UCLA researchers implement, evaluate effectiveness of pilot health-promotion program.

Wendy Slusser, UCLA

FINDINGS:
Research has shown that children from low-income neighborhoods are at higher risk of being obese and overweight than children from affluent neighborhoods; in fact, one-third of low-income children enter kindergarten either overweight or obese.

In an effort to address this issue, UCLA researchers implemented and evaluated the effectiveness of a pilot after-school health-promotion program that focused on increasing students’ opportunities for physical activity and healthy snacks — and boosting their knowledge about physical activity and nutrition — at four low-income, diverse elementary schools in Los Angeles County (four additional school sites were used as comparisons). The study involved students in grades 3 through 5.

After-school staff members were trained by UCLA researchers to implement the evidence-based, sequential nutrition and physical activity curriculum. Data were collected by researchers on students’ nutrition and physical activity knowledge and behavior, and their height and weight measurements, at the beginning and end of the academic year.

Results showed that the proportion of children who were obese or overweight in the intervention group decreased by 3.1 percent by the end of the school year, compared with a 2.0 percent reduction among children in the comparison group. The study found mixed results regarding diet and physical activity knowledge and behavior.

The authors conclude that enhancing after-school physical activity opportunities through evidence-based programs can potentially benefit low-income children who are overweight or obese.

IMPACT:
Findings from this study indicate that after-school programs have the potential to provide opportunities for enhanced physical activity and the development of healthy habits in children from socioeconomically disadvantaged families who may have limited access to nutritious foods and environments conducive to physical activity outside of school.

In addition, as approximately 60 percent of the students in the study were Asian American, the study helps address the dearth of published research on childhood obesity among Asian Americans. This is an important public health concern, given that Asian Americans are the fastest growing racial group in the U.S., and the literature suggests that current definitions of obesity underestimate the disease risk among this subgroup, the study authors said.

AUTHORS:
Study authors included Dr. Wendy M. Slusser, Michael L. Prelip, Mienah Z. Sharif and Janni J. Kinsler of UCLA; Jennifer Toller Erausquin of the North Carolina Division of Public Health; and Daniel Collin of California State University, Long Beach.

JOURNAL:
The article, “Improving Overweight Among At-Risk Minority Youth: Results of a Pilot Intervention in After-School Programs,” is published in a supplement to the current edition of  the Journal of Health Care for the Poor and Underserved.

FUNDING:
The study was supported by funds from the California Vitamin Settlement Fund (#20063972).

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Peds by the Bay highlights child health advocacy initiatives, forum to share ideas.

UC San Francisco medical residents Rhea Boyd (left) and Jessica Schumer

What role can social media play in an academic medical center? The UCSF Department of Pediatrics is exploring that question with the launch of its Peds by the Bay blog.

Third-year resident Rhea Boyd, M.D., and chief resident Jessica Schumer, M.D., created the blog with the support of the department’s Division of Medical Education, under Daniel West, M.D. The two women shared a vision of how this social media tool might foster a broad conversation about child health.

“We wanted to make the work we do at an academic medical center more transparent to colleagues in other settings,” said Boyd.

Both she and Schumer are affiliated with the Pediatric Leadership for the Underserved (PLUS) residency track. They hope their blog, Peds by the Bay, will serve as a platform to highlight the child health advocacy initiatives UCSF champions and offer a creative way to share ideas with child health advocates outside the university.

“We felt a blog was one way to really do that,” said Schumer. “As residents and faculty, we’re always writing, and this is a way to expand the conversation with advocates at the local, state and national level.”

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Risk in children could be reduced by 62 percent, UC Davis-led study finds.

Diana Miglioretti, UC Davis

A study examining trends in X-ray computed tomography (CT) use in children in the United States has found that reducing unnecessary scans and lowering the doses for the highest-dose scans could lower the overall lifetime risk of future imaging-related cancers by 62 percent. The research by a UC Davis Health System scientist is published online today (June 10) in JAMA Pediatrics. It is accompanied by a journal editorial.

The 4 million CT scans of the most commonly imaged organs conducted in children each year could result in approximately 4,870 future cancers, the study found. Reducing the highest 25 percent of radiation doses could prevent 2,090 — or 43 percent — of these future cancers. By also eliminating unnecessary imaging, 3,020 — or 62 percent — of cancers could be prevented, said Diana Miglioretti, lead study author and Dean’s Professor in Biostatistics in the Department of Public Health Sciences at UC Davis Health System.

“There are potential harms from CT, meaning that there is a cancer risk, albeit very small in individual children, so it’s important to reduce this risk in two ways,” said Miglioretti, who is a member of the UC Davis Comprehensive Cancer Center. “The first is to only do a CT when it’s medically necessary, and use alternative imaging when possible. The second is to dose CT appropriately for children.”

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Related links:

• UC Davis a longtime leader in appropriate CT scanning in children
• UC DOSE
• UC Health innovation center awards grant to standardize and optimize CT patient radiation doses across UC medical centers

Pulse oximetry test, already used at UCLA, will be mandatory statewide July 1.

Baby Gaël

Before he was discharged from UCLA Medical Center, Santa Monica, baby Gaël Villegas received the standard panel of newborn screenings to check for genetic and metabolic diseases and hearing. The results showed a healthy baby.

Then, one more screening — a non-mandatory test that the UCLA Health System routinely offers — was performed to check for critical congenital heart disease, or CCHD.

The test, known as a pulse oximetry screening, detected a problem. Baby Gaël was soon diagnosed with a condition that prevented his blood from flowing properly, and he was transferred to Mattel Children’s Hospital UCLA in Westwood. At 7 days old, he underwent a six-hour open-heart surgery with Dr. Hillel Laks, a professor of cardiothoracic surgery at UCLA, to repair the defect. Had it been left undetected and untreated, Gaël would have eventually ended up back in the hospital in serious condition.

“Without the screening, we would have taken him home thinking that he was perfectly healthy,” said Gaël’s father, Davis Villegas. “When they did the test and told us about his heart condition it was hard news to get, but now we see that it was a blessing in disguise. It was better to know about the problem from the beginning so they could fix it.”

While UCLA has been performing pulse oximetry tests voluntarily for the past year as part of its overall program to provide the best methods for early detection and the prompt initiation of appropriate therapies for CCHD, recently passed legislation mandates that all babies born in California hospitals be screened for CCHD starting July 1.

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Only about 40 percent of children received a 2012-13 flu vaccine.

Byung-Kwang Yoo, UC Davis

Offering flu vaccines at elementary schools could expand vaccination rates and reduce costs, according to a new study reported in the scientific journal Vaccine by researchers from UC Davis Health System; the Monroe County, N.Y,, Department of Public Health; University of Rochester Medical Center; and U.S. Centers for Disease Control and Prevention (CDC).

The best protection against flu for children at least 6 months of age is the seasonal vaccine, yet vaccination rates among children are low, according to the CDC. Only about 40 percent of children received a 2012-13 flu vaccine, which is typically provided in a primary care setting.

“Primary care practices may not have the capacity to vaccinate all U.S. children against seasonal influenza,” said Byung-Kwang Yoo, an associate professor of public health sciences at UC Davis and lead author of the study. “If the CDC’s recommendations were followed, primary care offices would have to accommodate 42 million additional patient visits during the five-month window for each flu season.”

The vaccine can be lifesaving, especially for children, who are among those most at risk for the flu and its complications. The CDC reports that 90 percent of children who died from flu during 2012-13 were not vaccinated. This is why public health experts have made it a priority to identify cost-effective ways to broaden access to flu vaccines for children.

“The flu is a disease with high probability of reaching epidemic levels even though we have an effective vaccine,” said Yoo, who was with the University of Rochester when the study was conducted. “Our goal is to find ways to ensure that the best prevention is as accessible as possible.”

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UCSF pediatrician: “The best thing to replace soda is water or milk.”

While there has been a steep decline in kids’ consumption of sugar-sweetened beverages in California, African-American and Latino children may be replacing soda with 100 percent fruit juice while their white peers are not, according to a new study from UC San Francisco.

The study was the first to compare trends of sugar-sweetened beverages and 100 percent juice consumption in California.

“The decrease in the consumption of sugar-sweetened beverages among kids is a promising public health trend,” said Amy Beck, M.D., M.P.H., lead author and pediatrician at UCSF Benioff Children’s Hospital and San Francisco General Hospital and Trauma Center. “But it is concerning that minority children are increasing their consumption of 100 percent fruit juice, which often has just as much sugar as soda.”

Researchers examined data from the California Health Interview Survey, a telephone survey conducted every two years from 2003 to 2009, which asked parents how many servings of sugar-sweetened beverages and 100 percent fruit juice their children, ages 2 to 11, consumed the day before.

“Parents who are thinking actively about nutrition wouldn’t give their kids Coca-Cola, but might give apple juice,” said Beck. “But 8 ounces of Coca-Cola contains 27 grams of sugar, as does 8 ounces of apple juice. We need to make sure parents understand the best thing to replace soda is water or milk.”

The results are published in the June/July issue of journal of Academic Pediatrics.

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PCORI awards $1.6M for project.

Tumaini Coker, UCLA

The Patient-Centered Outcomes Research Institute (PCORI) has approved a $1.6 million research award to the Children’s Discovery and Innovation Institute at Mattel Children’s Hospital UCLA to study the use of videoconferencing technology to deliver behavioral health services to pediatric patients in community primary care settings.

Dr. Tumaini R. Coker, assistant professor of pediatrics at UCLA, will lead the research. The project will focus on the integration of developmental, behavioral and mental health services into pediatric primary care using live videoconferencing technology. This study will examine whether using this telehealth technology can be an effective, efficient and family-centered way to provide these integrated services to children in low-income communities.

“One of the key strengths of this project will be the emphasis on the partnership between UCLA researchers,  the community clinics and the families to develop and test this strategy to bring behavioral health services into the primary care setting using live videoconferencing visits,” said Coker.

The project brings together UCLA researchers from general pediatrics, developmental and behavioral pediatrics, child and adolescent psychiatry, the UCLA/RAND Prevention Research Center and the UCLA Center for Health Services and Society to work in partnership with Northeast Valley Health Corp., one of the nation’s largest community health centers.

The study is part of a portfolio of patient-centered research that addresses PCORI’s national research priorities and will provide patients with information that will help them make better informed decisions about their care.

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Eight-bed pediatric ED to help fill need for child-focused emergency services.

Christine Cho, clinical director of UCSF's Division of Pediatric Emergency Medicine, examines a young patient.

New signs and fresh arrows painted on the sidewalks of Parnassus Avenue mark the important opening of a new, child-friendly, Pediatric Emergency Department (ED) at UCSF Benioff Children’s Hospital, on UCSF’s Parnassus campus.

In late April, a new, eight-bed pediatric ED opened its doors — most of which are covered in dinosaur wall stickers or painted with under the sea vignettes — to the San Francisco community, to help fill the need for child-focused emergency services.

Prior to its opening, pediatric patients with emergency health problems were seen by pediatric or emergency medicine providers in the main ED. The whitewashed rooms with adult-sized equipment made for a setting that was often stressful for children, who are often terrified at the prospect of being in the emergency room in the first place.

For walk-in pediatric patients and their parents, the new entrance, check-in and triage are separate from the main ED; the pediatric ED entrance is just around the corner from the gift shop on the first floor of Moffitt Hospital.

It is located in a former adult prepare space, which was used for adult anesthesia pre-operation. The space also houses the lower acuity pediatric ED beds, as well as the pediatric urgent care facility and a family-friendly waiting area with toys and games.

Because the urgent care unit is located within the same space as the pediatric ED, patients who arrive at check-in can be quickly triaged and screened for the appropriate level of care. The four higher-acuity pediatric ED beds are located just across the hall and adjacent to the main ED, but are outfitted with equipment designed for children and their unique needs — as well as the stickers, Disney DVDs and painted walls that make it a more welcoming setting for kids.

To staff the new department, UCSF has brought on two new physicians who are board-certified in pediatric emergency medicine, in addition to two who were already on the faculty. Residents from both the emergency medicine and pediatrics programs rotate through the pediatric ED as part of their training at the academic medical center.

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Low-cost, at-home treatment involves sensory exercises with common household items.

Michael Leon, UC Irvine

Children with autism showed significant improvement after six months of simple sensory exercises at home using everyday items such as scents, spoons and sponges, according to UC Irvine neurobiologists.

They found that a treatment known as environmental enrichment led to notable gains in male subjects between the ages of 3 and 12. Results appear online in Behavioral Neuroscience.

Study co-authors Cynthia Woo and Michael Leon randomly assigned 28 boys to one of two groups, balanced for age and autism severity. For half a year, all subjects participated in standard autism therapies, but those in one group also had daily sensory enrichment exercises.

Parents of these children were given a kit containing household products to increase environmental stimulation, including essential-oil fragrances such as apple, lavender, lemon and vanilla. The boys smelled four of these scents a day and listened to classical music each evening.

In addition, the parents conducted twice-daily sessions of four to seven exercises with their children involving different combinations of sensory stimuli – touch, temperature, sight and movement among them. Each session took 15 to 30 minutes to complete.

After six months of therapy, 42 percent of the children in the enrichment group showed significant improvement in behaviors commonly affected by autism – such as relating to people, having typical emotional responses and listening – compared with 7 percent in the standard-care group.

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Cable TV channel will feature grade-schooler treated at UC Davis.

UC Davis Dr. Jean Wiedeman (left) and Precious Reynolds

Cable television channel Animal Planet was at UC Davis Children’s Hospital last week to produce an episode of the series “Monsters Inside Me” about Precious Reynolds, the Humboldt County grade-schooler who in 2011 became the third person in the United States known to have survived rabies infection.

The team treating Precious was led by Jean Wiedeman, associate professor of pediatric infectious diseases. Wiedeman coordinated her care with state, local and federal officials at the U.S. Centers for Disease Control and Prevention (CDC), Carol Glaser of the California Department of Public Health’s Encephalitis and Special Investigations Section, and county health departments in Humboldt and Sacramento counties.

Portions of the Animal Planet program will include re-enactments. These were taped at the Center for Virtual Care with the assistance of Program Manager William Hammontree. An airdate has not been set.

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UCSF research explores benefits of early limited formula (ELF).

Recent public health efforts have focused extensively on reducing the amount of formula babies are given in the hospital after birth. But in the first randomized trial of its kind, researchers at UC San Francisco have found that giving small amounts of formula in the first few days of life to infants experiencing high levels of early weight loss actually can increase the length of time their mothers end up breastfeeding.

“Until now, we haven’t explored if it is possible to identify babies who might benefit from early formula use. This study provides the first evidence that early limited formula (ELF) can provide important benefits to some newborns,” said lead author Valerie Flaherman, M.D., M.P.H., an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at UCSF Benioff Children’s Hospital. “Based on our findings, clinicians may wish to consider recommending the temporary use of small amounts of formula to new moms whose babies are experiencing significant early weight loss.”

Study findings will be published online by the journal Pediatrics, and will appear in an upcoming print issue of the journal.

“Formula use has the potential to be a slippery slope to breastfeeding discontinuation, but ELF is a different way to envision using it,” said Flaherman. “Rather than giving full bottles of formula that make it hard for the baby to return to the breast, ELF is a small amount of supplementation with a clear end point that alleviates some of the stress new mothers feel about producing enough milk.”

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