Law Restricting Use of Off-Road-Vehicles by Young Drivers Helps to Curb Injury Rates, Researchers Say

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Although off-road-vehicles (ORVs), including all-terrain vehicles (ATVs), bear a striking resemblance to motorized toy cars, they are not intended for all ages — their high centers of gravity and capability for high speeds make them unstable and unsafe for children. Despite the dangers, children still operate these vehicles, often with disastrous results.

In response to growing rates of injuries and hospitalizations among children riding ORVs, a 2010 law passed in Massachusetts restricted their use to those ages 14 and older. In a recent study published in the October issue of Pediatrics, researchers at Massachusetts General Hospital found that there were significant reductions in both emergency department (ED) visits and hospital admissions resulting from ORV injuries in the three years after the law was enacted. Given that this is the first law of its kind, the results provide important insight for the design of future legislation.

Here are five things to know about the study:

1. Over the past three decades, there have been more than 3,000 ORV-related childhood fatalities in the U.S. – half in 12- to 15-year olds. Between 2001 and 2010, there were more than 350,000 emergency department visits for those under 15.

2. Enacted in 2010, “Sean’s Law” — named for Sean Kearney, an 8-year-old who died after an ORV he was riding overturned on him — banned ORV operation by anyone under the age of 14, except in rare cases with direct supervision by an adult, and required children 14 to 17 years old to take education and training classes and be supervised by an adult when riding an ORV. “No other legislation to date has restrictions as tight as those in Massachusetts,” says lead and corresponding author Michael Flaherty, DO, of the Division of Pediatric Critical Care Medicine at MassGeneral Hospital for Children (MGHfC).

3. To investigate whether rates of both ED visits and hospital admissions resulting from ORV injuries have gone down since the law was introduced, Flaherty and a team of investigators from MGHfC analyzed data for four age categories — ages 9 and under, 10 to 13, 14 to 17, and for purposes of comparison, adults ages 25 to 34.

4. They found that the rate of hospitalizations for all those 17 and under dropped 41 percent after the law’s implementation, while the 25-to-34-year comparison group had a drop of 26 percent.

5. “The results of our study indicate that comprehensive laws that include age restrictions can in fact decrease the numbers of pediatric injuries that result from ATV crashes,” says senior author Peter Masiakos, MS, MD, of the MGHfC Department of Pediatric Surgery. However, improvements are still needed. “We have more room to go in strengthening our state law,” adds Masiakos. “Our results suggest the tighter age restrictions may be even more beneficial.”

Obesity Prevention Researchers Make Strides with First 1,000 Days Program

How early should we start taking steps to prevent childhood obesity? It could be before the baby is even born.

That’s the thinking of the research team behind the First 1,000 Days Program, an initiative launched by Massachusetts General Hospital for Children that provides assistance to women during the timeframe believed to be most critical to their child’s health – pregnancy and the first two years after birth.

The program is led by Elsie Taveras, MD, MPH, chief of General Pediatrics at MGHfC, and Derri Shtasel, MD, MPH, executive director of The Kraft Center for Community Health at Partners HealthCare.

Here are some quick facts about the growing childhood obesity problem in the United States:

  • One in 10 infants are considered overweight
  • By kindergarten, an estimated 1 in 5 children are overweight or obese
  • Being overweight or obese increases the risk of developing diabetes, high blood pressure and early heart disease
  • Overweight or obese children are also at an increased risk of being bullied, which can cause additional psychological problems

The 1,000 Days Program is based at the MGH Health Centers in Chelsea and Revere, and is designed to provide expectant mothers with the tools and resources needed to get their children off to a healthy start in life.

The research team is working to address childhood obesity by:

  • Encouraging pregnant women to maintain a healthy weight throughout pregnancy
  • Working with parents to help them distinguish between different cries from their children, so they don’t mistakenly feed a sleepy child
  • Advocating the complete elimination of juice and sugary drinks, which contribute to weight gain and cavities
  • Encouraging breastfeeding if possible, and if bottle feeding, for parents to watch for cues that the baby is full in order to prevent overfeeding
  • Holding off on introducing solid foods until at least four months, six months if possible
  • Revising expectations so toddlers are not required to clear their plate at every meal

The team also encourages parents to set a good example for their children by eating healthy as well.

The goal of the program is to reach 1,000 women during 2017. As of April the team had already met with over 600 women.

A portion of the study is supported by Dr. Taveras’ MGH Research Scholar award. These philanthropy funded awards provide investigators at Mass General with unrestricted funds that they can use to pursue promising new avenues of research. Taveras is an Ofer and Shelly Nemirovsky MGH Research Scholar.

Read more about the 1,000 Days Program here.

Team Effort Finds First Definitive Answers to Complex Genetic Basis of Tourette Syndrome

A large scale analysis of genetic information from individuals with Tourette syndrome led by researchers at Massachusetts General Hospital and UCLA has identified alterations in two genes that significantly increase the risk of developing the disorder.

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A team effort between genetic researchers, clinicians, a patient advocacy group and volunteer study participants has revealed new genetic insights into Tourette syndrome—a neuropsychiatric disorder that results in involuntary physical and verbal tics.

The study helps to confirm the theory that Tourette syndrome results from a complex series of genetic changes rather than a single mutated gene. It may also provide comfort for individuals with the disorder, who are often stigmatized for their uncontrollable movements and outbursts.

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Continue reading “Team Effort Finds First Definitive Answers to Complex Genetic Basis of Tourette Syndrome”

Potentially Dangerous Pregnancy Complication Leads to Significant Health and Cost Burdens for Mothers and Their Babies

What should be a joyous and exciting time for soon-to-be parents can sometimes take a turn for the worse if the mother develops a blood-pressure related condition called preeclampsia. Globally, preeclampsia and other related disorders of pregnancy are a leading cause of maternal and infant illness and death.

Because little is known about the extent of the health and cost burden of preeclampsia in the United States, a team of researchers including senior investigator Anupam B. Jena, MD, PhD, a physician in the Department of Medicine at Massachusetts General Hospital, sought to quantify preeclampsia’s impact.

The study, published in the American Journal of Obstetrics and Gynecology, found that preeclampsia results in billions of additional healthcare costs and can increase the short- and long-term health risks for mother and baby, underscoring the need to do more to understand the disorder and prevent it from occurring.

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Here are five things to know:

    1. 1. Preeclampsia is a condition that only occurs during pregnancy and postpartum and can lead to serious, even fatal, complications for both the mother and the unborn baby. It is characterized by high blood pressure and usually begins after 20 weeks of pregnancy (in the late 2nd or 3rd trimesters) and up to six weeks after delivery. Symptoms include protein in the urine, swelling, sudden weight gain, and headaches; however, some women with rapidly advancing disease report few symptoms. Preeclampsia can’t be reversed and currently, the only “cure” for preeclampsia is delivery of the baby.
    1. 2. Driven in part by older maternal age and greater obesity, rates of preeclampsia are rising rapidly. Since 1980, cases have increased steadily from 2.4% to about 5% today. “From an epidemiologic perspective, preeclampsia is growing at a rate more rapid than diabetes, heart disease, Alzheimer’s disease, obesity, and chronic kidney disease — diseases for which substantial research and treatment funding have been allocated,” says Jena. Although preeclampsia has affected pregnant women for many years, the true cause remains unknown.
    1. 3. Women affected by preeclampsia are at an increased long-term risk for cardiovascular diseases, such as heart attacks and hypertension, and liver or kidney failure in the years and decades after delivery. When preeclampsia causes the blood vessels to constrict and reduce blood flow to vital organs including the uterus, it can also cause short- and long-term health complications for the baby including low birth weight, and cerebral palsy, epilepsy, blindness and deafness later in life. In addition, the baby may suffer the effects of prematurity if delivered early.
    1. 4. Taking into account the level of care needed to treat mothers and babies affected by the condition, Jena and the research team calculated that the cost of preeclampsia within the first 12 months after birth is $2.18 billion in the United States ($1.03 billion for mothers and $1.15 billion for infants). Considering the short- and long-term health risks associated with preeclampsia for both the mother and the baby, this number is only a mere minimum estimate of the total economic and health burden imposed by the condition.
    1. 5. “This new research underscores the urgent need to continue research into its causes and to implement strategies that may help women manage this condition,” commented William Callaghan, MD, chief of Maternal and Infant Health Branch at the Centers for Disease Control and Prevention (CDC).

Check out this video to learn more about Dr. Jena’s research:

The Fatherhood Project Works to Engage New Dads

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Photos courtesy of the Fatherhood Project

Ask an expecting dad what resources he needs to become a parent, and he may tell you he wants information on how to contribute to his partner’s healthy pregnancy, or for a list of practical parenting skills. He also might tell you it would be nice to have a bar to order drinks from in the waiting room at the hospital.

This is the type of honest insight that the team at the Fatherhood Project has gathered in an effort to better support fathers as they enter parenthood.

The Fatherhood Project, a nonprofit program in the Department of Psychiatry at Massachusetts General Hospital, has been working to improve the health and well-being of children and families since its creation in 2010.

The program aims to assist fathers, as well as medical and social service practitioners who work alongside families, by hosting workshops and trainings, serving as a hub for vital parenting resources, and conducting research to hone their programming. In equipping fathers with crucial parenting skills, the Fatherhood Project empowers them to be knowledgeable, active and emotionally engaged with their children.

The Fatherhood Project’s programming addresses a multitude of issues commonly faced by parents, including father readiness, teen pregnancy, single parenthood, divorce and addiction recovery. Their programs are intended for all fathers with a focus on underserved, at-risk populations. To help reach these dads, they have collaborated with groups such as the MGH Revere Department of Pediatrics and the MGH Departments of Obstetrics and Pediatrics.

They recently administered a survey to men who attended prenatal classes with their partners to see how to better support them. In addition to the tongue-in-cheek suggestion of adding a bar to the waiting room, respondents said they would benefit from additional information regarding how to understand their infant’s emotions and needs.

The survey found that men are excited about becoming fathers, but 56% agreed that fatherhood is stressful. The majority of men were interested in the impact pregnancy and parenting has on their health and recognize that their current health is important for the health of their infant. However, a third of them had not had a physical within the past year, and 50% percent were overweight and 17% obese.

In the future, the Fatherhood Project plans on creating programs and interventions that are designed to engage fathers and encourage a healthy lifestyle for both parents and children. Their overarching goal, however, remains simple: to increase paternal involvement in early childhood.

Take part here: http://www.thefatherhoodproject.org/

A New Strategy for Assessing Sleep Apnea Risk in Individuals with Down Syndrome

Investigators at the MassGeneral Hospital for Children have developed a promising new method for assessing the risk of obstructive sleep apnea (OSA) in children with Down syndrome.

The new method, which employs information that can be gathered during a visit to a primary care physician, could help to reduce the need for overnight sleep studies, which can be expensive and difficult for children and their families.

OSA occurs when the airway becomes restricted or blocked during sleep, causing breathing to become shallow or temporarily stop. In addition to interrupting sleep, OSA lowers oxygen levels in the blood and can impair cardiac, metabolic and cognitive functioning.

It is estimated that close to half of individuals with Down syndrome have OSA due to alterations in their craniofacial features that result from the syndrome. The American Academy of Pediatrics recommends that all children with Down syndrome undergo an overnight sleep study to screen for OSA starting at age 4.

The sleep studies are effective in measuring OSA risk, but they can be expensive and difficult to access in certain areas of the U.S. The studies can also be a challenging experience for individuals with Down syndrome, particularly young children.

The new method, which was developed by a research team led by Brian Skotko, MD, MPP, co-director of the MGH Down Syndrome Program, uses a variety of factors – including the physical characteristics and vital signs of the participants plus information provided by parents on a questionnaire – to predict the risk of OSA.

In a study of 102 children with Down syndrome, the team’s new method was able to accurately predict the risk of moderate to severe OSA in 90 percent of those who were diagnosed with the condition following an overnight sleep study.

The team is now working to confirm those results in a follow-up study.

Adhering to Treatment During Adolescence Keeps HIV-Positive Youth on Healthier Track

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As HIV therapies have improved in recent decades, we are now seeing the first generation of youth who were born with the disease, or acquired it shortly after birth, live to adulthood. As this population matures, researchers are looking to learn more about how these individuals have fared in managing their condition in order to improve long-term treatment and care.

A recent Massachusetts General Hospital study of 1,400 individuals between the ages of 7 and 30 born with HIV found that teens and young adults are more likely to have a difficult time managing their condition than they did as younger children. Those in the study group who had good HIV control generally experienced good overall health outcomes, while those who had poor HIV control – meaning higher levels of HIV virus and lower levels of CD4 immune cells had more physical and mental health conditions, a higher incidence of health complications, and a greater risk of death.

“Adolescents infected with HIV – either at birth or later in life – experience poorer health outcomes compared to adults with HIV in nearly every respect”, says Anne Neilan, MD, MPH, of the Division of Infectious Diseases and the Medical Practice Evaluation Center, who led the study. “We need to act to strengthen these services for youth, taking into account their developmentally specific needs. That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to antiretroviral therapy delivery, and improving support for youth transitioning from pediatric to adult health care providers.”

Andrea Ciaranello, MD, MPH, of the Massachusetts General Hospital Division of Infectious Diseases and the Medical Practice Evaluation Center, is senior author of the study. Anne Neilan, MD, MPH, of the Division of Infectious Diseases and the Medical Practice Evaluation Center, led the study. Read more about this study here.

Children’s Sleep Habits Could Improve Their Ability to Focus, Make Friends and Solve Problems Later on in Childhood: Five Things to Know

A recent study by the MassGeneral Hospital for Children found that children ages 3 to 7 who don’t get enough sleep are more likely to have problems with attention, emotional control and relationship building later on in childhood. Here are five things to know about the study…

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  1. The recommended amount of sleep for children is 11 hours or more at ages 3 to 4 year; and 10 hours or more at ages 5 to 7 years.
  2. A recent study from MassGeneral Hospital for Children reports that children ages 3 to 7 who don’t get enough sleep are more likely to have problems with attention, emotional control and peer relationships in mid-childhood (ages 7-10). The study found significant differences in the surveys responses of parents and teachers depending on how much sleep the 7-year-old children regularly received at younger ages.
  3. Analyzed data came from Project Viva, a long-term study that looks at the health impacts of several factors during pregnancy and after birth.  Information was gathered from mothers via interviews and questionnaires conducted at varying time points between when children were ages 6 months and 7 years old. Mothers and teachers were also sent surveys evaluating factors such as emotional symptoms and problems with conduct or peer relationships, when children were around 7.
  4. Among the 1,046 children enrolled in the study, those living in homes with lower household incomes and whose mothers had lower education levels were more likely to sleep less than nine hours at ages 5 to 7. Other factors associated with insufficient sleep include more television viewing and a higher body mass index. Sleep deficiencies also tend to be more prevalent in African American children. Sleep levels during infancy often predict levels at later ages, supporting the importance of promoting a good quantity and quality of sleep from the youngest ages.
  5. “Our previous studies have examined the role of insufficient sleep on chronic health problems – including obesity– in both mothers and children,” explains Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children, who led the study.  “The results of this new study indicate that one way in which poor sleep may lead to these chronic disease outcomes is by its effects on inhibition, impulsivity and other behaviors that may lead to excess consumption of high-calorie foods. It will be important to study the longer-term effects of poor sleep on health and development as children enter adolescence.”

You can read more about this study here. And in honor of #WorldSleepDay today, check out this great article from the American Academy of Sleep Medicine that offers tips on helping your child get a better night’s rest.