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Newswise — Texas A&M researchers have shown, for the first time, evidence that standing desks in classrooms can slow the increase in elementary school children’s body mass index (BMI)—a key indicator of obesity—by an average of 5.24 percentile points. The research was published today in the American Journal of Public Health. “Research around the world has shown that standing desks are positive for the teachers in terms of classroom management and student engagement, as well as positive for the children for their health, cognitive functioning and academic achievement,” said Mark Benden, PhD, CPE, an associate professor in the Department of Environmental and Occupational Health at the Texas A&M School of Public Health and an author of the study. “It’s literally a win-win, and now we have hard data that shows it is beneficial for weight control.” Twenty-four classrooms at three elementary schools (eight in each of the three schools) in College Station, Texas, participated in the study. At each school, four classrooms were outfitted with stand-biased desks (which allow students to sit on a stool or stand at will) and four classrooms in each school acted as a control and utilized standard classroom desks. The researchers followed the same students—193 in all—from the beginning of third grade to the end of fourth grade. The researchers found that the students who had the stand-biased desks for both years averaged a three percent drop in BMI while those in traditional desks showed the two percent increase typically associated with getting older. However, even those who spent just one year in classrooms with stand-biased desks had lower mean BMIs than those students in traditional seated classrooms for their third and fourth grade years. In addition, there weren’t major differences between boys and girls, or between students of different races, suggesting that this intervention works across demographic groups. “Classrooms with stand-biased desks are part of what we call an Activity Permissive Learning Environment (APLE), which means that teachers don’t tell children to ‘sit down,’ or ‘sit still’ during class,” Benden said. “Instead, these types of desks encourage the students to move instead of being forced to sit in poorly fitting, hard plastic chairs for six or seven hours of their day.” Many school-based initiatives for weight loss focus on better, more nutritious cafeteria lunches, and although these programs are important, they don’t focus on the other side of weight control: calories expended. Previous studies from Benden’s lab have shown that children who stand burn 15 percent more calories, on average, than those who sit in class, but this is the first study showing, over two years, that BMI decreases over time (versus controls) when using a stand-biased desk. “It is challenging to just measure weight loss with children,” Benden said, “because children are supposed to be gaining weight as they get older and taller.” At the beginning of this study, which was funded by the National Institutes of Health (NIH), roughly 79 percent of the students were of normal weight category, 12 percent were overweight and nine percent were obese, according to height and weight measurements made by the researchers. These are better numbers than nationally, where 14.9 percent of children were overweight and 16.9 percent were obese in 2012. The fact that the students who started at a healthy weight benefited from stand-biased desks as much as they did might indicate that these desks help students who aren’t overweight maintain their BMI, while at the same time help those who start out overweight or obese get to a healthier weight. These desks, designed by Benden and his team, are called stand-biased, not “standing” because they do include a tall stool the students can perch on if they so choose. They also include a footrest, a vital feature because it allows children to get their lower backs out of tension and reduce leg fatigue to stand more comfortably over time. These United States-patented desk designs are now licensed to Stand2Learn, which has commercialized the products through translational research focused on moving university studies to publicly available solutions. “Sit less, move more,” Benden said. “That’s our message.” ###
Newswise — Neurons in the brain interact by sending each other chemical messages, so-called neurotransmitters. Gamma-aminobutyric acid (GABA) is the most common inhibitory neurotransmitter, which is important to restrain neural activity, preventing neurons from getting too trigger-happy and from firing too much or responding to irrelevant stimuli. Researchers led by Dr Tobias Bast in the School of Psychology at The University of Nottingham have found that faulty inhibitory neurotransmission and abnormally increased activity in the hippocampus impairs our memory and attention. Their latest research -- "Hippocampal neural disinhibition causes attentional and memory deficits" -- published in the academic journal Cerebral Cortex, has implications for understanding cognitive deficits in a variety of brain disorders, including schizophrenia, age-related cognitive decline and Alzheimer's, and for the treatment of cognitive deficits. The hippocampus -- a part of the brain that sits within our temporal lobes -- plays a major role in our everyday memory of events and of where and when they happen -- for example remembering where we parked our car before going shopping. This research has shown that a lack of restraint in the neural firing within the hippocampus disrupts hippocampus-dependent memory; in addition, such aberrant neuron firing within the hippocampus also disrupted attention -- a cognitive function that does not normally require the hippocampus. Increased activity can be more detrimental than reduced activity Dr Bast, said: "Our research carried out in rats highlights the importance of GABAergic inhibition within the hippocampus for memory performance and for attention. The finding that faulty inhibition disrupts memory suggests that memory depends on well-balanced neural activity within the hippocampus, with both too much and too little causing impairments. This is an important finding because traditionally, memory impairments have mainly been associated with reduced activity or lesions of the hippocampus. "Our second important finding is that faulty inhibition leading to increased neural activity within the hippocampus disrupts attention, a cognitive function that does not normally require the hippocampus, but depends on the prefrontal cortex. This probably reflects that there are very strong neuronal connections between hippocampus and prefrontal cortex. Our finding suggests that aberrant hippocampal activity has a knock-on effect on the prefrontal cortex, thereby disrupting attention." "Overall, our new findings show that increased activity of a brain region, due to faulty inhibitory neurotransmission, can be more detrimental to cognitive function than reduced activity or a lesion. Increased activity within a brain region can disrupt not only the function of the region itself -- in this case hippocampus-dependent memory -- but also the function of other regions to which it is connected -- in this case prefrontal cortex-dependent attention." Adding to existing research findingsDr Bast's research is motivated by recent clinical findings that patients in early stages of schizophrenia, age-related cognitive decline and Alzheimer's show faulty inhibition and increased activity within the hippocampus. The new study, where inhibition in the hippocampus of rats was disrupted before the animals took part in tests of attention and memory, revealed that such faulty inhibition and aberrant activity within the hippocampus causes the type of memory and attentional impairments seen in patients. This research adds to the team's recent findings, where they found that attention was disrupted by faulty inhibition and increased activity within the prefrontal cortex, a brain region important for attention. Dr Bast, said: "Overall, these findings highlight that higher brain functions, such as attention and memory, depend on well-balanced neural activity within the underlying brain regions." Potential target for new treatments This research has important implications for treating cognitive impairments. The findings show that simply 'boosting' the activity of the key memory and attention centres in the brain (the hippocampus and prefrontal cortex), which has been a long-standing strategy for cognitive enhancement, will not necessarily improve memory and attention, but can actually impair these functions. What's important is to re-balance activity within these regions. Dr Bast, said: "One emerging idea is that early stages of cognitive disorders, such as schizophrenia and age-related cognitive decline and Alzheimer's, are characterised by faulty inhibition and too much activity; this excess neural activity leads then to neuronal damage and the reduced brain activity characterizing later stages of these disorders. So, rebalancing aberrant activity early on may not only restore attention and memory, but also prevent further decline. "We have new studies on the way where we aim to identify medicines that might be able to re-balance neural activity within hippocampus and prefrontal cortex and to restore memory and attention."
Newswise — New Brunswick, N.J., – Thanks to a two-year, $70,000 commitment from Embrace Kids Foundation, the Rutgers Robert Wood Johnson Medical School Comprehensive Sickle Cell Center housed at Rutgers Cancer Institute of New Jersey is expanding to include a Pediatric Sickle Cell and Hemoglobinopathies Nurse Navigator position. The Center receives referrals from the state’s newborn screening program and from pediatricians in the central New Jersey region. Sickle cell disease, an inherited disorder in which the red blood cells become hard and sticky, clogging the blood flow, affects approximately 100,000 Americans, according to the Centers for Disease Control and Prevention. The disease, which can result in repeated episodes of severe pain, infections and anemia, occurs in one in every 365 African-American births and in one out of every 16,300 Hispanic-American births. Other affected populations include those whose ancestors are from Latin America, the Caribbean, Saudi Arabia, India, and Mediterranean countries. The primary focus of the Pediatric Sickle Cell and Hemoglobinopathies Nurse Navigator is to enhance patient services, remove barriers to care, and improve care coordination. The nurse navigator supports the families of infants identified by newborn screening, beginning at the first point of contact, and facilitates communication between the family and care team. This includes collaborating with psychosocial counselors and service organizations to direct families to various resources. The navigator also educates families about their disease and treatment process including identifying clinical trials for which the patient may be eligible. And as adolescent patients begin to transition into an adult hematology care setting, the navigator plays a vital role in making sure the teenager is informed and connected to treatment and other resources. Sickle cell disease is a lifelong condition that is marked by episodic medical setbacks. “The impact of this disease is disruptive to the family unit on many levels,” notes Embrace Kids Foundation Executive Director Glenn Jenkins. “The role of the Pediatric Sickle Cell and Hemoglobinopathies Nurse Navigator is integral in getting families back on track and returning a youngster to a normal childhood. Embrace Kids Foundation is pleased to be able to support this critical work in partnership with Jason and Devin McCourty through their Tackle Sickle Cell campaign.” “Due to research and clinical advancements, the average life expectancy of babies born today with sickle cell disease has greatly improved, and many likely will live late into adulthood. However, this goal cannot be achieved unless medical care takes a comprehensive, multidisciplinary approach with emphasis placed on prevention of long-term complications and timely treatment,” notes Richard Drachtman, MD, section chief, pediatric hematology/oncology at Rutgers Cancer Institute and professor of pediatrics at Rutgers Robert Wood Johnson Medical School. “With this commitment from Embrace Kids Foundation, we will be able to further empower patients and families with the knowledge and resources necessary to assume self-care to maximize longevity and quality of life. We thank Embrace Kids Foundation for its dedication to this population.” About Rutgers Cancer Institute of New JerseyRutgers Cancer Institute of New Jersey (www.cinj.org) is the state’s only National Cancer Institute-designated Comprehensive Cancer Center. As part of Rutgers, The State University of New Jersey, the Cancer Institute of New Jersey is dedicated to improving the detection, treatment and care of patients with cancer, and to serving as an education resource for cancer prevention. Physician-scientists at Rutgers Cancer Institute engage in translational research, transforming their laboratory discoveries into clinical practice. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-8013 or visitwww.cinj.org/giving. Follow us on Facebook at www.facebook.com/TheCINJ. The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Affiliate Hospitals: JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), and Robert Wood Johnson University Hospital Somerset. ###
Newswise — A study by Johns Hopkins researchers of more than 13,000 people has found that even after accounting for such risk factors as high blood pressure, high cholesterol and diabetes, so-called morbid obesity appears to stand alone as a standout risk for heart failure, but not for other major types of heart disease. In a report on the research, published online on July 28 in theJournal of the American Heart Association, the Johns Hopkins team says morbidly obese individuals were more than two times more likely to have heart failure than comparable people with a healthy body mass index, after accounting for high blood pressure, cholesterol and blood sugar levels. And yet, after accounting for these factors, people with morbid obesity weren't any more likely to have a stroke or coronary heart disease -- basically disease of the heart's arteries," due in part to inflammation and an accumulation of plaque in the heart and surrounding blood vessels. The researchers caution that their study suggests a strong, independent link between severe obesity and heart failure but does not definitively determine cause and effect. Nevertheless, they say, their findings suggest that while treating hypertension, diabetes and other conditions associated with obesity may be sufficient to prevent coronary heart disease and stroke, this approach may not be enough to prevent an increased risk of heart failure, for which weight loss may be the only foolproof, currently available preventive measure. The federal government estimates that one in three Americans is obese and more than 5 percent are morbidly obese -- defined as a body mass index of greater than 35. According to the U.S. Centers for Disease Control and Prevention, almost 6 million people in the United States are living with heart failure, a condition of aging marked by enlarged and/or weakened heart muscle and diminished blood-pumping efficiency, resulting in shortness of breath, fatigue, weakness, trouble breathing when lying down, and swelling in the ankles and feet. Overall, there is a 50 percent mortality rate for people with heart failure five years after diagnosis. "Obesity in our study has emerged as one of the least explained and likely most challenging risk factors for heart failure because there is no magic pill to treat it, no drugs that can easily address the problem like there are for high cholesterol and high blood pressure," says Chiadi Ndumele, M.D., M.H.S., assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine. "Even with diet and exercise, people struggle to lose weight and keep it off, and for the morbidly obese, the struggle is often insurmountable." Although it isn't completely clear why obesity alone is linked to heart failure independent of risk factors and not to stroke or coronary heart disease, Ndumele says that there is evidence to suggest that extra body weight exerts a higher metabolic demand on the heart and that fat cells in the abdomen may even release molecules toxic to heart cells. Obesity has long been known to increase the likelihood of high blood pressure, elevated blood cholesterol and diabetes -- all established risk factors for heart and blood vessel diseases. Treating and controlling these conditions have formed the bedrock strategies for reducing the risk of cardiovascular disease, Ndumele says. To learn if this was truly the case for all types of cardiovascular disease, Ndumele and his colleagues looked at the medical records of 13,730 participants in the Atherosclerosis Risk in Communities Study who had body mass indexes in healthy ranges or higher at the start of the study and no initial heart disease. The group was composed of 63.8 percent women and 16.9 percent African-Americans. The average age was 54, and body mass index ranged from 18 to 50. All were followed for approximately 23 years to assess links between body mass index and heart failure, coronary heart disease or stroke. The records also included data for participants' height, weight, and levels of blood sugar, cholesterol and triglycerides, along with smoking status, alcohol use, professions and exercise levels. After the final participant follow-up in 2012, there were 2,235 recorded cases of heart failure, 1,653 cases of coronary heart disease and 986 strokes. In their initial assessment, the Johns Hopkins researchers controlled for differences that might be due to age, sex, race, education level, career, smoking history, exercise and alcohol consumption. Severe obesity was associated with a nearly fourfold higher risk of heart failure and about a twofold higher risk for both coronary heart disease and stroke compared with rates for those with a normal body mass index. Next, the researchers controlled for other heart disease risk factors, such as diabetes, high blood pressure, or high levels of cholesterol and triglycerides. After this adjustment, Ndumele's team no longer saw an increase in risk for coronary heart disease or stroke in people with obesity. However, the increased risk for heart failure remained. For every five-unit higher body mass index, there was an almost 30 percent higher risk of developing heart failure across all participants. "Even if my patients have normal blood sugar, cholesterol and blood pressure levels, I believe I still have to worry that they may develop heart failure if they are severely obese," says Ndumele. "If our data are confirmed, we need to improve our strategies for heart failure prevention in this population."
Newswise — New research led by scientists from King's College London and the University of Bristol has found that a high-fat, high-sugar diet during pregnancy may be linked to symptoms of ADHD in children who show conduct problems early in life. Published today in the Journal of Child Psychology and Psychiatry, this study is the first to indicate that epigenetic changes evident at birth may explain the link between unhealthy diet, conduct problems and ADHD. Early onset conduct problems (e.g. lying, fighting) and attention-deficit/hyperactivity disorder (ADHD) are the leading causes of child mental health referral in the UK. These two disorders tend to occur in tandem (more than 40 per cent of children with a diagnosis of conduct disorder also have a diagnosis of ADHD) and can also be traced back to very similar prenatal experiences such as maternal distress or poor nutrition. In this new study of participants from the Bristol-based 'Children of the 90s' cohort, 83 children with early-onset conduct problems were compared with 81 children who had low levels of conduct problems. The researchers assessed how the mothers' nutrition affected epigenetic changes (or DNA methylation) of IGF2, a gene involved in fetal development and the brain development of areas implicated in ADHD - the cerebellum and hippocampus. Notably, DNA methylation of IGF2 had previously been found in children of mothers who were exposed to famine in the Netherlands during World War II. The researchers from King's and Bristol found that poor prenatal nutrition, comprising high fat and sugar diets of processed food and confectionary, was associated with higher IGF2 methylation in children with early onset conduct problems and those with low conduct problems. Higher IGF2 methylation was also associated with higher ADHD symptoms between the ages of 7 and 13, but only for children who showed an early onset of conduct problems. Dr Edward Barker from King's College London said: 'Our finding that poor prenatal nutrition was associated with higher IGF2 methylation highlights the critical importance of a healthy diet during pregnancy. 'These results suggest that promoting a healthy prenatal diet may ultimately lower ADHD symptoms and conduct problems in children. This is encouraging given that nutritional and epigenetic risk factors can be altered.' Dr Barker added: 'We now need to examine more specific types of nutrition. For example, the types of fats such as omega 3 fatty acids, from fish, walnuts and chicken are extremely important for neural development. 'We already know that nutritional supplements for children can lead to lower ADHD and conduct problems, so it will be important for future research to examine the role of epigenetic changes in this process.' ###
Newswise — The majority of smokers who successfully switch to vaping say they have fewer respiratory infections, according to a study led by Queen Mary University of London (QMUL). The on-line survey of 941 respondents assessed subjective changes in respiratory symptoms in smokers who switched to vaping for at least two months. The results, published in theJournal of Addiction Research & Therapy, show that 66 per cent of respondents reported an improvement in respiratory symptoms, 29 per cent reported no change and 5 per cent reported worsening. Senior author Professor Peter Hajek from QMUL said: "There is no doubt that e-cigarettes are much safer than conventional cigarettes, but smokers are still led to believe that they're dangerous. This misinformation includes a misreported study on rats that claimed that vaping may increase vulnerability to infections. These new findings from human vapers show that this is not the case. "The study needs to be interpreted with caution because it is based on self-reported data, and further studies using objective measures are needed. However, the present results provide sufficient information to suggest that vaping does not increase infection rates and may in fact lead to a decrease in infections." Some previous cell and animal studies have been interpreted as suggesting that vaping may increase vulnerability to infection, but these studies did not use realistic exposure levels. Human trials have reported no significant adverse respiratory effects associated with e-cigarette use for up to 1.5 years and a follow-up study of smokers with asthma who switched to vaping found significant improvements. The researchers say that it is not surprising that the survey respondents noticed improvements in their respiratory health. This is because smoking increases susceptibility to respiratory infections and stopping smoking can be expected to have a positive effect. In addition to this, vaping may also provide some antimicrobial protection through the e-liquid ingredient propylene glycol, though further evidence is needed to confirm this. The main limitation of the study is that the reports are subjective. Future studies should assess respiratory symptoms objectively and on unselected samples of vapers. Despite the limitations, the researchers say that the study provides a reasonable reassurance that vaping does not promote respiratory infections and may in fact reduce them. ###
Newswise — Obstructive sleep apnea – a disorder that affects nearly one out of four people between the ages of 30 and 70 – is a common cause of high blood pressure. In the Aug. 17, 2016, issue of the journal Science Signaling, researchers based primarily at the University of Chicago describe the signaling cascade that leads to this form of hypertension and suggest ways to disrupt those signals and prevent elevated blood pressures. “Our results, using a rodent model, establish a mechanism that is the cause of apnea-associated hypertension,” said study leader Nanduri Prabhakar, PhD, director of the Institute for Integrative Physiology and Center for Systems Biology of Oxygen Sensing at the University of Chicago. “They also offer a novel way to block the process, preventing this form of hypertension and restoring normal blood pressures.” The connection between sleep apnea and high blood pressure begins in the carotid body, a small cluster of cells located in the carotid arteries, which pass through the right and left sides of the neck. Chemosensory cells in the carotid bodies constantly measure oxygen levels in the blood and use that information to regulate breathing. When people with sleep apnea periodically slow or stop their breathing during sleep, their blood-oxygen levels plummet. The carotid bodies recognize this deficit and quickly release signals to increase breathing and bring oxygen levels back to normal. These signals, however, can also increase blood pressure, which can lead to strokes during sleep. “In both central and obstructive sleep apnea, the acute elevations in blood pressure associated with apneic episodes may predispose patients to hemorrhagic stroke, while chronic hypertension increases the risk of heart failure,” the authors wrote. “Thus, controlling hypertension in sleep apnea patients is a major clinical problem.” So the researchers carefully mapped out the chain of signaling events that began with sleep-disordered breathing and led to the onset of hypertension. When an episode of apnea causes low blood oxygen levels, the carotid bodies quickly detect the decrease and begin to generate reactive oxygen species (a natural byproduct of the normal metabolism of oxygen). These inactivate heme oxygenase-2, an enzyme that generates carbon monoxide (CO). This leads to an increase in hydrogen sulfide, which stimulates the carotid bodies to send out chemical signals to take in more oxygen. Unfortunately, those signals also stimulate the sympathetic nervous system and cause blood vessels to constrict, boosting blood pressure. The standard therapies for hypertension caused by constricted vessels “do not work in this form of hypertension,” Prabhakar said. In the 1960s, when the relationship between the carotid bodies and asthma was being first investigated, researchers tried to treat the disease by surgical removal of the carotid bodies. However, some of those patients developed sleep apnea. Although carotid body resection prevented hypertension, that approach came with serious side effects. Because they lacked the urge to breathe more during exertion, patients were unable to exercise safely, Prabhakar said, adding that “some died in their sleep from extended apneic episodes.” The authors suggest instead that drugs designed to inhibit the enzyme cystathionine-y-lyase – required for the production of hydrogen sulfide, the signal to increase oxygen intake – could be used to disrupt the cascade of signals leading to apnea-related hypertension. “A major finding of the present study is that blockade of hydrogen sulfide synthesis is sufficient to prevent carotid body activation and hypertension in intermittent hypoxia-exposed rodents,” the authors note. Treating rats with a cystathionine-y-lyase inhibitor L-propargylglycine (L-PAG) “restored normal carotid body function, sympathetic nerve activity and blood pressure, and blocked hypertensive responses to simulated apneas.” “Our results,” they conclude, “suggest that inhibiting cystathionine-y-lyase to reduce hydrogen sulfide signaling in the carotid body with more potent inhibitors than L-PAG may be a novel approach to treat hypertension in patients with sleep apnea.” The National Institutes of Health supported this effort. Additional authors were Guoxiang Yuan, Ying-Jie Peng, Shakil Khan, Jayasri Nanduri, Amritha Singh and Ganesh Kumar from the University of Chicago, and Chirag Vasavda, Gregg Semenza and Solomon Snyder of Johns Hopkins University School of Medicine.
Newswise — A team of researchers from nine leading academic hospitals and research centers have published a paper in the early online edition of the journal Cancer that describes pulmonary outcomes among childhood cancer survivors. The study also evaluates the impact of complications such as asthma, chronic cough, emphysema and recurrent pneumonia on daily activities. Led by Andrew C. Dietz, MD, MSCR, of the Center for Childhood Cancer and Blood Diseases at Children’s Hospital Los Angeles, and Daniel A. Mulrooney, MD, of St. Jude Children’s Research Hospital, the study shows that cumulative incidence of lung complications continues to increase up to 25 years from initial cancer diagnosis, and survivors treated with a combination of chemotherapy and radiation are at highest risk. Based on self-reporting by more than 14,000 individuals identified through the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study, the findings suggest the need for follow-up health care with advancing age and time from diagnosis. Medical advances have led to improved survival rates for children diagnosed with cancer – with five-year survival rates now exceeding 80 percent – and it is estimated that there are more than 420,000 survivors of childhood cancer alive in the United States. Despite these improvements, late mortality rates for cancer survivors exceed those of the general population. Leading causes of death in this population include subsequent cancer, followed by pulmonary and cardiovascular events. Lung tissue is particularly sensitive to cancer treatment and the cumulative incidence for pulmonary symptoms -- such as lung fibrosis, chronic cough and difficult or labored breathing with exercise – increases over time. “While often asymptomatic, damage to the lungs may limit activities of daily living with potential impact on the overall quality of life,” said Dietz. The researchers identified 20,690 five-year cancer survivors, of whom 69 percent completed a baseline survey, and/or one of two follow-up surveys years later. A comparison, or control, group of 4,027 survivor siblings were also surveyed. The rates of chronic cough, oxygen need, lung fibrosis and recurrent pneumonia were elevated among survivors when compared to the control group. Survivors with some of these pulmonary events were also more likely to report limitations on their activities than siblings with the same conditions. “This study adds to our understanding of specific, long-term risks to pulmonary health for survivors of childhood cancer, and will help refine guidelines for appropriate screening, health surveillance and counseling,” said Mulrooney, adding that such knowledge will hopefully contribute to the design and testing of better, targeted interventions to decrease adverse pulmonary events in this population. Additional contributors to the study include Yan Chen, University of Alberta, Edmonton; Yutaka Yasui, PhD, Kirsten K. Ness, PhD, Leslie L. Robison, PhD, and Gregory T. Armstrong, MD, St. Jude Children’s Research Hospital; James S. Hagood, Rady Children’s Hospital, San Diego; Eric J. Chow, MD, Fred Hutchinson Cancer Research Center, Seattle; Marilyn Stovall, PhD, University of Texas, M.D. Anderson Cancer Center; Joseph P. Neglia, MD, University of Minnesota; Kevin C. Oeffinger MD, Memorial Sloan Kettering Cancer Center, New York; and Ann C. Mertens, PhD, Emory University, Children’s Healthcare of Atlanta. The study was supported by the National Cancer Institute (CA55727), a Cancer Center Support grant (CA21765), and the American Lebanese-Syrian Associated Charities.
Newswise — Although strollers and carriers are typically used to safely transport children, injuries do occur while using these products. A study conducted by the Center for Injury Research and Policy of the Research Institute at Nationwide Children’s Hospital found that, over a 21-year period from 1990 through 2010, almost 361,000 children aged 5 years and younger were treated in U.S. hospital emergency departments for stroller- or carrier-related injuries – that’s about two children every hour. The study, published online today in Academic Pediatrics, found that most children were injured when they fell from the stroller (67%) or carrier (63%) or when the stroller (16%) or carrier (29%) tipped over. The head (43% stroller, 62% carrier) and face (31% stroller, 25% carrier) were the most commonly injured parts of the body. While many of the injuries were soft tissue injuries like bumps and bruises (39% for strollers, 48% for carriers), traumatic brain injuries (TBIs)/concussions accounted for one-quarter (25%) of stroller-related injuries and one-third (35%) of carrier-related injuries. In fact, the proportion of stroller-related TBIs/concussions doubled during the study period going from 19% of injuries in 1990 to 42% of injuries in 2010 and the proportion of carrier-related TBI/concussions tripled going from 18% of injuries in 1990 to 53% of injuries in 2010. “While these products are used safely by families every day, when injuries do occur they can be quite serious,” said Kristi Roberts, MS, MPH, study author and research associate in the Center for Injury Research and Policy at Nationwide Children’s. “The majority of injuries we saw were head injuries which is scary considering the fact that traumatic brain injuries and concussions in young children may have long term consequences on cognitive development.” While most of the children were sent home after receiving treatment in the emergency department, 7% of children with a carrier-related injury and 2% with a stroller-related injury were hospitalized. This means that every day in the U.S. a child is hospitalized for a stroller or carrier-related injury. TBIs/concussions accounted for 65% of stroller-related hospitalizations and 79% of carrier-related hospitalizations. “As parents, we place our most precious cargo in strollers and carriers every day,” said Roberts. “By taking a few simple steps like making sure your child is buckled up every time he is in his stroller or carrier and being aware of things that can cause these products to tip over can help prevent many of these injuries.” Safety experts recommend the following to help prevent injuries from strollers and carriers: • Always buckle up. Follow all manufacturer’s instructions for properly securing children in strollers or carriers. Make sure your child is seated and buckled in at all times. • Keep handles clear. Hanging heavy items like purses and bags on the handle of strollers can cause them to tip over. Store these items under the stroller or on your shoulder. If getting a new stroller, look for one with a wide wheel base that will be harder to tip over. • Get a model that fits your child. Strollers and carriers are not one-size fits all. Both strollers and carriers have age and weight limits. Make sure to get one that is the right size for your child and follow all manufacturer’s guidelines for use. • Lock it. Lock stroller wheels when you “park” to prevent it from rolling away unexpectedly. Be careful using a stroller near a curb and in high traffic areas where sidewalks are not available. • Keep it low. Keep carriers low to the ground so the child has a shorter fall if the carrier tips over. • Check for recalls. Both strollers and carriers have had recalls in recent years. Check www.recalls.gov to see if the model you plan to use has been recalled. “While the number of overall injuries from strollers and carriers did go down during the 21 years we looked at in our study, it is still unacceptably high,” said Roberts. “The updates to manufacturer standards and frequent product recalls in recent years have been a good first step but the large number of injuries we are still seeing shows we need to do more.” Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS database provides information on consumer product-related and sports- and recreation-related injuries treated in hospital emergency departments across the country. The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org.
Newswise — A diet rich in fruits, vegetables, low-fat dairy and reduced in fats and saturated fats (the DASH diet), designed decades ago to reduce high blood pressure, also appears to significantly lower uric acid, the causative agent of gout. Further, the effect was so strong in some participants that it was nearly comparable to that achieved with drugs specifically prescribed to treat gout, a new study led by Johns Hopkins researchers shows. The findings--derived from a randomized clinical trial--could offer an effective, safe and sustainable dietary approach to lower uric acid and possibly prevent gout flare-ups in those with mild to moderate disease and who can't or don't want to take gout drugs. Dietary excesses, such as consuming a lot of red meat and alcohol, have long been associated with gout, a disease marked by high levels of uric acid in the blood and whose causes remain somewhat of an enigma despite centuries of investigation. The Hopkins researchers noted that while symptoms of gout outbreaks -- severe inflammation and sharp pain in the joints, particularly the base of the big toe -- have been linked to elevated uric acid, it's been unclear exactly what type of diet might lower uric acid and decrease the risk of flare-ups. In an effort to find out, Stephen P. Juraschek, M.D., Ph.D., research and clinical fellow in general internal medicine at the Johns Hopkins University School of Medicine, and his colleagues used data from the DASH (Dietary Approaches to Stop Hypertension) clinical trial, a widely popular and often-cited study whose results were first published in 1997. These results showed that the DASH diet --which emphasizes reduced salt, whole grains, fruits, vegetables, low-fat dairy products and reduced intake of red meats, sweets and saturated fats -- had a marked positive improvement on blood pressure and cholesterol. In the original DASH-sodium trial, 412 participants ate either the DASH diet or a typical American diet for three months. For each month of the study, the participants' diets provided a different level of sodium in a random order, including low (1.2 grams per day or about half a teaspoon), medium (2.3 grams per day or about one teaspoon), and a high level (3.4 grams per day or about 1.5 teaspoons). The high sodium level was comparable to the average daily intake in a typical American diet. At baseline and at the end of each sodium intake period, the researchers conducting the original study also took blood samples, which were analyzed for a variety of blood markers, including uric acid. In this new study, Juraschek and his colleagues examined these data to determine whether and how each intervention affected uric acid blood concentrations. They found that the DASH diet led to a modest 0.35 milligrams per deciliter decrease in uric acid concentrations overall. However, the higher participants' baseline uric acid levels, the more dramatic the decrease. For those with the highest baseline uric acid levels--more than 7 milligrams per deciliter -- for example, the decrease was as high as 1.3 milligrams per deciliter. In the context of what is known about levels of uric acid linked to gout flare-up risk, "That's a large reduction in uric acid," explains Juraschek. Gout-treating medications, such as allopurinol, often reduce patients' blood uric acid concentrations about 2 milligrams per deciliter. "When you get as high as the reduction we believe occurred with the original DASH diet in this study, the effect starts being comparable with gout medications." Juraschek noted that the effect of sodium on uric acid concentrations was small, but significant and quite the opposite of what the researchers expected. Specifically, during the part of the DASH trial in which participants were given the least sodium, their uric acid concentrations were the highest, with slight decreases achieved during the medium and high sodium portions of the trial. Although high sodium levels appear to slightly decrease uric acid concentrations, Juraschek cautions against jumping to the conclusion that to reduce blood uric acid it's a good idea to purposely consume lots of sodium. "More than 70 percent of people with gout have high blood pressure," Juraschek says. "If one was to consume more sodium to improve uric acid, it could worsen blood pressure." The researchers caution that further research is needed to more clearly establish the link between the DASH diet and uric acid in patients with gout and to directly explore whether the DASH diet might reduce or prevent gout flare-ups. But, they conclude, the new study, described in the August 15 issue of Arthritis and Rheumatology, could offer patients a viable way to control uric acid concentrations -- and presumably gout flare-ups -- through a diet already shown to have positive effects on blood pressure, a well-established risk factor for cardiovascular disease. There are about 8.3 million people in the United States with gout, costing the health care system an estimated $7.7 billion. "Results of this trial are good news to patients with high blood levels of uric acid or those at risk for gout. A dietary approach to prevent gout should be considered first line therapy. This study suggests that standard dietary advice for uric acid reduction which is to reduce alcohol and protein intake, should now include advice to adopt the DASH diet," says senior author Edgar R. Miller III, M.D. Ph.D., professor of medicine at the Johns Hopkins University School of Medicine. Other researchers who participated in this study include Allan C. Gelber, M.D., Ph.D., Lawrence J. Appel, M.D., M.P.H., and Edgar R. Miller III, M.D. Ph.D., all from Johns Hopkins, and Hyon K. Choi, M.D., Dr.P.H., of Harvard Medical School. Funding for this study was provided by the National Heart Lung and Blood Institute under grant/contract numbers U01-HL57173, U01-HL57114, U01-HL57190, U01-HL57139, K08 HL03857-01 and U01-HL57156 and by the General Clinical Research Program of the National Center for Research Resources under grant/contract number M01-RR02635 and M01-RR00722. Juraschek receives support from The National Institute of Diabetes and Digestive and Kidney Diseases under grant number T32DK007732-20.