Pregnancy and Alcohol, MRSA, Innovative Teaching – PediaCast 071
- Pregnancy and Alcohol – How Much is Safe?
- FDA Grant To Study An Emerging Health Issue for U.S. Infants
- MRSA Confirmed in Dead New York Student
- Older Brothers Increase Aggressive Behavior in Younger Siblings
- Innovative Teaching Involves Students in Science
- Community Superbug is a Growing Danger Across US
- EPA Registered Antimicrobial Products Effective Against MRSA
- MRSA in Schools (CDC)\
Announcer 1: This is PediaCast.
Dr. Mike Patrick: Bandwidth for PediaCast is Nationwide Children's Hospital. For every child, for every reason.
Katie: Welcome to PediaCast, a pediatric podcast for parents. The News Edition and now direct from BirdHouse Studios here is your host, Dr. Mike.
Dr. Mike Patrick: Good Monday everyone, it's PediaCast episode number 71, the News edition for Monday, October 29th 2007 and this is Dr. Mike coming to you from BirdHouse Studio.
I'd like to welcome everyone to the program.
Alcohol, MRSA or M-R-S-A, you've probably heard of that, and siblings all coming up plus some other new stories as well.
I'd like to welcome all of you who are joining us on Stickam, that's Stickam.com, if you stop by there and search for user PediaCast, we are doing the show live on Stickam so you can listen as it's recorded and you can watch too, not just listen.
It's not really a lot exciting, I mean, you know, you see my face talking into a microphone which you can probably imagine without really needing to see it.
But anyway that is an option, usually in the evenings Eastern Time between seven and eight is when we're going to try to do it.
It's almost ten o'clock now but, you know, the best laid plans right?
So in our community we had Trick or Treat on Saturday, so I went over to my Dad's house, so the kids' grandparents.
They have a nice neighborhood to go trick or treating in and then my sisters were there and their significant-other-type people and that makes it sound not what it is.
Anyway, let me just say that we had a good time, watched the Ohio State Buckeyes pound Penn State, sorry Penn State fans out there, but watched that.
Before that we did do trick or treat, the kids this year weren't going to do it, and then the last minute they decided with maybe some prodding from their parents cause any excuse to get a KitKat bar or Three Musketeer is fine with me so they put together some costumes really quickly.
My daughter wanted to be an arctic, no I'm sorry, an Antarctic Researcher.
So, she basically put on snow pants and a snow jacket and some goggles, ok I know it's really lame but it was her idea.
I didn't tell her it was lame. But you know it was a last minute thing.
Now, my son, you know she said she's going to be an Antarctic Researcher, what do you want to be?
Now remember this is my ADHD kid, immediately he says, "Her penguin, I want to be her penguin".
So we got a, I shouldn't say we, Karen got a white shirt and a black zip-up hood thingy and basically made a penguin outfit on the fly.
It was pretty good; we have to have her put some pictures of the two of them together up on our blog, at Pediascribe.
But anyway, so he went as her penguin, and I have to tell you one thing is different about trick or treating compared when I was a kid, now even the neighborhood's houses are fairly close together, there were so many parents driving their kids from house-to-house.
I just, I don't get that.
You know, these yards are acre, acre and a half. I mean, you know it's not that much room between houses in this neighborhood and I can't tell you the number of kids that would go up to a house, trick or treat, hop in the back of like an SUV and they drive them to the next house.
We wonder why there's an obesity problem.
OK, we better move on to the show.
Pregnancy and alcohol, how much is safe? The FDA grants a grant to study an emerging health issue for US infants.
MRSA is confirmed in a dead New York student. Older brother's increase aggressive behavior in younger siblings, and innovative teaching involves students in science.
So we'll discuss all these new stories. Don't forget if there is a topic 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 go to firstname.lastname@example.org or call the voice line at 347-404-KIDS.
Also, my lawyers want to make sure that I 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.
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.
Pregnancy and Alcohol, How Much is Safe?
Well, the National Institute for Health and Clinical Excellence of the United Kingdom is at odds with guidance from the British Medical Association over the issue of Pregnancy and Alcohol and how much is safe to drink.
In this week's British Medical journal, two experts debate the topic.
On the side of the 'individual women should decide' is Pat O'Brien, Consultant Obstetrician, at the Institute for Women's Health in London.
And Dr. O'Brien says that, "Up to May of 2007 the United Kingdom's Department of Health recommended that a pregnant woman not exceed one or two alcohol units once or twice a week. The Department, as well as the British Medical Association, now say pregnant women should abstain from alcohol altogether."
O'Brien asks, "Why this change if no new evidence has come to the fore." He explains that heavy alcohol intake during pregnancy brings with it a serious risk of fetal alcohol syndrome, a serious condition. However, no evidence exists that moderate alcohol consumption during pregnancy has any long-term detrimental effects.
O'Brien says that, "Telling women to abstain completely is paternalistic as the decision should be made by the mother herself."
The advice has changed because, as it is, the recommendation is ambiguous – at the same time people are uncertain about what a unit of alcohol is. "If we in the medical and midwifery professions have failed to communicate clearly to women the meaning of safe limits, then we need to put this right – not take the easy option for us and ban alcohol completely," writes O'Brien.
In 1981 the US Surgeon General advised complete avoidance of alcohol during pregnancy.
However, the incidence of regular alcohol drinking during pregnancy in the USA rose from 0.9% in 1991 to 3.5% in 1999. If the advice is to abstain completely it becomes more difficult to collect data and know exactly what is going on.
Women are less likely to admit to drinking during pregnancy if they know total abstinence is the only advised option.
Obviously, faced with the current evidence, many women will chose to abstain completely anyway. However, that choice should be freely made by each individual mother-to-be, concludes O'Brien.
On the flip side 'Tell Mothers-to-Be to Definitely Abstain' is Vivienne Nathanson, Director of Professional Activities at the British Medical Association.
Nathanson believes the safest thing to do is tell pregnant women and those planning to become pregnant to avoid alcohol altogether. Alcohol can have a negative effect on the reproductive process in several different ways – it can cause: infertility, miscarriage, preterm deliveries, stillbirth, low birth weight infants, fetal alcohol syndrome and, neonatal developmental problems.
Nathanson explains that some evidence is surfacing that there may even be risks if a pregnant mother consumes alcohol in moderation.
Studies are indicating that two to five units of alcohol a week might delay the development of the fetus' nervous system an effect which could be permanent.
Another large recent study found that occasional low to moderate drinking during the first three months of pregnancy may undermine the infant's future mental health.
"Guidelines, as they stand, can be interpreted in many different ways", argues Nathanson. If people do not clearly understand what standard drinks or units are exactly, moderate drinking for one person could be heavy drinking for another. How many women continue to drink in their pre-pregnancy fashion during their first trimester before they realize they are pregnant?
"As the present guidelines are confusing, likely to be interpreted in many different ways, the most sensible step is to advise the pregnant woman, as well as the woman who plans to become pregnant, not to drink at all", according to Nathanson.
So they report, and you decide.
The Food and Drug Administration has awarded the Medical College of Wisconsin in Milwaukee, a three-year-one million dollar orphan products development grant to study infantile hemangiomas, a vascular tumor of the skin or internal organs.
The unique, interdisciplinary, and multi-institutional study is led by co-principal investigators Dr. Beth Drolet, professor of Pediatric Dermatology, and Dr. Michael E. Kelly, Assistant Professor of Pediatric-Hematology/Oncology. Both of the University Hospital and Medical College of Wisconsin.
"This is a major achievement for Doctors Drolet and Kelly to receive an FDA grant to study a neglected but important health issue in infants", says Dr. Michael Dunn. He's Dean and Executive Vice President of the Medical College.
He goes on to say, "Dr. Drolet noted the increase in incidence of this disease and found a way to fund research to develop better treatment options."
In 2004, Children's Hospital and the Medical College created the Birthmarks and Vascular Anomalies Center to better care for infants with hemangiomas and other vascular anomalies. This interdisciplinary program composed of surgeons, oncologists, radiologists, and pathologists and they treat patients from around the country.
"Our preliminary studies show that the increased incidence of hemangiomas may be related to the increase in the rate of low birth weight infants in the United States", says Dr. Drolet.
"We are treating more of these infants while uniform guidelines for therapy and methods used to measure response to treatment of infants with hemangiomas are lacking."
Infantile hemangiomas are a common, yet poorly understood vascular tumor. Most of them are found in the skin, but sometimes, they occur in other organs in the body such as the liver, spleen, intestine, airways, lungs and even the central nervous system.
Unlike most birthmarks, cutaneous hemangiomas are tumors that undergo cellular proliferation. They are either absent or barely evident at birth proliferating in the first few weeks to months of life, followed by a phase where they tend to decrease in size over several months to years.
Although most hemangiomas eventually completely resolve, many infants will suffer complications such as permanent disfigurement, ulceration, bleeding, loss of vision, airway obstruction, congestive heart failure and even death.
Now, again, this is rare. I'm just adding that but it is.
Since hemangiomas can behave in vastly different ways and affect many different areas of the body, even physicians who are knowledgeable about hemangiomas and have access to diagnostic resources often find caring for affected infants challenging.
Again, those are the rare, huge, complicated ones.
Doctors Drolet and Kelly will study infants diagnosed with large, complicated hemangiomas (which are rare), to determine and compare the effectiveness and safety of steroids in the current standard of care with a current drug used for cancer.
Fifty infants (so not a very large study yet they have a million dollars), Fifty infants with large and complicated hemangiomas (cause I could probably only find about fifty), will be randomly assigned to receive daily oral Prednisolone a corticosteroid, or weekly IV Vincristine for up to six months (that's where they need the million dollars).
The diagnostic, therapeutic and response criteria determined in this study may be used as a framework for future multi-institutional clinical trials to treat hemangiomas.
The study will provide answers as to which drug is more effective while at the same time providing opportunities for several additional investigators at the Medical College and at the Children's Research Institute to examine pathogenesis of hemangiomas (meaning, how they get there), and these unique partnerships should help develop even better and safer treatment options for these infants.
Health officials from New York City confirmed last week that a seventh grade male student who died on the 4th of October had MRSA, a highly infectious drug resistant form of staph bacteria that normally occurs in hospitals and nursing homes but is now beginning to take hold in community based places such as sports centers, schools and gyms. It has become known as CA-MRSA, or community-acquired MRSA.
MRSA stands for Methicillin-resistant Staphylococcus Aureus, a bacteria that normally causes skin infection and has become resistant to penicillin and other antibiotics. Most people make a full recovery with treatment, but sometimes, if the bacteria gets into the bloodstream through a cut for instance, and the person has a weak immune system, it can lead to serious illness and death.
Of course lots of other bacteria can do that too.
Health officials said they were not able to establish if the student, who attended an intermediate school in Canarsie Brooklyn, picked up the infection at school or somewhere else.
According to the New York Times, the school has informed all parents by letter of the student's death and that the school has been cleaned thoroughly. The letter also explained how to reduce the spread of MRSA by frequent hand washing.
The young man's death comes after a number of reports throughout the US of students infected with Community Acquired MRSA.
So far three deaths have been reported, but in the majority of cases the illnesses have been mild and once treated the students made a full recovery.
According to the New York Times, because doctors are not required to report bacterial infections originating outside hospitals and nursing homes, health officials find it very difficult to establish if the apparent rise in cases is real or due to heightened awareness.
I'm going to make a comment here just at least in our own pediatric practice; we've been seeing this quite a bit for the last, probably, five years or so now.
So really, we have not seen in our office and it is a pretty busy, six-doctor group and I usually tell people, I probably personally see somewhere between five and ten kids every week with a MRSA skin abscess.
So it seemed pretty commonly and I would say that that's been true, really, over the past, you know, few years. It's just now catching the media's attention.
So anyway (this is the news, not my commentary), the New York City's Board of Health is currently considering whether to make the reporting of bacterial infections acquired outside hospitals mandatory or not.
‘Cause, you know, we doctors need more paper work.
The US Centers for Disease Control and Prevention on its MRSA in Schools website says that the decision to close a school for any communicable disease including MRSA lies with school officials and local or state public health authorities.
But they point out in most cases it is not necessary to close a school because one student becomes infected with MRSA, and they stress the importance of hand hygiene and covering infections as a way to stop the spread of the disease.
The CDC recommends that when MRSA skin infections occur, surfaces that are likely to come into contact with infections should be cleaned and disinfected.
MRSA can be effectively removed by cleaning surfaces with a detergent-based or Environmental Protection Agency-registered-disinfectant.
People should read instruction labels on cleaning agents carefully to make sure they are used safely and correctly.
Infections should not be treated with cleaners and disinfectants intended for surfaces. So don't spray those surface disinfectants on your skin please.
MRSA skin infections should be covered with clean dry bandages until healed and the healthcare provider's instructions on wound care should be followed carefully.
Pus from an infected wound can contain infectious bacteria so keeping it covered and that will stop it spreading to others.
It's OK to throw soiled bandages and tape out with the regular trash.
Wash hands frequently with soap and water or clean with an alcohol-based sanitizer, especially after changing wound dressings or touching an infected site. Other people who are in close contact with someone who is infected should also take extra care with hand hygiene. Really, we should all take extra care with hand hygiene.
People should not share personal items such as towels, washcloths, clothes, razors that have come into contact with an infected wound or bandage or you know, otherwise.
Wash soiled clothes, towels and bed linen with water and laundry detergent and dry clothes thoroughly in a drier. Hey look, that's the CDC recommendations, not me.
But you know, I agree with them, just some of them are a little obvious.
I do have some links in the show notes, on this one is a related article, Community Super Bug is a Growing Danger Across the US.
We also have a link to some EPA-registered anti-microbial products effective against MRSA, so just give you an idea what kind of cleaners you can use. Not on the skin.
And also, the CDC site on MRSA in schools, we have a link to that as well. So you can check it out.
Children who have older brothers become more aggressive over time on average than those who have older sisters and older siblings with younger sisters become less aggressive.
Children with older sisters who are very aggressive, become more aggressive and older siblings with younger brother showed fairly stable levels of aggression over time.
In sum, the presence of both older and younger siblings influences the development of aggressive behavior in adolescence. Having a brother or a highly aggressive sibling of either gender can lead to greater increases in aggression over time.
These are the findings from researchers at the University of California, Davis, and are published in the September-October 2007 issue of the journal Child Development.
Researchers looked at 451 sibling pairs, ages 9 through 18, and their parents.
The adolescent siblings each rated their own aggressive behaviors, and parents described economic pressures on the family, such as difficulty paying bills.
Trained observers assessed the hostility the parents directed toward each adolescent during family interactions.
In their work, the researchers took into consideration the age difference between the siblings as well as such factors as parenting styles and family economics.
The study also found that older siblings who were aggressive tended to have younger siblings who were also aggressive, and vice versa. This association was found for sibling pairs with two boys, two girls, and one boy and one girl.
Aggression in younger siblings also predicted increases in aggression in older siblings over time, and vice versa, to the extent varied according to each sibling's gender.
Parents' hostility also played a role in the development of aggression in their children (so parents, you got to role model).
Family economic pressure predicted increased aggression indirectly, through its association with parental hostility.
"Understanding the factors associated with the development of aggression is essential to the design and implementation of effective intervention efforts aimed at decreasing aggression and its negative consequences…, notes Shannon Tierney Williams, a researcher at the University of California, Davis, and the study's lead author. "These findings suggest that such interventions may benefit from including both siblings and parents in the efforts….
That's a little bit of a confusing study I mean, I think here's the bottom line if you grew up in an aggressive environment, if you have younger siblings who are aggressive, if you have older siblings who are aggressive, if you have parents who are hostile and aggressive, then guess what? You just might turn out to be aggressive yourself.
Now is that environment or is it genetic or is it both? I don't know.
And finally, Rochelle Schwartz-Bloom, a Duke University (excuse me), Pharmacology Professor who left the lab bench to focus on science education, has developed a tactic for keeping students' hands in the air at the end of class.
"What does get students' attention?" she and her co-authors asked this question in their new research article on Fostering Science Literacy. And the answer is, "Sex, drugs and rock-n-roll, of course."
Schwartz-Bloom's team describe in the September 28 issue of the research journal Science how they boosted the basic science knowledge of 7,210 high school students by 16%. Her team taught high school teachers how to incorporate drug-related topics into biology and chemistry classes in a national experiment.
"I call it stealth learning", she said in an interview. "The students are having fun picking up facts about things they're interested in. But at the same time they're actually learning basic principles about science."
In an 11-year-old project funded by the National Institute on Drug Abuse, Schwartz-Bloom's group has developed a Pharmacology Education Partnership involving Duke faculty and high school science teachers from around the United States.
Teachers and their university colleagues have interacted to develop classroom and laboratory activities for six different instruction modules. Each unit focuses on a pharmacological topic that integrated basic science principles in biology and chemistry with issues from other relevant disciplines such as mathematics, public policy, psychology and social sciences.
Sample topics dealt with the chemistry of cocaine addiction, how drugs kill nerve cells and how steroids and athletes relate to gene function.
During a sabbatical from Duke, Schwartz-Bloom first tested her instructional concepts on the students of Myra Halpin, a chemistry teacher at the North Carolina School of Science and Mathematics in Durham, who is also a co-author of the report.
While her own high school teacher taught her about oxidation by describing how iron and oxygen combine to create rust, "I'm not going to talk about rust", Schwartz-Bloom told those students. "I'm going to tell you how methamphetamines kill neurons. It's through oxidation, and it's the same reaction."
So, your brain rusts when you do drugs.
On another occasion, "I talked about the different formulations of cocaine if it's smoked or it's snorted," Schwartz-Bloom recalled.
"Of course they were already street-savvy about the fact that you can get addicted more easily if you smoke crack. So I asked them, how can that be? It's the same chemical. We talked the whole hour about that.
At the end of class they didn't get up when the bell rang. They still had their hands in the air," she said.
The first author of the Science article is Nicole Kwiek, a former graduate student in Duke's Pharmacology (sorry folks, it's getting late), program and a post doctoral investigator of Schwartz-Bloom. She is now an assistant professor in pharmacy and assistant director of science education and outreach at (drum roll please) The Ohio State University. That's my alma mater.
Other authors include Jerome Reiter, a Duke assistant professor of statistical science who recently won an award for undergraduate teaching, and Leanne Hoeffler, Schwartz-Bloom's former project manager who is now a private consultant in Tennessee.
Schwartz-Bloom recently won a Duke Provost's award to establish and direct the new Duke Center for Science Education.
"I'm using the very rigorous research skills I built during 25 years in the laboratory and applying them to science learning," she said.
The career shift began when she and a fellow pharmacology researcher decided to create a 3-D animated video of how nicotine, cocaine and marijuana affect the brain. It turned into an eight-year pilot effort in scientific visualization, supported by the National Institute on Drug Abuse that has been aired on television nationwide and widely disseminated since.
"We developed it for high school, but now it's all over the place," she said (probably YouTube too). "It's being used by police departments and by physician assistant and nursing programs. It's in libraries and community colleges."
Well that wraps up the news and we will be back to wrap up the show right after this.
I would like to thank Nationwide Children's Hospital for providing the bandwidth for this program.
Also, thanks go out to Medical News Today for letting us use some of their news stories.
Vlad, over VladStudio.com for letting us use his artwork. And listeners all of you for letting us use your ears.
Also thanks go out to my family and you know, who else do I want to thank? It's like the Academy Awards out here. [Laughter] Just thank everybody.
I'm sorry, I'm a little bit goofy tonight but, it was a long weekend.
Reminders, the PediaCast Shop is open, if you like to get a t-shirt. We don't make any money off those; it's just for, to help spread the word about the program.
Also reviews in iTunes are helpful and the poster page has some posters that you can print out to take to your doctor's office or hang them up in your church, your nurseries, community centers, those sorts of things.
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We have lots more in store this week including answers to your questions, some of your comments, a research round-up and, an in-depth episode on febrile seizures.
So stick around this week cause there's plenty more coming your way.
And until tomorrow, this is Dr. Mike saying, "Stay safe, stay healthy and, stay involved with your kids".
So long everybody.