Pre-K and early Head Start programs enhance children's development, say researchers
Recent pre-K study shows significant improvements in reading, writing, and spelling abilities; Early Head Start participants show improved child development in many areas including enhanced family support for children's learning
WASHINGTON -- In two studies appearing in a special issue of Developmental Psychology, researchers show the benefits of universal pre-K programs (serving 4-year-olds) and Early Head Start programs (serving infants, toddlers, and their families) on children's cognitive and language development, but especially for those children who are from low-income families. The study of pre-K documented benefits in several aspects of school readiness, and the Early Head Start study showed gains in social-emotional development and benefits for parents as well. Developmental Psychology is published by the American Psychological Association (APA).
Findings from both studies confirm the positive effects of these programs for children from birth to age five, including higher performance in children's cognitive and language functioning. The Early Head Start program benefited children's social and emotional development and health as well as reduced aggressive behavior, and improved parent-child relations, and the pre-K program increased parents' involvement in school and home activities.
In the study authored by public policy professor William T. Gormley, Jr., Ph.D., and his colleagues of Georgetown University, 1,567 pre-K 4-year-old children and 1,461 children who just completed one of the pre-K programs in Tulsa, Oklahoma, were compared on letter-word identification, spelling and applied problems. Statistical controls for demographic characteristics equalized the two groups. Those children who participated in the state-funded universal pre-K program did better on cognitive tests that measured pre-reading and reading skills, prewriting and spelling skills and math reasoning and problem-solving skills than those children who did not participate in the pre-K program.
The pre-K program improved performances for children from different ethnic backgrounds (Hispanic, Black, White and Native American) and income brackets (measured by those who are eligible for a full price lunch, a reduced-price lunch and no lunch subsidy), according to the study. Disadvantaged children and Hispanic children benefited the most.
This study, says lead author Gormley, is an improvement over past studies on effectiveness of school readiness programs because it uses more scientifically sound methods. "We use a methodological design that reduces the likelihood of biasing our selection of children and we use standardized measurements that are administered to the children only by college-educated and specially trained teachers."
The Georgetown team concluded that universal pre-K programs run by the public schools can prepare children from varied backgrounds to learn the foundations of reading, writing and problem solving and be better able to master these skills in later grades.
The second study examined the benefits of Early Head Start programs for young children and their families using a rigorous experimental design. These programs were originally developed in the mid-1990s as an expansion of the federally funded Head Start program to enhance children's development while strengthening low-income families.
This study conducted by a team of researchers at Mathematica Policy Research in Princeton and Columbia University examined 3,001 families who applied to 17 Early Head Start programs located in rural and urban areas across the United States. The families were randomly assigned to enroll in the program or to serve as the control group. Families were eligible to participate in this program if their incomes were at or below the federal poverty level and were expecting a child or had a child under a year old. Ten percent of the families participating could be above the poverty level.
The children were assessed on measures of cognitive, language, social and emotional development and health (overall status and immunization rates) at 14 months, 24 months and then at 36 months. Parents of the children who participated in the program were compared to parents whose children did not participate in the Early Head Start program on how they related to their children, specifically, how supportive or detached they were when interacting with their child, how supportive the home environment was for children's cognitive and language development, whether parents read to their child daily and how often they spanked their child.
Each Early Head Start program provided either home- or center-based services or a combination of both. Programs that met the federal Head Start program performance standards produced the best results. By directly assessing the children and observing them interacting with their parents, the authors found that the children in the programs performed better on cognitive and language development measures than the children in the control group. These children scored lower on an aggressive behavior problems scale and showed higher levels of attention in a play situation while being better able to engage their parents during parent-child interactions.
From interviews with primary caregivers and parents and through observation of parents interacting with their children, the researchers found that the parents who did participate in Early Head Start were more emotionally supportive, provided more language and learning opportunities at home, read to their children more and spanked their children less than did control group parents. The programs that offered a mix of home visiting and center-based services and had fully implemented the performance standards early achieved the best results with the children and the parents.
From these results, said project director John Love, "we can conclude that Early Head Start can influence multiple aspects of development--cognitive, language, and social-emotional--in very young children from poverty-level families. And this happens one or two years before the children typically begin pre-kindergarten programs. Early Head Start participation can also improve overall family life as indicated by the enhanced supportiveness parents demonstrated--aspects of parenting that have the potential to continue supporting children's development after they leave the program." Dr. Love also noted that other research has shown the value of larger vocabularies, reduced behavior problems, and enriched home environments for children being successful when they get to school.
Interferon with ribavirin is safe and effective for children with chronic Hepatitis C
Side effects are common, but mostly mild
Nearly half of 118 children with chronic Hepatitis C virus (HCV) treated with a combination of interferon-alpha-2b and an optimized dose of ribavirin achieved sustained viral response, and side effects were generally mild. These results are reported in the November 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD).
Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.
HCV is usually asymptomatic in children though it can lead to serious liver damage. Treatment with interferon is standard and induces lasting remission in more than a third of infected children. The addition of ribavirin to treatment with interferon has been shown to markedly improve outcomes for adults with HCV, but the combination has not been extensively studied in children. Led by Regino González-Peralta, M.D. of the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at the University of Florida, researchers addressed combination therapy for children with a twofold program.
The first part searched for the optimal dose of ribavirin for children with HCV while testing the drug's safety and efficacy. Fifty-six children, ages five to 16, were randomly assigned to take interferon along with ribavirin in varying doses for 48 weeks. They were evaluated for efficacy and side effects at regular intervals, and followed-up for an additional 24 weeks. By the end of the follow-up period, 35 percent of children taking 8 mg/kg/day of ribavirin, 37 percent taking 12 mg/kg/day, and 47 percent of 15/mg/kg/day had undetectable levels of HCV in their blood. Side effects were similar among all doses. Based on this data, the researchers selected the dosage 15 mg/kg/day for further study.
In all, 118 children with HCV received the optimized treatment--interferon with 15 mg/kg/day of ribavirin. They were evaluated regularly throughout treatment and follow-up to determine viral response and assess and manage side effects. At the end of the study, 46 percent had achieved sustained viral response. Children with HCV genotype 2/3 had higher sustained virologic response rates than those with HCV genotype 1.
All subjects experienced some side effects, but most were mild, the most common being flu-like symptoms. Severe side effects included anemia, neutropenia, depression and suicidal thoughts, and one child in the study attempted suicide. The researchers responded to adverse side effects by dose modification, and 8 subjects completely discontinued treatment because of adverse events.
As in previous studies, children in this one exhibited growth inhibition while receiving the therapy, however, they typically experienced height and weight catch-up gains after it ended. Interestingly, none of the African-American children in the study had a sustained virologic response to combination therapy. "The number of African-American children studied was too small to draw firm conclusions," say the authors. But this observation matches previous reports that African-American adults have lower response rates to combination therapy.
Overall, "our studies demonstrate that interferon alfa 2b in combination with oral ribavirin is effective and reasonably safe for the treatment of childhood chronic hepatitis C," the authors conclude. Importantly, "sustained virologic response rates in children with chronic HCV given interferon alfa-2b with ribavirin in these studies are higher than in those using interferon alone."
Family meals cut teenage fatness
They might prefer to be in front of the TV or Playstation, but Brisbane teenagers are likely to be healthier if they eat meals with mum and dad.
University of Queensland researchers working on the world's longest health study found teens who ate regularly with their family were less likely to be overweight.
Lead researcher, Dr Abdullah Al Mamun from UQ's School of Population Health said regular family meals could reduce snacking and make for healthier food and social habits.
"Eating together will enable the parent to have better knowledge of the child's food choices and amount that they tend to eat," Dr Mamun said of the study, which appears in the latest edition of American journal, Obesity Research.
The study found having a healthy maternal attitude to family eating and diet was more important than the frequency of shared meals.
Even though most mothers said they had a family meal at least once a day, only 43 percent of them said eating together was very or quite important.
The findings have been drawn from the world's longest running health study -- the Mater-University of Queensland Study of Pregnancy, which has followed the progress of Brisbane mothers and their families since 1981.
The survey of 3795 mothers and their teenagers was collected in Brisbane when the teenagers were at age 14, in 1995.
It showed about half the families ate red meat most days and one-fourth had fast food most days or two to three times per week.
Even though more than half of the families had children who played sports four to seven days a week about 40 percent still found enough time to watch five or more hours of TV a day.
Dr Mamun's paper was co-written, with Mater and University of Bristol researchers and fellow UQ researcher and Mater Study founder, Professor Jake Najman.
The Mater Study was started in 1981 by Professor Najman as a health and social study of 7223 pregnant women.
Researchers have followed the children's growth over the decades and study was widened to include prenatal, postnatal, childhood and adolescent periods of the child with those babies now in their early 20s.
Children with neurological and neuromuscular diseases at risk for flu-related respiratory failure
Children with neurological and neuromuscular diseases should receive an annual influenza vaccination because of a higher risk of respiratory failure if they are hospitalized with influenza, according to a study in the November 2 issue of JAMA.
Influenza is a common disease of childhood and is responsible for significant illness, according to background information in the article. Healthy young children are hospitalized for influenza-related illness at rates similar to those for elderly persons and adults with chronic medical conditions. Perhaps most concerning to parents and physicians is the potential for serious influenza-associated complications, including carditis (inflammation of the heart), encephalitis, myositis (inflammation of muscle tissue), pneumonia, respiratory failure, and death.
Population-based studies suggest that individuals with certain chronic medical conditions are at increased risk of serious complications of influenza infection. The Advisory Committee on Immunization Practices (ACIP) has identified 9 groups of chronic medical conditions for which annual influenza vaccination is recommended. They include asthma, chronic lung disease, cardiac disease, immunosuppression, hemoglobinopathies (a blood disease characterized by the presence of abnormal hemoglobins in the blood), chronic renal dysfunction, metabolic and endocrine conditions, long-term salicylate (aspirin and some other drugs) therapy, and pregnancy. Despite the frequency of influenza infection and the prevalence of these chronic medical conditions, little is known about their relative contribution to the development of serious influenza-associated complications.
Ron Keren, M.D., M.P.H., of The Children's Hospital of Philadelphia, and colleagues conducted a study to identify chronic medical conditions that were associated with respiratory failure in children hospitalized with influenza. In addition to the current ACIP-designated high-risk conditions, the researchers also examined three other categories of chronic medical conditions--neurological and neuromuscular disease (NNMD, such as muscular dystrophy), gastroesophageal reflux disease (GERD), and history of prematurity, that in recent studies have been associated with influenza hospitalization and severe influenza-related complications. The study included patients aged 21 years or younger hospitalized at The Children's Hospital of Philadelphia, with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (June 2000 through May 2004).
Of 745 children hospitalized with influenza, 322 (43 percent) had one or more ACIP-designated high-risk chronic medical conditions. NNMD, GERD, and history of prematurity were present in 12 percent, 14 percent, and 3 percent, of children, respectively. Thirty-two children (4.3 percent) developed respiratory failure. In further analyses, conditions associated with respiratory failure included NNMD (6 times increased risk), chronic pulmonary disease other than asthma (4.8 times increased risk), and cardiac disease (4 times increased risk). The predicted probabilities of respiratory failure derived from the multivariate model were 12 percent, 9 percent, and 8 percent for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively. Children hospitalized with influenza who had 2 of these 3 chronic conditions had a 31 percent to 39 percent predicted probability of respiratory failure.
"The significantly increased probability of respiratory failure in children with NNMD hospitalized with influenza supports the ACIP's recent decision to add NNMD that may compromise respiratory function to the list of chronic conditions that warrant annual influenza vaccination. Coordinated efforts are needed to educate parents, primary care pediatricians, and pediatric neurologists about the risks of serious influenza complications and the need for annual vaccination for children with NNMD. Future studies should determine the risk of hospitalization among children with NNMD, the number of additional children with NNMD who will require annual vaccination, as well as the effectiveness and cost-effectiveness of the influenza vaccine in preventing hospitalizations and serious complications in these children," the authors conclude.
Fatherhood possible for many testicular cancer survivors, study finds
The overall rate of fatherhood after treatment for testicular cancer is high, but the ability to conceive and the time to conception are influenced by the type and intensity of treatment, according to a new study in the November 2 issue of the Journal of the National Cancer Institute.
Testicular cancer, the most common cancer among men ages 20 to 40, has a high cure rate: 95% of patients are cured through treatment. Because many of these patients are diagnosed at an age when they are starting a family, the ability to father children after treatment is often a concern. However, there are little reliable data on post-treatment fertility available to guide these men.
To assess post-treatment fertility among testicular cancer survivors, Marianne Brydøy, M.D., of Haukeland University Hospital in Bergen, Norway, and colleagues studied 1,814 men who had been treated for testicular cancer in Norway between 1980 and 1994 who had been invited to participate in a follow-up survey between 1998 and 2002.
Of the 1,433 men who were assessable, post-treatment conception was attempted by 554, and 71% were successful within 15 years of treatment (without the use of cryopreserved semen) and 76% were successful within 20 years. Success varied by type of treatment, ranging from just 48% among men treated with higher doses of chemotherapy to 92% among men followed by surveillance alone (after removal of the testicle affected by cancer). The median time from diagnosis to birth of the first child was 6.6 years, but this also varied with treatment type. About 22% of couples who attempted post-treatment conception reported that they needed some form of assistance with reproduction.
"With recent advances in assisted fertility techniques, more testicular cancer survivors may be helped to father children. However, because infertility cannot be predicted on an individual basis, it is important to continue the policy of offering sperm preservation prior to treatment," the authors write.
In an editorial, Scott Saxman, M.D., of the National Cancer Institute, notes that the results of this study will help physicians to provide answers to testicular cancer patients who are concerned about their ability to father children, although some of the data may no longer be relevant because of improvements in treatments now available. "Clearly the impact of therapy on fertility, as well as other long-term complications, for men with testicular cancer needs to be better categorized and understood," he writes. "However, this will be a moving target as treatment approaches continue to change and improve. Seriously addressing these public health issues for patients in the United States will require a national collaborative effort that identifies and collects, on an ongoing basis, longitudinal information on the health status of these men."
Study examines cancer risks after cancer diagnosis in family member
After a person is diagnosed with cancer, increased surveillance among their family members may result in the earlier detection of asymptomatic familial cancers. This phenomenon is called detection bias and may occur for a variety of cancers, according to a new study in the November 2 issue of the Journal of the National Cancer Institute.
Accurate assessments of the risk of cancer among the family members of cancer patients are essential for clinical and genetic counseling. Knowledge of these risks may also help to identify environmental and/or heritable factors that are associated with the risks of specific cancers and may lead to prevention strategies. Because a person's diagnosis of cancer may trigger the medical examination of their relatives and the subsequent identification of more cancers, detection bias may be present and the familial risks of cancer may therfore be overestimated.
Justo Lorenzo Bermejo, Ph.D., of the German Cancer Research Centre in Heidelberg, and Kari Hemminki, M.D., Ph.D., of the German Cancer Research Centre and the Karolinska Institute in Huddinge, Sweden, followed nearly 1.7 million offspring and siblings of almost 850,000 people who had been diagnosed with cancer. They compared the incidence of melanoma and cancers of the breast, cervix, colon/rectum, lung, and prostate among relatives of patients with the incidence of those cancers in the general population.
The researchers found that daughters of women with breast cancer were more likely to be diagnosed with in situ breast cancer during the year following their mother's diagnosis than they were 5 or more years later. Similarly, the offspring of people diagnosed with melanoma were more likely to be diagnosed with melanoma in the year following their parent's diagnosis than they were 5 or more years later. In addition, the risks of in situ breast cancer, in situ cervical cancer, and invasive prostate cancer in siblings decreased with time after the diagnosis of the first familial tumor.
"The most likely reason for the detection of familial cancers close in time is that the first diagnosis leads to the earlier detection of some asymptomatic tumors by increased surveillance in relatives," the authors write.
In an editorial, Marvin Zelen, Ph.D., of the Harvard School of Public Health in Boston, notes that data on familial cancer risks may also be influenced by fluctuations in family size and that controlling for this may lead to more precise analyses. "It is apparent that in counseling, care must be taken with respect to using cancer risks derived from observations on families," he writes.
Infectious disease doctors respond to President Bush's strategy on pandemic influenza
The following statement can be attributed to Martin J. Blaser, MD, president of the Infectious Diseases Society of America:
The Infectious Diseases Society of America (IDSA) applauds President Bush and his administration for outlining an aggressive domestic and international approach to pandemic influenza preparedness and giving this issue the high level of attention that it warrants. IDSA has long urged the U.S. government to develop preparedness and response strategies to limit the death, pain, human suffering, and economic burden that will result from a pandemic.
IDSA believes the pandemic clock is ticking; we just don't know what time it is. By strengthening global surveillance activities and reinvigorating the development of vaccines and antivirals, the president's strategy will go a long way toward pandemic influenza preparedness. This preparedness will yield important health benefits, even if the next pandemic does not appear for years. IDSA specifically supports the proposed investments for new cell-based vaccine technologies and incentives to lure new manufacturers into the vaccine and antimicrobial market, such as liability protections. Although the president did not mention tax credits, we also support such incentives for research and manufacturing to motivate industry to produce new vaccines, antivirals, and antibiotics, particularly within U.S. borders.
Significant issues remain to be resolved, however, including investment in state and local preparedness, surge capacity, and risk communication.
We realize that the Department of Health and Human Services' (HHS) pandemic preparedness and response plan, which will soon be released, will include more specific details about the president's strategy. As soon as the new plan comes out, IDSA will review it carefully with an eye toward continued refinement, including the following safeguards:
- centralized coordination of federal pandemic and interpandemic ("normal" flu season) activities with clear lines of accountability known to all
- adequate stockpiles of vaccine and antivirals
- research and development efforts for new vaccines, antivirals, and antibiotics
- strengthened and coordinated capabilities to help state and local health departments prepare and respond
- significant enhancements for hospital surge capacity and information technology development
- energized global surveillance activities at the Centers for Disease Control and Prevention, including epidemic detection and response
- a discussion of how to measure progress and accountability in implementing the plan
Preparing for pandemic flu is like preparing for a professional football game. You need a sophisticated and well-thought-out playbook. You need good, strong players. You need to plot out the scenarios, and every player needs to practice and know the drill. But once you are on the field, you need the flexibility to think fast and change the game plan when the need arises.
The president's strategy provides an initial framework with strong potential. Success will require a long-term commitment and coordinated effort from the state and local government, the medical profession, business, and the American people.
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