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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_433"
                     title="Household Routines Linked to Lower Childhood Obesity (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Pediatrics/Parenting/tb/18340?impressionId=1265732860485"
                     
      &lt;p&gt;Want to protect your preschooler from obesity?&lt;/p&gt;
&lt;p&gt;Eat dinner as a family six or seven times a week, limit the time the child watches TV to less than two hours a day, and make sure he or she gets more than 10.5 hours of sleep a night.&lt;/p&gt;
&lt;p&gt;Those three simple household routines are associated with an&lt;strong&gt; &lt;/strong&gt;almost 40% reduction in the risk of childhood obesity, according to Sarah Anderson, PhD, of Ohio State University College of Public Health in Columbus, and Robert Whitaker, MD, of Temple University in Philadelphia.&lt;/p&gt;
&lt;p&gt;The association remained significant even in the face of other predictors of childhood obesity, such as maternal obesity or being in a single-parent family, the authors said in the March issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;I imagine people are going to want to know which of the routines is most important: Is it limited TV, is it dinner, is it adequate sleep?&quot; Anderson said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;What this suggests is that you can&apos;t point to any one of these routines,&quot; she said. &quot;Each one appears to be associated with a lower risk of obesity, and having more of these routines appears to lower the risk further.&quot;&lt;/p&gt;
&lt;p&gt;The findings are based on data collected in 2005 on 8,550 children born in the U.S. in 2001 who were part of the Early Childhood Longitudinal Study, Birth Cohort.&lt;/p&gt;
&lt;p&gt;For the study, the 4-year-olds were considered to be obese if they were at or above the 95th percentile in weight for their age and sex.&lt;/p&gt;
&lt;p&gt;Overall, the authors reported, 18% of children were obese by that measure.&lt;/p&gt;
&lt;p&gt;The researchers found that 14.5% of the children in the study lived in families where all three of the routines were observed, and 12.4% in families where none took place.&lt;/p&gt;
&lt;p&gt;Among children exposed to all three, 14.3% were obese, compared with 24.5% among those exposed to none of the routines, they found.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis, children used to all three routines had an odds ratio for obesity of 0.63, compared with those who were exposed to none, the researchers found. (The 95% confidence interval was 0.46 to 0.87.)&lt;/p&gt;
&lt;p&gt;Any two routines, again compared with none, had an odds ratio for obesity of 0.64, with a 95% confidence interval from 0.47 to 0.85.&lt;/p&gt;
&lt;p&gt;A similar pattern was seen for one routine compared with none, but in the multivariate analysis the benefit was no longer statistically significant.&lt;/p&gt;
&lt;p&gt;However, in a univariate analysis, any single routine, compared with none, reduced the odds of obesity by between 23% and 25%, the authors found, and the odds did not change much when the presence or absence of the other two was factored in.&lt;/p&gt;
&lt;p&gt;That finding suggests an &quot;independent association of each routine with obesity,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;The study is limited by elements of its design, the researchers said. The study was unable to account for differences in diet or physical activity, and the prevalence of the three routines was assessed by parent report, which might have introduced bias.&lt;/p&gt;
&lt;p&gt;Information on types of foods served, how many people were present at dinner, concomitant television viewing along with the meal, advertising viewed on television, and quality of sleep was not available.&lt;/p&gt;
&lt;p&gt;They also noted that the study is cross-sectional and can&apos;t be used to establish any causal relations between the three routines and obesity.&lt;/p&gt;
&lt;p&gt;Nonetheless, they concluded, the three routines &quot;may be promising behavioral targets for counseling, given their association with obesity and their potential benefits beyond obesity prevention.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the U.S. Department of Agriculture.&lt;/p&gt;&lt;p&gt;The authors said they had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265732860485"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_202"
                     title="Survival Rates Vary with Congenital Anomalies (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18035?impressionId=1265732860485"
                     
      &lt;p&gt;Survival among children with congenital anomalies has increased in recent decades, but still varies notably depending on the condition, a British study found.&lt;/p&gt;
&lt;p&gt;Overall 20-year survival was 85.5% (95% CI 84.8 to 86.3) among children born with at least one congenital anomaly, Peter W.G. Tennant, MsC, of Newcastle University, and colleagues reported online in &lt;em&gt;Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;For specific conditions, the 20-year survival rates were as follows: &lt;ul&gt; &lt;li&gt;Orofacial clefts, 97.6% (95% CI 95.9 to 98.6)&lt;/li&gt; &lt;li&gt;Urinary system, 93.2% (95% CI 91.6 to 94.5)&lt;/li&gt; &lt;li&gt;Cardiovascular system, 89.5% (95% CI 88.4 to 90.6)&lt;/li&gt; &lt;li&gt;Digestive system, 83.2% (95% CI 79.8 to 86)&lt;/li&gt; &lt;li&gt;Chromosomal anomalies, 79.1% (95% CI 76.6 to 81.3)&lt;/li&gt; &lt;li&gt;Nervous system, 66.2% (95% CI 61.5 to 70.5)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Congenital anomalies are recognized as a major cause of perinatal and infant mortality, but little is known about longer-term survival with conditions other than Down syndrome or spina bifida.&lt;/p&gt;
&lt;p&gt;So Tennant and colleagues analyzed data from the Northern Congenital Abnormality Survey, which is a population-based register for the north of England.&lt;/p&gt;
&lt;p&gt;Their study included 13,758 cases of congenital anomaly reported to the registry between January 1985 and December 2003, representing a prevalence of 20.8 per 1,000 births.&lt;/p&gt;
&lt;p&gt;Among these, 0.9% were late miscarriages, 16.3% were terminations after prenatal diagnosis, 3.1% were stillbirths, and 79.7% were live births.&lt;/p&gt;
&lt;p&gt;Of the 10,850 liveborn cases for whom survival status was known, 1,465 (13.5%) died during the course of the study.&lt;/p&gt;
&lt;p&gt;Year of birth was a highly significant predictor of survival, (HR 0.92, 95% CI 0.92 to 0.93, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), which likely relates to important medical and surgical advances such as surfactant therapy and corticosteroid use for respiratory distress syndrome, as well as intrapartum treatment for chorioamnionitis.&lt;/p&gt;
&lt;p&gt;The rate of termination for fetal anomaly increased over time, rising from 12.4% (95% CI 9.8 to 15.5) in 1985 to 18.3% (95% CI 15.6 to 21.2) in 2003.&lt;/p&gt;
&lt;p&gt;The investigators further analyzed survival among specific subtypes of anomalies and found rates of 20-year survival exceeding 95% for the following: &lt;ul&gt; &lt;li&gt;Ventricular septal defects, 98.3% (95% CI 96.6 to 99.1)&lt;/li&gt; &lt;li&gt;Pulmonary valve stenosis, 98.1% (95% CI 96.1 to 99.1)&lt;/li&gt; &lt;li&gt;Cleft lip and palate, 97.7% (95% CI 94.6 to 99.1)&lt;/li&gt; &lt;li&gt;Atrial septal defects, 96.3% (95% CI 93.3 to 98)&lt;/li&gt; &lt;li&gt;Cleft palate, 96.3% (95% CI 92.8 to 98.1)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In contrast, subtypes with less than 50% one-year survival included arhinencephaly/holoprosencephaly, common arterial trunk, and hypoplastic left heart.&lt;/p&gt;
&lt;p&gt;Previous studies have found ten-year survival rates ranging from 76.5% to 88.6% for Down syndrome, 80.9% for all phenotypes of spina bifida, and 64% for spina bifida with hydrocephalus.&lt;/p&gt;
&lt;p&gt;In this study, the ten-year survival for Down syndrome was 83.9%, which probably reflects differences in care over time and by location, as well as surgical management and changing rates of terminations.&lt;/p&gt;
&lt;p&gt;The ten-year survival for spina bifida without hydrocephalus was 86.7% but fell to 53.3% with hydrocephalus, and 20-year survival remained 36.7% lower in those having hydrocephalus (95% CI 24 to 40, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;Previous estimates of survival among children with cardiovascular anomalies ranged from 74.7% to 76.9% at five years, which are substantially lower than the 91.1% reported in the present study.&lt;/p&gt;
&lt;p&gt;As with Down syndrome, this may represent advances in care, but also may reflect the fact that the investigators stratified cases according to the presence of multiple anomalies.&lt;/p&gt;
&lt;p&gt;&quot;This effect is inconsequential for primary anomalies with a high mortality rate, such as hypoplastic left heart syndrome, since the effect of the primary anomaly is likely to overwhelm the effect of any additional anomalies. However, as the severity of the primary anomaly decreases, the confounding effect of any additional anomalies is likely to increase,&quot; they explained.&lt;/p&gt;
&lt;p&gt;For example, the 20-year survival of 98.3% for ventricular septal defect would have fallen to 91.7% if multiple anomalies had not been classified separately.&lt;/p&gt;
&lt;p&gt;The biggest limitation of the study was that only 10% of patients were born twenty years before the matching date of the study (Jan. 28, 2008) so that 20-year survival rates were only estimates for most of the anomaly subtypes.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, David H. Stone, MD, of the University of Glasgow, called for more research and funding for congenital anomalies.&lt;/p&gt;
&lt;p&gt;&quot;Birth-defect registries have had a chequered history since their initial proliferation after the thalidomide disaster,&quot; he wrote.&lt;/p&gt;
&lt;p&gt;They are a crucial source of data, but face an endless struggle for funding, with the result that good quality data on etiology, prevalence, and outcomes are sparse.&lt;/p&gt;
&lt;p&gt;&quot;The publication of today&apos;s findings from the north of England should provide a much-needed boost to the cause of congenital anomaly surveillance,&quot; Stone concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Funding for the study was provided by BDF Newlife.&lt;/p&gt;&lt;p&gt;All investigators and the editorialist declared no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_182"
                     title="Kids with Bionic Ears Have Trouble Controlling Their Voices (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265732860485"
                     
      Although children who are deaf may be able to hear when fitted with cochlear implants in both ears, they have a more difficult time controlling their voices than kids with normal hearing, a single-center study showed.&lt;br&gt;
&lt;br&gt;Children with bilateral implants had deficits in controlling both the pitch and loudness of their voices when making a sustained &quot;ahh&quot; sound (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Karen Gordon, PhD, of the Hospital for Sick Children in Toronto, and colleagues.&lt;br&gt;
&lt;br&gt;Pitch control, however, improved significantly the longer the implants were used (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the January issue of &lt;em&gt;Archives of Otolaryngology  --  Head &amp;amp; Neck Surgery.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;&quot;The more experience one has with hearing, the better able to produce voice they have,&quot; Gordon said in an interview.&lt;br&gt;
&lt;br&gt;The number of children who receive cochlear implants for deafness has been increasing steadily over the past two decades, and it is now common, she said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The implants directly stimulate the auditory nerve to compensate for a nonfunctioning cochlea, regardless of the reason for the deafness.&lt;/p&gt;
&lt;p&gt;At the Hospital for Sick Children, a multidisciplinary team  --  including an audiologist, otolaryngologist, social worker, speech language pathologist, and auditory verbal therapist  --  assesses each child&apos;s suitability for the implants.&lt;/p&gt;
&lt;p&gt;&quot;We really look at the child, their candidacy from a hearing point of view, their expectations for what the implant can do for them, whether they&apos;re up for the surgery, and whether they&apos;re up for the therapy that&apos;s involved afterward,&quot; Gordon said.&lt;/p&gt;
&lt;p&gt;Although children with cochlear implants are able to hear, it&apos;s unclear exactly what their perception of sound is, she said. All must go through therapy lasting about two years to be able to interpret what they&apos;re hearing.&lt;/p&gt;
&lt;p&gt;However, the voicing of children with the implants compared with that of kids with normal hearing has not been extensively studied.&lt;/p&gt;
&lt;p&gt;So Gordon and her colleagues evaluated how 27 children with bilateral implants  --  ages 3 to 15  --  were able to control their voices, finding poorer control of long-term frequency perturbation (pitch) and long-term amplitude perturbation (loudness) compared with those with normal hearing.&lt;/p&gt;
&lt;p&gt;&quot;Despite the incredible opportunities that cochlear implants provide for auditory and linguistic development, abnormalities in acoustic voice outcomes persist,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, through a four-month follow-up, pitch control  --  but not loudness control  --  improved significantly with increased implant use.&lt;/p&gt;
&lt;p&gt;&quot;This result underlines the importance of early recognition and treatment of children with hearing loss to provide auditory experience as soon as possible,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, the use of cochlear implants is not free of complications, according to another study in the same issue of the journal by Natalie Loundon, MD, of the H&amp;#244;pital d&apos;Enfants Armand-Trousseau in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;Among 434 children younger than 16 who received the devices, 9.9% had complications, nearly two-thirds of which occurred more than eight days after implantation (mean 2.2 years).&lt;/p&gt;
&lt;p&gt;Major complications included severe cutaneous infections or hematoma, magnet displacement, meningitis, cholesteatoma, cerebrospinal fluid leak, and electrode misplacement.&lt;/p&gt;
&lt;p&gt;Minor complications included vertigo, soft-tissue infection, persistent otitis media, and facial nerve palsy.&lt;/p&gt;
&lt;p&gt;A large minority of those with complications (30.2%) required reimplantation.&lt;/p&gt;
&lt;p&gt;Trauma to the mastoid area and inner ear malformations were risk factors for delayed major complications and early minor complications, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both).&lt;/p&gt;
&lt;p&gt;Age at implantation was not associated with complication risk.&lt;/p&gt;
&lt;p&gt;&quot;The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family,&quot; Loundon and colleagues wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the authors of either of the studies made any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_668"
                     title="AAO: Vision Threat from Pediatric Uveitis Persists Over Time"
                     score="-0.006"
                     href="