1
|
Darrow SM, Illmann C, Gauvin C, Osiecki L, Egan CA, Greenberg E, Eckfield M, Hirschtritt ME, Pauls DL, Batterson JR, Berlin CM, Malaty IA, Woods DW, Scharf J, Mathews C. Web-based phenotyping for Tourette Syndrome: Reliability of common co-morbid diagnoses. Psychiatry Res 2015; 228:816-25. [PMID: 26054936 PMCID: PMC4532555 DOI: 10.1016/j.psychres.2015.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/04/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
Collecting phenotypic data necessary for genetic analyses of neuropsychiatric disorders is time consuming and costly. Development of web-based phenotype assessments would greatly improve the efficiency and cost-effectiveness of genetic research. However, evaluating the reliability of this approach compared to standard, in-depth clinical interviews is essential. The current study replicates and extends a preliminary report on the utility of a web-based screen for Tourette Syndrome (TS) and common comorbid diagnoses (obsessive compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD)). A subset of individuals who completed a web-based phenotyping assessment for a TS genetic study was invited to participate in semi-structured diagnostic clinical interviews. The data from these interviews were used to determine participants' diagnostic status for TS, OCD, and ADHD using best estimate procedures, which then served as the gold standard to compare diagnoses assigned using web-based screen data. The results show high rates of agreement for TS. Kappas for OCD and ADHD diagnoses were also high and together demonstrate the utility of this self-report data in comparison previous diagnoses from clinicians and dimensional assessment methods.
Collapse
Affiliation(s)
- Sabrina M. Darrow
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Caitlin Gauvin
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Crystelle A. Egan
- Martinez Outpatient Clinic and Community Living Center, Northern California VA Health Care System, 150 Muir Road, Martinez, CA 94553 USA
| | - Erica Greenberg
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Monika Eckfield
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA,School of Nursing, University of California San Francisco 2 Koret Way, #N-319X, San Francisco, CA 94143 USA,Department of Nursing and Health Sciences, California State University East Bay 25800 Carlos Bee Blvd., Hayward, CA 94542 USA
| | - Matthew E. Hirschtritt
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - James R. Batterson
- Children’s Mercy Hospitals & Clinics, University of Missouri, Kansas City School of Medicine, 2401 Gilham Road, Kansas City, MO 64108 USA
| | - Cheston M. Berlin
- Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State, 500 University Dr., Hershey, PA 17033 USA
| | - Irene A. Malaty
- UF Center for Movement Disorders and Neurorestoration, Department of Neurology, College of Medicine, University of Florida, 3450 Hull Road, Gainesville, FL 32607 USA
| | - Douglas W. Woods
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843 USA
| | - Jeremiah Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, 415 Main St., Cambridge, MA 02142 USA,Division of Cognitive and Behavioral Neurology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115 USA,Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Carol Mathews
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA,Address correspondence to Carol A. Mathews, M.D., Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box F-0984, San Francisco, CA 94143-0984; ; phone: 415-476-7702; fax: 415-476-7389
| |
Collapse
|
2
|
Marchitti SA, LaKind JS, Naiman DQ, Berlin CM, Kenneke JF. Improving infant exposure and health risk estimates: using serum data to predict polybrominated diphenyl ether concentrations in breast milk. Environ Sci Technol 2013; 47:4787-95. [PMID: 23582134 DOI: 10.1021/es305229d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Women in the United States have breast milk concentrations of polybrominated diphenyl ethers (PBDEs) that are among the highest in the world, leading to concerns over the potential health implications to breastfeeding infants during critical stages of growth and development. Developing cost-effective and sustainable methods for assessing chemical exposures in infants is a high priority to federal agencies and local communities. PBDE data are available in nationally representative serum samples but not in breast milk. As a method to predict PBDE concentrations in U.S. breast milk, we present the development of congener-specific linear regression partitioning models and their application to U.S. serum data. Models were developed from existing paired milk and serum data and applied to 2003-2004 NHANES serum data for U.S. women. Highest estimated median U.S. breast milk concentrations were for BDE-47 (30.6 ng/g lipid) and BDE-99 (6.1 ng/g lipid) with the median concentration of Σ7PBDEs estimated at 54.2 ng/g lipid. Predictions of breast milk PBDE concentration were consistent with reported concentrations from 11 similarly timed U.S. studies. When applied to NHANES data, these models provide a sustainable method for estimating population-level concentrations of PBDEs in U.S. breast milk and should improve exposure estimates in breastfeeding infants.
Collapse
Affiliation(s)
- Satori A Marchitti
- National Exposure Research Laboratory, U.S. Environmental Protection Agency, Athens, Georgia 30605, USA
| | | | | | | | | |
Collapse
|
3
|
Abstract
The two ultimate goals of using maternal medications during breastfeeding are (i) to provide definitive therapy for maternal conditions for which the drugs have been prescribed, and (ii) to assure protection of the nursing infant from any adverse event related to his/her mother's treatment. Fortunately there are only a few drugs that have been identified as potentially causing harm to the infant. Analytic techniques exist to measure compounds in concentrations as small as nanograms per liter of milk. For nearly all compounds these very small amounts would not be able to exert pharmacological activity, even if absorbed by the infant via the oral route. For environmental chemicals, this ability to measure very small amounts exceeds our knowledge of any biological activity. Concern over any possible adverse event to the nursing infant should take into account the drug, its dose, the age of the infant, recognition of the interindividual variation in drug response and the role of pharmacogenetics. The latter two variables are closely linked.
Collapse
Affiliation(s)
- Cheston M Berlin
- Department of Pediatrics, Penn State Children's Hospital, Milton S. Hershey Medical Center, P.O. Box 850, MC HS83, Hershey, PA 17033, USA.
| | | |
Collapse
|
4
|
Dórea JG, Fenton SE, LaKind JS, Berlin CM. Researching chemicals in human milk can be conducted without discouraging breastfeeding. Bosn J Basic Med Sci 2012; 12:137-8. [PMID: 22642600 DOI: 10.17305/bjbms.2012.2515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Paul IM, Sturgis SA, Yang C, Engle L, Watts H, Berlin CM. Efficacy of standard doses of Ibuprofen alone, alternating, and combined with acetaminophen for the treatment of febrile children. Clin Ther 2011; 32:2433-40. [PMID: 21353111 DOI: 10.1016/j.clinthera.2011.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many pediatricians recommend, and many parents administer, alternating or combined doses of ibuprofen and acetaminophen for fever. Limited data support this practice with standard US doses. OBJECTIVE This study compared the antipyretic effect of 3 different treatment regimens in children, using either ibuprofen alone, ibuprofen combined with acetaminophen, or ibuprofen followed by acetaminophen over a single 6-hour observation period. METHODS Febrile episodes from children aged 6 to 84 months were randomized into the 3 treatment groups: a single dose of ibuprofen at the beginning of the observation period; a single dose of ibuprofen plus a single dose of acetaminophen at the beginning of the observation period; or ibuprofen followed by acetaminophen 3 hours later. Ibuprofen was administered at 10 mg/kg; acetaminophen at 15 mg/kg. Temperatures were measured hourly for 6 hours using a temporal artery thermometer. The primary outcome was temperature difference between treatment groups. Adverse-event data were not collected in this single treatment period study. RESULTS Sixty febrile episodes in 46 children were assessed. The mean (SD) age of the children was 3.4 (2.2) years, and 31 (51.7%) were girls. Differences among temperature curves were significant (P < 0.001; the combined and alternating arms had significantly better antipyresis compared with the ibuprofen-alone group at hours 4 to 6 (hour 4, P < 0.005; hours 5 and 6, P < 0.001). All but one of the children in the combined and alternating groups were afebrile at hours 4, 5, and 6. In contrast, for those receiving ibuprofen alone, 30%, 40%, and 50% had temperatures >38.0 °C at hours 4, 5, and 6, respectively (hour 4, P = 0.002; hours 5 and 6, P < 0.001). CONCLUSION During a single 6-hour observation period for these participating children, combined and alternating doses of ibuprofen and acetaminophen provided greater antipyresis than ibuprofen alone at 4 to 6 hours. ClinicalTrials.gov identifier: NCT00267293.
Collapse
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Abstract
OBJECTIVE To determine if a single application of a vapor rub (VR) or petrolatum is superior to no treatment for nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection. METHODS Surveys were administered to parents on 2 consecutive days--on the day of presentation when no medication had been given the previous evening, and the next day when VR ointment, petrolatum ointment, or no treatment had been applied to their child's chest and neck before bedtime according to a partially double-blinded randomization scheme. RESULTS There were 138 children aged 2 to 11 years who completed the trial. Within each study group, symptoms were improved on the second night. Between treatment groups, significant differences in improvement were detected for outcomes related to cough, congestion, and sleep difficulty; VR consistently scored the best, and no treatment scored the worst. Pairwise comparisons demonstrated the superiority of VR over no treatment for all outcomes except rhinorrhea and over petrolatum for cough severity, child and parent sleep difficulty, and combined symptom score. Petrolatum was not significantly better than no treatment for any outcome. Irritant adverse effects were more common among VR-treated participants. CONCLUSIONS In a comparison of VR, petrolatum, and no treatment, parents rated VR most favorably for symptomatic relief of their child's nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection. Despite mild irritant adverse effects, VR provided symptomatic relief for children and allowed them and their parents to have a more restful night than those in the other study groups.
Collapse
Affiliation(s)
- Ian M. Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jessica S. Beiler
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Tonya S. King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Edelveis R. Clapp
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Julie Vallati
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Cheston M. Berlin
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
7
|
LaKind JS, Berlin CM, Sjödin A, Turner W, Wang RY, Needham LL, Paul IM, Stokes JL, Naiman DQ, Patterson DG. Do human milk concentrations of persistent organic chemicals really decline during lactation? Chemical concentrations during lactation and milk/serum partitioning. Environ Health Perspect 2009; 117:1625-31. [PMID: 20019916 PMCID: PMC2790520 DOI: 10.1289/ehp.0900876] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 06/15/2009] [Indexed: 05/18/2023]
Abstract
BACKGROUND Conventional wisdom regarding exposures to persistent organic chemicals via breast-feeding assumes that concentrations decline over the course of lactation and that the mother's body burden reflects her cumulative lifetime exposure. Two important implications stemming from these lines of thought are, first, that assessments of early childhood exposures should incorporate decreasing breast milk concentrations over lactation; and, second, that there is little a breast-feeding mother can do to reduce her infant's exposures via breast-feeding because of the cumulative nature of these chemicals. OBJECTIVES We examined rates of elimination and milk/serum partition coefficients for several groups of persistent organic chemicals. METHODS We collected simultaneous milk and blood samples of 10 women at two times postpartum and additional milk samples without matching blood samples. RESULTS Contrary to earlier research, we found that lipid-adjusted concentrations of polybrominated diphenyl ethers, polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins and furans, and organochlorine pesticides in serum and milk do not consistently decrease during lactation and can increase for some women. Published research has also suggested an approximate 1:1 milk/serum relationship (lipid adjusted) on a population basis for 2,3,7,8-tetrachlorodibenzo-p-dioxin; however, our results suggest a more complex relationship for persistent, lipophilic chemicals with the milk/serum relationship dependent on chemical class. CONCLUSIONS Decreases in concentration of lipophilic chemicals on a lipid-adjusted basis during lactation should no longer be assumed. Thus, the concept of pumping and discarding early milk as means of reducing infant exposure is not supported. The hypothesis that persistent lipophilic chemicals, on a lipid-adjusted basis, have consistent concentrations across matrices is likely too simplistic.
Collapse
|
8
|
Freeman RD, Zinner SH, Müller-Vahl KR, Fast DK, Burd LJ, Kano Y, Rothenberger A, Roessner V, Kerbeshian J, Stern JS, Jankovic J, Loughin T, Janik P, Shady G, Robertson MM, Lang AE, Budman C, Magor A, Bruun R, Berlin CM. Coprophenomena in Tourette syndrome. Dev Med Child Neurol 2009; 51:218-27. [PMID: 19183216 DOI: 10.1111/j.1469-8749.2008.03135.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this descriptive study were to examine the prevalence and associations of coprophenomena (involuntary expression of socially unacceptable words or gestures) in individuals with Tourette syndrome. Participant data were obtained from the Tourette Syndrome International Database Consortium. A specialized data collection form was completed for each of a subset of 597 consecutive new patients with Tourette syndrome from 15 sites in seven countries. Coprolalia occurred at some point in the lifetime of 19.3% of males and 14.6% of females, and copropraxia in 5.9% of males and 4.9% of females. Coprolalia was three times as frequent as copropraxia, with a mean onset of each at about 11 years, 5 years after the onset of tics. In 11% of those with coprolalia and 12% of those with copropraxia these coprophenomena were one of the initial symptoms of Tourette syndrome. The onsets of tics, coprophenomena, smelling of non-food objects, and spitting were strongly intercorrelated. Early onset of coprophenomena was not associated with its longer persistence. The most robust associations of coprophenomena were with the number of non-tic repetitive behaviors, spitting, and inappropriate sexual behavior. Although coprophenomena are a frequently feared possibility in the course of Tourette syndrome, their emergence occurs in only about one in five referred patients. Because the course and actual impact of coprophenomena are variable, additional prospective research is needed to provide better counseling and prognostic information.
Collapse
|
9
|
|
10
|
LaKind JS, Berlin CM, Mattison DR. The heart of the matter on breastmilk and environmental chemicals: essential points for healthcare providers and new parents. Breastfeed Med 2008; 3:251-9. [PMID: 19086828 DOI: 10.1089/bfm.2008.0121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract The increasing number of environmental chemicals measured in breastmilk is a consequence of improved analytical capabilities and the increased interest in biomonitoring. It has been generally concluded that the benefits to the infant from breastfeeding outweigh potential risks associated with environmental chemical exposures associated with breastfeeding. However, there have been reports of subtle effects on infants associated with chemicals in breastmilk. Associations between concentrations of chemicals in breastmilk and a biochemical or other change in infants may signal the need for further study or regulatory action, whereas on an individual level, these changes may not be considered adverse. For healthcare providers, this distinction is critical, as many in the field are being asked for nuanced information on risks and benefits associated with breastfeeding, and this information is not readily available. Recognizing the challenge faced by healthcare providers, we have explored and developed a case study on dioxins in breastmilk. The essential conclusion for healthcare providers and new parents is that in studies of breastfed versus formula-fed infants across time, including times when levels of environmental chemicals such as dioxins were higher, beneficial effects associated with breastfeeding have been found. The current evidence does not support altering the World Health Organization recommendations promoting and supporting breastfeeding.
Collapse
|
11
|
LaKind JS, Berlin CM, Stokes JL, Naiman DQ, Paul IM, Patterson DG, Jones RS, Niehüser S, Wang RY, Needham LL, Lorber MN, Sjödin A. Lifestyle and polybrominated diphenyl ethers in human milk in the United States: A pilot study. Toxicological & Environmental Chemistry 2008; 90:1047-1054. [DOI: 10.1080/02772240801937230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
|
12
|
Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. ACTA ACUST UNITED AC 2007; 161:1140-6. [PMID: 18056558 DOI: 10.1001/archpedi.161.12.1140] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033-0850, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND The types of and extent to which medications are used by breastfeeding women have not been thoroughly investigated in the United States. The relationship between medication use during pregnancy and lactation has also been insufficiently investigated. METHODS A survey was given to a cohort of women who delivered their babies at a single center. The participants were asked to record the medications they had taken during pregnancy and subsequently were contacted each month during lactation to determine what medications they had taken. RESULTS Breastfeeding women took significantly more medications per month than pregnant women (p < 0.0001). Women who were breastfeeding also took prescription medications more frequently than women who were pregnant (p < 0.0001). The number of medications taken per month showed no trend throughout the course of breastfeeding. The medications most often used by breastfeeding women were multivitamins, nonsteroidal anti-inflammatory drugs, acetaminophen, progestins, antimicrobials, and decongestants. Over a third of the subjects took medications rated possibly or probably unsafe, or had unknown safety. CONCLUSION The women in this study took more prescription and nonprescription medications while breastfeeding than they did during pregnancy. Many of the medications taken have unknown safety for the breastfed infant. The results of this study should direct further research toward determining the safety of medications commonly used during lactation and to promote the labeling of these medications.
Collapse
Affiliation(s)
- Esther E Stultz
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Amler RW, Barone S, Belger A, Berlin CM, Cox C, Frank H, Goodman M, Harry J, Hooper SR, Ladda R, LaKind JS, Lipkin PH, Lipsitt LP, Lorber MN, Myers G, Mason AM, Needham LL, Sonawane B, Wachs TD, Yager JW. Hershey Medical Center Technical Workshop Report: optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure. Neurotoxicology 2006; 27:861-74. [PMID: 16889835 PMCID: PMC1935386 DOI: 10.1016/j.neuro.2006.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 01/08/2023]
Abstract
Neurodevelopmental disabilities affect 3-8% of the 4 million babies born each year in the U.S. alone, with known etiology for less than 25% of those disabilities. Numerous investigations have sought to determine the role of environmental exposures in the etiology of a variety of human neurodevelopmental disorders (e.g., learning disabilities, attention deficit-hyperactivity disorder, intellectual disabilities) that are manifested in childhood, adolescence, and young adulthood. A comprehensive critical examination and discussion of the various methodologies commonly used in investigations is needed. The Hershey Medical Center Technical Workshop: Optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure provided such a forum for examining these methodologies. The objective of the Workshop was to develop scientific consensus on the key principles and considerations for optimizing the design and interpretation of epidemiologic studies of in utero exposure to environmental chemicals and subsequent neurodevelopmental effects. (The Panel recognized that the nervous system develops post-natally and that critical periods of exposure can span several developmental life stages.) Discussions from the Workshop Panel generated 17 summary points representing key tenets of work in this field. These points stressed the importance of: a well-defined, biologically plausible hypothesis as the foundation of in utero studies for assessing neurodevelopmental outcomes; understanding of the exposure to the environmental chemical(s) of interest, underlying mechanisms of toxicity, and anticipated outcomes; the use of a prospective, longitudinal cohort design that, when possible, runs for periods of 2-5 years, and possibly even longer, in an effort to assess functions at key developmental epochs; measuring potentially confounding variables at regular, fixed time intervals; including measures of specific cognitive and social-emotional domains along with non-cognitive competence in young children, as well as comprehensive measures of health; consistency of research design protocols across studies (i.e., tests, covariates, and analysis styles) in an effort to improve interstudy comparisons; emphasis on design features that minimize introduction of systematic error at all stages of investigation: participant selection, data collection and analysis, and interpretation of results; these would include (but not be limited to) reducing selection bias, using double-blind designs, and avoiding post hoc formulation of hypotheses; a priori data analysis strategies tied to hypotheses and the overall research design, particularly for methods used to characterize and address confounders in any neurodevelopmental study; actual quantitative measurements of exposure, even if indirect, rather than methods based on subject recall; careful examination of standard test batteries to ensure that the battery is tailored to the age group as well as what is known about the specific neurotoxic effects on the developing nervous system; establishment of a system for neurodevelopmental surveillance for tracking the outcomes from in utero exposure across early developmental time periods to determine whether central nervous system injuries may be lying silent until developmentally challenged; ongoing exploration of computerized measures that are culturally and linguistically sensitive, and span the age range from birth into the adolescent years; routine incorporation of narrative in manuscripts concerning the possibility of spurious (i.e., false positive and false negative) test results in all research reportage (this can be facilitated by detailed, transparent reporting of design, covariates, and analyses so that others can attempt to replicate the study); forthright, disciplined, and intellectually honest treatment of the extent to which results of any study are conclusive--that is, how generalizable the results of the study are in terms of the implications for the individual study participants, the community studied, and human health overall; confinement of reporting to the actual research questions, how they were tested, and what the study found, and avoiding, or at least keeping to a minimum, any opinions or speculation concerning public health implications; education of clinicians and policymakers to critically read scientific reports, and to interpret study findings and conclusions appropriately; and recognition by investigators of their ethical duty to report negative as well as positive findings, and the importance of neither minimizing nor exaggerating these findings.
Collapse
|
16
|
Scahill L, Erenberg G, Berlin CM, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J. Contemporary assessment and pharmacotherapy of Tourette syndrome. NeuroRx 2006; 3:192-206. [PMID: 16554257 PMCID: PMC3593444 DOI: 10.1016/j.nurx.2006.01.009] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.
Collapse
Affiliation(s)
- Lawrence Scahill
- Yale Child Study Center, 230 South Frontage Road, P.O. Box 207900, New Haven, CT 06520, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hartmann SU, Wigdahl B, Neely EB, Berlin CM, Schengrund CL, Lin HM, Howett MK. Biochemical analysis of human milk treated with sodium dodecyl sulfate, an alkyl sulfate microbicide that inactivates human immunodeficiency virus type 1. J Hum Lact 2006; 22:61-74. [PMID: 16467288 DOI: 10.1177/0890334405280651] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reduction of transmission of human immunodeficiency virus type 1 (HIV-1) through human milk is needed. Alkyl sulfates such as sodium dodecyl sulfate (SDS) are microbicidal against HIV-1 at low concentrations, have little to no toxicity, and are inexpensive. The authors have reported that treatment of HIV-1-infected human milk with < or = 1% (10 mg/mL) SDS for 10 minutes inactivates cell-free and cell-associated virus. The SDS can be removed with a commercially available resin after treatment without recovery of viral infectivity. In this article, the authors report results of selective biochemical analyses (ie, protein, immunoglobulins, lipids, cells, and electrolytes) of human milk subjected to SDS treatment and removal. The SDS treatment or removal had no significant effects on the milk components studied. Therefore, the use of alkyl sulfate microbicides to treat milk from HIV-1-positive women may be a simple, practical, and nutritionally sound way to prevent or reduce transmission of HIV-1 while still feeding with mother's own milk.
Collapse
Affiliation(s)
- Sandra Urdaneta Hartmann
- Department of Microbiology and Immunology, Pennsylvania State University, College of Medicine, Hershey, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Hartmann SU, Berlin CM, Howett MK. Alternative modified infant-feeding practices to prevent postnatal transmission of human immunodeficiency virus type 1 through breast milk: past, present, and future. J Hum Lact 2006; 22:75-88; quiz 89-93. [PMID: 16467289 DOI: 10.1177/0890334405280650] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preventing mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) through breastfeeding is important to reduce the number of infected children. Research on making breastfeeding safer is a high priority. The authors reviewed the attempts to develop alternative methods, other than antiretroviral (ARV) therapy of mothers and/or babies, to decontaminate breast milk of infectious HIV-1 (free and associated with lymphocytes). They also review how these methods affect milk constituents, as well as their current and prospective status. A PubMed search for English publications on methods to prevent MTCT through breast milk was completed. Methods that have been tested, other than systemicuse or ARV or immunoprophylaxis, to reduce or prevent MTCT of HIV-1 through breast milk were broadly classified into 5 groups: (1) modified feeding practices, (2) heat treatment of milk, (3) lipolysis, (4) antimicrobial treatment of the breastfeeding mother, and (5) microbicidal treatment of infected milk. Their advantages and disadvantages are discussed, as well as future directions in the prevention of MTCT through breastfeeding.
Collapse
Affiliation(s)
- Sandra Urdaneta Hartmann
- Department of Microbiology and Immunology, Pennsylvania State University, College of Medicine, USA
| | | | | |
Collapse
|
19
|
LaKind JS, Berlin CM, Bates MN. Overview: technical workshop on human milk surveillance and biomonitoring for environmental chemicals in the United States. J Toxicol Environ Health A 2005; 68:1683-9. [PMID: 16176915 DOI: 10.1080/15287390500225617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Judy S LaKind
- LaKind Associates, LLC, Catonsville, Maryland 21228, USA.
| | | | | |
Collapse
|
20
|
Berlin CM, LaKind JS, Fenton SE, Wang RY, Bates MN, Brent RL, Condon M, Crase BL, Dourson ML, Ettinger AS, Foos B, Fürst P, Giacoia GP, Goldstein DA, Haynes SG, Hench KD, Kacew S, Koren G, Lawrence RA, Mason A, McDiarmid MA, Moy G, Needham LL, Paul IM, Pugh LC, Qian Z, Salamone L, Selevan SG, Sonawane B, Tarzian AJ, Rose Tully M, Uhl K. Conclusions and recommendations of the expert panel: technical workshop on human milk surveillance and biomonitoring for environmental chemicals in the United States. J Toxicol Environ Health A 2005; 68:1825-31. [PMID: 16176920 DOI: 10.1080/15287390500226896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Cheston M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Berlin CM, Crase BL, Fürst P, LaKind JS, Moy G, Needham LL, Pugh LC, Tully MR. Methodologic considerations for improving and facilitating human milk research. J Toxicol Environ Health A 2005; 68:1803-23. [PMID: 16176919 DOI: 10.1080/15287390500226755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Over the past several decades, interest in using human milk as a biomonitoring matrix has increased. However, it is not always an easy matter for a new mother to provide a milk sample. In this article, guidance on facilitating collection of human milk is provided. This includes addressing the mother's ease in expressing a milk sample, and engaging with many audiences to reduce the likelihood of negatively impacting the already low breastfeeding rates in the United States. In addition, this article covers concepts regarding long-term storage and integrity of human milk samples to maximize the utility of those samples, and proposed methods for improving public access to the full spectrum of human milk biomonitoring data, with context to understand the information presented. The environmental chemicals and chemical classes for which robust analytical methods exist are enumerated, and a process for prioritizing the development of analytical methods for additional environmental chemicals is described.
Collapse
Affiliation(s)
- Cheston M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Urdaneta S, Wigdahl B, Neely EB, Berlin CM, Schengrund CL, Lin HM, Howett MK. Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium dodecyl sulfate (SDS). Retrovirology 2005; 2:28. [PMID: 15888210 PMCID: PMC1097759 DOI: 10.1186/1742-4690-2-28] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 04/29/2005] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reducing transmission of HIV-1 through breast milk is needed to help decrease the burden of pediatric HIV/AIDS in society. We have previously reported that alkyl sulfates (i.e., sodium dodecyl sulfate, SDS) are microbicidal against HIV-1 at low concentrations, are biodegradable, have little/no toxicity and are inexpensive. Therefore, they may be used for treatment of HIV-1 infected breast milk. In this report, human milk was artificially infected by adding to it HIV-1 (cell-free or cell-associated) and treated with RESULTS SDS (>or=0.1%) was virucidal against cell-free and cell-associated HIV-1 in breast milk. SDS could be substantially removed from breast milk, without recovery of viral infectivity. Viral load in artificially infected milk was reduced to undetectable levels after treatment with 0.1% SDS. SDS was virucidal against HIV-1 in human milk and could be removed from breast milk if necessary. Milk was not infectious after SDS removal. CONCLUSION The proposed treatment concentrations are within reported safe limits for ingestion of SDS by children of 1 g/kg/day. Therefore, use of alkyl sulfate microbicides, such as SDS, to treat HIV1-infected breast milk may be a novel alternative to help prevent/reduce transmission of HIV-1 through breastfeeding.
Collapse
Affiliation(s)
- Sandra Urdaneta
- Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
- Department of Bioscience and Biotechnology, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Institute for Molecular Medicine and Infectious Diseases, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA
| | - Elizabeth B Neely
- Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
| | - Cheston M Berlin
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
| | - Cara-Lynne Schengrund
- Department of Biochemistry, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
| | - Hung-Mo Lin
- Department of Health Evaluation Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
| | - Mary K Howett
- Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
- Department of Bioscience and Biotechnology, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA
| |
Collapse
|
23
|
Abstract
There is continuing emphasis by many professionals and organizations on the importance of breastfeeding as optimal infant nutrition. Pediatricians are frequently asked about the safety of medications taken by the nursing mother and the risk to the infant. Most drugs and many chemicals will be transferred into milk. For a vast majority of these compounds, there is no risk to the infant. It is almost always possible for the mother to continue nursing while taking the necessary medication. This article presents an introduction to the pharmacology of the transfer of drugs into milk, discusses the importance of the infant's age in assessing safety and presents a number of maternal conditions for which drugs need to be used.
Collapse
Affiliation(s)
- Cheston M Berlin
- Penn State Children's Hospital, MS Hershey Medical Center, PO Box 850, 500 University Drive, Hershey, PA 17033-0850, USA.
| | | |
Collapse
|
24
|
Urdaneta S, Berlin CM, Howett MK. Efforts to prevent mother-to-child transmission of human immunodeficiency virus type 1 through human milk: past, present, and future. Adv Exp Med Biol 2004; 554:475-80. [PMID: 15384628 DOI: 10.1007/978-1-4757-4242-8_68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- S Urdaneta
- Departments of Microbiology and Immunology, Pennsylvania State University, College of Medicine, MS Hershey Medical Center, Hershey, PA 17033, USA.
| | | | | |
Collapse
|
25
|
Paul IM, Shaffer ML, Yoder KE, Sturgis SA, Baker MS, Berlin CM. Dose-response relationship with increasing doses of dextromethorphan for children with cough. Clin Ther 2004; 26:1508-14. [PMID: 15531013 DOI: 10.1016/s0149-2918(04)80297-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The efficacy of dextromethorphan (DM) for treating acute cough is uncertain, and its use is not supported by the American Academy of Pediatrics. Nevertheless, DM is often administered to children as an antitussive. DM dosages are based on age rather than body weight, resulting in substantial variability in the relative amount of drug administered. OBJECTIVE The aim of this work was to determine whether a dose-response relationship existed among a group of children administered a single nocturnal dose of DM for cough due to an upper respiratory tract infection. METHODS As part of a larger double-blind, placebo-controlled trial of over-the-counter cough medications, children received DM. The administered doses (per manufacturer recommendations) were as follows: ages 2 to 5 years, 7.5 mg; ages 6 to 11 years, 15 mg; and ages 12 to 18 years, 30 mg. This resulted in a range of 0.35 to 0.94 mg/kg per dose. Subjective parental assessments of cough and sleep were obtained using a 7-point Likert-type scale that compared symptoms after medication with symptoms during the prior night (without medication). Three dose ranges were compared as a subset analysis of the group that received DM. RESULTS Thirty-three patients (19 girls, 14 boys; median [interquartile range] age, 4.90 [2.90-6.80] years; age range, 2.10-16.50 years) received DM and completed the study. No significant differences were found for any of the outcome measures when comparing the effects of different doses of DM, but our observations suggested somewhat more symptomatic relief for patients receiving medium-dose DM (0.45 to <0.60 mg/kg per dose) or high-dose (HD) DM (0.60-0.94 mg/kg per dose) compared with low-dose DM (0.35 to <0.45 mg/kg per dose). Adverse events occurred most often in the HD group. CONCLUSIONS Although no statistically significant differences were detectable for the outcomes studied, our observations suggest the potential for improved clinical symptom control with increasing doses of DM. Our findings may further suggest that a dose of 0.5 mg/kg should be considered in future assessments of the antitussive effect of DM in pediatric studies, to balance symptomatic relief with the avoidance of adverse events.
Collapse
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | | | | | | | | | | |
Collapse
|
26
|
LaKind JS, Amina Wilkins A, Berlin CM. Environmental chemicals in human milk: a review of levels, infant exposures and health, and guidance for future research. Toxicol Appl Pharmacol 2004; 198:184-208. [PMID: 15236953 DOI: 10.1016/j.taap.2003.08.021] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 08/05/2003] [Indexed: 11/25/2022]
Abstract
The aim of this review is to introduce the reader to various science and policy aspects of the topic of environmental chemicals in human milk. Although information on environmental chemicals in human milk has been available since the 1950s, it is only relatively recently that public awareness of the issue has grown. This review on environmental chemicals in human milk provides a resource summarizing what is currently known about levels and trends of environmental chemicals in human milk, potential infant exposures, and benefits of breast-feeding relative to the risks of exposures to environmental chemicals. The term "environmental chemicals," as it pertains to human milk, refers to many classes of exogenous chemicals that may be detected in human milk. For example, pharmaceutical agents and alcohol are environmental chemicals that have been found in human milk. Other chemicals, such as heavy metals and volatile organic compounds, have also been detected in human milk. Most research on environmental chemicals in human milk has concentrated on persistent, bioaccumulative, and toxic (PBT) chemicals. In this review, a description of human milk is provided, including a brief review of endogenous substances in human milk. Determinants of levels of PBTs are discussed, as are models that have been developed to predict levels of PBTs in human milk and associated body burdens in breast-feeding infants. Methodologies for human milk sampling and analysis, and concepts for consideration in interpretation and communication of study results, as developed by the Technical Workshop on Human Milk Surveillance and Research for Environmental Chemicals in the United States are described. Studies which have compared the health risks and benefits associated with breast-feeding and formula-feeding are discussed.
Collapse
|
27
|
Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, Dilworth DA, Berlin CM. Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics 2004; 114:e85-90. [PMID: 15231978 DOI: 10.1542/peds.114.1.e85] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo. METHODS Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights. RESULTS For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine. CONCLUSIONS Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families.
Collapse
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Division of General Pediatrics, Pennsylvania State College of Medicine, Hershey, Pennsylvania 17033-0850, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
In spite of significant exposure to drugs and chemicals through breast milk, there are very few reports of documented adverse effects on the infant. It is perhaps appropriate to consider that the presence of drugs and chemicals in milk may have a positive effect on developmental processes of the young infant. New experimental techniques coupled with increasing sensitive assays for chemical moieties present opportunities for measuring the effect of such chemicals on development processes in the neonate and young infant.
Collapse
Affiliation(s)
- Cheston M Berlin
- Department of Pediatrics H085, Penn State Milton S. Hershey Medical Center, PO Box 850, 500 University Drive, Hershey, PA 17033-0850, USA.
| |
Collapse
|
29
|
Paul IM, Berlin CM. Advances in pediatric pharmacology, therapeutics, and toxicology. Adv Pediatr 2003; 50:147-80. [PMID: 14626486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, The Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, USA
| | | |
Collapse
|
30
|
LaKind JS, Berlin CM. Technical workshop on human milk surveillance and research on environmental chemicals in the United States: an overview. J Toxicol Environ Health A 2002; 65:1829-1837. [PMID: 12470489 DOI: 10.1080/00984100290071739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Interest in human milk research and monitoring for environmental chemicals is growing, and as studies of chemicals in human milk are initiated, it is of the utmost importance that these studies be conducted using harmonized methods. Due to numerous limitations in previous studies and the fact that few studies on environmental chemicals in human milk have been conducted in the United States, there is a growing need for a human milk sampling and analysis protocol in this country. The Technical Workshop on Human Milk Surveillance and Research on Environmental Chemicals in the United States was organized to develop state-of-the-science protocols describing the various aspects of such a program. An expert panel, comprised of specialists in the fields of pediatrics, family medicine, nursing, lactation, human milk sampling, analytical chemistry, epidemiology, pharmacology, toxicology, nutrition, and risk evaluation and communication, was assembled to participate in a 2-day workshop at the Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine. The expert panel was tasked with carefully describing and defining the components of well-conducted human milk surveillance and research studies, including participant selection, sample collection and analysis techniques, questionnaire development, chemical selection, and data reporting and interpretation, especially for use in the United States. The articles that follow this overview describe the results of the expert panel's deliberations on the components of human milk surveillance and research programs.
Collapse
|
31
|
Berlin CM, LaKind JS, Sonawane BR, Kacew S, Borgert CJ, Bates MN, Birnbach N, Campbell R, Dermer A, Dewey KG, Ellerbee SM, Fürst P, Giacoia GP, Gartner L, Groer M, Haynes SG, Humerick SS, Lawrence RA, Lorber M, Lovelady C, Mason A, Needham LL, Picciano MF, Plautz J, Ryan JJ, Selevan SG, Sumaya CV, Tully MR, Uhl K, Vesell E, Wilson JT. Conclusions, research needs, and recommendations of the expert panel: technical workshop on human milk surveillance and research for environmental chemicals in the United States. J Toxicol Environ Health A 2002; 65:1929-1935. [PMID: 12470495 DOI: 10.1080/00984100290071801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Cheston M Berlin
- Milton S. Hershey Medical Center, Department of Pediatrics, Pennsylvania State University College of Medicine, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Berlin CM, Kacew S, Lawrence R, LaKind JS, Campbell R. Criteria for chemical selection for programs on human milk surveillance and research for environmental chemicals. J Toxicol Environ Health A 2002; 65:1839-1851. [PMID: 12474858 DOI: 10.1080/00984100290071748] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The people of the United States is exposed to a large number of chemicals in their daily lives. In order to prioritize chemicals that should be considered for surveillance of and/or research in human milk, criteria were developed at the Technical Workshop on Human Milk Surveillance and Research on Environmental Chemicals in the United States. The criteria include (1) lipid solubility and/or persistence in the environment; (2) extensive exposure (e.g., high-production-volume chemicals and chemicals in personal care products); (3) known or suspected toxicity in a biological system; (4) historical interest, trend information; (5) chemicals of emerging concern; and (6) chemicals for medicinal use and chemicals in occupational settings. A working list of chemicals was developed for each of the criteria. It should be noted that more than one criterion may be applicable to a selected chemical, but the selected chemical should possess at least one of these designated criteria. It is hoped that by following a cohort of nursing women through their lactational cycle for a group of these chemicals, data generated will indicate the extent of infant exposure and may suggest methods for risk management to decrease inadvertent exposure for breast-feeding mothers and infants. While not the focus of this article, certain endogenous chemicals in human milk beneficial to the health of the infant warrant study as well.
Collapse
Affiliation(s)
- Cheston M Berlin
- Pennsylvania State University College of Medicine, Penn State Children's Hospital, Hershey 17033, USA.
| | | | | | | | | |
Collapse
|
33
|
Abstract
Weight deficit is common among children with brain stem tumors and is often accompanied by height deficit. Among 22 consecutive children (< or =18 years) with brain stem tumor, 16 had weight deficit (< or =20th percentile) (p<1.4e-7). Eleven were at or less than the 5th percentile, and 5 were less than the 1st weight percentile. Eight also had height deficit (< or =20th percentile) (p<0.06). Misdiagnoses occurred: failure to thrive in 5, growth retardation in 2, and anorexia nervosa in 2. Delay between these diagnoses and that of brain tumor averaged 4.5 years. Detailed neuroradiologic study seems worthwhile if weight deficit is extreme and either unexplained or uncorrectable, or if the weight deficit is accompanied by an abnormality suggestive of intracranial disease.
Collapse
Affiliation(s)
- Ralph A W Lehman
- Department of Neurological Surgery and Rehabilitation, University of South Florida College of Medicine, Tampa, USA
| | | | | |
Collapse
|
34
|
Berlin CM. Advances in pediatric pharmacology, therapeutics, and toxicology. Adv Pediatr 2001; 48:439-64. [PMID: 11480767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
This chapter reviews published studies in the field of pediatric therapeutics between July 1998 and July 2000. The most important area discussed in the first part of the chapter concerns the significant advances made in the labeling of drugs for children in the United States. Dr Harry Shirkey coined the term "therapeutic orphan" in 1968 to describe the state of children who were not being considered in either drug development or in drug clinical trials. This explains why about 80% of drugs listed in each edition of the Physicians' Desk Reference do not have labeling for the pediatric age group, especially children younger than 12 years. The recent legislative, regulatory, and pharmaceutical company activities to change this situation are summarized. These changes are current and promise to make significant contributions to the availability of drugs with adequate pediatric indications to the practicing physician. Another important change in recent years has been the appreciation of the importance of placebo-controlled clinical trials for psychotropic medications in children. Trials with one of the selective serotonin reuptake inhibitors, as well as further studies involving the appropriate dosing and preparation of stimulant drugs for attention-deficit/hyperactivity disorder (ADHD), are also discussed. Several new areas that promise significant knowledge in therapeutics are in the treatment of osteoporosis (a neglected condition in pediatrics), arthritis (a condition for which drugs are used to treat the disease rather than the symptoms), and acquisition of data concerning transplacental transfer of human immunodeficiency virus (HIV) and use of multiple anti-HIV drugs for treatment of this virus in the pediatric population.
Collapse
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, USA
| |
Collapse
|
35
|
LaKind JS, Berlin CM, Naiman DQ. Infant exposure to chemicals in breast milk in the United States: what we need to learn from a breast milk monitoring program. Environ Health Perspect 2001; 109:75-88. [PMID: 11171529 PMCID: PMC1242055 DOI: 10.1289/ehp.0110975] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The presence of environmental chemicals in breast milk has gained increased attention from regulatory agencies and groups advocating women's and children's health. As the published literature on chemicals in breast milk has grown, there remains a paucity of data on parameters related to infant exposure via breast-feeding, particularly those with a time-dependent nature. This information is necessary for performing exposure assessments without heavy reliance on default assumptions. Although most experts agree that, except in unusual situations, breast-feeding is the preferred nutrition, a better understanding of an infant's level of exposure to environmental chemicals is essential, particularly in the United States where information is sparse. In this paper, we review extant data on two parameters needed to conduct realistic exposure assessments for breast-fed infants: a) levels of chemicals in human milk in the United States (and trends for dioxins/furans); and b) elimination kinetics (depuration) of chemicals from the mother during breast-feeding. The limitations of the existing data restrict our ability to predict infant body burdens of these chemicals from breast-feeding. Although the data indicate a decrease in breast milk dioxin toxic equivalents over time for several countries, the results for the United States are ambiguous. Whereas available information supports the inclusion of depuration when estimating exposures from breast-feeding, the data do not support selection of a specific rate of depuration. A program of breast milk monitoring would serve to provide the information needed to assess infant exposures during breast-feeding and develop scientifically sound information on benefits and risks of breast-feeding in the United States.
Collapse
Affiliation(s)
- J S LaKind
- LaKind Associates, LLC, Catonsville, Maryland 21228, USA.
| | | | | |
Collapse
|
36
|
Abstract
For many decades, and with the exception of the treatment of infections, drug use in children has been confined to symptom relief. But the emphasis in asthma treatment has now shifted to the use of antiinflammatory agents that prevent the process resulting in bronchoconstriction, thus removing a symptom's cause. Newer understanding from the use of antiinflammatory agents in adults has led to an appreciation of preventative therapy and a growing understanding that effective drug therapy during childhood could prevent changes in the disease process that lead to chronic symptoms during adulthood. Alongside these developments, and while the debate over conducting drug trials in children continues, a persistent gap remains in the knowledge about drug use in children. Challenges remain not only in the regulatory environment but also in research and in the identifying, recruiting, and fostering of pediatric investigators.
Collapse
Affiliation(s)
- C M Berlin
- Department of Pediatrics, The Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| |
Collapse
|
37
|
LaKind JS, Berlin CM, Park CN, Naiman DQ, Gudka NJ. Methodology for characterizing distributions of incremental body burdens of 2,3,7,8-TCDD and DDE from breast milk in North American nursing infants. J Toxicol Environ Health A 2000; 59:605-39. [PMID: 10839496 DOI: 10.1080/009841000156628] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A clear picture of ranges of doses of breast-milk contaminants experienced by nursing infants in North America has not yet been described, resulting in a significant gap in our understanding of potential health risks to infants from those contaminants. While point estimates of incremental dose have appeared in the published literature, these do not account for the wide variability in exposures experienced by nursing infants. This research expands on the current state of understanding of breast-milk contaminant exposure by characterizing distributions, rather than point estimates, of dose. Distributions of milk intake by nursing infants were characterized to examine intake of 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD) and dichlorodiphenyl dichloroethane (DDE). The results indicate that, despite the uncertainties inherent in modeling incremental body burdens of chemicals from nursing, estimating incremental infant body burdens of lipophilic chemicals from breastfeeding using point estimates may result in overly conservative estimates of the contribution of breastfeeding to long-term body burdens of those chemicals in children. To develop reliable estimates of incremental body burden from nursing, depuration via lactation and half-life in the infant should be considered. Further, incremental infant body burdens of lipophilic chemicals increase rapidly at the start of lactation, but decrease after approximately 5 to 6 mo; by 2 yr postpartum, incremental body burdens have decreased substantially. Given the benefits afforded to infants who breastfeed, and because breastfeeding does not necessarily lead to significantly increased long-term body burdens in infants, breastfeeding should be encouraged and promoted.
Collapse
Affiliation(s)
- J S LaKind
- LaKind Associates, LLC, Catonsville, Maryland 21228, USA.
| | | | | | | | | |
Collapse
|
38
|
Berlin CM. Advances in pediatric pharmacology, toxicology, and therapeutics. Adv Pediatr 1999; 46:507-38. [PMID: 10645474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- C M Berlin
- Penn State Geisinger Health System, Pennsylvania State University College of Medicine, Hershey, USA
| |
Collapse
|
39
|
Abstract
Increased lead exposure and increased body burden of lead remains a significant problem for children in the United States. With the increased use of blood level screening methods, a large percentage of children in many industrialized countries are being tested as a being at risk. A controversy continues over the definition of what population to screen and at what age to screen. There are parts of the United States, especially rural areas and health maintenance organization populations, where screening for lead exposure has not been productive. A new drug, DMSA (meso 2,3-dimercaptosuccinic acid) has been approved for oral chelation of children with increased body burden of lead. At the present time it is labeled for use in children with blood lead concentrations in excess of 45 micrograms/dL. Evidence exists that DMSA is effective in lowering the blood lead concentrations in children with levels between 25 and 45 micrograms/dL. The long-term effectiveness of chelation at lower levels is at present uncertain. There remains no substitution for strict environmental decontamination in the home environment of children and the workplace environment of their parents.
Collapse
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, Pannsylvania State University College of Medicine, Harshey 17033-0850, USA
| |
Collapse
|
40
|
Berlin CM. Advances in pediatric pharmacology and toxicology. Adv Pediatr 1997; 44:545-74. [PMID: 9265981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C M Berlin
- Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| |
Collapse
|
41
|
Berlin CM. Advances in pediatric pharmacology and toxicology. Adv Pediatr 1995; 42:593-629. [PMID: 8540440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C M Berlin
- Pennsylvania State University College of Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, USA
| |
Collapse
|
42
|
Berlin CM. Silicone breast implants and breast-feeding. Pediatrics 1994; 94:547-9. [PMID: 7936870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- C M Berlin
- Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey 17033
| |
Collapse
|
43
|
Guldberg P, Levy HL, Koch R, Berlin CM, Francois B, Henriksen KF, Güttler F. Mutation analysis in families with discordant phenotypes of phenylalanine hydroxylase deficiency. Inheritance and expression of the hyperphenylalaninaemias. J Inherit Metab Dis 1994; 17:645-51. [PMID: 7707686 DOI: 10.1007/bf00712004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neonatal hyperphenylalaninaemia caused by mutations in the gene encoding phenylalanine hydroxylase (PAH) represents a wide spectrum of metabolic phenotypes, ranging from classical phenylketonuria (PKU) to mild hyperphenylalaninaemia (MHP). The marked interindividual heterogeneity is due to the expression of multiple PAH mutations in genetic compounds. We have investigated four unusual families in which both PKU and MHP were present. In each family three different mutations in the PAH gene were identified, including two associated with PKU and one associated with MHP. The unexpected outcome of discordant phenotypes within the families described is explained by previously unrecognized parental MHP. By mutation analysis we have also predicted the phenotypical outcome in a hyperphenylalaninaemic infant born to a mother who before pregnancy had been diagnosed as having MHP. Our results demonstrate the utility of nucleic acid analysis in follow-up in PKU screening programmes.
Collapse
Affiliation(s)
- P Guldberg
- Danish Center for Human Genome Research, John F. Kennedy Institute, Glostrup
| | | | | | | | | | | | | |
Collapse
|
44
|
Berlin CM. Advances in pediatric pharmacology and toxicology. Adv Pediatr 1993; 40:405-39. [PMID: 8249713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey
| |
Collapse
|
45
|
Abstract
Six normal subjects each ingested a single 12-oz can of a diet cola (Diet Coke) providing 184 mg aspartame (APM), of which 104 mg is phenylalanine (Phe), and, on another occasion, a single 12-oz can of regular cola (Coke Classic). Neither cola significantly affected plasma concentrations of Phe or tyrosine over the three-hour postingestion study period. Each of five homozygous phenylketonuric (PKU) subjects (ages 11, 16, 17, 21, and 23 years) ingested a single 12-oz can of the same diet cola. In these five subjects (three with classic PKU and two with hyperphenylalinemia), the increase in plasma Phe concentrations varied from 0.26 mg/dL to 1.77 mg/dL two or three hours after ingestion (baseline levels, 5.04 to 17.2 mg/dL). Tyrosine concentrations did not differ significantly from baseline levels. The data indicate that ingestion of dietary Phe, as supplied in a single can of diet cola, is readily handled in both normal and PKU subjects. The small increases in plasma Phe concentrations in the homozygous PKU patients are not considered clinically significant.
Collapse
Affiliation(s)
- S A Mackey
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033
| | | |
Collapse
|
46
|
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey 17033
| |
Collapse
|
47
|
Berlin CM. Advances in pediatric pharmacology and toxicology. Adv Pediatr 1991; 38:389-413. [PMID: 1927707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C M Berlin
- Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey
| |
Collapse
|
48
|
Abstract
A breast-fed 4-month-old infant girl observed since birth had gained only 1230 g (2 lb 11 oz). The mother had three older children with birth weights of 3440 g (7 lb 9 oz), 4000 g (8 lb 13 oz), and 4895 g (10 lb 13 oz). All were exclusively breast-fed and thrived, eventually growing between the 25th and 50th percentiles on the National Center for Health Statistics growth charts. The mother also had five miscarriages during these 7 years. She had gastric bypass surgery for morbid obesity between her third and fourth children. She had lost 49 kg (109 lb) (114 kg to 65 kg) [254 lb to 145 lb]) in the first 12 months after surgery and had been stable at her new weight for 4 months prior to becoming pregnant with this baby.
Collapse
|
49
|
Abstract
A patient is described who presented with a 1-month history of daily fever to 38.8 degrees C. There was no sign of joint pain or swelling and no skin rash. The patient had impressive hepatomegaly without splenomegaly. The only abnormal laboratory test was a sedimentation rate of 120 mm/hr. Ultrasound examination showed hypoechoic foci throughout the liver. These foci were confirmed by CT scan, which showed multiple well-marginated lesions of decreased attenuation and variable size throughout the right and left lobes of the liver. A liver biopsy specimen showed large nodules that were yellow and gritty in texture. Microscopic examination of biopsy specimens of these nodules showed extensive areas of necrotizing granulomatous inflammation with palisading histiocytes and occasional giant cells surrounded by necrotic foci. There was an associated fibroinflammatory infiltrate. The patient was treated with a nonsteroidal anti-inflammatory agent with prompt cessation of fever. A repeat CT examination of the liver after 14 months of treatment showed only mild hepatomegaly and a normal liver parenchyma. The focal lesions had disappeared. This is a case of hepatic granulomata in a child showing features of necrotizing inflammation.
Collapse
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey 17033
| | | | | | | |
Collapse
|
50
|
Abstract
Over half of newborn infants begin life breastfeeding. Nearly all drugs ingested by nursing mothers appear in their milk; amount is 1 to 2 per cent of the mother's dose. Drugs for most maternal conditions are safe for the nursing infant. Information is presented to permit nursing mothers who need medication to nurse safely.
Collapse
Affiliation(s)
- C M Berlin
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey
| |
Collapse
|