July 13, 2012
NIH Podcast Episode #0163
Balintfy: Welcome to episode 163 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode a pair of stories about children and obesity: first, understanding the staggering numbers of children who are overweight and the impact of that; and then a study linking stress to childhood obesity; plus some insight on participating in a clinical research trial – get a personal, inside perspective.
But first, this news update. Craig Fritz kicks off our child-themed show with these two stories.
Fritz: An intervention in which adults actively engaged the attention of preschool children with autism by pointing to toys and using other gestures to focus their attention results in a long term increase in language skills, according to researchers supported by NIH. At age 8, children with autism who received therapy centered on sharing attention and play when they were 3 or 4 years old had stronger vocabularies and more advanced language skills than did children who received standard therapy. All of the children in the study attended preschool for 30 hours each week. Scientists say some studies have indicated that such pre-verbal interactions provide the foundation for building later language skills. This study confirms that intensive therapy to engage the attention of young children with autism helps them acquire language faster and build lasting language skills. The researchers found that children who started the attention-focusing therapy earlier had more advanced linguistic skills at age 8. Those who learned to point or direct an adult's attention to an object of interest at age 3 and 4 also developed more advanced language skills when they were 8. And children who showed greater flexibility in playing with objects at age 3 or 4 demonstrated better memory and other cognitive skills at age 8.
Children exposed to HIV in the womb may be more likely to experience hearing loss by age 16 than are their unexposed peers, according to an NIH research network. The scientists estimated that hearing loss affects 9 to 15 percent of HIV-infected children and 5 to 8 percent of children who did not have HIV at birth but whose mothers had HIV infection during pregnancy. Study participants ranged from 7 to 16 years old. Compared to national averages for other children their age, children with HIV infection were about 200 to 300 percent more likely to have a hearing loss. Children whose mothers had HIV during pregnancy but who themselves were born without HIV were 20 percent more likely than to have hearing loss. Even a mild hearing loss in children can delay the acquisition of language skills. More severe hearing loss may require the use of assistive devices, such as a hearing aid.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up later in the show, my outpatient experience in a clinical trial, but next: childhood obesity.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Balintfy: In this first of two features on childhood obesity, NIH Research Radio talks to Dr. Kristina Rother. She’s a clinical investigator here at the NIH Clinical Center, and a pediatric endocrinologist. Our discussion was spurred by a May paper in the journal Pediatrics about heart disease risk among young Americans. Dr. Rother says the study, authored by CDC researchers using a very large, national database, shows that obesity affects many children in this country, but the rise of obesity that we’re seeing in adults, has not occurred the same in children.
Rother: So the question is what does that mean? Are we doing a good job with preventing obesity in children? I guess I have to be skeptical there because we still have too many overweight and obese children.
Balintfy: In the Pediatrics paper, researchers collected information on what it means to be obese or overweight as a child in regards to cardiovascular risk factors.
Rother: That means in the long run, how likely is a child who is obese, who is overweight or obese today to eventually develop a cardiovascular disease? And that could be a heart attack; that could be a stroke. Unfortunately, they have found that the more overweight or obese a child is, the more frequently you find these risk factors, which means in the long run, the obese children are truly at a higher risk to develop myocardial infarction or heart attack, stroke, and other complications from obesity.
So we really need to let go of this concept that it's kind of nice to have a chubby child, it's all right and they'll probably outgrow it. That's probably not the case. They will not outgrow it and it's not okay to be heavy as a child because you will observe consequences down the line.
Balintfy: One consequence says Dr. Rother, is type 2 diabetes, which is also a growing public health problem.
Rother: We know in adults for a long time, that's why we called it adult onset diabetes, we know for a long time that heavier individuals have a higher risk of developing of type 2 diabetes. Of course other factors also play an important role, for example, your genes depending on whether your parents have type 2 diabetes.
But now we're learning that the risk of developing type 2 diabetes is not only due to who are your parents and whether they have it, whether you are overweight or obese, but also to which environment you were exposed while you were a baby or better in the womb of the mother.
Balintfy: Dr. Rother emphasizes the importance of awareness.
Rother: Many, many parents don't know whether their child is in fact overweight or obese and the first step is often taken by the pediatrician who at a well baby check or a well child visit points out that the child is too heavy. And then most parents ask, "What can I do about it?"
And typically, it's a family affair. The whole family needs to actually change some lifestyle components, most often diets but also exercise, television time, sleep time, when does the child go to bed, overall stress level. So there are many components that can then be addressed. Well, the first step is to make sure that everybody knows the child is overweight or obese.
Balintfy: She also encourages participation in clinical trials, noting that currently in the United States there are roughly 18 intervention trials.
Rother: They try to find solutions, interventions that either prevent the development of obesity or that will help with the treatment of obesity in children.
Balintfy: She adds there are active trials going on for obese children as well as children with type 2 diabetes here at NIH. Dr. Rother also recommends resources like WeCan! - Ways to Enhance Children's Activity & Nutrition; WIN – the Weight Information Network; and Let’s Move, with First Lady Michelle Obama.
Rother: I think the wealth of resources is really there. What is so hard is to implement the changes.
Balintfy: Dr. Rother is encouraged that there is a leveling of childhood obesity rates, but thinks it is too early to be optimistic. For more information on obesity prevention in children, visit these websites: wecan.nhlbi.nih.gov, win.niddk.nih.gov, and letsmove.gov.
Social risk and obesity in children
Balintfy: From that last report we know that one cause of obesity in children can be when the mother is overweight or has diabetes, even before the child is born. In this report, another risk-factor: NIH-funded researchers have been studying the relationship between social adversity, or stress, and childhood obesity.
King: They're looking at the children at age 5 to see if they're obese or not.
Balintfy: That’s Dr. Roslyn King. She’s a health science administrator at the NIH.
King: The possible causal factors that they're looking at are stressful experiences within the family.
Balintfy: Dr. King explains that the researchers used data from the Fragile Families and Child Well-being Study.
King: So the idea behind Fragile Families was to create kind of a new sampling of families, was to capture them at something that the investigators called the magic moment, which is when the child is actually born.
Balintfy: By recruiting at that magic moment, researchers could get information from the whole family – including fathers – and then follow them moving forward. Researchers have now examined the data from Fragile Families which appears to show a link between stress and obesity.
King: They found a statistically significant association for girls in the sample between stressful life events at age 1 and age 3 and obesity at age 5.
Balintfy: Dr. King says the stressful life events researchers looked to measure include things like material hardship.
King: So housing and security, food and security that the family is experiencing. They're also looking for intimate partner violence that the mother might be experiencing. And they're also looking at mother substance use and whether or not the father of the child is incarcerated.
Balintfy: And these factors, researchers say, have an impact. In girls in particular, it is overweight.
King: Stress in the environment, kids, either they're sensitive or they're smart, they get it and impacts them, and it can show up in a variety of ways. In this case, it's showing up in the girls in their body weight. But you can't say that it's not affecting the boys. It's just possibly affecting them in different ways.
Balintfy: Dr. King adds that the general pattern is that girls under stress tend to exhibit internalizing behaviors and boys tend to exhibit externalizing behaviors, things like aggression and acting out.
King: Overeating and like eating as comfort food could be seen as more of an internalizing behavior and so that could be the reason that you're seeing a difference in body weight as a manifestation, whereas the boys, for example, they didn't in the study look at acting out behaviors, and possibly you might have seen that the boys were showing their stress in that way.
Balintfy: The researchers conclude in their article, also in the May issue of the journal Pediatrics, that there is a difference in how risk factors affect children. Dr. King reminds that this is an observational study, meaning there is not a clear-cut cause and effect relationship. But there is enough evidence to make recommendations to parents and caregivers.
King: I think this falls into this broader science that's developing right now that stressful situations impact kids. They get under their skin. And parents shouldn't think that kids don't know what's going on or at least aren't feeling something about what's going on.
Balintfy: She says there are ways to help kids cope.
King: Parents can teach kids their own coping strategies and people who are trying to intervene with these families. There are interventions to help parents improve their coping strategies and to take a more family-based view and work with parents and kids at the same time.
Balintfy: For more information on the relationship between stress and childhood obesity, visit www.nichd.nih.gov. And for details on how to combat childhood obesity, again those websites are wecan.nhlbi.nih.gov, win.niddk.nih.gov, and letsmove.gov.
Coming up, some important insight about participating in a clinical trial. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Clinical research trial outpatient experience
[Sound: beep of blood pressure monitor]
Balintfy: Have you ever wondered what it’s like to participate in a clinical research trial? Maybe you’re thinking of being hooked up to machines and tests and procedures? Well, there is some of that, but a lot more.
[Sound: “OK, so I need you to sign in for me, put down the time, print your last name and first name…”]
Balintfy: I recently signed up for a clinical research trial – I mentioned that back in episode 157, which included an interview with Diana Dominguez. In this episode, you’ll hear some of what the process was like, including my experience getting an EKG and blood draw, as well as what it means to participate in medical research. The first step: admissions.
Harrison: So what’s going to happen is we are your welcoming committee. What we’ll do is you already signed in and then we will get you registered.
Balintfy: That’s Monique Harrison, she’s the admission supervisor. I commented to her, walking into the Clinical Center isn’t like walking into a regular hospital.
Harrison: It isn’t. It’s like wow. I don’t know, my experience when I first walked in, I was like wow. I was just – first, I didn’t know that the government had a hospital and then it’s so grand. When you come in from that front, that north lobby, it doesn’t look like a hospital. It just looks wow. It doesn’t even look like a government building truthfully. So we are a hospital but we’re probably a little more. I always say that. We’re unique and different, that what I always say.
[Sound: fish tank]
Balintfy: There’s a fish tank in the admissions waiting area. It’s not that busy, so I’m called into an interview room fairly quickly – within a couple minutes – and start the first batch of consent forms.
[Sound: “We’re getting ready to do two things, first we’re going to do the consent forms…”]
Balintfy: These are general consent forms for the hospital. I’m also entered into the hospital’s system. But I’m reminded of what Denora Dominguez said in the earlier interview with her that consent is a process…
Dominguez: …informed consent is a process; that it's not just that one time that you sign a document and then you're done and that's it, but that it's really a process that you want to be involved in and you want to have conversations with all of the individuals that are providing research care for you.
Balintfy: After I signed my consent forms, I headed for an EKG – one of the fastest medical procedures I’ve ever experienced.
[Sound: “Lay back, relax, you’re already, prepared bare-chested…”
Balintfy: Paul Strother explained that it takes longer to connect the 12 leads for the 12-lead resting EKG, than it does to take the test itself.
Strother: Well the test itself is latterly 10-seconds long. It does 10-seconds of information and does its calculations from that. But it’s breaking that 10-seconds down into milliseconds and milivolts so it’s really quite a bit of information in 10-seconds. And you are done; you can get dressed. This copy’s going to go up with you to the floor. Give it to your coordinator, your nurse or the unit clerk when you get upstairs.
[Sound: doors open and close]
Balintfy: Upstairs, I meet my nurse coordinator, Megan Mattingly; she’s a registered nurse, and a captain in the public health service so she’s wearing a uniform. I sign in and have more consents to review and sign.
Mattingly: There’s three consents. This one Dr. Cizza will go over with you...
Balintfy: She reminds that signing a consent does not obligate me to be in the study. In fact, she emphasizes that taking part in NIH research is completely voluntary and I can leave at any time if I don’t like it. This is also where I learn more details about the study from Megan, and the principal investigator, Dr. Giovanni Cizza.
Cizza: So this is the study of subjects with narcolepsy. You are a normal control. And narcolepsy is a rare condition, and when patients have narcolepsy, they fall asleep during the day suddenly, and that's a problem because it could be dangerous. If they drive or even if you swim, they can just go down.
Balintfy: Dr. Cizza explains that patients with narcolepsy also lack a small hormone in the brain which alters their metabolism – it makes it difficult for them to keep their weight down.
Cizza: What we've done, we have studied those subjects. We have measured how much energy they burn, how much they eat, how much they move, how they sleep. And where the comparison, we then asked subjects like you to come and do the same studies.
Ideally, we would like to have identical twins, one with narcolepsy and one without, but that of course is a little impractical. But to give you the idea, we would like the controls to be identical to the subjects of narcolepsy with the other exception of not having the narcolepsy. Of course the best thing that we can do is to have subjects of the same sex, of similar weight so we use something called BMI, body mass index, and we like the subjects to be similar to the control within two units and three years of age and same ethnicity.
And we have recruited about 15 or 16 patients with narcolepsy, which is not a easy because it's a rare condition over the years. And now, I think you are the control number 10.
Balintfy: Today’s out-patient visit is mostly a screening. I’ve had an EKG, get weighed and measured, and get a thorough blood test.
Mattingly: Today we’ll be drawing some basic blood work and it’s basically to see if you’re healthy.
Mattingly: It’ll seem to you like there’s going to be a lot of tubes of blood, but it’s not really a huge amount of blood.
Balintfy: I’m not going to watch.
Balintfy: So I won’t know how many tubes you take. [Laughs]
Mattingly: Okay. That’s good. And by the time you leave, I’ll tell you what your cholesterol results are and then some of the other normal results that people like to tell their doctors. …
Balintfy: Megan also explains some of the risks associated with the blood draw, as well as the potential benefits of participating in a trial as a healthy volunteer.
Mattingly: As far as benefits of taking part of the study, there aren’t any for you. You might learn some interesting things basically and you get some medical tests results. And as for unforeseeable risks because there is a medical evaluation, it’s possible that we could see that, find that there’s something wrong and if that’s the case we’ll tell you and we’ll suggest that you go off to your doctor.
Balintfy: And it would be better finding now than not.
Mattingly: Yeah. Exactly.
Balintfy: For some healthy volunteers, not me, I work here, there is sometimes the option of compensation. Again the Clinical Center’s Dominguez:
Dominguez: So our volunteers, our healthy volunteers or otherwise known as healthy controls, normal volunteers, controls, all of those are compensated for their time and inconvenience and that is a decision that's made from the principal investigator and his or her scientific director and so forth, and it’s whether it's inpatient or outpatient, as well as also inconvenience units assigned to different procedures that they may be a part of.
Balintfy: My procedure in this outpatient visit wasn’t that inconvenient.
[Sound: “Ouch”… “Sorry”]
Balintfy: That worst of it was a little pinch when I lost a few hairs on my arm. Other than that, I just sat back and relaxed as a nurse tended to an IV, blood draws, and blood pressure measurements. It was over before I knew it and the IV was coming out.
[Sound: “not bad at all” … “yay!”]
Balintfy: While I found out about this trial through work, there are resources for both patients and healthy volunteers to find clinical trials.
Dominguez: So we do have a phone number where individuals can call us and we're open Monday through Friday from 8:30 to 3:30 Standard Eastern Time and that's 1-800-411-1222. And then we also have clinicaltrials.gov and that website is also extremely helpful for individuals throughout the country and throughout the world. Also our own NIH website, our own NIH website has right on the front page Clinical Trials and You. And then also if you go into the Clinical Center website, it has the Search the Studies website that individuals can search all of the intramural studies done here at the Clinical Center.
Balintfy: Dinora Dominguez asks that healthy volunteers do some research on those sites – clinicaltrials.gov and clinicaltrialsandyou.nih.gov – if possible. For patients with an existing, or undiagnosed condition, a referral from a doctor may help, but isn’t absolutely necessary.
Dominguez: There are some studies that do require a physical referral or really a healthcare provider referral; and we would let you know that information, whether it's that you need to send a particular letter, if you need to send particular lab results. So there are some studies that still require that, but the patients can initiate the process whether they go straight through and we do very preliminary screening and then forward that information on to the research team or if we have very specific instructions from the research team as to what we need to provide to the patients that are calling in.
Balintfy: Again, the number to call for information on clinical trials at the NIH’s Clinical Center is toll free: 1-800-411-1222. And to hear more from Dinora Dominguez tune into episode 157 of NIH Research Radio. Also more from the interview with Dr. Cizza is in episode 156. And be sure to tune in to episodes later this summer as I’ll enter the in-patient portion of this clinical trial.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, July 27 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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