“No Screens Under 2” Q&A with Dr. Brenda Hussey-Gardner

brenda-hussey-gardnerHi, my name is Dr. Brenda Hussey-Gardner. I am a developmental specialist who works with the Department of Pediatrics at the University of Maryland Children’s Hospital. I attended the American Academy of Pediatrics conference in San Francisco to share the results of research that I have done with colleagues here at the University of Maryland and to learn what other researchers are doing across the nation in order to bring this new knowledge back to the hospital to better serve our children and their families. At this conference, the American Academy of Pediatrics released their new guidelines regarding screen time and children.

Please see the Q&A here for more information on these guidelines.

Q: What is the “No Screens Under 2” rule and in what ways is it changing?

A: The American Academy of Pediatrics (AAP) previously recommended no screen time for children under 2 years of age. In its new guidelines, the AAP offers slightly different recommendations for children less than 18 months and those 18 to 24 months of age.

Children less than 18 months

The AAP discourages parents from using digital media with one exception: video-chatting (e.g., Skype, FaceTime). This form of interactive media can be used, with parent support, to foster social relationships with distant relatives.

Children 18 to 24 months

The AAP recommends that parents, who want to introduce their child to digital media, do the following:

  1. Only use high-quality educational content.
  2. Always watch shows or use apps with your child. Talking about what the child sees helps foster learning.
  3. Never allow your child to use media alone.
  4.  Limit media to a maximum of 1 hour per day.
  5. Avoid all screen time during meals, parent-child playtime and an hour before bedtime.

Q: Can you provide some insight into how the decision was made? What research was taken into account?

A: The AAP Council on Communications and Media reviewed research on child development, television, videos and mobile/interactive technologies to develop their current recommendations. Research shows that children under the age of 2 years need two things to develop their thinking, language, motor and social-emotional skills: (1) they need to interact with their parents and other loving caregivers, and (2) they need hands-on experiences with the real world. In fact, researchers have demonstrated that infants and toddlers don’t yet have the symbolic, memory and attention skills needed to learn from digital media. Importantly, research also shows evidence of harm (e.g., delayed thinking, language and social-emotional development; poorer executive functioning) from excessive media use with young children.

Q: Why do these new guidelines matter to parents, and should they affect the ways parents and their young children interact with technology?

A: AAP guidelines matter because parents want their children to be well adjusted and smart, and they don’t want to do anything that may harm their child’s development. As such, parents should try their best to avoid screens with their children who are less than 18 months of age and realize that it is their interactions with their child that are the most important. Then, from 18 to 24 months of age, parents should strive to use only the highest quality educational technology with their child. As hard as it is, parents should try to avoid using technology as a babysitter and try to understand the negative impact that it can have on their child’s development.

Q: What is your biggest take-away from the session?

A: A parent’s lap is always better than any app!

Q: What is your opinion on the new guidelines and do you think it will affect your clinical practice? If so, how?

A: I believe that the new AAP guidelines, while a little more flexible, may still be difficult for parents to adhere to, as screen time is so pervasive in our society. However, it is very important for parents to make smart choices about digital media and screen time if they want to help their infant and toddler develop into a child who is healthy and ready for success in preschool. It is my goal to develop a pamphlet summarizing the research findings and AAP guidelines to help parents make the best choices for their child and family.

 

For more information about media, screen time, and child development, parents are encouraged to read the AAP recommendations located within the publication “Media and Young Minds,” and to read the “Early Learning and Educational Technology Brief” published by the U.S. Department of Education and the U.S. Department of Health and Human Services.

Kathy’s Story: Living Better with Mesothelioma – Possible with the Right Team of Experts

Kathy Ebright was enjoying life with her husband, 2 kids and 7 grandchildren in rural Pennsylvania, when everything changed suddenly.  This is true for thousands of people fighting cancer across the world, but hearing the word “mesothelioma” is not common.

“I went numb, I might have said a few words, but I couldn’t put words together to speak,” Kathy said.

Kathy and her husband, Doug

Almost everyone has been touched by cancer, but Kathy and her husband didn’t know anyone with mesothelioma in their small town of Richfield. They only heard of the disease from commercials for lawyers who specialize in asbestos lawsuits.

Kathy’s mesothelioma was discovered during a scan of her abdomen, which she has regularly to monitor a heart condition.  Her vascular doctor saw unusual spots on her scans, which her primary care doctor and oncologist reviewed, and they determined it was pleural mesothelioma.  This means the cancerous cells are located in the chest cavity, and sometimes the lung.  Usually, those with pleural mesothelioma experience shortness of breath, but Kathy was lucky enough to catch her mesothelioma before experiencing any symptoms.

Kathy’s daughter, Ally, who works with the tumor registry at the Geisinger Medical Center, sprang into action after the initial shock.  They attended tumor boards at Geisinger, where physicians from multiple disciplines (radiation, medical, and surgical oncology) meet to discuss cases.  Kathy’s medical oncologist, Dr. Rajiv Panikkar, suggested to Kathy that she go to the University of Maryland Greenebaum Comprehensive Cancer Center in Baltimore, where she would see a team skilled and experienced in the most novel treatments for mesothelioma.

On December 20, 2015, about a month after her initial diagnosis, Kathy had her first appointment with Dr. Joseph Friedberg, a nationally known expert in mesothelioma and head of thoracic surgery at the University of Maryland Medical Center.

Kathy and her family were nervous, but mesothelioma nurse navigator Colleen Norton helped them navigate the unfamiliar and frightening process of a mesothelioma diagnosis.  She made sure they were prepared for their appointment beforehand, and Colleen even handled authorization with their health insurance company.

“We just felt we were along for the ride because Colleen always had everything taken care of,” said Kathy’s husband Doug.

And they were just as impressed with Dr. Friedberg, who was calm, reassuring and explained Kathy’s situation very clearly.

“On the back of his folder, he hand drew a lung to display what was going on with me, and it could’ve been taken right from a textbook it was so good,” Kathy said.

Kathy’s granddaughter, Carleigh, who serves as her main cancer-fighting motivator

They were also impressed with Dr. Friedberg’s tenacity and understanding.  Kathy wanted to spend Christmas with her family, but Dr. Friedberg didn’t want wait too long to perform the lung sparing surgery.

Her surgery was scheduled for January 5, 2016.

Throughout the surgery, Kathy’s family couldn’t have been more comfortable and informed.

“We camped out in the Healing Garden just about the entire time,” Doug said. “Melissa Culligan, Dr. Friedberg’s nurse, was in and out of the operating room, updating us every two hours.  We were never left wondering how Kathy was doing.  We also had the option to call into the operating room if we had any questions.”

During Kathy’s recovery in the hospital, she said the nurses were “phenomenal.”  Colleen also came to see her several times a day, and they added a La-Z-Boy to Kathy’s room so her husband could more comfortably spend the nights with her.

While there is no cure for mesothelioma, yet, Kathy and her family couldn’t be happier to have the UMGCCC team in their corner.  She now returns every 3 months for the next 2 years for check-ups, and Dr. Friedberg describes her scans as “pristine.”

“It’s very reassuring to know we have such caring people looking out for my health,” Kathy said.

Learn more about the Mesothelioma and Thoracic Oncology Treatment Center at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Center by clicking here, or calling 410-328-6366.

Brain Attack Team Marshals Forces to Save a Stroke Patient

Six weeks after suffering a stroke while driving on the Baltimore Beltway, Paul Sargent, 45, is back on his feet, speaking normally and continuing physical therapy. A sprinkler fitter with the United Association of Plumbers, Pipefitters and Steamfitters, Local 536, he often worked on ladders and aerials lifts that put him 100 feet in the air. While he has not yet regained enough balance to work atop a ladder, he is hopeful.

 “It’s amazing, considering what I was like that night, that I’ve been able to recover this much,” Sargent says, pictured here with his wife, Tammy Sargent, during a follow-up visit.

By Anne Haddad

During a heavy rainstorm the week between Christmas and New Year, Paul Sargent, 45, was driving his truck on the Baltimore Beltway. He exited onto I-795 toward his home inManchester. Within minutes, a convergence of difficulties forced him to pull over.

For one thing, he had been feeling increasingly sick for the last few miles. For another, the rain was coming down in sheets, making visibility difficult. His cell phone rang, and he could see the call was coming from his son, Curtis. But he was unable to coordinate his hands and fingers to answer the call.

Sargent didn’t realize it, but he was in the early stages of a stroke. He had been experiencing some occasional dizziness for about a month, but now it was disabling him. Somehow, he managed to dial the magic number – 911 – and talk with the dispatcher. Paramedics arrived and took him to a community hospital, where the emergency staff realized he was having a stroke.

Because the University of Maryland Medical Center is a designated primary stroke center, the community hospital called the Maryland ExpressCare offices to consult with physician specialists here — the Brain Attack Team.

As a primary stroke center, UMMC is equipped to deal with the most advanced treatments and the serious risks that are associated with those treatments. The conference call included Marcella Wozniak, MD, PhD, interim medical director of the team and associate professor of neurology, and John W. Cole, MD, MS, associate professor of neurology.

The Brain Attack Team arranged for the local hospital staff to begin the time-sensitive administration of the clot-busting tissue plasminogen activator (t-PA). While that drug, administered intravenously, made its way to the clot that was impeding blood flow in his brain, Sargent was on his way to UMMC via ground ambulance.

On the Neurocare Intensive Care Unit (NCICU), charge nurse John Pfeifer, RN, updated staff nurses who would be waiting to care for Sargent and accompany him to the MRI suite. Staff from Housekeeping Hospitality Services were making sure the room was cleaned and ready for the new patient, while nursing staff reviewed his case to be ready to care for him when he arrived.

Seconds after Sargent arrived, nurses and physicians moved him from the stretcher to his bed, while Ermias Aytenfisu, MD, a neurology fellow at UMMC, introduced himself to Sargent and began asking questions to assess his condition.

“What is your name?”

“How old are you?”

“What month is it?”

“Can you hold your right hand up like this while I count to 10?”

“Where am I touching you now?”

Sargent was able to answer most questions, but with enough impairment that an MRI would be needed to determine whether and where he had a clot impeding blood flow in his brain, and which path of treatment was most appropriate.

“We’re going to do an MRI, so we need to take your jewelry off,” Aytenfisu told him.

Another physician had been standing by since Sargent arrived: Joao Prola Netto, MD, a fellow in neuro-interventional radiology, was following Atyenfisu’s assessment to help determine not just whether they could get an image of the blood clot on the MRI, but whether they could use the latest interventional radiology techniques to remove it, should that become necessary. And when Cole became concerned that Sargent’s condition was becoming worse, he called for anesthesiologist Joshua M. Tobin, MD, assistant professor of anesthesiology, to come quickly to the MRI suite to secure Sargent’s airway with an endotracheal tube.

Nurse practitioner Karen L. Yarbrough, MS, ACNP, acute care nurse practitioner and programs director for the Maryland Stroke andBrainAttackCenter, was observing and making notes to determine whether Sargent qualified for inclusion in any clinical trials, should he choose to participate.

One of the reasons Sargent was transferred was that he received t-PA, the clot-busting drug that must be administered within three hours of the onset of stroke symptoms, or the treatment becomes too risky. Even when administered within that three-hour period, t-PA carries a risk of hemorrhage. But after three hours, the blocked blood vessel is weakened from lack of blood flow. A sudden return of blood flow could cause it to bleed. Because of this risk, the patient must be in a hospital with intensive care nurses and vascular surgeons when t-PA is administered, so they can manage any complications.

After his MRI, Sargent was taken back to the Neurocare Intensive Care Unit, where the nurses specialize in the vigilant care required during a stroke. In fact, several nurses from the NCICU accompanied him to the MRI to care for him before and after the imaging procedure. They included: Betsy Raine, BSN, RN; Olga Pranov, BSN, RN; Ann Adams, RN; and Naomi Crosen, RN.

Once Sargent was out of danger, UMMC rehabilitation staff – occupational, physical and speech therapists – began working with him.

“As soon as someone is stable medically, we want them to start rehab,” says Cole. “The sooner, and more consistent, the better the outcomes.”

After 10 days in the hospital, he was discharged to Kerman Hospital, a rehabilitation hospital that is part of the University of Maryland Medical System, for 14 days of intensive physical, occupational and speech therapy to regain his strength, balance, coordination and ability to speak and swallow. On Jan. 20, he went home with his wife, Tammy, and their son and daughter — Curtis, 19, and Heather, 17.

Today, Sargent continues to improve. His speech betrays none of the impairment of those first few days. He has returned for follow-up visits with the neurologists at UMMC, but has continued physical and occupational therapy closer to home in Carroll County. He has aced speech therapy: He talks animatedly and a mile a minute, just like before the stroke.

“I’m walking by myself, and I can make myself a grilled-cheese sandwich on the stove without burning myself, but I don’t think I can get back up on a ladder yet,” Sargent says.

Whether or not he can go back to his trade, installing fire sprinkler systems in such Baltimore landmarks as the Hippodrome Theatre and airplane hangars that required him to be 100 feet up in the air, he doesn’t know. But he does believe he’s lucky.

“It’s amazing, considering what I was like that night, that I’ve been able to recover this much,” Sargent says.

 

All About Triglycerides: An Interview with Dr. Michael Miller

Editor’s Note: A scientific statement published today in Circulation: Journal of the American Heart Association found that dietary and lifestyle changes significantly reduce elevated triglycerides, a type of blood fat, which is associated with heart, blood vessel and other diseases.

So what exactly are triglycerides, how significant are this statement’s findings and what specific steps can people take to reduce their triglyceride level and improve their heart health? Dr. Michael Miller, chair of the AHA’s statement committee, a cardiologist at the University of Maryland Medical Center and director of the Center for Preventive Cardiology at the University of Maryland School of Medicine, answers those questions and more to help you improve your triglycerides IQ.

As compared to lowering cholesterol, it sounds like lifestyle changes can go a long way toward lowering cholesterol levels.

Yes, lifestyle changes may only lower cholesterol 5-10% while they can lower triglycerides 30-50% and higher in some cases!

How significant are these findings, and why should people care and take action?

This is the most comprehensive statement on triglycerides and puts into perspective the important role that they serve as a barometer of our “metabolic” health. Optimal triglycerides suggest that fat is being effectively broken down whereas high triglycerides indicate abnormal processing, which may lead to excess fat in other tissues.

For example, excess fat in muscle may lead to insulin resistance and diabetes, excess fat in the liver may produce a fatty liver and excess fat in the belly may produce inflammation and increase risk of heart disease. In fact, a high triglyceride level may predict development of diabetes years down the road. Therefore, it is important that people pay close attention to their triglyceride level, especially because it can often be effectively treated with lifestyle measures.

What are triglycerides, and why are they important?

Triglycerides are simply our fats and high triglyceride levels in our blood tell us that our body is carrying around too much unhealthy fat. Too much unhealthy fat in our blood is associated with an increased risk of diabetes and heart disease.

Talk about the work your committee did, as well as the key findings.

Our committee of 15 men and women physician scientists evaluated more than 500  studies involving triglycerides during the past 30 years. In summary, our findings indicate that triglycerides are an important marker for heart disease risk.  High triglycerides may raise the risk of heart disease 20-50% and double the risk if accompanied by high levels of LDL (the bad cholesterol). High triglycerides are also associated with increased belly fat, high blood pressure, insulin resistance and low levels of HDL (the good cholesterol).

How are and how often should triglycerides be measured?

Screening levels can now be obtained in a non-fasting state and depending on the results will determine whether additional testing should be performed. For example, a normal non-fasting test (less than 200) may not need additional testing for a period of 1 year or greater, whereas high levels (200 or greater) should have a fasting test within a reasonable period such as 2-4 weeks.

It sounds like triglycerides are somewhat similar to cholesterol. Can you talk about that, as well as why the public is so familiar with lowering its cholesterol levels but not its triglycerides?

Cholesterol is a waxy substance whereas triglyceride is fat, but they are both connected by the lipoproteins that transport them to and from various body tissues. For example, triglyceride-rich lipoproteins include chylomicrons (that transfer triglycerides after a fatty meal) and VLDL (very low density lipoprotein) that transfers triglycerides from the liver. The triglycerides are broken down and stored in fat or used as an energy source in muscle. Cholesterol-rich lipoproteins include LDL and HDL and they transfer cholesterol to or from body tissues.

What are the current guidelines for triglyceride levels, and what is the optimal level?

In addition to the previous guidelines that define desirable levels (less than 150), borderline-high (150-199), high (200-499) and very high (500 and greater), we have now added the optimal level of less than 100.

What can people do to lower their triglyceride levels?

High triglycerides are very responsive to lifestyle changes. They include reducing weight if overweight by decreasing the total number of calories eaten daily, reducing simple sugars, especially fructose, decreasing saturated fat and eliminating trans fats. Physical activity, especially aerobic exercise, will also lower triglyceride levels.

Are there specific foods people should eat more of and avoid, and forms of exercise that are better than others?

Omega-3 fats that contain EPA and/or DHA such as found in fatty fish can lower triglycerides. Decreasing simple carbohydrates, saturated and trans fats are also recommended. Aerobic activity is also effective in reducing elevated triglycerides.

 

Good News for People With Parkinson’s Disease

A study conducted by researchers at the University of Maryland School of Medicine and the Baltimore VA Medical Center found that low-intensity exercise improves walking for people with Parkinson’s disease. Walking, though, is just one of many benefits.

“Our study showed that low-intensity exercise performed for 50 minutes three times a week was the most beneficial in terms of helping participants improve their mobility, says study principal investigator Dr. Lisa Shulman, co-director of the Maryland Parkinson’s Disease and Movement Disorders Center. “Walking difficulty is the major cause of disability in Parkinson’s disease. These results show that exercise in people with Parkinson’s disease can make a difference in their function. Exercise may, in fact, delay disability and help to preserve independence.”

“Many patients ask us what kind of exercise they should be doing,” continues Dr. Shulman. Now we can tell them that this research shows that low-intensity walking, which most people with Parkinson’s can do, combined with stretching and resistance training may be the best option.”

Honoring the Legacy of Henrietta Lacks

More than 750 people attended one of two events on February 11 to honor the legacy of Henrietta Lacks. The events were hosted by the University of Maryland Medical Center and the professional schools of the University of Maryland.

Mrs. Lacks was an African-American Baltimore woman who died of cervical cancer more than 60 years ago. But her cells, known as HeLa, continued to reproduce in the laboratory and eventually became one of the most important contributions to medicine because of their usefulness in developing vaccines, drugs and other therapies. Her family was unaware of her contributions for decades.

The day event was a symposium that looked into the medical, ethical, social, legal and economic lessons that can be learned from the scientific contributions of Ms. Lacks (See videos of the day event.). One guest speaker was Rebecca Skloot, author of the bestselling “The Immortal Life of Henrietta Lacks.”

High school sophomore Hayley Warren, though, stole the show with a moving speech about how Ms. Lacks’ story and cells have inspired her to find a cure for cancer. Ms. Warren, who got to know about the HeLa cells in a paper she wrote about their impact in medical research, was warmly greeted by many members of the Lacks family in attendance after her speech.

The evening event featured spoken and artistic tributes to Ms. Lacks and her family, more than 30 of whom were in attendance.

When Bad Tastes Good: Discovery of Taste Receptors in the Human Lung

This short video provides an overview of the groundbreaking discovery of taste receptors in the human lung. This discovery, made by researchers at the University of Maryland School of Medicine, has the potential to revolutionize the future treatment of asthma, chronic obstructive pulmonary disease (COPD) and other respiratory illnesses. Featured in the video is Stephen Liggett, M.D., professor of medicine and physiology at the University of Maryland School of Medicine and senior author of the study.

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