful pictures.
Also I want remind you. The PediaCast shop is open. There's a link in the side bar at pediacast.org. We don't have any additional mark-up on any of the merchandise. It's all about the advertising, folks, so head on over there.
It's a little bit more expensive than CafePress but I've ordered from both places. And the folks that we're using at the PediaCast do really a nice job. I think it's definitely higher quality merchandise, in my opinion.
And again, you can check them out by visiting the link in the Show Notes.
Tomorrow's episode, we're going to have an interview with Dr. Thomas Pommering. Dr. Pommering is a professor of Pediatrics and Family Medicine at the Ohio State University College of Medicine. He's also the director of the Sports Medicine Program at Columbus Children's Hospital.
He and I are going to have about 20, 25-minute discussion on football, from a health standpoint, not from who's going to win this year [Laughter] kind of thing.
So, especially, high school and Pee Wee football, that's what we're really going to be talking about and how to keep it safe.
So until next time, which will be tomorrow, this is Dr. Mike saying, stay safe, stay health and stay involved with your kids.
So long, everybody!