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Pediatrics

Genetics, Pediatrics, Transplants, Women's Health

Rare African genes might reduce risks to pregnant women and their infants

Rare African genes might reduce risks to pregnant women and their infants

Khoe-SanWhen Hugo Hilton began working at Stanford as a young researcher several years ago, his supervisor set him to work on a minor problem so he could practice some standard lab techniques. His results, however, were anything but standard. His supervisor — senior research scientist Paul Norman — told him to do the work over, convinced the new guy had made a mistake. But Hilton, got the same result the second time, so Norman made him do it over again. And then again.

“This was Hugo’s first PCR reaction in our lab and I gave him the DNA,” recalled Norman, “and the very first one he did, he pulled out this mutation. I was convinced that he’d made a mistake.” Norman even quietly redid the work himself. But the gene variant was real.

Norman and colleagues had been studying the same group of immune genes for decades and he knew them like the back of his hand. Yet he was astonished by what Hilton had stumbled on — a mutation that switched a molecular receptor from one protein target to another. It would be as if you bent your house key ever so slightly and discovered it now opened the door to your neighbor’s apartment — but not yours.

And the mutation, far from causing some illness, might contribute to healthier mothers and babies. Parallel research at another institution suggests the odd gene most likely changes the placenta during early pregnancy, leading to better-nourished babies and a reduced risk of pre-eclampsia, a major cause of maternal death.

The surprising finding grew out of a long-term effort to understand how immune system genes make us reject organ transplants. A big part of that puzzle is understanding how much immune genes can vary. On the surfaces of ordinary cells are proteins called HLAs. Combinations of these proteins mark cells in a way that makes each person’s cells so nearly unique that the immune system can recognize cells as either self or not self. When a surgeon transplants a kidney, the recipient’s immune system can tell that the kidney is someone else’s — just from its cell surface HLA proteins. The patient’s immune system then signals its natural killer cells to attack the transplanted kidney. The key to all that specificity is the huge variation in the genes for the HLA proteins.

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Neuroscience, Pediatrics, Research

Stanford team uses brain scans to forecast development of kids’ math skills

Stanford team uses brain scans to forecast development of kids' math skills

multiplication-table-2Back in the third grade, I did not like math. It was boring! It was hard! Why did I have to memorize the times tables, anyway?

Did this mean I would have trouble with math for the rest of my life, or would I get over my eight-year-old’s funk and end up being good at it? At the time, there was no way to know. But now, in a longitudinal study published today in The Journal of Neuroscience, a team of Stanford researchers show that scans of third graders’ brains forecast which children will eventually do well in math and which of them will continue to struggle.

The resting MRI scans collected in the study evaluated the brain’s structure and connectivity between different brain regions in 43 eight-year-olds of normal intelligence. The researchers also gave the children several standardized tests outside the scanner. They then re-tested the kids’ math skills regularly for the next six years.

The brain scans were better than standard IQ, math or other tests at predicting how the children’s math skills would develop. Larger volume and greater connectedness of specific brain regions at age eight was linked to better math skills down the road. From our press release:

“A long-term goal of this research is to identify children who might benefit most from targeted math intervention at an early age,” said senior author Vinod Menon, PhD, professor of psychiatry and behavioral sciences. “Mathematical skills are crucial in our increasingly technological society, and our new data show which brain features forecast future growth in math abilities.”

In addition to identifying at-risk kids, the scans may help scientists design better ways to help them. Because the new work gives a baseline understanding of brain features in children with normal math skills, it may help guide efforts to strengthen the brains of kids with math difficulties. The researchers, who are now exploring how math tutoring changes the brain, encourage parents and teachers not to give up on children who have a hard time with math:

“Just because a child is currently struggling doesn’t necessarily mean he or she will be a poor learner in the future,” said [Tanya] Evans, [PhD, first author of the new study].

As for me, math never became my favorite subject. But I did eventually shake my early aversion to it. Since my job requires me to understand a range of mathematical concepts, I’m grateful — and I hope the new work being done at Stanford will allow today’s struggling third-graders to someday say the same.

Previously: A not so fearful symmetry: Applying neuroscience findings to teaching math, Peering into the brain to predict kids’ responses to math tutoring and New research tracks “math anxiety” in the brain
Photo by jmawork

Behavioral Science, Emergency Medicine, Health Disparities, Pain, Patient Care, Pediatrics, Research

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

crying-613389_1280When a child arrives in the emergency room complaining of a stomach pain, appendicitis is the last thing you want to miss, says KT Park, MD, assistant professor of pediatrics.

“The question is, ‘Does this patient have appendicitis – yes or no?,” he said. It is the most common immediate emergency that could bring a child into the emergency room with abdominal pain. If not treated in a timely manner, the appendix can burst, leading to infection or a host of other serious complications.

But kids arrive in the emergency room complaining of stomach aches all the time; most with perfectly healthy appendices. And what if you’re a doctor who has seen seven kids with more minor stomach problems one day? It might be tricky to spot that first case of appendicitis.

Unfortunately, misdiagnosis happens more often when the pediatric patient is black, Hispanic or low-income, according to a study published today in PLOS ONE led by Park and Stanford medical student Louise Wang.

“Our goal in this study is getting the word out about abdominal pain and appendicitis and the importance of the decisions made in the emergency room,” Wang said.

The researchers analyzed national data from 2 million pediatric visits to emergency rooms between 2004 and 2011 complaining primarily of abdominal pain. They found that blacks, Hispanics and low-income children were less likely to receive imaging that could help their physicians diagnose serious conditions like appendicitis. These patients were also less likely to be admitted to the hospital, but more likely to suffer perforated appendicitis, a clue that perhaps they didn’t receive adequate treatment in time, Park said. For example, low-income blacks were 65 percent more likely to have a perforated appendix compared to other children.

The study was not able to precisely determine why these disparities exist, Wang said. “What is the driving influence of these outcomes? Are these kids being mismanaged in the emergency department, or are they presenting at a later time in a more serious condition?,” she asked.

She and Park have a few ideas, based on other findings and their personal experience. Minorities and low-income families are more likely to use the emergency room as a first-stop for more minor conditions, rather than visiting their primary care doctor or pediatrician.

“This is a very delicate topic,” Park said. “Physicians are humans and there is potentially some intuitive thinking that goes on about the probabilities of various diagnoses more common in certain patient groups, potentially leading to differences in how clinicians perceive the acuity of a patient’s status.”

Appendicitis can be tricky to diagnose, a task made even harder when patients are young and unable to clearly describe their pain, Park said.

“The psychology of physicians is an area needing further evaluation,” Park said. “We have internal biases that we often are not even aware of. We want to be objective, but it’s never a black-and-white decision making tree.”

Previously: A young child, a falling cabinet, and a Life Flight rescue, New test could lead to increase of women diagnosed with heart attack and Exploring how the Affordable Care Act has affected number of young adults visiting the ER
Photo by amandacatherine

Cancer, Events, Patient Care, Pediatrics

Girls’ Day Out event helps unite — and nurture — teens battling cancer

Untitled designThere are many treatments, therapies and drugs for cancer, but sometimes a day of pampering with friends is just what the doctor ordered.

That’s why nine teenage girls being treated for cancer at Lucile Packard Children’s Hospital Stanford  were lavished with a bit of tender loving care — and some quality bonding time — at the seventh annual Girls’ Day Out.

The festivities began at 8:30 on Wednesday night with a limo ride from the hospital to TOVA Day Spa in the Fairmont Hotel in downtown San Jose. At TOVA, teens that had attended Girls’ Day Out events from years before had the opportunity to reconnect, chat and welcome newcomers as they received massages, pedicures, manicures, hairstyling and a gourmet lunch. This story in the San Jose Mercury News explains:

“It’s really fun and a great getaway; it’s really nice to be with people who won’t keep asking ‘what happened to your arm,’ ” said incoming Saratoga High School freshman Simran Mallik, 14. She was left with a scar on her arm after undergoing treatment for Ewing Sarcoma, a type of bone cancer. “I feel like I connect with them more; it’s just easier to communicate.”

Tova Yaron, the owner of TOVA Day Spa, has sponsored this event for the past seven years with support from the Children Having Exceptional Educational and Recreational Support (CHEERS) program that’s a part of the 19 for Life Foundation. At the event, Yaron and her staff donate their time and expertise to create a day of fun, and free spa treatments, for the girls.

TOVA’s spa treatments are a refreshing break from the kind of treatments and therapies the teens are used to receiving as cancer patients, but perhaps the most important gift the girls receive is the opportunity to relax and be themselves among friends who understand what it’s like to be a teenager battling cancer.

“It’s interesting to see how other people are after they’ve gone through (cancer treatment),” said Vivian Lou 15, a student at James Logan High School in Union City who was diagnosed with Wilms Tumor, a type of kidney cancer, five years ago. “It’s nice because I don’t have to feel weird about it because they’ve also been through it.”

“I wish I could do more,” said Yaron. “I am honored, they are lovely girls, they have amazing attitudes, they are brave beyond belief, they are amazing. They are inspiring us with their bravery.”

Previously: Not just for kids: A discussion of play and why we all need to do itHow social connection can improve physical and mental health and The scientific importance of social connections for your health
Photo by Lucile Packard Children’s Hospital Stanford

Cancer, Health and Fitness, Pediatrics, Public Health, Research, Women's Health

Examining the long-term health benefits for women of exercise in adolescence

Examining the long-term health benefits for women of exercise in adolescence

soccer_8.4.15Sometime around the age of five, I distinctly remember my mother telling me, “You have to play a sport. You can pick any sport you want, but you have to play a sport.” I recall this encounter vividly because I really, really didn’t want to play sports. At the time, I was the “everything-has-to-be-pink, Barbie-doll-playing, glitter-loving” type. But I picked a sport, soccer, and surprisingly stuck with it through college.

Fast forward to today, when I came across new research touting the health benefits of exercise during adolescence and was compelled to send a “Thanks, mom” text for her fitness mandate. The findings, which were recently published in the journal Cancer Epidemiology, Biomarkers & Prevention, show that women who regularly exercised as teenagers had a decreased risk of dying from cancer, cardiovascular disease and other causes during middle-age and later in life.

The study was conducted by Vanderbilt University Medical Center and the Shanghai Cancer Institute and involved the analysis of data from the Shanghai Women’s Health Study, a large ongoing prospective cohort study of 74,941 Chinese women ages 40 to 70.

Researchers defined regular exercise as occurring a minimum of once a week for three consecutive months. Lead author Sarah Nechuta, PhD, said in a release, “In women, adolescent exercise participation, regardless of adult exercise, was associated with reduced risk of cancer and all-cause mortality.”

More details about the study results:

Investigators found that participation in exercise both during adolescence and recently as an adult was significantly associated with a 20 percent reduced risk of death from all causes, 17 percent for cardiovascular disease and 13 percent for cancer.

While there have been several studies of the role of weight gain and obesity on overall mortality later in life, the authors believe this is the first cohort study of the impact of exercise during adolescence on later cause-specific and all-cause mortality among women.

The authors note that an important next step is to evaluate the role of adolescent exercise in the incidence of major chronic diseases, such as cardiovascular disease and major cancers, which will also help provide more insight into the mechanisms of disease.

Previously: Study finds teens who play two sports show notably lower obesity rates, Exercise may lower women’s risk of dementia later in life, How physical activity influences health and Stanford pediatrician discusses developing effective programs to curtail childhood obesity
Photo by Ole Olson

Health Policy, Pediatrics, Research, Sleep

Rethinking middle and high-school success: strategies for creating healthier students

Rethinking middle and high-school success: strategies for creating healthier students

512px-Sleeping_while_studyingMy daughters are still years away from college or even high school, but I’m not looking forward to the high-pressure arena that they look to be from afar. The stress and lack of sleep has to take a toll on students’ health. I was curious, then, to hear about a program developed by researchers from Stanford’s Graduate School of Education called Challenge Success. The program helps parents and schools develop a more even-keeled approach to the high-pressure world that many college-bound middle- and high-schoolers find themselves in.

Last week, the program released Overloaded and Underprepared: Strategies for Stronger Schools and Healthy, Successful Kids, a book that gathers what researchers at Challenge Success have learned in the dozen years the program has been in place. The GSE’s website features a Q&A with two of the book’s authors: Denise Pope, PhD, EdM, a Stanford GSE lecturer and co-founder of Challenge Success, and Maureen Brown, Challenge Success Executive Director.

Below are some highlights of the interview, which is worth reading all the way through:

How are students overloaded today?

Pope: People assume with the new standards and requirements for college admission, that teachers need to cover more topics in class and that kids need to take more courses and do more activities in school and after school to meet expectations for success. This is a confusion between rigor and load. Rigor is real depth of understanding, mastery of the subject matter. That’s what we want. Load is how much work is assigned. Many educators and many parents assume that the more work you assign and the more work students do, the better they will understand it. That is not necessarily the case. For example, we have teachers who teach AP classes and cut their homework load in half, and the kids end up doing as well on the exam. You don’t have to do four hours of homework in order to learn something in depth or to retain it. But four hours of homework can be incredibly damaging physically and emotionally.

. . .

Who should read this book?

Pope: We started writing it for educators, to give a guide to those schools that couldn’t physically partner with us at Challenge Success. The goal was to compile our best practices. But after a little bit of writing, I handed it to my husband (who isn’t an educator) just to see if it made sense. He came back and said, ‘You know, I was really interested as a parent as to why a school would use a block schedule or why so many kids are cheating or what is the purpose of taking an Advanced Placement course.’ So we realized it was actually a book for a much broader audience of people who were interested in the research on some of these practices.

Brown: For example, if parents don’t understand the ‘why’ for certain policies or practices, they can’t help advocate for real systemic change. The book gives parents the ability to ask the right questions at their schools to understand why their school is going down a certain path.

Previously: Excessive homework for high-performing high schoolers could be harmful, study findsWith school bells ringing, parents should ensure their children are doing enough sleeping, Stanford expert: Students shouldn’t sacrifice sleep and Stanford researchers to study effectiveness of yoga-based wellness program at local schools
Photo by Psy3330 W10

Pediatrics, Research

The power of music: how music training in high school helps brain development

The power of music: how music training in high school helps brain development

3353349312_d6aa1254bc_zIt was my second year of high school and I was talking to a childhood friend. When I asked if she was taking any music classes she shrugged and told me, “They cut my choir this year.” I wish I could say I had never heard of such a thing, but I knew it was common in public schools.

When budgets are low, music programs are often some of the first things to get cut – and it might be because those classes don’t seem as important to the academic experience as other classes. But according to a recent study (subscription required) in the journal PNAS, they are.

In the study, researchers at Northwestern University showed that studying music promotes academic success and that brain development and language skills are especially strengthened. “Although learning to play music does not teach skills that seem directly relevant to most careers, the results suggest that music may engender what educators refer to as ‘learning to learn,’” Nina Kraus, PhD, senior author of the study, said in a Northwestern release.

The researchers observed two groups of high schoolers: those enrolled in band classes, which involved music and instrumental instruction, and those enrolled in Reserve Officers’ Training Corps, which focused on physical fitness. After three years in the same schools, the students in the music classes showed a stronger neural response to sound in comparison to the students in Reserve Officers’ Training Corps. In addition, the music students were also more sensitive to auditory details than their peers.

It appears that cutting music classes from schools might leave students at a disadvantage. At the very least, it denies students the opportunity to increase their brain development and language skills. “Our results support the notion that the adolescent brain remains receptive to training, underscoring the importance of enrichment during the teenage years,” the researchers said.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs. 

Previously: Excessive homework for high-performing high schoolers could be harmful, study findsMusic in the brain: A report on rare auditory hallucinations and Stanford researchers gain new insights into how auditory neurons develop in animal study
Photo by Monica Liu

Health Policy, In the News, Medicine and Society, Pediatrics, Stanford News

Stanford researchers analyze California’s new vaccine law

Stanford researchers analyze California's new vaccine law

CA vaccine photoWhat do California, West Virginia and Mississippi have in common? Stumped?

Thanks to a recent law signed by California Gov. Jerry Brown, these three states now have strict vaccine policies that require children to be vaccinated before entering school, unless they have a medical exemption. The new requirements eliminate religious and philosophical exemptions.

Stanford’s Michelle Mello, JD, PhD, and David Studdert, LLB, ScD, (along with co-author Wendy Parmet, JD) heralded the change in a New England Journal of Medicine commentary published this week. From a Stanford News release:

“The move represents a stunning victory for public health that affects not only California schoolchildren, but the prospects for strengthening vaccination requirements nationwide,” they wrote.

The new laws come in the wake of a measles outbreak that started at Disneyland last year. It fueled a nationwide debate about the merits of vaccines, and of the large number of children unvaccinated due to parental objections.

The new California law requires all children enrolled in private and public schools and day-care facilities to be vaccinated against measles, whooping cough and several other diseases.

Yet the law is sure to face challenges, particularly from opponents who say it violates their religious rights. In addition, a lack of enforcement may weaken the law’s ability to ensure widespread protection.

Nonetheless, California’s new law is worth celebrating, they say:

“Although California politics may be distinctive, its experience with SB277 teaches us that even strong opposition can be overcome with the right combination of astute public education, political strategy and legislative fortitude,” they wrote. “Fewer vaccination exemptions and vaccine-preventable illnesses would be accomplishments that other states would find difficult to ignore.”

Previously: A discussion of vaccines, “the single most life-saving innovation ever in the history of medicine”, Science Friday-style podcast explains work toward a universal flu vaccine and Side effects of childhood vaccines are extremely rare, new study finds
Image by Niyazz

Autism, Behavioral Science, Neuroscience, Pediatrics, Research, Stanford News

A new insight into the brain chemistry of autism

A new insight into the brain chemistry of autism

TrueHugFor several years now, scientists have been testing the hypothesis that one particular hormone, oxytocin, plays a role in autism. It seems logical: After all, this molecule nicknamed the “love hormone” promotes bonding between romantic partners and is one of the main signals involved in childbirth, breastfeeding and helping new mothers form strong bonds with their babies. And social-interaction difficulties are a known characteristic of autism, a developmental disorder that affects one in every 68 kids.

But in the flurry of interest around oxytocin, a related signaling molecule has been largely overlooked. Called vasopressin, it’s structurally very similar to oxytocin. Both are small proteins made of nine amino acids each, and the amino-acid sequence is identical at seven of the nine spots in the two hormones. Vasopressin is best known for its role in regulating blood pressure, but it also has social roles, which have mostly been studied in rodents.

Noting the dearth of autism-vasopressin research, a Stanford team decided to study vasopressin levels and social behavior in children diagnosed with autism and controls who had not been diagnosed with autism. Our press release about their study, which was published today in PLOS ONE, explains:

The research team found a correlation between low levels of vasopressin, a hormone involved in social behavior, and the inability of autistic children to understand that other people’s thoughts and motivations can differ from their own. …

“Autistic children who had the lowest vasopressin levels in their blood also had the greatest social impairment,” said the study’s senior author, Karen Parker, PhD, associate professor of psychiatry and behavioral sciences.

Parker and her colleagues examined “theory of mind,” the ability to deduce that others have a mind of their own – and that they may perceive the world differently than you do. It’s an important underpinning to forming empathetic relationships with other people. In kids with autism, the lower their vasopressin levels, the worse their scores on a test of theory of mind, the study found. Children without autism did not show this link; they all had pretty good theory of mind scores, whether their vasopressin levels were low or high.

It’s worth adding that low vasopressin level did not diagnose whether a child had autism; the hormone’s levels ranged from low to high in both groups of children. So autism is not simply a state of vasopressin deficiency. However, the researchers are interested in whether giving vasopressin might help relieve autism symptoms and are now carrying out a clinical trial to test its effects.

The work also provides an interesting complement to oxytocin findings published by the same team last year. In the oxytocin study, the scientists found that children with autism could have low, medium or high oxytocin levels, just like other children. However, oxytocin levels were linked to social ability in all children, not just those with autism.

Based on the new findings, it’s possible, Parker told me, that vasopressin is uniquely important for children with autism. She’s eager to expand her work in this overlooked corner of brain-chemistry research.

Previously: Stanford research clarifies biology of oxytocin in autism, “Love hormone” may mediate wider range of relationships than previously thought and Volunteers sought for autism drug study
Artwork by Dimka

Health Disparities, Mental Health, Pediatrics, Public Health

Stanford study of mental illness in incarcerated teens raises policy questions

Stanford study of mental illness in incarcerated teens raises policy questions

depressionMental illness is an even bigger problem for jailed teenagers than experts previously realized.

That’s the take-away message from a Stanford study, publishing today in the Journal of Adolescent Health, which compared 15 years’ worth of hospital stays for adolescents in California’s juvenile justice system with hospitalizations of other California kids and teens. Experts already knew that juvenile inmates are more likely than other young people to have mental health problems, but the new study gives fresh perspective on the scope of the issue.

The research team, led by Arash Anoshiravani, MD, an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford, looked at 15 years of hospital-stay data for California’s 11- to 18-year-olds. From a total of almost 2 million hospitalizations, about 11,000 were for incarcerated youth.

Of these 11,000 hospital stays, 63 percent were due to mental-health diagnoses. In contrast, just under 20 percent of the hospital stays by adolescents from the general population were prompted by mental illness. Hospital stays were also longer for the incarcerated teens, suggesting more severe illness.

However, the kinds of diagnoses were pretty similar between the two groups, with depression and substance abuse the most common. From our press release about the new study:

The types of diagnoses suggest that many incarcerated teens’ mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.

“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new data will motivate social change around the problem.

“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”

Previously: Online health records could help high-risk teens, study finds, Lucile Packard Children’s Hospital partners with high schools on student mental health programs and Increasing awareness and advocacy of emotional disorders with mental health first-aid programs
Photo by ryan melaugh

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