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Parenting, Pediatrics

Rattled by one child’s injury, a whole family becomes accident-prone

In an era when so many children spend gorgeous days sequestered inside suburban homes in front of glowing displays, I’m always thrilled to see kids playing in the street. Unless those kids are riding bicycles without wearing helmets. Then I’m horrified – many of the most emotionally traumatic experiences I had in the ER or in the ambulance were with sick or seriously injured children. I can’t even begin to imagine what sort of stress the children’s parents were going through.

Pediatrician-journalist Perri Klass, MD, thinks that one child’s serious injury might be so unsettling it could make the entire family more accident prone for months afterward. She builds her conclusions on a study conducted by University of Washington pediatrics professor Brian D. Johnston, MD. As Klass writes in her article for the New York Times:

Dr. Johnston and his colleagues studied large populations of children and found that if a child was injured seriously enough to be hospitalized, all the children in that family were at higher risk of injury for the next three months. After three months, the families’ risk returned to normal. In a follow-up prospective study published earlier this year, almost 20 percent of the families had a child injured or re-injured badly enough to need medical attention.

Moreover, children who experience symptoms of post-traumatic stress after a serious injury were more likely to be re-injured – as were their siblings, too, Klass wrote. And whole families often experience post-traumatic stress after car accidents.

Klass writes that parents have more control over their stress levels before an accident occurs. We can do a lot to prevent accidents by making the most of simple, effective safety measures like seat belts, bike helmets and fences around pools. And those measures don’t have to get in the way of childhood exploration and learning:

You want to keep children safe so that they can enjoy being children, and enjoy the summer as completely as possible. It’s our job to make sure that active and daring do not mean accident-prone.

In the News

Disagreement and uncertainty about Gulf oil spill effects on human health

Almost 8 weeks into the Gulf oil spill, the spill’s stunning ecological consequences are hard to ignore. But the official position of the Centers for Disease Control and Prevention and several other local and national officials is that the spill poses only mild, temporary health risks to cleanup workers and none at all to the general public.
As MSNBC reports, the public is skeptical of the governments’ claims relating to oil spill safety. And a recent post in the Los Angeles Times’ Greenspace blog points out that there haven’t been enough studies of the long-term health effects of oil spills to fully understand their impact on humans:

“Several people who worked on the Valdez spill complained of health problems,” added Dr. Stephen Cunnion, medical director for the Center for Health Policy and Preparedness at the Potomac Institute for Policy Studies. Skin and respiratory problems were the most common complaint from workers there, but little is known about longer-term effects. “There was no study,” Cunnion said. “Not following up on people in these situations has always been a problem.”

Another recent article in the Washington Post notes that the more than 1 million gallons of chemical dispersants BP has pumped into the Gulf might change the toxicity of the oil.

The dispersants themselves, Corexit 9500 and Corexit 9527A, are classified as posing low and moderate human health risks. According to its Material Safety Data Sheet (MSDS), Corexit 9527A contains a substance called 2-butoxyethanol, which can the irritate skin, lungs and digestive tract and can cause nausea over short-term exposure and damage liver and kidneys in the long term. The MSDS notes that the potential human hazard of Corexit 9527A is “high,” but that the potential for exposure while wearing gloves, goggles and standard protective clothing is low. The Post article also questioned whether officials in charge of the cleanup are doing enough to keep workers safe:

The National Institute of Environmental Health Sciences designed a worker safety training course in English, Spanish and Vietnamese that all gulf oil spill cleanup workers are supposed to complete before they can be hired. They are also supposed to be equipped with protective gear, such as gloves and boots. Nevertheless, anecdotal reports have emerged of workers doing cleanup in street clothes and bare hands, raising questions about how well trained and equipped they are.

The EPA has already asked BP to discontinue its use of dispersants and to ramp up its efforts to find less toxic alternatives. But BP has continued to use them, and last week a federal expert panel recommended as much.

In addition to the physical effects of oil spills, a few studies have suggested a relationship between oil spills and psychiatric disorders such as depression, anxiety and post-traumatic stress disorder in people exposed to the spill and clean-up. The American Journal of Psychiatry published one such study in 1993 after the Exxon Valdez spill, and the Journal of Epidemiology and Community Health published another after the Sea Empress tanker spill.

In the meantime, the Huffington Post reports that Erin Brockovich is on her way to southern Louisiana to speak with people who claim the dispersants made them ill.

In the News, Infectious Disease, Medicine and Society, Parenting

Andrew Wakefield: 17 years of disputed research, and now a book

Andrew Wakefield: famous in some circles and infamous in others. In February, the Lancet retracted his 1998 article that linked autism to the MMR vaccine and set off the modern anti-vaccine movement. Last week, the U.K. medical register revoked his license to practice medicine. But there’s more to the ex-surgeon’s story than just autism and the MMR vaccine.

According to an article on Slate.com, Wakefield has an almost 20-year history of disputed research practices, beginning with a 1993 paper in which he asserted that the measles virus causes Crohn’s disease:

He conducted biotechnology studies, liver studies, and even looked at the effects of smoking and the contraceptive pill on Crohn’s disease; an unusual array of work for one researcher. Wakefield was desperately trying to make his name in research, and it didn’t seem to matter what field it was in.

When three separate scientific reviews panned his Crohn’s research, he went on to develop the MMR vaccine-autism theory that made his name.

Despite the retraction, his revoked medical license, and a bevy of scientific evidence against him, Wakefield maintains that his vaccine-autism theory is sound. He recently published a book in which he defends himself and his theory against naysayers. And according to the Slate article, he has relocated to the U.S., where he still has a fan base.

Previously: How the false MMR vaccine-autism connection was perpetuated and It’s over: no MMR vaccine-autism connection

Technology

British scientist infects himself with a contagious computer virus

British scientist Mark Gasson, PhD, is the first person in the world to become infected with a computer virus, the BBC reported today.

Gasson infected an RFID chip that was implanted in his left hand last year. The chip communicates with a system that, among other things, tracks Gasson, allows him through secure doors and unlocks a mobile phone that only he can use. The virus on Gasson’s chip corrupted the system.

Gasson, a systems engineer at the University of Reading in the UK, studies implantable devices. These devices – which include pacemakers, cochlear implants, and the ID ‘chips’ commonly implanted in pets – are now sophisticated enough to suffer regular computer problems. As he said in a news release:

They are essentially mini computers. This means that, like mainstream computers, they can be infected by viruses and the technology will need to keep pace with this so that implants, including medical devices, can be safely used in the future.

Mental Health

Depressed? Allergies may make it worse

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If you suffer from seasonal allergies, you already know the pollen-rich blooms of spring and fall can usher in several weeks of watery-eyed, congested misery. Researchers at the University of Maryland School of Medicine have gone further and shown that seasonal allergies can deepen the misery of existing depression.
During the height of allergy season, the scientists monitored symptoms and took blood samples from people who had been previously diagnosed with depression. Their depression tended to worsen when they had observable allergy symptoms. The subjects also suffered more depressive symptoms when they didn’t have allergy symptoms, but their blood still showed signs of an immune reaction to pollen.

The Washington Post‘s Checkup blog described the unpublished study results, which were presented this week at the American Psychiatric Association’s annual meeting:

The findings indicate that allergies can make depression worse in those who suffer from both conditions. It’s the first time that’s been shown. While more research is needed to understand how allergies may make depression worse, the findings also indicate that treating a depressed person’s allergies may help improve their mood, even if they aren’t actually experiencing symptoms of an allergic reaction.

Scientists have long suspected a link between depression and allergies, but they still don’t know exactly how the former might cause the latter. A 2008 story in USA Today noted some theories that used inflammation and sleep loss to draw the missing links.

In the meantime, consider the possibility that your favorite antihistamine could function as an antidepressant, too.

Photo by Cordey

Infectious Disease, Microbiology, Research

New antibiotic shows promise in fighting superbugs

Scientists at the University of Massachusetts at Amherst and the biotech company PolyMedix have developed a new antibiotic that quickly kills bacteria by blasting holes in their cell membranes. The antibiotic, called PMX-30063, works like a defensin, a type of molecule that immune cells use to digest invading bacteria. PolyMedix reported in March that in a clinical trial, PMX-30063 worked on staph infections, including MRSA.

Traditional antibiotics work by recognizing specific structures within the bacteria, but bacteria can quickly adapt by tweaking those structures enough to evade recognition. According to an article posted today on Wired, the new drug takes a different approach and works from the outside to kill bacteria:

The drugs work by poking holes in bacterial membranes, killing the cells instantly. Within a few hours, the antibiotics are able to kill off entire colonies of bacterial pathogens. And resistance is futile: Because the meds don’t enter the actual cell, it’s impossible for the bacteria to fight back through structural adaptation.

According to the article, the Pentagon, which funded the research, is looking to develop an arsenal of compounds for “biodefense applications” and to treat bacterial infections in troops.

Genetics

Genetic testing companies under scrutiny; UC Berkeley to test frosh genes

The Washington Post reported today that the House Committee on Energy and Commerce is launching an investigation of several private genetic testing companies in California: Pathway Genomics Corp., 23&Me Inc., and Navigenics Inc..

The investigation follows after Walgreens reneged on its decision to sell Pathway genetic testing kits in its stores. The FDA immediately responded to Walgreens’ original decision by claiming that the companies violated federal law by not submitting the tests to the FDA for review.

Commercial genetic testing is already controversial for scientific, ethical and practical reasons. Stanford professor Hank Greely, JD, spoke out against the sale of over-the-counter genetic tests in response to the Walgreens incident.

Meanwhile, UC Berkeley is embracing the personalized use of genetic testing. The New York Times reported today that Berkeley is asking its incoming freshman class to volunteer to submit DNA samples for confidential testing. The tests will target genes related to the ability to metabolize alcohol, lactose and folate:

“In the decade ahead, the new genetics is going to penetrate everyday medical practice,” said Mark Schlissel, dean of biology at Berkeley. “We wanted to give students a sense of what’s coming, through genes that can provide them with useful information. I think it’s one of the best things we’ve done in years.”

The genes Berkeley is testing are related to nutrition and don’t warrant counseling as tests for serious genetic diseases would, Schlissel said.

Previously: Over-the-counter genetic tests are a bad idea, Stanford expert says

Emergency Medicine

Ambulance drivers: slow down, it won’t hurt

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After three years as an emergency medical technician (EMT) in metropolitan Boston, the sight and sound of an approaching ambulance still quickens my pulse. But my EMT trainers cautioned me not to drive recklessly while using lights and sirens, because it’s embarrassing and tragic when reckless driving leads EMTs to need rescuing themselves.

Speeding wouldn’t have necessarily saved any of my patients’ lives, either, according to an article in Slate magazine. The article cites a recent study in Annals of Emergency Medicine that shows no association between the survival of serious trauma patients and the amount of time emergency medical services took to get them to the hospital. As the article reports:

These results are fascinating, in part because the principal question – how important is speed in the care of trauma patients before they get to the hospital? – has never been so elegantly explored. Previous efforts to measure the effect of ambulance time on survival have been plagued by the fundamental problem that medics may behave differently, like driving faster or spending more time working on patients, depending on the severity of the condition, making it impossible to tease out the effect of time on survival. While some of these biases remain, the authors of this study used sophisticated methods to account for many of these problems, allowing the reader to reasonably conclude that for ambulance care, a few minutes either way neither saves nor costs lives for patients with severe trauma.

I admit, I was drawn to the profession by the thrill of the driving. Without that adrenaline rush, the work of an emergency medical technician is mostly paperwork and heavy lifting.

Image by comedy_nose

Patient Care, Public Health

Using signs to help patients navigate hospitals

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Hospitals in the United States are providing care for an increasingly diverse range of patients, many of whom may be unable to read English signage. So the Robert Wood Johnson Foundation funded a project called Signs that Work to develop and test symbols to replace text-based hospital signs.

Professional designers developed and tested a system of 28 signs in 2006, and last year students at four U.S. design schools created another set of 22 signs that tested well among English and non-English speaking subjects. The second set of signs will be integrated with the first 28, which are already in use at four hospital testing sites across the country.

In a University of Cincinnati news release about the project, George Smith, a project manager at one of the test hospitals, commented on the practical and psychological value of the new signs:

Overall, he said, signage symbols are the way of the future as part of a larger wayfinding approach that allows visitors and patients to have a sense of autonomy and control upon entering a health center.

Smith added, “We’ve identified 26 language groups that use our facility, which spans 22 stories and 12 wings. If we had to use text to communicate on our signs, we’d have run out of wall space long ago. In the long run, the use of signage symbols will save us money in terms of implementation and updates.

The University of Cincinnati has a slideshow of some of the 15 signs contributed by its design students.

Images (mental health, anesthesiology, and dermatology signs) from University of Cincinnati School of Design students Paige Farwick, Kim Louis, and Emily Boland

In the News, Research, Stanford News, Stem Cells

Growing new inner-ear cells: a step toward a cure for deafness

Growing new inner-ear cells: a step toward a cure for deafness

Researchers in the lab of Stefan Heller, MD, PhD, have successfully used mouse stem cells and fibroblasts to re-create the rodent’s inner ear cells – right down to the tiny hairs that sense vibrations. The breakthrough makes the normally sparse hair cells much easier to study, and could pave the way to the development of therapies for human hearing loss.

Otolaryngology professor Heller and Stanford postdoc Kazuo Oshima, PhD, appeared in a segment yesterday on KGO describing their result:

Now, with so many testable cells, researchers hope to test drugs on them in the coming years and find a cure for deafness.

“We can look for novel drugs that can lead to regeneration of the cells,” Heller says.

Heller and colleagues published their findings in the May 14 issue of Cell.

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