Impacts of CIHR-funded research: Child, Youth and Maternal Health
Improving outcomes for infants
Drug combination reduces hospitalization for babies with lung infection
Overview
In Canada, about 35 in 1,000 babies are hospitalized each year with bronchiolitis, an inflammation of the tiny airways in the lungs, usually for about two-to-four days. It is the most common infection that puts infants into hospital. These hospitalizations amount to hefty health care costs– at least $23 million. Dr. Amy Plint of the University of Ottawa has found that combining two drugs – epinephrine, a hormone, and dexamethasone, a steroid – when babies come to the emergency room significantly reduces hospitalizations. Both drugs have been used on their own but they had not been studied in combination. Dr. Plint led a clinical trial that involved 800 infants aged six weeks to 12 months at eight pediatric hospitals across Canada. The study found that 35% fewer infants who received both drugs required hospitalization. The results of her study were reported in the New England Journal of Medicine.
Impact
The ability to treat infants with medication in the emergency department reduced the need for hospitalization, potentially saving the health-care system millions each year and improving outcomes for infants and their families.
First Published
New England Journal of Medicine, May 14. 2009.
Schools as centres of activity
Program has benefits years later
Overview
Children in school spend six hours a day at their desks – and recess may be spent playing electronic games or chatting with friends instead of being active. The result – fewer than half of Canadian children get the daily physical activity necessary for their healthy growth and development. Action Schools! BC is a program designed to help elementary schools create individual school action plans to promote healthy living.
Impact
The program is having a significant impact on activity levels, awareness of healthy eating and even academic achievement of participating children. As of 2008, more than 15,000 teachers in some 1,500 schools in British Columbia are delivering Action Schools! BC to 400,000 children in kindergarten through grade 7. The province has provided $15 million to support the program until 2010. With daily physical activity now mandatory in BC schools, the province is promoting Action Schools! BC as a way for schools to meet the requirement.
First Published
Research profile, August 2006; August 2008
Balance is the key
Protecting teenaged athletes from injury
Overview
Staying active is important for teenagers – but so is staying injury free. Dr. Carolyn Emery of the University of Calgary has found a way to reduce injury rates among teenaged athletes through training on a wobble board. A wobble board is a disk perched on half a ball, with the rounded side of the ball touching the floor. By standing on the board and carrying out dynamic activities while trying to maintain balance, teens who play fast-moving sports like basketball can help prevent knee and ankle injuries.
Impact
Training programs using wobble boards reduced injuries when delivered in physical education classes at the junior-high level. The research findings should influence policies related to injury prevention practices in both community sport and school settings.
First Published
Research profile, August 2006; updated 2009
Heads up!
Taking kids' concussions seriously
Overview
It used to be thought that a child's brain would recover more quickly from injury than adults' brains. But it turns out that a child's brain may actually be more sensitive to the effects of concussion. Dr. Dave Ellemberg of the University of Montreal conducted the world's first large-scale study of the effects of sports-related concussion in children. Using a more sensitive test than is generally used, he found that mild concussion affects the brain cells and that neurons don't respond as rapidly even up to a year after a concussion. While the effects might go unnoticed in an adult, even a small change can have pronounced effects in a child, such as difficulty focusing. The key to recovery is "brain rest" -- no sports activities until a week with no symptoms and no tiring mental activity, such as school, either. Dr. Ellemberg also observed that, while coaches are aware of the need to recover after a concussion, parents require education about how to respond when their child suffers a concussion.
Impact
Dr. Ellemberg has advised Quebec's Ministry of Health and Social Services of the need to respond to concussions in children and has received a positive response.
First Published
Research profile July 2007; updated 2009
Addressing pre-eclampsia
Common condition can lead to heart disease
Overview
Pre-eclampsia is a leading cause of maternal and child illness and death worldwide, affecting 5-8% of all pregnancies. The condition is characterized by high blood pressure and the presence of protein in urine. In addition to placing mothers and babies in immediate danger, the condition also contributes to the development of heart disease for both. Dr. Graeme Smith of Queen's University is examining the role of pre-eclampsia in heart disease. He has found that pre-eclampsia doesn't so much cause heart disease in mothers as act as a signal for future risk.
Impact
The development of pre-eclampsia identifies a predisposition toward heart disease, enabling physicians to undertake interventions to prevent the disease. Dr. Smith is preparing guidelines for physicians.
First Published
CIHR Health Research Results, 2003-04; updated 2009
Caffeine – it's not just for adults anymore
Caffeine helps regulate breathing of very premature babies
Overview
Apnea is one of the dangers lying in wait for very premature babies – it affects about 85% of babies born prior to 34 weeks' gestation. Dr. Barbara Schmidt of McMaster University has found that about a third of babies treated with caffeine for apnea – interrupted or irregular breathing due to their prematurity – required extra oxygen, compared to about half of those who received a placebo. The latter group also needed an extra week of ventilator therapy to support their breathing, compared to the babies who received caffeine. Caffeine increased the likelihood of surviving without neurodevelopmental disability to the end of the second year of life, by reducing rates of cerebral palsy and cognitive delay. The caffeine helped to regulate the babies' breathing. In 2008, the trial received the inaugural "Trial of the Year" award from the Society for Clinical Trials.
Impact
Of all drugs used in the neonatal intensive care unit, caffeine is, to date, the only drug that has been shown to reduce disability in very pre-term children. While caffeine is not yet licensed for this indication outside the United States, it is being used.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Breathing easy – it's not easy work
Premature babies get help taking their first breath
Overview
Until the 1980s, Respiratory Distress Syndrome (RDS) claimed the lives of many babies born even just a few weeks premature. Their tiny lungs couldn't inflate properly. Some people believed the babies couldn't produce enough of a natural material called pulmonary surfactant, which is needed to reduce the surface tension of water within the lung and causes the lung's surface area of expand. Dr. Fred Possmayer, professor emeritus at the University of Western Ontario demonstrated in the lab that surfactant could help premature rabbits breathe easier and survive. He then went further, and found a way to purify the substance so it could be used in human babies.
Impact
Thanks to the surfactant and other medical interventions for premature babies, the risk of dying due to RDS is much lower. The company Dr. Possmayer founded makes surfactants for more than 99% of the neonatal intensive care units in Canada.
First Published
CIHR-CMAJ Top Canadian Achievements in Health Research Awards, 2009
Sunscreen and DEET
Mix with care
Overview
Rare is the child who goes outside in summer without the double protection of sunscreen and DEET. But are they truly protected? Dr. Xiaochen Gu of the University of Manitoba has looked at the combination of the two products and found that mixing the two reduces the protection they offer individually and may increase long-term health risks. DEET and sunscreen are intended to work on the skin's surface, but combining the two increases the amount of and rate at which the active ingredients pass into the body.
Impact
The research provides valuable information about two widely used products. Parents can take steps to reduce the risks of combining DEET and sunscreen while ensuring their children's protection by applying DEET on clothing rather than on skin, or by applying sunscreen first and DEET afterward. Other steps they can take including washing them off with soap and water after use and avoiding the use of DEET on hands or face.
First Published
Research profile, July 2007
Managing children's mental health from a distance
Programs help families and family physicians
Overview
Children's mental health is a difficult issue for families and family physicians, who often find it difficult to treat. Nonetheless, in areas far from a city, family physicians may be the only ones who can provide care. Dr. Patrick McGrath of Dalhousie University has developed two programs – Managing our Moods and Family Help – to help families and family physicians manage problems ranging from depression to attention deficit disorder to more serious mental illnesses.
Impact
Currently, Dr. McGrath's programs are serving hundreds of families with children with anxiety and disruptive behaviour disorders across Nova Scotia and in one health district in Ontario. He is negotiating contracts with health districts in several other provinces. Families report they are delighted with the access they have to convenient and effective interventions for their children and administrators are pleased with the cost-effective service for hard-to-serve families. A company is being formed to market the programs.
First Published
CIHR Health Research Results, 2004-05; updated 2009
Inoculating girls against eating disorders
Tools support healthy body weights
Overview
When kids, girls in particular, reach the age of 12, they enter a vulnerable period filled with conflicting information about what constitutes a healthy body type and weight. Dr. Gail McVey of Toronto's Hospital for Sick Children has developed tools and programs to help "vaccinate" students during this vulnerable period and prevent risk factors that can trigger eating disorders such as anorexia nervosa and bulimia. The tools include a series of Web-based resources that can be used by teachers and students as part of daily classroom activities and cover topics such as media literacy, healthy eating, the impact of teasing, the impact of adult role models and active living.
Impact
The website, called "The Student Body", is being widely used in Ontario and is providing a model for other provinces as they develop programs to prevent eating disorders. Dr. McVey also participated in a recent revision of the Ontario physical education and health curriculum, using evidence from her research to inform the new curriculum. The website is part of a larger body of research that has resulted in the creation of peer support groups in Hamilton that are still going strong, eight years after the completion of the initial research and the creation of a comprehensive, school-wide, year-long initiative in the Peel region of Ontario whose impacts were still being felt the following year.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Stepping into better nutrition
CIHR-funded tool assesses nutrition in preschoolers
Overview
Childhood is a time of growth – but sometimes it's hard to know if children are getting the nutrition they need to support their growth. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®), developed by Dr. Heather Keller of the University of Guelph, is a screening questionnaire that helps identify nutrition risks or problems among children aged 3-5. Designed for use by parents, caregivers or community professionals, the questionnaire takes no more than five minutes to complete.
Impact
NutriSTEP is a licensed product. It is free to anyone in Ontario, but people out of province and in other countries pay a small fee. As of spring 2010, over 150 licenses have been issued. NutriSTEP is used in a variety of settings across Canada such as screening programs organized by regional health units, hospital settings, and 'school readiness fairs' (health screening) for preschoolers. It is now used by provincial agencies in New Brunswick, Manitoba, Ontario, British Columbia and Alberta, as well as by many family doctors. In Ontario, NutriSTEP® has been adopted by the Ontario Public Health Association's Nutrition Resource Centre. The program is being monitored by the Ontario Ministry of Health Promotion and will be a requirement of the proposed Ontario Public Health Standards, which set the minimum standard for public health programs and services in the province.
First Published
CIHR Institute of Nutrition, Metabolism and Diabetes, INMD Update, October 2007; Your Health Research Dollars at Work, 2007-08; updated 2009.
Enhancing early childhood opportunities
Saskatchewan project maps neighbourhood effects
Overview
Children in Saskatoon, as a group, lag behind national norms in physical health and well being, language and cognitive development, communication skills and general knowledge. Their parents similarly scored below average on parenting skills and their mothers scored below average on maternal mental health. These findings come from a study by Dr. Nazeem Muhajarine of the University of Saskatchewan, entitled Understanding the Early Years in Saskatoon. The study also found links between the families and neighbourhoods where children lived and how likely they were to thrive in learning environments when they arrived at school. Dr. Muhajarine and his team then worked with school boards, provincial ministries, community agencies and associations, aboriginal organizations and municipal politicians and planners to apply their findings to policies and programs.
Impact
The team's research has contributed to improved programs and services for children in Saskatoon. Saskatoon's public and separate school boards have established board-wide literacy programs and the public board has reported significant gains in literacy as a result. The boards have also established full-day, every-day kindergarten pilot programs. The study team is advising the public board as it transforms one of its elementary schools into an integrated centre providing, in addition to education, child care and community support services. The provincial government has funded additional speech and language pathologist to work with children, in part based on the team's findings. The Saskatoon Public Library has improved access to services in underprivileged areas and, in the summer of 2009, will open a new branch to better serve these communities.
First Published
Moving population and public health knowledge into action: CIHR Institute of Population and Public Health Knowledge Translation Casebook, 2006.
Additional details from Knowledge to Action: A Knowledge Translation Casebook, 2008, and A Celebration of Excellence in Canadian Health Research, 2006.
Reducing smoking among mothers
FACET program targets pregnant women, new mothers
Overview
In both Canada and the United States, it is estimated that between 20 and 30% of pregnant women smoke and, while half try to quit during pregnancy, nearly all of them (70-90%) have resumed smoking within a year after giving birth. The Families Controlling and Eliminating Tobacco (FACET) project took a different approach to smoking cessation by focusing on couple dynamics and routines. The program, developed by Dr. Joan Bottorff of the University of British Columbia and her team, focuses on smoking and tobacco reduction in the context of women's interactions and relationships with their partners. It takes a women-centred approach, addressing the smoking in the context of women's lives and their relationships, rather than focusing on fetal health, and it avoids stigmatizing women's smoking.
Impact
The research findings have been used in a Health Canada report focusing on the development of guidelines for a "quit smoking" telephone counselling protocol for pregnant women and new mothers. Information from the booklet developed as part of this project has been adapted for use by the US National Cancer Institute, Tobacco Control Branch for its website for pregnant smokers. The team is now focusing its efforts on new and expectant fathers, because of their finding that becoming a father is when many men are motivated to quit, as well as the fact that if their partner smokes, many women take up smoking again once their child is born.
First Published
Knowledge to Action: A Knowledge Translation Casebook, 2008; updated 2009.
New revelations about ovulation
It's not what we've thought
Overview
The traditional model of the menstrual cycle has it that a group of follicles grows together during the cycle, with one selected in waves. Dr. Roger Pierson of the University of Saskatchewan has discovered that's not exactly how it works. He's found that follicles develop in waves, with women experiencing two-to-three periods of follicular development each month, though, like the traditional understanding, only one egg is selected for ovulation.
Impact
The original discovery that women ovulate in waves has underpinned the development of "seasonal" oral contraceptives that result in women having fewer periods each year. It has also resulted in the development of a new emergency contraceptive technique, currently in clinical trials, as well as two protocols for ovarian stimulation in women undergoing assisted human reproduction. One protocol, for low doses of ovarian-stimulating drugs, is in clinical trials, while the other, for better use of the regular doses of ovarian stimulating drugs, is still at the research stage.
First Published
CIHR Health Research Results, 2004-05; updated 2009
Answering questions for concerned parents
Scale assesses likelihood of walking for children with cerebral palsy
Overview
Parents of children with cerebral palsy often want to know whether their children will ever walk. Dr. Peter Rosenbaum of McMaster University, where he holds a Canada Research Chair in Childhood Disability, has developed the Gross Motor Function Classification System (GMFCS) to assess the likelihood of the children walking.
Impact
The GMFCS is in use in more than 20 countries around the world, and the team continues to get requests for translation. Virtually every publication about cerebral palsy uses the GMFCS as a descriptor of the motor status of the people they are writing about. In fact, the system is not explained any more because it has become part of the language of the field. Teams in Sweden and Australia have demonstrated a direct relationship between level of the GMFCS and risk of hip dislocation, so that physicians can now focus on those at risk of dislocation, rather than x-raying everyone, as was previously the case. The creation of the GMFCS has led to the creation of a Manual Abilities Classification System by the team, working with colleagues in Sweden, and a Communication Function Classification System, also developed by the team in collaboration with international colleagues. Dr. Rosenbaum is working with colleagues to create an Autism Function analogue.
First Published
CIHR Health Research Results, 2004-05; updated 2009
Stopping a preventable disorder
Test enables early diagnosis of fetal alcohol spectrum disorder
Overview
While there are no national statistics on the prevalence of fetal alcohol spectrum disorders (FASD) in Canada, it is estimated that 280,000 Canadians are affected by the disorder. FASD is caused by maternal alcohol consumption during pregnancy and is the most common reason for developmental delays in Canada. Now, a novel test can determine if new mothers were drinking during their second trimester of pregnancy. The test, developed by Dr. Gideon Koren of Toronto's Hospital for Sick Children, measures the fatty acid ethyl esters (FAEEs) found in meconium, a baby's first stools, obtained within the first two or three days of birth.
Impact
The test has been adopted as a national standard for diagnosing FASD, one of five so adopted by the Public Health Agency of Canada and the only one to screen newborns. It is now in use across Canada.
First Published
Research profile, Sept. 2005; updated 2009
Giving newborns at risk a better chance
Network ensures best outcomes for newborns in intensive care
Overview
The Canadian Neonatal Network is a research and knowledge translation initiative aimed at improving the health and quality of health care for newborn babies. The network, made up of researchers, clinicians and administrators from 27 Canadian hospitals and 16 universities across Canada, conducts evidence-based collaborative research with an emphasis on the implementation of practice and policy changes.
Impact
This internationally recognized network has contributed to the development of policies to better allocate neonatal resources in British Columbia. The network completed the first-ever comprehensive description of outcomes and practices in Canadian neonatal intensive care units; this enabled one institution to reduce its incidence of infections by half. As well, its findings regarding retinopathy of prematurity (an eye disease that affects premature infants) will halve the number of infants routinely screened, reducing costs by more than $1 million each year. The network has also, together with researchers from the United States, developed a neonatal illness severity score called SNAP-II. This patented tool has become the international standard for assessing the severity of neonatal illness and comparing outcomes from hospital to hospital. SNAP-II has also been licensed to companies for risk assessment, setting insurance premiums and incorporating into hospital patient monitoring equipment.
First Published
Evidence in action, acting on evidence: CIHR Institute of Health Services and Policy Research Knowledge Translation Casebook, 2006.
Common procedure not effective
Amnioinfusion, thought to prevent neonatal lung infection, doesn't work
Overview
Meconium aspiration syndrome (MAS) is a rare, but severe, neonatal lung infection caused when a newborn inhales a combination of meconium and amniotic fluid during labour and delivery. Meconium is the material that fills the fetal intestinal tract during pregnancy; when inhaled, it can cause a partial or complete blockage of the baby's airway when it exhales. Amnioinfusion was thought to reduce the risk of MAS by diluting the meconium. But Dr. William Fraser of the University of Montreal led an international randomized trial that demonstrated that it is ineffective at preventing MAS.
Impact
The American College of Obstetrics and Gynecology has modified its guidelines on the management of meconium-stained amniotic fluid as a result of the study. In addition, the American Pediatric Association Neonatal Resuscitation Program has modified its recommendations on amnioinfusion as well.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Bridging the "know-do" gap
The case of home fortification with Sprinkles
Overview
According to the United Nations, micronutrient malnutrition, or "hidden hunger" affects some two billion people worldwide, including 750 million children. About half of all child deaths in developing countries are associated with this insidious form of malnutrition. Dr. Stanley Zlotkin of Toronto's Hospital for Sick Children has developed a small sachet with a day's supply of powdered micronutrients like iron, zinc and vitamin A that can be added to any semi-liquid food, such as porridge or yoghurt without changing its taste, colour or texture. He called it Sprinkles. Dr. Zlotkin then worked with stakeholders to produce and distribute Sprinkles where it is needed most.
Impact
Sprinkles has reached 2.5 million at-risk children in more than 20 countries. Individual countries, such as Pakistan, Bangladesh and Mongolia, have included home fortification with powdered minerals and vitamins as a component of their country-wide nutritional strategies for children. And the World Health Organization, the World Food Programme and the United Nations Children's Fund have published policy guidelines for the use of micronutrient fortification as a component of relief aid. "The work that Dr. Zlotkin has published and (that of) other collaborators in consultation with him, this is what informs most of the program's introduction and scale-up in many of these countries. We have taken that work, taken the best lessons from it and applied it," says Ms. Nita Dalmiya, UNICEF nutrition specialist.
First Published
Knowledge to Action: A Knowledge Translation Casebook, 2008
Building a better booster seat
Making cars safer for children
Overview
Each year, Canadian children suffer very high rates of death and serious, life-changing injury in road crashes. Those most at risk are four-to-eight-year-old children, who are using seatbelts alone to keep them safe, rather than the booster seats they need. In fact, only 28% of children in Canada actually use them. Dr. Anne Snowdon and her team at the University of Windsor built on these findings by interviewing children to find out why they didn't use booster seats. They found that children in this age group find booster seats uncomfortable and too much like baby seats, so they decided to build a better booster seat that would be more acceptable to the children.
Impact
The research team partnered with Magna International to develop a new generation of booster seats, called the Clek. The seat launched in Canada in 2006, in the US in 2007 and is now in progress to launch in 15 other countries worldwide.
First Published
CIHR, Portraits of Partnerships: Annual Report 2007-08
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