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Brown University study: Computer models provide new understanding of sickle cell disease

30 Jul

The National Heart, Lung and Blood Institute describes sickle cell disease:

The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in their red blood cells.
Hemoglobin is a protein in red blood cells that carries oxygen throughout the body.
“Inherited” means that the disease is passed by genes from parents to their children. SCD is not contagious. A person cannot catch it, like a cold or infection, from someone else.
People who have SCD inherit two abnormal hemoglobin genes, one from each parent. In all forms of SCD, at least one of the two abnormal genes causes a person’s body to make hemoglobin S. When a person has two hemoglobin S genes, Hemoglobin SS, the disease is called sickle cell anemia. This is the most common and often most severe kind of SCD.
Hemoglobin SC disease and hemoglobin Sβ thalassemia (thal-uh-SEE-me-uh) are two other common forms of SCD…. https://www.nhlbi.nih.gov/health/health-topics/topics/sca/

The Centers for Disease Control and Prevention provide data about sickle cell disease:

In the United States
The exact number of people living with SCD in the U.S. is unknown. Working with partners, the CDC supports projects to learn about the number of people living with SCD to better understand how the disease impacts their health.
It is estimated that:
• SCD affects approximately 100,000 Americans.
• SCD occurs among about 1 out of every 365 Black or African-American births.
• SCD occurs among about 1 out of every 16,300 Hispanic-American births.
• About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT).
Comprehensive Care
• People with SCD have less access to comprehensive team care than people with genetic disorders such as hemophilia and cystic fibrosis. [Read article]
Mortality
• Sickle cell-related death among Black or African-American children younger than 4 years of age fell by 42% from 1999 through 2002. This drop coincided with the introduction in 2000 of a vaccine that protects against invasive pneumococcal disease.
[Read summary]
• Relative to the rate for the period 1983 through 1986, the SCD mortality rate for the period 1999 through 2002 decreased by:
o 68% at age 0 through 3 years;
o 39% at age 4 through 9 years; and
o 24% at age 10 through 14 years.
[Read summary]
• Mortality Among Children with Sickle Cell Disease Identified by Newborn Screening During 1990-1994 — California, Illinois, and New York:
o Among the children with Hb SS disease, 1% died as a result of SCD-related causes during the first 3 years of life.
o In California and Illinois, by the end of 1995, the cumulative mortality rate was 1.5 per 100 Black or African-American children with SCD. The equivalent cumulative mortality rate for all Black or African-American infants born during this period in California and Illinois was 2.0 per 100 Black or African-American newborns.
[Read article]
Economic Costs
• During 2005, medical expenditures for children with SCD averaged $11,702 for children with Medicaid coverage and $14,772 for children with employer-sponsored insurance. About 40% of both groups had at least one hospital stay.
[Read summary]
• SCD is a major public health concern. From 1989 through 1993, an average of 75,000 hospitalizations due to SCD occurred in the United States, costing approximately $475 million.
[Read summary]
https://www.cdc.gov/ncbddd/sicklecell/data.html

See, American Society of Hematology http://www.hematology.org/Patients/Anemia/Sickle-Cell.aspx
Science Daily reported in Computer models provide new understanding of sickle cell disease:

Computer models developed by Brown University mathematicians show new details of what happens inside a red blood cell affected by sickle cell disease. The researchers said they hope their models, described in an article in the Biophysical Journal, will help in assessing drug strategies to combat the genetic blood disorder, which affects millions of people worldwide.
Sickle cell disease affects hemoglobin, molecules within red blood cells responsible for transporting oxygen. In normal red blood cells, hemoglobin is dispersed evenly throughout the cell. In sickle red blood cells, mutated hemoglobin can polymerize when deprived of oxygen, assembling themselves into long polymer fibers that push against the membranes of the cells, forcing them out of shape. The stiff, ill-shaped cells can become lodged in small capillaries throughout the body, leading to painful episodes known as sickle cell crisis….
The model uses detailed biomechanical data on how sickle hemoglobin molecules behave and bind with each other to simulate the assembly of a polymer fiber. Prior to this work, the problem had been that as the fiber grows, so does the amount of data the model must crunch. Modeling an entire polymer fiber at cellular scale using the details of each molecule was simply too computationally expensive….
The researchers’ solution was to apply what they call a mesoscopic adaptive resolution scheme or MARS. The MARS model calculates the detailed dynamics of each individual hemoglobin molecule only at the each end of polymer fibers, where new molecules are being recruited into the fiber. Once four layers of a fiber have been established, the model automatically dials back the resolution at which it represents that section. The model retains the important information about how the fiber behaves mechanically, but glosses over the fine details of each constituent molecule….
Using the new MARS simulations, the researchers were able to show how different configurations of growing polymer fibers are able to produce cells with different shapes. Though the disease gets its name because it causes many red blood cells take on a sickle-like shape, there are actually a variety of abnormal cell shapes present. This new modeling approach showed new details about how different fiber structures inside the cell produce different cell shapes….
There are only two drugs on the market that has been approved by the FDA for treating sickle cell, Karniadakis says. One of them, called hydroxyurea, is thought to work by boosting the amount of fetal hemoglobin — the kind of hemoglobin that babies are born with — in a patient’s blood. Fetal hemoglobin is resistant to polymerization and, when present in sufficient quantity, is thought to disrupt the polymerization of sickle cell hemoglobin.
Using these new models, Karniadakis and his colleagues can now run simulations that include fetal hemoglobin. Those simulations could help to confirm that fetal hemoglobin does indeed disrupt polymerization, as well as help to establish how much fetal hemoglobin is necessary. That could help in establishing better dosage guidelines or in developing new and more effective drugs, the researchers say. https://www.sciencedaily.com/releases/2017/07/170728153954.htm

Citation:

Computer models provide new understanding of sickle cell disease
Date: July 28, 2017
Source: Brown University
Summary:
Simulations developed by mathematicians provide new details of how sickle cell disease manifests inside red blood cells, which could help in developing new treatments.

Journal Reference:
1. Lu Lu, He Li, Xin Bian, Xuejin Li, George Em Karniadakis. Mesoscopic Adaptive Resolution Scheme toward Understanding of Interactions between Sickle Cell Fibers. Biophysical Journal, 2017; 113 (1): 48 DOI: 10.1016/j.bpj.2017.05.050

Here is the Brown press release:

Computer models provide new understanding of sickle cell disease
July 28, 2017 Media contact: Kevin Stacey 401-863-3766
Simulations developed by Brown University mathematicians provide new details of how sickle cell disease manifests inside red blood cells, which could help in developing new treatments.
PROVIDENCE, R.I. [Brown University] — Computer models developed by Brown University mathematicians show new details of what happens inside a red blood cell affected by sickle cell disease. The researchers said they hope their models, described in an article in the Biophysical Journal, will help in assessing drug strategies to combat the genetic blood disorder, which affects millions of people worldwide.
Sickle cell disease affects hemoglobin, molecules within red blood cells responsible for transporting oxygen. In normal red blood cells, hemoglobin is dispersed evenly throughout the cell. In sickle red blood cells, mutated hemoglobin can polymerize when deprived of oxygen, assembling themselves into long polymer fibers that push against the membranes of the cells, forcing them out of shape. The stiff, ill-shaped cells can become lodged in small capillaries throughout the body, leading to painful episodes known as sickle cell crisis.
“The goal of our work is to model both how these sickle hemoglobin fibers form as well as the mechanical properties of those fibers,” said Lu Lu, a Ph.D. student in Brown Division of Applied Mathematics and the study’s lead author. “There had been separate models for each of these things individually developed by us, but this brings those together into one comprehensive model.”
The model uses detailed biomechanical data on how sickle hemoglobin molecules behave and bind with each other to simulate the assembly of a polymer fiber. Prior to this work, the problem had been that as the fiber grows, so does the amount of data the model must crunch. Modeling an entire polymer fiber at cellular scale using the details of each molecule was simply too computationally expensive.
“Even the world’s fastest supercomputers wouldn’t be able to handle it,” said George Karniadakis, professor of applied math at Brown and the paper’s senior author. “There’s just too much happening and no way to capture it all computationally. That’s what we were able to overcome with this work.”
As the simulated fiber grows, the model dials back the resolution, representing established parts of the fiber with courser grain, which makes simulating the fibers computationally tractable.
The researchers’ solution was to apply what they call a mesoscopic adaptive resolution scheme or MARS. The MARS model calculates the detailed dynamics of each individual hemoglobin molecule only at the each end of polymer fibers, where new molecules are being recruited into the fiber. Once four layers of a fiber have been established, the model automatically dials back the resolution at which it represents that section. The model retains the important information about how the fiber behaves mechanically, but glosses over the fine details of each constituent molecule.
“By eliminating the fine details where we don’t need them, we develop a model that can simulate this whole process and its effects on a red blood cell,” Karniadakis said.
Using the new MARS simulations, the researchers were able to show how different configurations of growing polymer fibers are able to produce cells with different shapes. Though the disease gets its name because it causes many red blood cells take on a sickle-like shape, there are actually a variety of abnormal cell shapes present. This new modeling approach showed new details about how different fiber structures inside the cell produce different cell shapes.
“We are able to produce a polymerization profile for each of the cell types associated with the disease,” Karniadakis said. “Now the goal is to use these models to look for ways of preventing the disease onset.”
The researchers used their models to create “polymerization profiles” for different cell shapes associated with sickle cell disease. The model above shows a cell with multiple fibers forming.
There are only two drugs on the market that has been approved by the FDA for treating sickle cell, Karniadakis says. One of them, called hydroxyurea, is thought to work by boosting the amount of fetal hemoglobin — the kind of hemoglobin that babies are born with — in a patient’s blood. Fetal hemoglobin is resistant to polymerization and, when present in sufficient quantity, is thought to disrupt the polymerization of sickle cell hemoglobin.
Using these new models, Karniadakis and his colleagues can now run simulations that include fetal hemoglobin. Those simulations could help to confirm that fetal hemoglobin does indeed disrupt polymerization, as well as help to establish how much fetal hemoglobin is necessary. That could help in establishing better dosage guidelines or in developing new and more effective drugs, the researchers say.
“The models give us a way to do preliminary testing on new approaches to stopping this disease,” Karniadakis said. “Now that we can simulate the entire polymerization process, we think the models will be much more useful.”
Lu and Karniadakis’ co-authors on the paper were He Li, Xin Bian and Xuejin Li, all from Brown’s Division of Applied Mathematics. The work was supported by the National Institutes of Health (U01HL114476). Computer time and other resources were provided under grants from the Department of Energy (DE-AC02-06CH11357, DE-AC05-00OR22725).
Note to Editors:
Editors: Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.

The Brown study is a breakthrough because it may lead to advanced and individual specific treatment for sickle cell disease.

WebMD described current treatment for sickle cell disease:

Treatment involves getting routine tests to monitor health, managing pain events (crises), and treating related health problems as they arise.
Treatment for severe cases of sickle cell disease may include medicines. For more information, see Medications.
Treatment for children
When parents learn that their baby has sickle cell disease, it’s the beginning of a lifelong education process. Knowing as much as you can about the disease can help you control symptoms as they arise and know what to do in emergency situations. Treatment includes:
• Routine childhood immunizations. Immunizations in adulthood are important too.
• Daily antibiotics from 2 months to 5 years of age to prevent life-threatening infections. This practice stops at age 5 because older children don’t have as many severe infections.
• The medicine hydroxyurea.
• Multivitamin supplements with iron during infancy.
• Folic acid supplements daily.
• Protein supplements if there is a lag in weight gain.
Starting at age 2 years, your child should get screened every now and then with a transcranial ultrasound. This test measures blood flow in the arteries of the head and neck. If test results show a high chance for stroke, your child may get blood transfusions to lower the risk.3 http://www.webmd.com/a-to-z-guides/tc/sickle-cell-disease-treatment-overview#1

As with any chronic disease, early diagnosis and treatment by qualified medical personnel is essential. See, Children’s Hospital Directory https://www.childrenshospitals.org/Directories/Hospital-Directory

Resources:

Sickle cell anemia patient ‘cured’ by gene therapy, doctors say
http://www.cnn.com/2017/03/03/health/sickle-cell-anemia/index.html

What Is Sickle Cell Disease?
https://www.nhlbi.nih.gov/health/health-topics/topics/sca/

Sickle Cell Anemia
http://www.nytimes.com/health/guides/disease/sickle-cell-anemia/overview.html

Sickle Cell Anemia Treatment & Management
http://emedicine.medscape.com/article/205926-treatment

Where information leads to Hope. © Dr. Wilda.com

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Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
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Massachusetts Eye and Ear Infirmary study: Antibiotic-resistant microbes date back to 450 million years ago, well before the age of dinosaurs

14 May

Kathleen Doheny wrote the WebMD article, What You Should Know About ‘Superbug’ CRE:

Feb. 20, 2015 — The ”superbug” infection at the heart of an outbreak at Ronald Reagan UCLA Medical Center in Los Angeles is sometimes called “the nightmare bacteria” because it’s so resistant to antibiotics.
Two deaths at the California medical center are linked to the bacteria, known as CRE, or carbapenem-resistant Enterobacteriaceae. Five other patients are infected and nearly 200 may have been exposed, the center says. Exposure stemmed from two contaminated instruments used during procedures done over the past few months at the facility…
What is CRE and how does it spread?
CRE is in a family of bacteria that are normally found in the gut and have become resistant to antibiotics. They are resistant to most of the available antibiotics, says Stephen Calderwood, MD. He’s the president of the Infectious Diseases Society of America and chief of the infectious disease division at Massachusetts General Hospital, Boston.
The devices linked with the UCLA outbreak, known as duodenoscopes, are used in more than 500,000 procedures a year in the U.S., according to the CDC.
The scope is inserted into the mouth and through the throat, stomach, and the top of the small intestine. It helps doctors diagnose and treat diseases of the liver, bile ducts and pancreas. The FDA warned that the scopes might still carry a risk of infection even after proper cleaning procedures.
The problems can start when the bacteria leave the intestine and live in other areas, such as the urinary tract, lungs, skin, and on medical equipment, Calderwood says. “They mainly cause infections when they get to a certain number and the ability of the body to fight off infection breaks down.”
Who is most at risk?
“Most healthy people don’t get these infections,” says Robert Glatter, MD. He’s an emergency medicine doctor at Lenox Hill Hospital, New York. “It’s the people living in long-term care facilities, nursing homes, or who have long hospital stays.”
Those who get infected often have other diseases, are on antibiotics, and have had a procedure involving a medical device, Calderwood says…. http://www.webmd.com/a-to-z-guides/news/20150220/superbug-cre-infections#1

Resources:

What is a Superbug? http://www.livescience.com/32370-what-is-a-superbug.html

Medical Definition of Superbug http://www.medicinenet.com/script/main/art.asp?articlekey=38448

Superbug: What it is, how it spreads, what you can do http://www.latimes.com/science/sciencenow/la-sci-sn-cre-outbreak-carbapenem-resistant-enterobacteriaceae-20150218-story.html

Science Daily reported in Antibiotic-resistant microbes date back to 450 million years ago, well before the age of dinosaurs:

Leading hospital “superbugs,” known as the enterococci, arose from an ancestor that dates back 450 million years — about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study led by researchers from Massachusetts Eye and Ear, the Harvard-wide Program on Antibiotic Resistance and the Broad Institute of MIT and Harvard. Published online today in Cell, the study authors shed light on the evolutionary history of these pathogens, which evolved nearly indestructible properties and have become leading causes of modern antibiotic-resistant infections in hospitals.
Antibiotic resistance is now a leading public health concern worldwide. Some microbes, often referred to as “superbugs,” are resistant to virtually all antibiotics. This is of special concern in hospitals, where about 5 percent of hospitalized patients will fight infections that arise during their stay. As researchers around the world are urgently seeking solutions for this problem, insight into the origin and evolution of antibiotic resistance will help inform their search.
“By analyzing the genomes and behaviors of today’s enterococci, we were able to rewind the clock back to their earliest existence and piece together a picture of how these organisms were shaped into what they are today” said co-corresponding author Ashlee M. Earl, Ph.D., group leader for the Bacterial Genomics Group at the Broad Institute of MIT and Harvard. “Understanding how the environment in which microbes live leads to new properties could help us to predict how microbes will adapt to the use of antibiotics, antimicrobial hand soaps, disinfectants and other products intended to control their spread.”
The picture the researchers pieced together begins with the dawn of life. Bacteria arose nearly 4 billion years ago, and the planet has teemed with them ever since, including the sea. Animals first arose in the sea during the time known as the Cambrian Explosion, 542 million years ago. As animals emerged in a sea of bacteria, bacteria learned to live in and on them. Some bacteria protect and serve the animals, as the healthy microbes in our intestines do today; others live in the environment, and still others cause disease. As animals crawled onto land about 100 million years later, they took their microbes with them.
The authors of the Cell study found that all species of enterococci, including those that have never been found in hospitals, were naturally resistant to dryness, starvation, disinfectants and many antibiotics. Because enterococci normally live in the intestines of most (if not all) land animals, it seemed likely that they were also in the intestines of land animals that are now extinct, including dinosaurs and the first millipede-like organisms to crawl onto land. Comparison of the genomes of these bacteria provided evidence that this was indeed the case. In fact, the research team found that new species of enterococci appeared whenever new types of animals appeared. This includes when new types of animals arose right after they first crawled onto land, and when new types of animals arose right after mass extinctions, especially the greatest mass extinction, the End Permian Extinction (251 million years ago)…. https://www.sciencedaily.com/releases/2017/05/170511142012.htm

Citation:

Antibiotic-resistant microbes date back to 450 million years ago, well before the age of dinosaurs
Survival of mass extinctions helps to explain near indestructible properties of hospital superbugs
Date: May 11, 2017
Source: Massachusetts Eye and Ear Infirmary
Summary:
Leading hospital ‘superbugs,’ known as the enterococci, arose from an ancestor that dates back 450 million years — about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study.
Journal Reference:
1. François Lebreton, Abigail L. Manson, Jose T. Saavedra, Timothy J. Straub, Ashlee M. Earl, Michael S. Gilmore. Tracing the Enterococci from Paleozoic Origins to the Hospital. Cell, 2017; DOI: 10.1016/j.cell.2017.04.027

Here is the press release from Massachusetts Eye and Ear:
The Prehistory of Antibiotic Resistance
Hospital “superbugs” evolved from an ancient ancestor

An artist’s rendering of what life may have looked 335 million years ago, well before the age of By Suzanne Day May 12, 2017
Leading hospital “superbugs” known as the enterococci arose from an ancestor that dates back 450 million years—about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study led by researchers from Harvard Medical School, Massachusetts Eye and Ear, the Harvard-wide Program on Antibiotic Resistance and the Broad Institute of MIT and Harvard. Published in Cell, the study authors shed light on the evolutionary history of these pathogens, which evolved nearly indestructible properties and have become leading causes of modern antibiotic-resistant infections in hospitals.
Antibiotic resistance is now a major public health concern worldwide. Some microbes, often referred to as “superbugs,” are resistant to virtually all antibiotics. This is of special concern in hospitals, where about 5 percent of hospitalized patients will fight infections that arise during their stay. As researchers around the world are urgently seeking solutions to this problem, insight into the origin and evolution of antibiotic resistance will help inform their search.
“By analyzing the genomes and behaviors of today’s enterococci, we were able to rewind the clock back to their earliest existence and piece together a picture of how these organisms were shaped into what they are today” said co-corresponding author Ashlee Earl, group leader for the Bacterial Genomics Group at the Broad. “Understanding how the environment in which microbes live leads to new properties could help us to predict how microbes will adapt to the use of antibiotics, antimicrobial hand soaps, disinfectants and other products intended to control their spread.”
The picture the researchers pieced together begins with the dawn of life. Bacteria arose nearly 4 billion years ago, and the planet has teemed with them ever since. Animals first arose in the sea during the period known as the Cambrian Explosion, around 542 million years ago. As animals emerged in a sea of bacteria, the bacteria learned to live in and on them. Some bacteria protect and serve the animals, as the healthy microbes in our intestines do today; others live in the environment and still others cause disease. As animals crawled onto land about 100 million years later, they brought their microbes with them.
“We now know what genes were gained by enterococci hundreds of millions of years ago, when they became resistant to drying out.” —Michael Gilmore
The authors of the Cell study found that all species of enterococci, including those that have never been found in hospitals, are naturally resistant to dryness, starvation, disinfectants and many antibiotics. Because enterococci normally live in the intestines of most (if not all) land animals, it seemed likely that they were also in the intestines of land animals that are now extinct, including dinosaurs and the first millipede-like organisms to crawl onto land. Comparisons of the genomes of these bacteria provided evidence that this is indeed the case. In fact, the research team found that new species of enterococci appeared whenever new types of animals appeared.
Sea animals excrete intestinal microbes into the ocean, which usually contains about 5,000 mostly harmless bacteria per drop of water. These organisms sink to the seafloor into microbe-rich sediments and are consumed by worms, shellfish and other sea scavengers. Those are then eaten by fish, and the microbes continue to circulate throughout the food chain. However, on land, intestinal microbes are excreted in feces, where most dry out and die over time.
Not the enterococci, however. These microbes are unusually hardy and can withstand drying out and starvation, which serves them well on land and in hospitals where disinfectants make survival difficult for a microbe.
“We now know what genes were gained by enterococci hundreds of millions of years ago, when they became resistant to drying out, and to disinfectants and antibiotics that attack their cell walls,” said principal investigator and co-corresponding author Michael Gilmore, the HMS Sir William Osler Professor of Ophthalmology at Mass. Eye and Ear and director of the Harvard Infectious Disease Institute.
“These are now targets for our research to design new types of antibiotics and disinfectants that specifically eliminate enterococci, to remove them as threats to hospitalized patients,” added Francois Lebreton, HMS instructor in ophthalmology, first author of the study and project leader for the Gilmore team.
This research study was supported by Department of Health and Human Services/National Institutes of Health/National Institute of Allergy and Infectious Diseases (grants AI072360, AI083214, HHSN272200900018C and U19AI110818).
Adapted from a Mass. Eye and Ear news release. http://www.masseyeandear.org/news/press-releases/2017/05/antibiotic-resistant-microbes-date-back
https://hms.harvard.edu/news/prehistory-antibiotic-resistance

Appropriate use of antibiotics is crucial in limiting the danger of superbugs.

National Institutes of Health in the News reported in the 2014 article, Stop the Spread of Superbugs: Help Fight Drug-Resistant Bacteria:

Unfortunately, many antibiotics prescribed to people and to animals are unnecessary. And the overuse and misuse of antibiotics helps to create drug-resistant bacteria.
Here’s how that might happen. When used properly, antibiotics can help destroy disease-causing bacteria. But if you take an antibiotic when you have a viral infection like the flu, the drug won’t affect the viruses making you sick. Instead, it’ll destroy a wide variety of bacteria in your body, including some of the “good” bacteria that help you digest food, fight infection, and stay healthy. Bacteria that are tough enough to survive the drug will have a chance to grow and quickly multiply. These drug-resistant strains may even spread to other people.
Over time, if more and more people take antibiotics when not necessary, drug-resistant bacteria can continue to thrive and spread. They may even share their drug-resistant traits with other bacteria. Drugs may become less effective or not work at all against certain disease-causing bacteria.
“Bacterial infections that were treatable for decades are no longer responding to antibiotics, even the newer ones,” says Dr. Dennis Dixon, an NIH expert in bacterial and fungal diseases. Scientists have been trying to keep ahead of newly emerging drug-resistant bacteria by developing new drugs, but it’s a tough task.
“We need to make the best use of the drugs we have, as there aren’t many in the antibiotic development pipeline,” says Dr. Jane Knisely, who oversees studies of drug-resistant bacteria at NIH. “It’s important to understand the best way to use these drugs to increase their effectiveness and decrease the chances of resistance to emerge.”
You can help slow the spread of drug-resistant bacteria by taking antibiotics properly and only when needed. Don’t insist on an antibiotic if your health care provider advises otherwise. For example, many parents expect doctors to prescribe antibiotics for a child’s ear infection. But experts recommend delaying for a time in certain situations, as many ear infections get better without antibiotics.
NIH researchers have been looking at whether antibiotics are effective for treating certain conditions in the first place. One recent study showed that antibiotics may be less effective than previously thought for treating a common type of sinus infection. This kind of research can help prevent the misuse and overuse of antibiotics.
“Treating infections with antibiotics is something we want to preserve for generations to come, so we shouldn’t misuse them,” says Dr. Julie Segre, a senior investigator at NIH.
In the past, some of the most dangerous superbugs have been confined to health care settings. That’s because people who are sick or in a weakened state are more susceptible to picking up infections. But superbug infections aren’t limited to hospitals. Some strains are out in the community and anyone, even healthy people, can become infected.
One common superbug increasingly seen outside hospitals is methicillin-resistant Staphylococcus aureus (MRSA). These bacteria don’t respond to methicillin and related antibiotics. MRSA can cause skin infections and, in more serious cases, pneumonia or bloodstream infections.
A MRSA skin infection can appear as one or more pimples or boils that are swollen, painful, or hot to the touch. The infection can spread through even a tiny cut or scrape that comes into contact with these bacteria. Many people recover from MRSA infections, but some cases can be life-threatening. The CDC estimates that more than 80,000 aggressive MRSA infections and 11,000 related deaths occur each year in the United States.
When antibiotics are needed, doctors usually prescribe a mild one before trying something more aggressive like vancomycin. Such newer antibiotics can be more toxic and more expensive than older ones. Eventually, bacteria will develop resistance to even the new drugs. In recent years, some superbugs, such as vancomycin-resistant Enterococci bacteria, remain unaffected by even this antibiotic of last resort.
“We rely on antibiotics to deliver modern health care,” Segre says. But with the rise of drug-resistant bacteria, “we’re running out of new antibiotics to treat bacterial infections,” and some of the more potent ones aren’t working as well…. https://newsinhealth.nih.gov/issue/feb2014/feature1

Like opioids, antibiotics must be carefully prescribed by a competent medical professional who is careful not to overprescribe.

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Queens University Belfast study: New research shows illegal levels of arsenic found in baby foods

7 May

The U.S. has a child obesity problem. According to the Centers for Disease Control, Child Obesity facts:

Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.1, 2
The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.1, 2
In 2010, more than one third of children and adolescents were overweight or obese.1
Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.4
Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.5,6
http://www.cdc.gov/healthyyouth/obesity/facts.htm

Moi discussed child nutrition in Dr. Wilda Reviews book: Super Baby Foods https://drwilda.com/tag/baby-food/

Science Daily reported in New research shows illegal levels of arsenic found in baby foods:

In January 2016, the EU imposed a maximum limit of inorganic arsenic on manufacturers in a bid to mitigate associated health risks. Researchers at the Institute for Global Food Security at Queen’s have found that little has changed since this law was passed and that 50 per cent of baby rice food products still contain an illegal level of inorganic arsenic.
Professor Meharg, lead author of the study and Professor of Plant and Soil Sciences at Queen’s, said: “This research has shown direct evidence that babies are exposed to illegal levels of arsenic despite the EU regulation to specifically address this health challenge. Babies are particularly vulnerable to the damaging effects of arsenic that can prevent the healthy development of a baby’s growth, IQ and immune system to name but a few.”
Rice has, typically, ten times more inorganic arsenic than other foods and chronic exposure can cause a range of health problems including developmental problems, heart disease, diabetes and nervous system damage.
As babies are rapidly growing they are at a sensitive stage of development and are known to be more susceptible to the damaging effects of arsenic, which can inhibit their development and cause long-term health problems. Babies and young children under the age of five also eat around three times more food on a body weight basis than adults, which means that, relatively, they have three times greater exposures to inorganic arsenic from the same food item.
The research findings, published in the PLOS ONE journal today, compared the level of arsenic in urine samples among infants who were breast-fed or formula-fed before and after weaning. A higher concentration of arsenic was found in formula-fed infants, particularly among those who were fed non-dairy formulas which includes rice-fortified formulas favoured for infants with dietary requirements such as wheat or dairy intolerance. The weaning process further increased infants’ exposure to arsenic, with babies five times more exposed to arsenic after the weaning process, highlighting the clear link between rice-based baby products and exposure to arsenic…. https://www.sciencedaily.com/releases/2017/05/170504161538.htm

Citation:

New research shows illegal levels of arsenic found in baby foods
Date: May 4, 2017
Source: Queen’s University Belfast
Summary:
Almost half of baby rice food products contain illegal levels of inorganic arsenic despite new regulations set by the EU, new research concludes.
Journal Reference:
1. Antonio J. Signes-Pastor, Jayne V. Woodside, Paul McMullan, Karen Mullan, Manus Carey, Margaret R. Karagas, Andrew A. Meharg. Levels of infants’ urinary arsenic metabolites related to formula feeding and weaning with rice products exceeding the EU inorganic arsenic standard. PLOS ONE, 2017; 12 (5): e0176923 DOI: 10.1371/journal.pone.0176923

Here is the press release from Queens University:

Queen’s Research Shows Illegal Levels of Arsenic Found in Baby Foods
4/05/2017

Researchers from Queen’s University Belfast have found that almost half of baby rice food products contain illegal levels of inorganic arsenic despite new regulations set by the EU
In January 2016, the EU imposed a maximum limit of inorganic arsenic on manufacturers in a bid to mitigate associated health risks. Researchers at the Institute for Global Food Security at Queen’s have found that little has changed since this law was passed and that 50 per cent of baby rice food products still contain an illegal level of inorganic arsenic.
Professor Meharg, lead author of the study and Professor of Plant and Soil Sciences at Queen’s, said: “This research has shown direct evidence that babies are exposed to illegal levels of arsenic despite the EU regulation to specifically address this health challenge. Babies are particularly vulnerable to the damaging effects of arsenic that can prevent the healthy development of a baby’s growth, IQ and immune system to name but a few.”
Rice has, typically, ten times more inorganic arsenic than other foods and chronic exposure can cause a range of health problems including developmental problems, heart disease, diabetes and nervous system damage.
As babies are rapidly growing they are at a sensitive stage of development and are known to be more susceptible to the damaging effects of arsenic, which can inhibit their development and cause long-term health problems. Babies and young children under the age of five also eat around three times more food on a body weight basis than adults, which means that, relatively, they have three times greater exposures to inorganic arsenic from the same food item.
The research findings, published in the PLOS ONE journal today, compared the level of arsenic in urine samples among infants who were breast-fed or formula-fed before and after weaning. A higher concentration of arsenic was found in formula-fed infants, particularly among those who were fed non-dairy formulas which includes rice-fortified formulas favoured for infants with dietary requirements such as wheat or dairy intolerance. The weaning process further increased infants’ exposure to arsenic, with babies five times more exposed to arsenic after the weaning process, highlighting the clear link between rice-based baby products and exposure to arsenic.
In this new study, researchers at Queen’s also compared baby food products containing rice before and after the law was passed and discovered that higher levels of arsenic were in fact found in the products since the new regulations were implemented. Nearly 75 per cent of the rice-based products specifically marketed for infants and young children contained more than the standard level of arsenic stipulated by the EU law.
Rice and rice-based products are a popular choice for parents, widely used during weaning, and to feed young children, due to its availability, nutritional value and relatively low allergic potential.
Professor Meharg explained: “Products such as rice-cakes and rice cereals are common in babies’ diets. This study found that almost three-quarters of baby crackers, specifically marketed for children exceeded the maximum amount of arsenic.”
Previous research led by Professor Meharg highlighted how a simple process of percolating rice could remove up to 85 per cent of arsenic. Professor Meharg adds: “Simple measures can be taken to dramatically reduce the arsenic in these products so there is no excuse for manufacturers to be selling baby food products with such harmful levels of this carcinogenic substance.
“Manufacturers should be held accountable for selling products that are not meeting the required EU standard. Companies should publish the levels of arsenic in their products to prevent those with illegal amounts from being sold. This will enable consumers to make an informed decision, aware of any risks associated before consuming products containing arsenic.”
Find out more about the ground-breaking research taking place at the The Institute for Global Food Security.
Media inquiries to Suzanne Lagan, Communications Office at Queen’s University Belfast on Tel: 028 90 97 5292 or email suzanne.lagan@qub.ac.uk

Parents may wish to consider making their own baby food.

WebMD offers advice on preparing baby food in Starter Guide to Baby Food & Nutrition http://www.webmd.com/parenting/baby/baby-food-nutrition-9/making-baby-food?page=3

Parenting offers the following advice in 10 Best Ways to Feed Your Baby:

Here are 10 strategies that, from that first spoonful of solids, will help you to raise a child who will learn to eat—and love—everything.

1 Time those first bites right “The best time to feed your baby solids for the first time is when he’s feeling bright-eyed and bushy-tailed—in the morning or right after a nap,” says Karen Ansel R.D., a spokesperson for the American Dietetic Association (ADA) in Long Island, New York, and co-author of the upcoming book The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start….
2 Bombard her with variety After your baby has gotten used to the act of eating, introduce new foods rapidly, suggests Dr. Greene. Be creative….
3 Try, try again The carrots were a bust—so try again in a couple of days. Repeat as necessary. Studies say about three out of four moms throw in the towel after their baby refuses a new food five or fewer times. The problem is, research shows it can take up to 15 tries before a child will accept a new food….
4 Spice things up “There’s no research that says we have to give babies a bland diet,” says Jeannette Bessinger, co-founder of realfoodmoms.com and author of Great Expectations: Best Food for Your Baby & Toddler. “Once they’re enjoying a food plain, introduce it with mild herbs and spices.” Blend cilantro into avocado, nutmeg into sweet potatoes, cinnamon into apples, suggests Tracy…..
5 Help him connect to food Hand your baby an avocado and say “avocado.” If learning and using any signs with your baby, also make the sign for it. “Naming foods—and signing them—helps kids recognize those foods really early on,” says Dr. Greene….
6 Keep her close in the kitchen If you’ve ever felt guilty for parking your baby in an exersaucer while you made dinner, hear this: It may make her a better eater. She sees your relationship with food; she smells the garlic roasting, the soup simmering, which helps build that familiarity with foods. Get your child involved in cooking early…..
7 Sit down together Bringing your baby to the dinner table allows him to see you enjoying food. Plus, research links regular family meals with a slew of benefits for kids, including higher self-esteem and better academic performance. If eating together Monday through Friday is impossible, do it on the weekends…..
8 Be a supermodel Research shows clearly that when it comes to encouraging your child to eat something, it’s what you do—not what you say—that matters. So what if you are a picky eater? Don’t call attention to it, advises Ansel….
9 Make meals enticing When you’re dealing with a “discriminating” toddler, it’s tempting to push her to eat some broccoli or even to bribe her with dessert. Instead, encourage her to eat things by making them look delicious—and fun. Serve foods in colorful bowls. Offer dips—try hummus, yogurt and cottage cheese. Make faces on pancakes and sandwiches with cut-up fruits and vegetables….
10 Relax So what if your neighbor’s toddler eats sushi? This is not a competition. “All kids are different, and that includes their taste preferences,” notes Johnson….
Superfoods to make part of your menu:

One of the main reasons we want our kids to love eating everything is that a varied diet delivers a range of healthful nutrients. Here are three nutritious foods your kid should eat—but might be resistant to trying—and delicious serving suggestions from chef Geoff Tracy, co-author of Baby Love: Healthy, Easy, Delicious Meals for Your Baby and Toddler.

Fish is a good source of protein and omega-3 fatty acids, which are good for babies’ growing brains….
Lentils provide fiber, protein and iron, an important nutrient for infants and toddlers….
Green vegetables deliver a variety of nutrients, including beta carotene (important for a healthy immune system) and folate (a B vitamin that supports the healthy growth of new cells)….
http://www.parenting.com/article/best-ways-to-feed-baby

Many hospitals offer free or low-cost parenting classes. Love-to-know offers this advice in Parenting Classes in My Area:

How to Find Parenting Classes in Your Area
The approach you take to finding nearby courses may be dictated somewhat by the area in which you live; the denser the population, the more classes will be available.
Hospital Outreach Programs
Many hospitals cultivate partnerships with the community by offering a variety of outreach and educational programs. Parenting classes are sometimes offered. Many of these courses focus on how to parent newborns and how to help children adjust to a new baby in the home. In addition, parenting classes that are held at hospitals often include CPR classes and other first aid instruction. For more information, or to find out if the hospital or hospitals in your area offer any type of parenting class, contact the hospital and keep an eye on your local newspaper. Hospitals typically promote outreach and educational programs in the newspapers and online; check the hospital’s website as well.
Doctor’s Advice
In many cases, pediatricians and family physicians are quite knowledgeable regarding family programs in the area. Contact your doctor and your child’s pediatrician to find out if any classes or programs currently exist. In addition, sometimes several doctors who run a practice together may promote community seminars that focus on a variety of topics, including family related subjects.
Health Departments
People often overlook the wide variety of resources available at their local health departments. From free and reduced-fee vaccinations to physical exams and educational seminars, the health department’s goal is to serve the public. Contact your local health department to find out if it offers any parenting classes. In addition, ask to be placed on the health department’s mailing list, if available, to learn about all of the programs that offered throughout the year.
YMCA and Other Health Clubs
The YMCA, as well as other health clubs in the area, is often an excellent source for family activities. While these classes will probably charge a fee, there may be financial help available for those who can’t afford to pay but are in need of a parenting class in the area.
School Guidance Programs
Many schools reach out to the community through a variety of programs, including free parenting classes. These classes are typically led by local psychologists, psychiatrists, counselors and social workers. Contact your local school system’s central office for more information.
PTA, PTO, and Other Organizations
In addition to parenting programs that are promoted by a local school system, parent-teacher organizations, like a PTA or PTO, as well as other civic organizations in the area may offer parenting classes. These will typically be well advertised through the newspaper, radio stations, local marquees, and online, but if you still aren’t sure, contact your local school or chamber of commerce for more information.
http://kids.lovetoknow.com/child-behavior-development-parenting/parenting-classes-my-area

Our goal as a society should be a healthy child living in a healthy family who attends a healthy school in a healthy neighborhood.

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Dr. Wilda Reviews book: Super Baby Foods

11 Sep

Moi received a complimentary signed copy of Super Baby Food by Ruth Yaron. Here are the book details:

Product Details

Author: Ruth Yaron

ISBN-13: 9780965260329

Publisher: F. J. Roberts Publishing

Publication date: 9/9/2013

Edition description: Updated

Edition number: 3

Here is a bit about Ruth Yaron from WebMD:

Ruth Yaron

Ruth Yaron is married with three children and lives near the Pocono Mountains in Pennsylvania. When her twins were born 18 years ago, they were ten weeks premature and very sick. This is what prompted years of research on pediatric nutrition. When her third son was born in 1994, she was able to quit her job as a professor at a local university and become a stay-at-home mom. During the next two years, she wrote the Super Baby Food Book, which became a best seller and is still the best-selling book on the subject of feeding babies solid foods.

http://www.webmd.com/ruth-yaron

So, why would anyone need to buy Super Baby Food?

Let’s start with demographics. Infoplease provides the following statistics about mothers in the U.S.:

Mothers by the Numbers

Info about mothers from the Census Bureau

How Many Mothers
4.1 million
Number of women between the ages of 15 and 50 who gave birth in the past 12 months.

53%
Percentage of 15- to 44-year-old women who were mothers in 2010.

81%
Percentage of women who had become mothers by age 40 to 44 as of 2010. In 1976, 90 percent of women in that age group had given birth.

2,449
The total fertility rate or estimated number of total births per 1,000 women in Utah in 2010 (based on current birth rates by age), which led the nation. At the other end of the spectrum is Rhode Island, with a total fertility rate of 1,630.5 births per 1,000 women.

20%
Percentage of all women age 15 to 44 who have had two children. About 47 percent had no children, 17 percent had one, 10 percent had three and about 5 percent had four or more.

89.7%
Percentage of all children who lived with their biological mothers in 2012. About 1.2 percent of all children lived with a stepmother.

Recent Births
3.954 million
Number of births registered in the United States in 2011. Of this number, 329,797 were to teens 15 to 19 and 7,651 to women age 45 to 49.

25.4
Average age of women in 2010 when they gave birth for the first time, up from 25.2 years in 2009. The increase in the mean age from 2009 to 2010 reflects, in part, the relatively large decline in births to women under age 25.

29.2%
The percentage of mothers who had given birth in the past 12 months who had a bachelor’s degree or higher and 84 percent of mothers have at least a high school diploma.

Jacob and Sophia
The most popular baby names for boys and girls, respectively, in 2011.

Stay-at-Home Moms
5 million
Number of stay-at-home moms in 2012 — statistically unchanged from 2009, 2010 and 2011– down from 5.3 million in 2008. In 2012, 24 percent of married-couple family groups with children under 15 had a stay-at-home mother, up from 21 percent in 2000. In 2007, before the recession, stay-at-home mothers were found in 24 percent of married-couple family groups with children under 15, not statistically different from the percentage in 2012.

$236,500; 321,200; and 93,600
Median home value of owner-occupied units in Currituck, Dare and Hyde counties, respectively.

Compared with other moms, stay-at-home moms in 2007 were more likely:

Younger (44 percent were under age 35, compared with 38 percent of mothers in the labor force).
Hispanic (27 percent, compared with 16 percent of mothers in the labor force).
Foreign-born (34 percent, compared with 19 percent of mothers in the labor force).
Living with a child under age 5 (57 percent, compared with 43 percent of mothers in the labor force).
Without a high school diploma (19 percent versus 8 percent of mothers in the labor force).
Employed Moms
827,907
Number of child care centers across the country in 2010. These included 75,695 child day care services employing 859,416 workers and another 752,212 self-employed people or other businesses without paid employees. Many mothers turn to these centers to help juggle motherhood and careers.

62.1%
Percentage of women age 16 to 50 who had a birth in the past 12 months who were in the labor force.

Single Moms
10.3 million
The number of single mothers living with children younger than 18 in 2012, up from 3.4 million in 1970.

5.9 million
Number of custodial mothers who were owed child support in 2009.

36%
Percentage of births in the past 12 months that were to women age 15 to 50 who were unmarried (including divorced, widowed and never married women).

In 2011, 407,873 mothers who had a birth in the past 12 months were living with a cohabiting partner.

Mothers by the Numbers | Infoplease.com http://www.infoplease.com/spot/momcensus1.html#.UjC465J3Q5o.email#ixzz2ecJAMeon

Moi is not slighting dads, but mothers are the primary caretakers. We should all support dads, grandparents and those who are caretakers and have custody of children. One way of giving support is by sharing knowledge about what is healthy for children.

This is what Yaron says about Super Baby Food at her site:

Completely revised and updated edition: Coming September 2013!
Discover why Super Baby Food, with over half a million copies sold is the most complete and thoroughly researched infant nutrition resource available for feeding your baby the healthy, organic and money-saving way. Author Ruth Yaron, nationally recognized authority and media veteran shares her sound meticulous research to bring parents:

The most up-to-date, medically, nutritionally sound information on what to feed babies and toddlers at specific ages and how to prepare and store it safely.
Handy, alphabetical lists of fruits and vegetables with cooking instructions plus easy baby food storage and freezer tips.
Money-saving, easy recipes to enhance baby’s development through toddlerhood and beyond! See a sample of baby puree recipes and baby food recipes excerpted from the book right here!
Ideas for simply adding nutrition to an everyday meal by adding Healthy Extras like kelp, tahini, and nutritional yeast (among others) so that every bites counts.
Complete list of resources and tips to find organic foods and connect with others online in the Super Baby Food Community.
Excited to get started making your own nutritious baby food with a complete baby food system that is easy to use? Join parents around the world who have used Super Baby Food to feed their Super Baby. Sneak a peek preview inside the pages of the of Super Baby Food.

Enjoy this video of Ruth Yaron on the Martha Stewart Show: http://www.youtube.com/watch?v=s89EJO2dQNM

http://www.superbabyfood.com/

Moi gets approached to do reviews on all types of products. Although, she will review adult themed products, her focus is family friendly. Super Baby Foods is a system of support for families, especially during those crucial first years. The U.S. has a child obesity problem. According to the Centers for Disease Control, Child Obesity facts;

Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.1, 2

The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.1, 2

In 2010, more than one third of children and adolescents were overweight or obese.1

Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.4

Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.5,6

http://www.cdc.gov/healthyyouth/obesity/facts.htm

Super Baby Foods is a complete system to help parents make healthy choices for their children.

Yaron does not want to substitute her advice for the advice of your pediatrician regarding the needs a specific child and she makes this clear in the Disclaimer. Still, she states that her goal is “This book is designed to provide information on the care and feeding of babies and toddlers.” The book not only meets that goal but provides great recipes, a check list for the tools needed to prepare, store, and choose healthy foods for your child. The foundation of the book is “The Super Baby Food System” which she describes at pp. 5 – 10. Yaron makes the argument that home prepared organic food is better for children in the section where she answers myths about commercial baby food at page four:

The food that you make at home from fresh whole vegetables and fruits is nutritionally superior to any jarred commercial variety on your grocer’s shelf.

The book is well organized and easy to understand. The intended audience is anyone who has responsibility for caring for a baby or toddler. The recipes are clear and the “Super Baby Food System” is clearly explained along with the reasons why the system is a healthier choice for your child. This book can be classified as either an owner’s manual or toolkit for feeding your child.

This is a highly recommend from Dr. Wilda. If you are going to a baby shower or know parents with young children, you should give them this book. It is never too early to make healthy choices.

Where information leads to Hope. © Dr. Wilda.com

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Journal of American Medical Association study: Folic acid may reduce autism risk

12 Feb

Moi has written several blog posts about autism. In University of Connecticut study: Some children with autism may be ‘cured’ with intense early therapy:

In order for children with autism to reach their full potential there must be early diagnosis and treatment.

Autism Speaks reports about a University of Connecticut study in the post, Study Confirms “Optimal Outcomes”:

Some children diagnosed with autism in early childhood reach “optimal outcomes” with levels of function similar to their typical peers. The findings appear today in the Journal of Child Psychology and Psychiatry.

Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes,” says Thomas Insel, M.D., director of the National Institutes of Mental Health (NIMH). “For an individual child, the outcome may be knowable only with time and after some years of intervention.”

This week’s report is the first in a series of autism studies on optimal outcomes, sponsored by the NIMH. They follow up on earlier reports that a small group of children appear to “lose” their autism diagnosis over time. Some experts have questioned the accuracy of these children’s initial diagnoses. Others argued that simply being able to function in a mainstream classroom doesn’t mean that these children don’t quietly struggle with autism-related disabilities. http://www.autismspeaks.org/science/science-news/study-confirms-%E2%80%9Coptimal-outcomes%E2%80%9D

https://drwilda.com/2013/01/19/university-of-connecticut-study-some-children-with-autism-may-be-cured-with-intense-early-therapy/

The Journal of the American Medical Association (JAMA) is reporting in a new study that folic acid use during pregnancy may reduce autism risk.

Steven Reinberg, Health Day Reporter for WebMD reports in Folic Acid in Pregnancy May Lower Autism Risk:

A new study suggests that women who start taking folic acid supplements either before or early in their pregnancy may reduce their child’s risk of developing autism.

“The study does not prove that folic acid supplements can prevent childhood autism. But it does provide an indication that folic acid might be preventive,” said study lead author Dr. Pal Suren, from the division of epidemiology at the Norwegian Institute of Public Health in Oslo.

“The findings also provide a rationale for further investigations of possible causes, as well as investigations of whether folic acid is associated with a reduced risk of other brain disorders in children,” he said.

Taking folic acid supplements during pregnancy is already known to prevent birth defects such as spina bifida, which affects the spine, and anencephaly, which causes part of the brain to be missing.

Alycia Halladay, senior director of environmental and clinical sciences at Autism Speaks, said that “parents always wonder what they can do to reduce the risk [of autism], and this [folic acid] is a very inexpensive item that mothers can do both before pregnancy and very early in their pregnancy.”

As to why folic acid may be beneficial, Halladay speculated that the nutrient might blunt a genetic risk for autism or boost other processes during pregnancy that are protective.

Another expert, Dr. Roberto Tuchman, director of the Autism and Neurodevelopment Program at Miami Children’s Hospital’s Dan Marino Center, said, “This study suggests that in some kids autism spectrum disorders may be preventable. As a clinician who works with autism spectrum disorders it is exciting that we can look at potentially preventable factors in autism. This is really encouraging.”

Still, Tuchman cautioned that the study findings are very preliminary, and it isn’t possible to tell which autism spectrum disorders, if any, folic acid may prevent. http://www.webmd.com/brain/autism/news/20130212/folic-acid-in-pregnancy-may-lower-autism-risk

Citation:

February 13, 2013, Vol 309, No. 6 >

Original Contribution | February 13, 2013

Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children FREE

Pål Surén, MD, MPH; Christine Roth, MSc; Michaeline Bresnahan, PhD; Margaretha Haugen, PhD; Mady Hornig, MD; Deborah Hirtz, MD; Kari Kveim Lie, MD; W. Ian Lipkin, MD; Per Magnus, MD, PhD; Ted Reichborn-Kjennerud, MD, PhD; Synnve Schjølberg, MSc; George Davey Smith, MD, DSc; Anne-Siri Øyen, PhD; Ezra Susser, MD, DrPH; Camilla Stoltenberg, MD, PhD

JAMA. 2013;309(6):570-577. doi:10.1001/jama.2012.155925.

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Article

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References

Importance  Prenatal folic acid supplements reduce the risk of neural tube defects in children, but it has not been determined whether they protect against other neurodevelopmental disorders.

Objective  To examine the association between maternal use of prenatal folic acid supplements and subsequent risk of autism spectrum disorders (ASDs) (autistic disorder, Asperger syndrome, pervasive developmental disorder–not otherwise specified [PDD-NOS]) in children.

Design, Setting, and Patients  The study sample of 85 176 children was derived from the population-based, prospective Norwegian Mother and Child Cohort Study (MoBa). The children were born in 2002-2008; by the end of follow-up on March 31, 2012, the age range was 3.3 through 10.2 years (mean, 6.4 years). The exposure of primary interest was use of folic acid from 4 weeks before to 8 weeks after the start of pregnancy, defined as the first day of the last menstrual period before conception. Relative risks of ASDs were estimated by odds ratios (ORs) with 95% CIs in a logistic regression analysis. Analyses were adjusted for maternal education level, year of birth, and parity.

Main Outcome Measure  Specialist-confirmed diagnosis of ASDs.

Results  At the end of follow-up, 270 children in the study sample had been diagnosed with ASDs: 114 with autistic disorder, 56 with Asperger syndrome, and 100 with PDD-NOS. In children whose mothers took folic acid, 0.10% (64/61 042) had autistic disorder, compared with 0.21% (50/24 134) in those unexposed to folic acid. The adjusted OR for autistic disorder in children of folic acid users was 0.61 (95% CI, 0.41-0.90). No association was found with Asperger syndrome or PDD-NOS, but power was limited. Similar analyses for prenatal fish oil supplements showed no such association with autistic disorder, even though fish oil use was associated with the same maternal characteristics as folic acid use.

Conclusions and Relevance  Use of prenatal folic acid supplements around the time of conception was associated with a lower risk of autistic disorder in the MoBa cohort. Although these findings cannot establish causality, they do support prenatal folic acid supplementation. http://jama.jamanetwork.com/article.aspx?articleid=1570279

One of the implications of this study is the necessity that women receive adequate prenatal care and women really should have pre-pregnancy counseling and care.

United Health Foundation reports Prenatal Care (1990 – 2011): Percentage of pregnant women receiving adequate prenatal care, as defined by Kessner Index:

Prenatal care is a critical component of health care for pregnant women and a key step towards having a healthy pregnancy and baby. Early prenatal care is especially important because many important developments take place during the first trimester, screenings can identify babies or mothers at risk for complications and health care providers can educate and prepare mothers for pregnancy.  Women who receive prenatal care have consistently shown better outcomes than those who did not receive prenatal care[1]. Mothers who do not receive any prenatal care are three times more likely to deliver a low birth weight baby than mothers who received prenatal care, and infant mortality is five times higher[2].  Early prenatal care also allows health care providers to identify and address health conditions and behaviors that may reduce the likelihood of a healthy birth, such as smoking and drug and alcohol abuse.                                           http://www.americashealthrankings.org/All/PrenatalCare/2012

Given this recent study it is imperative that ALL women receive prenatal care particularly poor and those women at risk of difficult pregnancies.

Related:

Autism and children of color                                                https://drwilda.com/tag/children-of-color-with-autism/

Archives of Pediatrics and Adolescent Medicine study: Kids with autism more likely to be bullied                                   https://drwilda.com/2012/09/06/archives-of-pediatrics-and-adolescent-medicine-study-kids-with-autism-more-likely-to-be-bullied/

Father’s age may be linked to Autism and Schizophrenia https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Chelation treatment for autism might be harmful  https://drwilda.com/2012/12/02/chelation-treatment-for-autism-might-be-harmful/

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Dr. Wilda ©                                                                                      https://drwilda.com/

Energy drinks may pose a danger

18 Dec

The American Academy of Pediatrics is reporting at its site, Healthy Children.Org in the study, Energy Drinks Can Harm Children

Energy drinks may pose a risk for serious adverse health effects in some children, especially those with diabetes, seizures, cardiac abnormalities or mood and behavior disorders.

A new study, “Health Effects of Energy Drinks on Children, Adolescents, and Young Adults,” in the March issue of Pediatrics (published online Feb. 14), determined that energy drinks have no therapeutic benefit to children, and both the known and unknown properties of the ingredients, combined with reports of toxicity, may put some children at risk for adverse health events.

Youth account for half of the energy drink market, and according to surveys, 30 percent to 50 percent of adolescents report consuming energy drinks. Typically, energy drinks contain high levels of stimulants such as caffeine, taurine, and guarana, and safe consumption levels have not been established for most adolescents. Because energy drinks are frequently marketed to athletes and at-risk young adults, it is important for pediatric health care providers to screen for heavy use both alone and with alcohol, and to educate families and children at-risk for energy drink overdose, which can result in seizures, stroke and even sudden death.

Several deaths have been attributed to energy drinks.

The Washington Post reports in the articleEnergy drink popularity booms at college, despite health concerns:

A 2008 study of undergraduates at a large public university found that 39 percent of students had consumed at least one energy drink in the past month, with considerably higher rates for males and white students. The study, funded with a National Institute on Drug Abuse grant, noted that energy drink marketing tactics are “similar to those used to sell tobacco and alcohol to youths….”

Red Bull, which hit the country in the late 1990s, is credited with creating this industry using a Thai recipe. Today there are hundreds of energy drinks on the market, ranging from 1.93-ounce 5-Hour Energy shots to 32-ounce cans of Monster. Even Starbucks has gotten into the game, producing sparkling energy drinks and canned espresso beverages.

That proliferation has intensified debate about a long-standing question: Are energy drinks safe?

The focus of that question is often one of the main ingredients: caffeine. Energy drinks contain from 2.5 to 35.7 milligrams of caffeine per ounce; energy shots may have as much as 170 milligrams of caffeine per ounce, according to researchers. http://www.washingtonpost.com/local/education/energy-drink-popularity-booms-at-college-despite-health-concerns/2012/12/18/740e994e-45f8-11e2-8e70-e1993528222d_story.html

As more young people consume energy drinks, more problems are occurring.

Daniel J. DeNoon of WebMD Health News reports in the article, More Deaths, Illness Linked to Energy Drinks which was reviewed by Louise Chang, MD reports:

Nov. 16, 2012 — The FDA has posted adverse-event reports for two more energy drinks: 40 illnesses and five deaths linked to Monster Energy, and 13 illnesses and two lasting disabilities linked to Rockstar Energy.

The new reports follow this week’s revelation of FDA reports linking 92 illnesses and 13 deaths to 5-Hour Energy shots. The FDA previously said it was investigating the deaths linked to Monster Energy.

These adverse-event reports (AERs) are filed by patients, families, or doctors. They simply warn that the products might have harmed someone — but they do not prove that the product caused harm. The FDA can remove a product from the market only when investigation shows that the product causes harm when used according to the product label.

“If we find a relationship between consumption of the product and harm, FDA will take appropriate action to reduce or eliminate the risk,”  FDA public information officer Shelly Burgess says.

Moreover, the reports do not offer details on any underlying medical conditions that may have led to product-related illnesses.

The reports, some dating back to 2004, are not a complete inventory of all events that product users may have suffered. Most people, and many doctors, do not know how to file these reports or do not get around to filing them. And even when a product actually causes an illness, a user or doctor may not associate the product with the illness.

The new reports detail the events suffered by users of 5-Hour, Monster, and Rockstar energy drinks. These include:

  • Deaths due to heart attack or suicide linked to 5-Hour Energy
  • A miscarriage linked to 5-Hour Energy
  • Convulsions, life-threatening fear, deafness, and hemorrhage linked to 5-Hour Energy
  • Deaths due to heart attack or loss of consciousness linked to Monster Energy drink
  • Hospitalization due to irregular heartbeat, severe diarrhea, migraine, psychotic disorder, heart attack, and/or vomiting linked to Monster Energy drink
  • Disability from irregular heartbeat or stroke linked to Rockstar Energy drink
  • Hospitalization due to psychotic disorder, increased heart rate, or loss of consciousness linked to Rockstar Energy drink

All of these reports are collected by the product manufacturers. Because they market their products as nutritional supplements, they are required to submit them to the FDA. http://www.webmd.com/diet/news/20121116/more-deaths-illness-energy-drinks

There are many reasons why people use energy drinks.

Barbara Aufiero reports in the Livestrong article, Why Do People Buy Energy Drinks?

Daytime Sleepiness

Many people depend on coffee to start their day. Caffeine boosts your energy and causes you to feel more alert and awake. Since these effects wear off after a few hours, you may experience a mid-afternoon lull shortly after lunch. Energy drinks can provide the extra oomph that you seek in order to get through your day. These energy drinks are often marketed towards young adults who have responsibilities in addition to work, such as family obligations, or aspirations to further their education.

Lack of Sleep

The regular use of energy drinks may be indicative of an underlying condition such as fatigue or insomnia, according to registered dietitian Kara Mitchell from Duke University. Fatigue is a symptom of a multitude of mental and physical health conditions. Fatigue caused by insomnia or lack of sleep is treatable. However, frequent use of energy drinks may mask the underlying condition. Energy drinks may also cause adverse health conditions such as irritability and high blood pressure, according to Mitchell.

Alcohol

The majority of energy drinks do not contain alcohol. Mixing alcohol with energy drinks is not uncommon among college students and young adults. The idea is that caffeine will reduce the sedative effects of alcohol and make you more alert. Researchers assessed the attention and reaction times of young adult drinkers between the ages of 21 and 30, after drinking energy drinks with alcohol. This study was published in the February 2011 issue of “Addiction,” and found an association between alcohol and impairments in attention and reaction. However, the addition of caffeine did not mitigate these impairments.

Increase Performance

Energy drinks and sports drinks, like Gatorade and Powerade, are not interchangeable. As such, they may be kept in separate aisles at supermarkets. Dr. Edward Laskowski of the Mayo Clinic suggests drinking water or sports drinks when you exercise, not energy drinks. One reason is that sports drinks replenish fluids and electrolytes, whereas energy drinks do not. Another reason is that the caffeine in energy drinks may cause restlessness, headaches, nausea and tremors. Excessive use is associated with chest pains, seizures, heart attack and even sudden cardiac death.
http://www.livestrong.com/article/423042-why-do-people-buy-energy-drinks/#ixzz2FTi9iueO

Whatever benefit there is to the use of energy drinks must be weighed against the risks which can be substantial for some individuals.

Resources:

Energy Drinks (Audio Description)

Nutrition and Sports

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