A round-up: A new 9-strain HPV vaccine! The effects of debunking vaccine myths! News on phthalates, toys, IUDs, juice and breastfeeding!
I’ve been pretty busy the past several weeks with my HealthDay stories, my Forbes blog and my book, so I’ve neglected this blog more than I planned. However, I’d love to highlight the worthwhile studies and the stories I’ve covered elsewhere, so here’s a quick round-up of the past two weeks of my work in other places.
First, the FDA just approved Gardasil 9, an HPV vaccine that covers five more strains of the viral infection. Check out the details on my Forbes post, where you’ll learn that the new strains will prevent up to 90 percent of cervical, vulval and anal cancers.
Next, over at NPR, I discuss some new research that looked at the effects of debunking… myths about the flu vaccine. Yes, yes, I know. The irony is rich since I’m so well known for debunking exactly that vaccine, and they did test one of the misperceptions that I discuss, the false belief that the vaccine can give you the flu. I spent about an hour and a half talking to the lead researcher on that study and learned a great deal about science communication, plus some reminders of concepts I had previously learned from folks like Melanie Tannenbaum and Liz Neeley. There is actually a lot more to discuss on this topic, but I’ll be trying to get to that next week (and it’s something I’ll be frequently returning to).
Also at Forbes today, I wrote about a new BMJ study finding that press releases – GASP! – exaggerate scientific findings. It’s a duh study, to be sure, but there are some worthwhile insights I included from Gary Schwitzer of Health News Review and Matt Shipman, a PR officer at University of North Carolina. (I also wrote earlier this week about the return of Schwitzer’s HealthNewsReview.org with new funding.)
And then there are several HealthDay stories I think would be of interest to readers of this blog, the first of which is about prenatal exposures. (Note: HealthDay syndicates its stories, so I may share links to WebMD or CBS or other outlets that have run the story.)
While the compounds called phthalates have been banned from most children’s toys and baby products, they are still all around us and in hundreds of household products – and there is new evidence that they may play a role in your child’s development when the fetus is exposed to high levels. This is an observational study, so it can’t show that phthalates cause a lower IQ in children. It’s also only one study, and this is a new area of study, so I’m sharing the news cautiously, but it’s worthwhile to look for ways to reduce your exposure without becoming paranoid about it.
Another story I wrote had to do with a case study of a teenage football player who experienced atrial fibrillation – an irregular heart rhythm in the upper chambers of the heart – after a hard hit to the chest. This is a case study, which by definition means the circumstances are very rare, but it’s still worth drawing attention to the fact that symptoms like those described in the article shouldn’t be ignored, particularly following a hard hit in a sports game.
Another piece this week looked at rates of female contraception use over the past several years. The biggest change is that IUD use has nearly doubled, but I found the comments from Planned Parenthood about the impact of not having insurance on contraceptive choices particularly interesting.
Though these stories ran last week, they may also be of interest: breastfeeding just a few extra months might reduce risk of obesity in babies who are already at risk, and mothers who are obese during pregnancy have higher risk of poor birth outcomes.
Also last week, at Forbes, I wrote about the high rate of injuries caused by toys – which is dominated by non-motorized scooters. No, I don’t think there’s a problem with parents letting their children ride scooters, but they do need to be supervised and to be wearing protective gear (someone has pointed out that the photo on the post features one boy with a poorly fitting helmet).
I also wrote about the finding from a study in the journal of the American Dental Association that 100% juice doesn’t contribute to tooth decay. I oddly caught some pushback on this particular article from folks on social media and elsewhere who seem to think I’m promoting juice or in with Big Abbott or something. To the contrary, I think the guidelines from the American Academy of Pediatrics of 4 to 6 oz. a day are sensible. I also recognize that 4 to 6 oz. is a very, very small amount of juice and that juice is best thought of as a treat. That doesn’t change the fact that this amount – and in fact more than double this amount, as consumed by many kids in the study – doesn’t increase the risk of caries. Yes, I would imagine that if kids were swilling 20 or 30 oz. a day, we might see different results. But alas, that’s not the study I covered.
Finally, although I didn’t write this, I want to draw your attention to an excellent post over at Science of Mom about the Tdap during pregnancy. She discusses both the flu vaccine and the pertussis vaccine, but she spends extra time discussing the safety of the Tdap during each pregnancy. Check it out.
Regular readers of this blog know that I frequently write about vaccines and am particularly known for addressing misinformation about the flu vaccine. While the flu vaccine can reduce the risk of catching the flu, it cannot eliminate your risk, and it does nothing to prevent colds and most other viruses. Practicing good hygiene – washing your hands with soap and water, covering your mouth during coughs and sneezes, keeping hand sanitizer handy – can also go a long way to reducing your risk of getting sick.
But, alas, many of us will still end up catching a cold, the flu or some other nasty over the next few months. That means deciding how to treat it, and many of us might reach for acetaminophen, the fever-reducer and pain reliever Americans know as Tylenol. The handy infographic below, provided to me by a PR friend, offers some facts about colds and flu and emphasizes the need to check products to be sure you know whether they have acetaminophen in them.
Acetaminophen is one of my go-to pain and fever relievers, but taking too much can be extremely dangerous and potentially cause liver damage. So, if you or a family member is taking it, you want to be sure you’re not getting a double or triple dose if you’re taking other combination meds at the same time. McNeil Pharmaceuticals, the manufacturers of Tylenol and the creators of the infographic below, have an online medicine checker that lets you find out whether a specific product already contains acetaminophen. Read the rest of this entry »
A little over a week ago I wrote about sisters Natalia Luis and Cidalia Luis-Akbar who were climbing Mt. Kilimanjaro – the highest peak on the African continent – to raise awareness about earlier and more accurate prenatal screening, particularly for high-risk pregnancies. Well, the women made it! They reached the 19,341-feet summit on Thanksgiving Day, though they’re still not quite at their $500,000 fundraising goal. Seeing their photos below, provided to me by the Children’s National PR team, brought back memories of my own climb. If you’d like to watch a video after they reached the top, you can view that here.
It’s a bit ironic that since I began researching and writing the chapter section of our book on SIDS (sudden infant death syndrome) and on bedsharing, I’ve been assigned two articles related to infant sleep deaths and then saw a study last week about a new discovery related to SIDS. It’s an area I’m particularly interested in and well-versed in, and about which I’ve blogged about before here and here.
Despite how much I had already read, however, I was surprised to learn a number of new things, so it seemed a good time to write about the new studies and to provide some hints of what’s to come in the book. The new studies are especially interesting in light of what I’ve learned in my research, such as possible physiological aspects of SIDS involving arousal, some reasons upright sleeping (such as in a car seat) may be a SIDS risk, and why soft bedding *under* a baby is a SIDS risk even if the baby sleeps on her back.
Let’s start with the study in Acta Neuropathologica last week which identified a possible brain abnormality linked to SIDS cases. Researchers inspected tissue from the hippocampus in 153 babies who died suddenly between 1991 and 2012. Some of the deaths were classified as SIDS or otherwise unexplained, and the others were due to infection, suffocation, an accident, homicide or other identifiable reasons. The hippocampus is a part of the brain involved in “autonomic function.” Autonomic function is the body’s internal management system: it’s the part of the nervous system that controls breathing, heartbeat, digestion and other bodily process that we need to survive but which we do not consciously control. The hippocampus in particular is involved in aspects of breathing and heart function.
The autonomic function also controls our ability to arouse from sleep, especially if something is wrong. It’s long been thought that SIDS occurs in part because some infants have an underlying genetic or other biological condition that affects their ability to arouse and/or their autonomic control over cardiorespiratory functions. When they are placed in a difficult environmental circumstance – such as sleeping on their stomachs or being around tobacco smoke – they cannot wake themselves up when necessary, such as if they briefly stop breathing for a few moments or have a heartrate irregularity.
The combination of some kind of breathing or heart episode and their inability to arouse themselves then appears to lead to their death. It’s possible that certain unsafe sleeping environments may even trigger the problem in the first place, such as reducing their ability to breathe well. (HOWEVER – and this is important – remember that it is never possible to remove all risks for SIDS. Even babies sleeping in safe sleeping environments, on their backs, can and do die from SIDS, and it is impossible to make 100% certain that an infant will not die in his or her sleep.)
Evidence has been building for this hypothesis, and the latest study lends even more support. Among those 153 babies, 41 percent of the ones who died for unexplained reasons (including 43 percent of those specifically identified as SIDS cases) had an abnormality in the hippocampus. Only 8 percent of the babies with explained deaths had this brain abnormality.
This is good news because it provides more clues to what might actually cause SIDS, or at least some cases of it. The abnormality was present in less than half the babies with SIDS, but researchers have already suspected that there might be multiple ways that SIDS deaths occur. At the same time, these findings are just one small step toward understanding SIDS better: this was a pretty small sample size (though that’s typical for SIDS-related studies), and the abnormality can only be identified in an autopsy, so it’s not something we could screen for.
So that study dealt with physiological aspects of SIDS. The other two I wrote about – and a third I’ll get to in a moment – dealt with the environmental aspects.
The first was actually from last month and deals with both SIDS and infant sleep suffocation deaths: the dangers of infants sleeping on sofas (the link goes to the article I wrote for HealthDay). The study, from Pediatrics Oct. 13, concluded that the sofa was pretty much among the most dangerous places for babies to sleep. Among just over 1,000 deaths examined for the study, 13 percent occurred on a sofa.
This finding isn’t news, of course, but I’m pointing it out because among the findings, babies who died sleeping on a couch were more than six times more likely “to be found in a new sleep location.” That means they don’t usually sleep on the couch. And that means some of these deaths quite likely could have resulted from parents accidentally falling asleep on the sofa, something that has been documented in other studies and will be more relevant in a moment.
The second study came out yesterday and found that more than half – yes, more than HALF – 55 percent, to be exact – of parents still use soft bedding in their infants’ sleep environments. The good news is that this number is a big drop from the 86 percent using soft bedding back in 1993. The bad news is that the proportion hasn’t budged much in the past decade, but soft bedding is still as much a risk factor for SIDS as it ever was. Clearly this message isn’t getting out as much as it needs to.
I wrote about the study for HealthDay and was impressed as I read it that the data set was so large: 19,000 parents interviewed between 1993 and 2010. But I also remember reading that the use of blankets *under* babies had increased from 26 percent to 32 percent over that time and wondering about the mechanisms for SIDS with soft bedding under sleeping babies. It makes sense that sleeping on pillows provide opportunities for babies to roll or sink into the pillow – a dangerous situation – but why would softness under a baby sleeping on her back and not yet rolling be a problem? Read the rest of this entry »
Most of my blog posts center on recent research or interpreting studies relevant to parenting, and that means I’m frequently writing about vaccines. This time, rather than writing about a new study on vaccines or dispelling myths about them, I’m letting you know about a few organizations whose advocacy centers on immunizations (both in the U.S. and overseas) and then a third with a different focus.
Should you plan to participate in Giving Tuesday – the only part of the Black Friday – Small Business Saturday – Cyber Monday commercial insanity that I actually don’t find to be obnoxious – then these are organizations you may want to consider including in your giving campaign. (Side note: I really like the concept of Small Business Saturday, but I find the whole idea of such a shopping frenzy weekend so distasteful that I don’t tend to support any of it.)
The first organization is Voices for Vaccines, an organization headed up by my friend Karen Ernst which is unique in that it brings together parents specifically to counter the misinformation and fear-mongering promoted by anti-vaccine advocates. VFV encourages parents to speak up about vaccinating their children and has published on their blog several wonderful stories of parents who previously did not vaccinate and now are catching up or have caught up with vaccinations. The goal of VFV is to gather 1,000 donors on Giving Tuesday to support them, which you can do at www.voicesforvaccines.org/support. You can also help by joining their Facebook event here and inviting friends. You can also share their video below with your friends, family and colleagues.
The second organization is Shot@Life, whose button I’ve included on my blog for a while. Shot@Life is a United Nations Foundation campaign that “educates, connects and empowers Americans to champion vaccines as one of the most cost-effective ways to save the lives of children in developing countries.” For Giving Tuesday, the Bill and Melinda Gates Foundation will match donations to Shot@Life for up to $200,000. You can donate here.
Then, the third organization, though not vaccine-related, offers an opportunity to help by getting rid of what you no longer need. A group of dad bloggers called NYC Dads Group are collecting gently used baby items for Baby Buggy. You can find their event here.
The ideal scenario? Support the grassroots efforts of Voices for Vaccines in making sure anti-vaccine advocates don’t control the conversation about the safety and effectiveness of childhood vaccines in the U.S., support the efforts of the UN Shot@Life campaign in giving children overseas access to the life-saving vaccines we have here, and then unload those baby swings and bouncer seats in your closets with the NYC Dads Group. Whatever you choose to do with your time or money this Tuesday, finding a way to give back – thereby counteracting the retail madness of Friday and Monday.
Here is the video of Voices for Vaccines:
*video embed code*
I began writing this post almost two months ago when a study I had been waiting for almost a year came out – one looking for clinical, epidemiological (“real world”) evidence for “cocooning,” which I’ll explain in a moment. But now I’m kind of glad I didn’t finish it then because it’s perfect to combine with the study that just came out looking at the safety of the Tdap vaccine during pregnancy.
The Tdap is the adult booster for the tetanus-diphtheria-acellular pertussis vaccine. While the tetanus booster is important for everyone, it’s the pertussis, or whooping cough, protection that is a bigger issue at the moment because rates have been climbing in a big way over the past decade. I’ve written before about the reasons for that: primarily the waning effectiveness of the vaccine with some contribution from geographical clusters of low vaccination rates. I’ve also written about the insights we’ve gleaned from the “baboon study” which call into question how effective cocooning might be in preventing the littlest babies from catching the illness. And that’s all the more reason why both these studies are so important.
The most recent one, published in JAMA Nov. 12., looked at pregnancy and birth outcomes in women who received the Tdap during pregnancy. It offers reassuring conclusions: no increased risk of preterm birth or underweight babies occurred among mothers getting the prenatal Tdap, and no increased risk of high blood pressure in pregnancy among those getting the Tdap before 20 weeks of pregnancy. A moderately increased risk of the bacterial infection chorioamnionitis showed up in those getting the Tdap, which I’ll address in a bit, but with more than 120,000 participants in the study, it’s a large enough study to find these results reliable.
As I wrote over on Forbes today, the Tdap has been recommended by the CDC during between 27 and 36 weeks of every pregnancy – yes, *every* pregnancy, even back-to-back ones – since October 2012. The hope is that, since infants don’t receive their first DTaP vaccine to protect against pertussis until 2 months old, they will receive sufficient antibodies through the placenta during pregnancy to offer some protection in those first few months, especially since infants under 3 months old are at the highest risk for death from whooping cough. And indeed, as I noted on the Forbes piece, a small JAMA study earlier this year showed a much higher pertussis antibody concentration – an average five times higher – in babies whose mothers got the shot.
This recommendation replaced the one for postpartum Tdap vaccination, part of a “cocooning” strategy in which all the individuals who will be around an infant too young to be vaccinated – such as household members, caregivers and grandparents – get the Tdap booster. The concept is basically a micro version of herd immunity: reduce the risk that those around a baby will get sick and thereby reduce the risk that the baby will get sick.
The problem is that nearly all the studies looking at the effectiveness of cocooning has been based on mathematical models, not on real-life (epidemiological) evidence. The difference is that mathematical model evidence calculates how many cases *should* be prevented based on certain assumptions, including the assumption that a person who isn’t coughing doesn’t have pertussis and can’t transmit it to others. And the baboon study showed us that those assumptions cannot necessarily be made. (Caveat: the study was in baboons — we don’t *know* that that asymptomatic transmission occurs in humans too, but it’s something we have to consider as a possibility.)
For example, a study I wrote about a few years ago found mothers were almost four times more likely than other household members to transmit pertussis to their infants. The authors calculated a substantial theoretical drop in infant infections – cutting infant cases in half – if mothers were vaccinated. But this conclusion was based, again, on math models and assumptions.
Meanwhile, epidemiological evidence would show an actual reduction in disease cases from cocooning, something that’s been shown with other vaccines but not yet with pertussis. The only studies that came close were one finding that postpartum Tdap immunization didn’t reduce cases in infants (ie, the cocooning wasn’t working if just mothers were vaccinated) and one last year that found indirect evidence that adolescent boosters moderately reduced infant pertussis hospitalization, though these findings speak more to herd immunity than to cocooning.
So, the big question – especially after the baboon study – is whether cocooning is effective in protecting infants from pertussis. And the study in Pediatrics in September began to give us the first glimmer of an answer: cocooning is not futile, but its effectiveness appears much more limited than hoped. Read the rest of this entry »
As I write this, two businesswomen are somewhere along the long trek up Mount Kilimanjaro, the tallest mountain in Africa. Although I don’t typically write about awareness campaigns, I wanted to give a shout out on this one because Kilimanjaro has a special place in my heart, and the women’s cause does as well. Sisters Natalia Luis and Cidalia Luis-Akbar are making the climb to raise awareness about the importance of earlier and more accurate screening and diagnosis during high-risk pregnancies, thereby hopefully improving survival and quality of life for newborns at risk for premature birth or other complications.
The women were sponsored by Children’s National Hospital in Washington D.C., whose public relations folks reached out to me with this story. Although the hospital has already raised more than $200,000, their goal is more than double that, at half a million dollars. According to the press materials for the climb (available here), “Children’s National will use funds raised through Natalia and Cidalia’s 2014 Trek to engage bioengineers and bio-computational specialists to develop a holistic ‘fetal monitoring system,’ building off existing work spearheaded by Adré Jacques du Plessis, Children’s National’s Chief of Fetal and Transitional Medicine.”
In short, the hospital is raising funds to complete their design of software capable of analyzing data from ultrasound, fetal brain MRI results, placenta research and other diagnostics, and their hopes are admittedly lofty: “The resulting technology and protocols will allow our team, and ultimately other healthcare providers across the nation and around the world, to identify distress signals in utero, halt the development of cerebral palsy, spina bifida, and other diseases before they start, and ensure a safe transition for every baby.”
That’s clearly a bit overblown with the PR language — I don’t think climbing Kilimanjaro to raise a half million dollars will stop cerebral palsy and spina bifida (which, by the way, is best prevented with adequate folic acid intake) — but I am curious about what the software might be able to provide in terms of long-term research since Children’s National does conduct ongoing research that may lead to improved outcomes. Sometimes more information is beneficial, and sometimes it is harmful (especially if it leads to unnecessary interventions and causes undue stress and anxiety), so my hope is that the data gleaned from the software can lead to evidence-based interventions or preventive strategies, not just more information and more interventions. Read the rest of this entry »
Okay, so I admit I had a little fun with the headline, but that’s about all the fun I can have with this issue since the study I’m writing about is far from amusing. Research in Pediatrics last week investigated poisonings involving laundry detergent pods, and the numbers are a bit staggering, even to me. I’m not saying that to be alarmist – prevention in the home is mostly pretty straightforward – but when I did the math, a child under 6 is exposed to a laundry detergent pod once every hour, and about three out of every four calls involves the child ingesting the detergent. (You can read the full study for free.)
I didn’t coin the term “pretty poisons,” which is described in poison prevention tip sheets as poisons that look like tasty products to eat or drink, such as candy or juice, but it seems apt for the colorful detergent pods that make doing laundry a little more convenient. Consider the bright Jolly Rancher green of the ones from the Consumer Product Safety Commission pictured here – to an infant or toddler, who accounted for two thirds of the poisonings in the study – it could look like a sweet.
Researchers with Nationwide Children’s Hospital in Ohio analyzed data on all laundry detergent pod exposures in 2012 and 2013 in the National Poison Data System (pulled from all the poison control centers throughout the U.S.) for kids under 6 years old. The total? 17,230 exposures. (I use exposures as they do in the study since it’s technically possible, though unlikely, that the same kid had more than one exposure during that time.)
Not surprisingly, 74 percent of those cases involved children under 3 years old. The authors pointed out that 1- and 2-year-olds are developmentally primed to put darn near anything into their mouths. With their “newfound mobility, exploration, curiosity and teething,” they said, it’s the prime age for getting into stuff they shouldn’t. Among the 900 or so poison reports that included details on the scenario, just over 40 percent of the cases involved pods left out or in the child’s sight.
Most of the overall exposures – 80 percent of them – were kids eating or swallowing the detergent pods, so it was unsurprising that the most common problems were vomiting (about half of all kids) and coughing or choking (13%). Other problems kids suffered included eye irritation or pain, drowsiness and red eyes. Only one death, a 7-month-old boy, was definitively connected to a laundry pod poisoning, but more than 700 children (4.4% of the total) were hospitalized, and several dozen experienced some pretty serious effects: Read the rest of this entry »
I’ve been back in the U.S. just over a week, and I’m only just starting to get on top of my schedule (as much as that is ever possible, that is). The re-entry has been… I’m not sure how to describe it. In some ways it’s been rough, in others calming, in others disorienting. My head and heart have been swirling since I returned. The four long flights back — totaling more than 24 hours in the air — were relatively uneventful but exhausting nonetheless. Going from warmth and sunlight to cold and early darkness after the time change has been rough (more the light change than the temperature change). The jet lag has surprisingly been helpful, aiding me in a normalized sleep schedule for the first time in more than two years. (I’ve been aiming to be in bed by 1 a.m. — rather than my usual 3 or 4 a.m. — and out of bed by 9 a.m. While I haven’t met those goals daily, I’ve come closer than ever before for the past week, and I’m hopeful I can keep it up.)
I was thrilled to see my husband and my children, of course, but it feels incredibly odd to simply drop back down in the comforts of my life in the U.S., into my mundane (if impossibly busy) family life in a small town in the Midwest after spending two weeks intimately observing some of the worst healthcare facilities in the world and some of the most extreme poverty in the world. Last Thursday, my son had a routine dental check-up, and it was impossible not to compare the clean, spacious, heated office, with a corner for toys and an elevator whose glass back overlooks an indoor fountain, with the facilities I observed: cervical cancer screenings in a cell-like, hot, poorly lit room with mosquitoes buzzing about and the cacophony of mothers and children waiting for care just outside the door. A labor and delivery room where the toilet I used, just 15 feet from a laboring woman, had no seat, no toilet paper, no trash can and no soap that I could find — though it had more than two dozen mosquitoes buzzing about. And so on.
At the same time, I’ve been struggling just to get back into the swing of work. Although these two weeks in Africa were intense and full of work themselves, my stateside work was obviously put on hold, and I had stories to write and deadlines to meet starting from the weekend I returned. And then there were all the studies and other stories that have came out in the past week or two that I wanted to write about even while recognizing that I can’t freeze time and write about them all. (Expect to see some of them here and some on my new Forbes blog as I’m able to slowly catch up.)
I also lamented that I had so much to say in this blog, so many impressions from our visits that I had wanted to write about while there and after returning, from my additional pumping adventures (wait ’til you hear some of those!) to my personal experience as a mom and journalist working for two weeks far from my kids to visiting a mobile circumcision unit, observing a cervical cancer screening, talking with multiple HIV-positive wives of the same man, conversing with mothers and grandmothers at the market and all the many other experiences that have informed my understanding of Mozambican life. Yet it’s been all I can do to meet my minimum obligations here in Peoria, spend time with my family and get sleep. Read the rest of this entry »
Today’s guest post for Halloween is from Rachel Drake, a community manager at Obrello, an insurance company. The inclusion of this guest post does not mean that I endorse the services of Obrello. I think the information is important, and it is evidence-based, so I am hosting the guest post.
Sure, Halloween is frightfully full of ghosts and goblins, or maybe Iron Men and Elsas, but most children and parents recognize that it’s an evening of fun. That does not, however, mean that there are no safety concerns to look out for.
With little people dressed up in costumes that may partially obscure their vision, running around in the dusk and dark along the street, getting hit by a car is a real concern. According to research compiled by the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS) from 1990-2010, more children die from being hit by a car on Halloween than on any other night of the year.
And during what time frame do the most pedestrian accidents occur that night? Unsurprisingly, peak trick-or-treating times are the most dangerous for children, particularly from 5pm-8pm.
Image from Obrella.com.
Some parents may worry about urban legends focusing on razor blades in candy or about their children running and tripping as they traipse from one house to the next. But car collisions are the perhaps the biggest risk.
Even though child pedestrian fatalities are trending down every year, the data is still harrowing. Parents can take two approaches to reduce the risk of children’s deaths on Halloween. During trick or treating, be smart about where you go and don’t let children under the age of 12 trick-or-treat alone. Then, when you are driving, take extra precautions and keep an extra careful eye out for trick-or-treaters who may not be watching for you.