Virtual Reality And Robotics In Neurosurgery — Promise And Challenges

Main Category: Neurology / Neuroscience
Also Included In: Medical Devices / Diagnostics;  IT / Internet / E-mail
Article Date: 28 Dec 2012 – 0:00 PST

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Virtual Reality And Robotics In Neurosurgery — Promise And Challenges

Robotic technologies have the potential to help neurosurgeons perform precise, technically demanding operations, together with virtual reality environments to help them navigate through the brain, according to a special supplement to Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
“Virtual Reality (VR) and robotics are two rapidly expanding fields with growing application within neurosurgery,” according to an introductory article by Garnette Sutherland, MD. The 22 reviews, commentaries, and original studies in the special supplement provide an up-to-the-minute overview of “the benefits and ongoing challenges related to the latest incarnations of these technologies.”
Robotics and VR in Neurosurgery – What’s Here and What’s Next
Virtual reality and robotic technologies present exciting opportunities for training, planning, and actual performance of neurosurgical procedures. Robotic tools under development or already in use can provide mechanical assistance, such as steadying the surgeon’s hand or “scaling” hand movements. “Current robots work in tandem with human operators to combine the advantages of human thinking with the capabilities of robots to provide data, to optimize localization on a moving subject, to operate in difficult positions, or to perform without muscle fatigue,” writes Dr. Sutherland.
Virtual reality technologies play an important role, providing “spatial orientation” between robotic instruments and the surgeon. Virtual reality environments “recreate the surgical space” in which the surgeon works, providing 3-D visual images as well as haptic (sense of touch) feedback. The ability to plan, rehearse, and “play back” operations in the brain could be particularly valuable for training neurosurgery residents – especially since recent work hour changes have limited opportunities for operating room experience.
The special supplement to Neurosurgery presents authoritative updates by experts working in the field of surgical robotics and VR technology, drawn from a wide range of disciplines. Topics include robotic technologies already in use, such as the “neuroArm” image-guided neurosurgical robot; reviews of progress in areas such as 3-D neurosurgical planning and virtual endoscopy; and new thinking on the best approaches to development, evaluation, and clinical uses of VR and robotic technologies.
But numerous and daunting technical challenges remain to be met before robotic and VR technologies become widely used in clinical neurosurgery. For example, VR environments require extremely fast processing times to provide the surgeon with continuously updated sensory information – equal to or faster than the brain’s ability to perceive it.
Economic challenges include the high costs of developing and implementing VR and robotic technologies, especially in terms of showing that the costs are justified by benefits to the patient. Continued progress in miniaturization will play an important role both in overcoming the technical challenges and in making the technology cost-effective.
The editors of Neurosurgery hope their supplement will stimulate interest and further progress in the development and practical implementation of VR and robotic technologies for neurosurgery. Dr. Sutherland adds, “Collaboration between the fields of medicine, engineering, science, and technology will allow innovations in these fields to converge in new products that will benefit patients with neurosurgical disease.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
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Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. Read more…

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Health Reform: What’s Coming in 2013

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Article Link: http://www.webmd.com/health-insurance/news/20121227/health-reform-whats-coming?src=RSS_PUBLIC

By Lisa Zamosky
WebMD Health News
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This has been a big year for the Affordable Care Act.

It survived a Supreme Court challenge and another during the presidential election. With President Obama in office for another four years, the health reform law will continue down the road to take full effect in 2014. But there is much work yet to be done, and 2013 promises to be a very active year.

Health Insurance Exchanges Go Online

The big story to watch in 2013 will be the development of state-based health insurance exchanges. These marketplaces will allow uninsured people and small businesses to shop for, compare, and enroll in health plans. Only through the exchanges will people learn if they qualify for and can take advantage of  federal tax subsidies to help cover the cost of insurance. Exchanges must be up and running by Oct. 1, 2013, and it’s going to be a mad rush to get the job done.

States were given the option to build their own exchanges and had until Dec. 14 to decide. Just 18 states and the District of Columbia agreed to build their own. Seven states have opted for a partnership exchange, a model where the states and federal government work together to operate the marketplace. That leaves the federal government to put in place health insurance exchanges in the remaining 25 states that declined to participate.

Increased Medicare Taxes on the Wealthy

If you have Medicare coverage and earn more than $200,000 a year or are part of a married couple earning more than $250,000 annually, get ready to pay higher taxes for Medicare hospital insurance (Medicare Part A) in 2013.

Starting in January, taxes will rise by 0.9%, up to 2.35%, on earnings above $200,000 for individual taxpayers. In addition, income earned from investments (as opposed to salary) will face a 3.8% tax assessment.

Together, these two Medicare tax increases are expected to raise a total of $210 billion over 10 years to help pay for the changes brought by the health reform law.

Changes to Itemized Medical Deductions

For years we’ve been allowed to deduct unreimbursed medical costs that amount to 7.5% of our adjusted gross income. Starting next year, anyone under the age of 65 will see that threshold increase to 10%.

Limits to FSA Contributions

Flexible spending accounts (FSAs) allow people to set aside pre-tax salary dollars to pay for medical expenses not covered by insurance. Starting in January, contributions to these accounts will be limited to $2,500 a year.

Medicaid Expansion Becomes Optional

The Supreme Court’s ruling earlier this year brought changes to the part of the law that expanded the Medicaid program to include more low income Americans. The expansion allows for individuals who earn about $15,400 a year and families that earn about $26,300 annually to participate. In its decision, the court said the Medicaid expansion will be optional for states, not a requirement.

In response, many governors opposed to the law said they would refuse to expand their Medicaid programs. To date, 18 states have agreed to broaden rules for their Medicaid program, 11 states have said they would not expand their programs, and 16 remain undecided.

SOURCES:

Cornell University Law School Legal Information Institute: “Supreme Court Toolbox.”

Urban Institute.

Avalere: “Two-Thirds of Exchange Enrollees Will Buy Through Federally-Administered Exchanges in 2014.”

Kaiser Family Foundation: “Health Reform Source Implementation Timeline.”

Healthcare.gov. Affordable Insurance Exchanges: State Partnership Model: http://www.healthcare.gov/news/factsheets/2011/09/exchanges09192011a.html

Healthcare.gov: “Progress Continues in Setting up Health Insurance Marketplaces.”

Kaiser Family Foundation: “State Decisions for Creating Health Insurance Exchanges in 2014.”

Towers Watson: “High-Income Individuals to Pay Higher Medicare Taxes Starting in 2013.”

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Recall of More Hydrocodone-Acetaminophen Tablets

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Article Link: http://www.webmd.com/pain-management/news/20121226/recall-expansion-hydrocodone-acetaminophen?src=RSS_PUBLIC

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Dec. 26, 2012 — More lots of the combination painkiller hydrocodoneacetaminophen are being recalled by Mylan Institutional. The new alert follows a nationwide recall of 101 lots of the drugs issued by Qualitest Pharmaceuticals that occurred earlier this month.

The FDA says the newly recalled lots were manufactured by Qualitest Pharmaceuticals and were repackaged and distributed by Mylan Institutional. The three lots include:

  • 3037841
  • 3040859
  • 3042573

The recalled bottles are supposed to contain tablets made up of 10 milligrams of hydrocodone and 500 milligrams of acetaminophen. But they are being recalled because the tablets may contain higher amounts of acetaminophen or hydrocodone than indicated on the label.

High doses of acetaminophen may put you at increased risk for liver damage.

Especially at risk are people who:

  • Take other medications containing acetaminophen
  • Have liver disease
  • Drink more than three alcoholic beverages a day

Additionally, too-high doses of hydrocodone can cause increased sedation and/or breathing problems, particularly among the elderly, people with severe kidney or liver impairment, and those who are taking other sedating medications or certain antidepressants.

If you have the affected lots you can contact Mylan Customer Service at 800-848-0462. People who are unsure should call their pharmacist or doctor.

SOURCE:

FDA MedWatch alert, Dec. 21, 2012.

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Thousands of Mistakes Made in Surgery Every Year

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Article Link: http://www.webmd.com/news/20121220/thousands-mistakes-surgery?src=RSS_PUBLIC

By Jennifer Warner
WebMD Health News
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Dec. 26, 2012 — More than 4,000 preventable mistakes occur in surgery every year at a cost of more than $1.3 billion in medical malpractice payouts, according a new study.

How preventable? Well, researchers call them “never events” because they are the kind of surgical mistakes that should never happen, like performing the wrong procedure or leaving a sponge inside a patient’s body after surgery.

But researchers found that paid malpractice settlements and judgments for these types of never events occurred about 10,000 times in the U.S. between 1990 and 2010. Their analysis estimates that each week surgeons:

  • Leave a foreign object like a sponge or towel inside a patient’s body after an operation 39 times
  • Perform the wrong procedure on a patient 20 times
  • Operate on the wrong body site 20 times

“I continue to find the frequency of these events alarming and disturbing,” says Donald Fry, MD, executive vice president at Michael Pine and Associates, a health care think tank in Chicago. “I think it’s a difficult thing for clinicians to talk about, but it is something that must be improved.”

Surgical Mishaps Happen

In the study, researchers looked at malpractice claim information for surgical never events from the National Practitioner Data Bank from 1990 to 2010. The results are published in Surgery.

Malpractice settlements and judgments relating to leaving a sponge or other object inside a patient, performing the wrong operation, operating on the wrong site or on the wrong person were included in their analysis.

The results showed a total of 9,744 paid malpractice judgments and claims for these types of never events were reported over the 20-year period, totaling $1.3 billion.

Based on these results, researchers estimate that 4,044 surgical never events occur each year in the U.S.

Researchers say the actual number of these surgical mistakes is likely even higher.

“What we report is the low end of the range because many never events go unreported,” says researcher Marty Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine.

Makary says by law, hospitals are required to report never events that result in a settlement or judgment.

But not all items left behind after surgery are discovered. They are typically only reported when a patient experiences a complication after surgery, and doctors try to find out why.

“We believe the events we describe are real,” says Makary. “I cannot imagine a hospital paying out a settlement for a false claim of a retained sponge.”

The consequences of surgical mistakes ranged from temporary injury in 59% of the cases to death in 6.6% of the cases and permanent injury in 33% of people affected.

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Fungal Meningitis Patients: A Long Road to Recovery

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By Brenda Goodman, MA
WebMD Health News
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Dec. 26, 2012 — Johnnie McKee thought she was out of the woods.

McKee, a 72-year-old grandmother of four from Bethpage, Tenn., was one of nearly 14,000 people who found out this fall that they’d been exposed to tainted medications made by the now shuttered New England Compounding Center.

In her case, the threat came from a steroid shot that she’d had on Sept. 7 to relieve some nagging back pain.

“We got a letter. We were told that if we could make it 28 days, that we’d be clear,” says Fred McKee, her husband of 51 years. “We watched it and worried about it,” says Fred, his voice filling with emotion.

But Johnnie felt fine. She didn’t have any of the symptoms they were told to look for — headaches, nausea, fever.

The waiting period passed, and she felt good enough to get back to her yard, which she had always tended with great care. “She mowed the lawn,” says Fred.

Then, on Oct. 8, the pain hit like a bolt of lightning at the base of her spine. “It was just excruciating pain,” says Fred. Their surgeon told them to drive to the emergency room at St. Thomas Hospital in Nashville, where doctors had started to treat a wave of patients who were battling a rare type of fungal meningitis, an infection of the brain and spinal cord.

“There were three criteria they looked for to determine if you have fungal meningitis, and she met all three,” Fred says.

Still, he says, they didn’t worry. But that may have been because they didn’t understand what was coming.

“I don’t think we really realized that we were really getting into a two- to three-month hospitalization period and a six-month-to-a-year complete recovery,” he says.

An Outbreak Without Precedent

Since the outbreak began, 620 people have been infected and 39 have died in 19 states. No one has been cured.

“As far as we know, no one has been taken off medicines, and we wouldn’t recommend that now; it’s still too early,” says Tom M. Chiller, MD, MPH, deputy chief of the Mycotic Diseases Branch at the CDC in Atlanta.

Many hope they are on the road to recovery, but no one can tell them when it will end.

Experts say they’ve never seen these kind of fungal infections, much less this many cases.

“It’s very difficult for the doctors and the patients because we can’t say, ‘Well, just two more weeks of this and it will be over.’ What we’re saying is that we’re going to keep treating you. We’re going to keep caring for you, and when the experts tell us we can stop, we’re going to do that,” says William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville.

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Proteins Found In Urine May Enable Diagnosis Of Kawasaki Disease

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Also Included In: Pediatrics / Children’s Health;  Vascular
Article Date: 27 Dec 2012 – 0:00 PST

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A set of proteins detected in urine by researchers at Boston Children’s Hospital may prove to be the first biomarkers for Kawasaki disease, an uncommon but increasingly prevalent disease which causes inflammation of blood vessels that can lead to enlarged coronary arteries and even heart attacks in some children. If validated in more patients with Kawasaki disease, the markers could make the disease easier to diagnose and give doctors an opportunity to start treatment earlier.

The discovery was reported online by a team led by members of the Proteomics Center and the departments of Pathology and Rheumatology at Boston Children’s on Dec. 20 in the journal EMBO Molecular Medicine.

While only about two in 10,000 children in the United States develop Kawasaki disease annually, the disease is on the rise both here and worldwide; in Japan the prevalence approaches one in 100 among children under the age of 5. No one knows what triggers the disease, and though it can occur at any age, it most often appears in children under 5.

Kawasaki disease is highly treatable – approximately 80 percent of children diagnosed with it require only one round of treatment – but making a diagnosis is often a significant challenge. And if it is not detected early, Kawasaki disease can have serious consequences: About 25 percent of children with untreated Kawasaki disease develop coronary artery aneurysms.

“The symptoms of Kawasaki disease, including fever, rash and enlarged lymph nodes, mimic those found in many common viral or bacterial infections in children,” said Susan Kim, MD, MMSc, a rheumatologist with the Kawasaki Disease Program at Boston Children’s. “The process of diagnosis includes considering a long list of possibilities. Especially in children with an incomplete presentation, a diagnosis of Kawasaki can be delayed or even missed.

“We’d like to have a test that we can use to proactively distinguish children with Kawasaki disease from those with other causes of fever,” she continued. “This would allow us to start treatment much earlier and greatly reduce the risks of long-term complications.”

In order to develop an effective diagnostic test, Kim worked with proteomics experts Alex Kentsis, MD, PhD, and Hanno Steen, PhD, to screen the protein content of urine from patients with Kawasaki disease using mass spectrometry and enzyme-linked immunosorbant assays. Kentsis and Steen had previously identified urine biomarkers for acute appendicitis, an effort aimed at reducing the numbers of children who either underwent unnecessary appendectomies or who had a ruptured appendix that did not show up on an imaging scan.

The team identified 190 proteins found only in the urine of children with Kawasaki disease. When validated in samples from 107 children seen at Boston Children’s with suspected Kawasaki disease (53 of whom were ultimately diagnosed with it), two of the proteins – filamin C and meprin A, which are associated with injury to blood vessel and cardiac muscle cells as well as inflammation – proved to be 98 percent accurate at distinguishing children with Kawasaki disease from ones with conditions mimicking the disease. Levels of the markers also closely tracked treatment response and, in one patient, disease recurrence.

Other Kawasaki-associated markers detected in the study included proteins involved in immune activation, immune regulation and pathogen recognition.

The researchers caution that for the moment the markers are still research tools and that they are working to refine and validate the findings in a larger group of patients. “We are working with the hospital’s Technology Innovation and Development Office to find corporate partners with which to develop a clinical-grade test,” said Steen, who directs the Proteomics Center.

“This is very exciting and our results are very promising,” said Kim. “Of course we need to validate the results in a broader cohort of patients, ideally in collaboration with other centers. We are hopeful that these findings will help us to develop a test that can help specifically and proactively detect or rule out Kawasaki in suspected patients in the future.”

The study was supported by Harvard Catalyst | The Harvard Clinical and Translational Science Center (NIH grant UL1RR025758), the National Heart, Lung and Blood Institute (grants U01HL068285, U01HL068270, U01HL068269, U01HL068292, U01HL068290, U01HL068288, U01HL068281 and U01HL068279), the National Center for Research Resources (grant M01RR02172), the National Cancer Institute (grant K08CA160660) and Boston Children’s Hospital’s Division of Immunology and Translational Research Program.
Boston Children’s Hospital
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n.p. (2012, December 27). “Proteins Found In Urine May Enable Diagnosis Of Kawasaki Disease.” . Retrieved fromhttp://www.medicalnewstoday.com/releases/254404.php.

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‘Proteins Found In Urine May Enable Diagnosis Of Kawasaki Disease’

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Weight Loss Pill Qsymia 'Gaining Traction'

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Article Link: http://www.webmd.com/diet/news/20121224/qsymia-gaining-traction?src=RSS_PUBLIC

Dec. 26, 2012 — Sales of the prescription weight loss drug Qsymia, the first such drug to get the FDA’s OK in 13 years, are increasing, despite earlier reports of sluggish interest.

For the week ending Dec. 7, more than 2,000 new prescriptions for Qsymia were filled, according to Source Healthcare Analytics, a provider of pharmaceutical market data. That compares to 1,163 filled prescriptions for the week ending Nov. 23.

Depending on who you talk to, the drug, which went on sale in mid-September, is a godsend or a disaster.

Gwen Barton, 57, of New York, participated in a Qsymia clinical trial. She dropped 50 pounds in 18 months. She gained back half of that after the trial ended, then started back on the pill in early December.

The pounds came off again. “I have lost 12 pounds so far and I’m very happy,” she says. She wants to shed another 40 pounds on her 5-foot-5-inch frame to get to 140 pounds.

Barton offered to share her story through the public relations firm for Vivus, the maker of Qsymia.

When the FDA approved the drug earlier in 2012, Sidney Wolfe, MD, director of Public Citizen’s Health Research Group, called the decision ”reckless.”

His opinion hasn’t changed, he says. “The history of diet drugs is a disaster,” he says.

Qsymia Prescriptions Up

Michael Miller, chief commercial officer at Vivus, declined to release sales figures or quote prescription numbers until January, when fourth quarter results are in.

“We are pleased,” he says of sales. “We have been gaining traction.”

The drug is only sold through certified mail-order pharmacies whose personnel have finished a Qsymia-provided training program.

That was part of the risk reduction that Vivus agreed to with the FDA.

Average cost of the recommended dose is $160 for a one-month supply, Miller says.

Insurance coverage is not yet common. “About 1 out of 5 prescriptions are covered,” he says. “The average co-pay is $50 or $60.”

Qsymia combines two drugs already on the market: phentermine and topiramate.

Phentermine is an appetite suppressant. (It was the ”phen” part of the popular weight loss combination pill fen-phen. After reports of lung problems and heart valve damage surfaced, related to the ”fen” or fenfluramine, the FDA requested fenfluramine’s withdrawal from market in 1997).

Topiramate may work by suppressing appetite and helping you feel full, according to the drugmaker.

Qsymia is approved only for those who have a body mass index or BMI of 30+, termed obese, or a BMI of 27+, termed overweight, with another weight-related problem such as high blood pressure or high cholesterol.

It is prescribed with the understanding that patients will follow a healthy, reduced-calorie diet and get regular exercise.

Barton says she walks for exercise. She drinks a lot of water and has given up fatty foods, sodas, and another old favorite, doughnuts.

Thanksgiving was not the struggle it once was. “No seconds, no thirds, I didn’t bring food home,” she says.

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Weight Loss Pill Qsymia ‘Gaining Traction’

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Article Link: http://www.webmd.com/diet/news/20121224/qsymia-gaining-traction?src=RSS_PUBLIC

Dec. 26, 2012 — Sales of the prescription weight loss drug Qsymia, the first such drug to get the FDA’s OK in 13 years, are increasing, despite earlier reports of sluggish interest.

For the week ending Dec. 7, more than 2,000 new prescriptions for Qsymia were filled, according to Source Healthcare Analytics, a provider of pharmaceutical market data. That compares to 1,163 filled prescriptions for the week ending Nov. 23.

Depending on who you talk to, the drug, which went on sale in mid-September, is a godsend or a disaster.

Gwen Barton, 57, of New York, participated in a Qsymia clinical trial. She dropped 50 pounds in 18 months. She gained back half of that after the trial ended, then started back on the pill in early December.

The pounds came off again. “I have lost 12 pounds so far and I’m very happy,” she says. She wants to shed another 40 pounds on her 5-foot-5-inch frame to get to 140 pounds.

Barton offered to share her story through the public relations firm for Vivus, the maker of Qsymia.

When the FDA approved the drug earlier in 2012, Sidney Wolfe, MD, director of Public Citizen’s Health Research Group, called the decision ”reckless.”

His opinion hasn’t changed, he says. “The history of diet drugs is a disaster,” he says.

Qsymia Prescriptions Up

Michael Miller, chief commercial officer at Vivus, declined to release sales figures or quote prescription numbers until January, when fourth quarter results are in.

“We are pleased,” he says of sales. “We have been gaining traction.”

The drug is only sold through certified mail-order pharmacies whose personnel have finished a Qsymia-provided training program.

That was part of the risk reduction that Vivus agreed to with the FDA.

Average cost of the recommended dose is $160 for a one-month supply, Miller says.

Insurance coverage is not yet common. “About 1 out of 5 prescriptions are covered,” he says. “The average co-pay is $50 or $60.”

Qsymia combines two drugs already on the market: phentermine and topiramate.

Phentermine is an appetite suppressant. (It was the ”phen” part of the popular weight loss combination pill fen-phen. After reports of lung problems and heart valve damage surfaced, related to the ”fen” or fenfluramine, the FDA requested fenfluramine’s withdrawal from market in 1997).

Topiramate may work by suppressing appetite and helping you feel full, according to the drugmaker.

Qsymia is approved only for those who have a body mass index or BMI of 30+, termed obese, or a BMI of 27+, termed overweight, with another weight-related problem such as high blood pressure or high cholesterol.

It is prescribed with the understanding that patients will follow a healthy, reduced-calorie diet and get regular exercise.

Barton says she walks for exercise. She drinks a lot of water and has given up fatty foods, sodas, and another old favorite, doughnuts.

Thanksgiving was not the struggle it once was. “No seconds, no thirds, I didn’t bring food home,” she says.

Diet Tools & Calculators

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diet tools and calculators

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Rates of Childhood Obesity Fall Slightly

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Article Link: http://children.webmd.com/news/20121220/rates-childhood-obesity-fall?src=RSS_PUBLIC

By Denise Mann
WebMD Health News
children in huddle smiling

Dec. 25, 2012 — New data suggest that we may have turned an important corner in the childhood obesity epidemic.

While rates of obesity and extreme obesity in preschoolers rose from 1998 to 2003, they began to plateau soon thereafter. And childhood obesity rates decreased slightly in 2010.

“We are very encouraged by this data,” says study researcher Heidi M. Blanck, PhD, of the CDC in Atlanta. “It’s pretty exciting and a nice turning of the tide. But we have to stay vigilant or it will go in the other direction.”

Researchers looked at data on 27.5 million children aged 2 to 4 from 1998 to 2010. These children were from 30 states and Washington, D.C. Many were eligible for government assistance.

The rate of child obesity rose from 13.05% in 1998 to 15.21% in 2003. But it fell to 14.94% in 2010.

The rate of extreme child obesity declined from 2.22% in 2003 to 2.07% in 2010, the study shows.

The findings appear in the Journal of the American Medical Association.

What makes the data even more promising is that many of the national initiatives aimed at lowering rates of childhood obesity hadn’t been started or were not at full force during most of the study period, Blanck says.

For example, efforts aimed at making it easier for new moms to breastfeed are just now gaining traction. Breastfeeding has been shown to help prevent obesity. There are also new programs that help people on food stamps purchase healthier foods.

Fighting Obesity With Lifestyle Changes

There’s also a lot that families can do in their own homes to encourage healthy lifestyles. These include getting more physical activity during the day and less screen time. “Walk the family dog together to get exercise,” Blanck says.

Also, get rid of sugary drinks and beverages in the home, and make fruits and vegetables available. “We know that childhood obesity tracks into adulthood, so it’s important to make these changes early and maintain them,” she says.

“The news is definitely encouraging,” says Leslie Lam, MD. He is a doctor at The Children’s Hospital at Montefiore Medical Center in New York City.

William Muinos, MD, says the new findings have not trickled down to his patients yet. He is the associate director of pediatric gastroenterology at Miami Children’s Hospital. “My childhood obesity clinic is growing in leaps and bounds,” he says. “We can do a lot better.”

Shari Barkin, MD, is also not sold on the fact that rates are declining yet. She is a professor of pediatrics at Vanderbilt University in Nashville, Tenn. “I’m heartened because we are holding our own,” she says. “It is good news that we have stabilized, but these current rates, even stabilized, are unacceptable.”

Her advice to families is to aim for 30 minutes a day of physical activity. “More is great, but we should all start here,” she says. “The best way to get preschoolers active is to get the family involved. “Parents are the best teachers.”

And make it fun. “We don’t call it exercise, we call it play.”

SOURCE:

Pan, L. Journal of the American Medical Association, Dec. 26, 2012.

Leslie Lam, MD, division of endocrinology and diabetes, The Children’s Hospital at Montefiore Medical Center, New York.

Shari Barkin, MD, professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn.

William Muinos, MD, associate director, pediatric gastroenterology, Miami Children’s Hospital.

Heidi M. Blanck, PhD, CDC, Atlanta.

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Low Vitamin D More Common in Overweight Kids

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Article Link: http://children.webmd.com/news/20121220/vitamin-d-overweight-kids?src=RSS_PUBLIC

By Rita Rubin
WebMD Health News
overweight boy with serious expression

Dec. 24, 2012 — Overweight and obese children and teens are more likely to have low vitamin D levels than kids with healthy weights, a new study suggests.

The study is published in Pediatrics.

Vitamin D is essential for bone health. Bone growth is high during childhood and adolescence. So it may be especially important to identify and treat vitamin D deficiency during that time, the researchers write.

Vitamin D deficiency is also linked to a variety of chronic conditions, such as:

  • High blood pressure
  • Type 1 diabetes
  • Multiple sclerosis

 Previous research suggests that obesity may put you at risk for vitamin D deficiency.

Overweight Kids and Vitamin D

Researchers in the study analyzed data from more than 12,000 U.S. children and teens aged 6 to 18. The children were enrolled in the 2003-2006 National Health and Nutrition Examination Survey.

About 21% of the healthy-weight youngsters were deficient in vitamin D. That was also true for 29% of those who were overweight, 34% of those who were obese, and 49% of those who were severely obese.

Even after accounting for such factors as vitamin D supplementation and intake of milk, which is typically fortified with vitamin D, the rates of vitamin D deficiency were higher in Latinos and African-Americans. Among the severely obese youngsters, 27% of whites, 52% of Latinos, and 87% of African-Americans were deficient in vitamin D.

“The particularly high prevalence in severely obese and minority children suggests that targeted screening and treatment guidance is needed,” the researchers conclude.

Researcher Christy Turer, MD, a pediatrician at the University of Texas Southwestern Medical Center and Children’s Medical Center in Dallas, says she and her colleagues already were routinely checking vitamin D levels in children at specialty clinics, such as weight management clinics. Those found to be deficient are prescribed high-dose vitamin D supplements, a pill taken weekly. After eight weeks of treatment, their levels are rechecked, and if they’re near normal, she’ll cut them back to monthly doses of vitamin D supplements.

Turer also recommends that vitamin-D-deficient patients drink low-fat milk. If they don’t like to drink plain milk, she says they can add artificially sweetened flavors that add only 15 calories a serving.

“The reason that milk is important is it has not just vitamin D, but it has calcium,” she says. Unsweetened soy milk and almond milk are also good sources of vitamin D and calcium, Turer says.

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