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Pitt Public Health Finds Association Between Air Toxics and Childhood Autism

PITTSBURGH, Oct. 22, 2014 – Children with autism spectrum disorder (ASD) were more likely to have been exposed to higher levels of certain air toxics during their mothers’ pregnancies and the first two years of life compared to children without the condition, according to the preliminary findings of a University of Pittsburgh Graduate School of Public Health investigation of children in southwestern Pennsylvania.

This research, funded by The Heinz Endowments, will be presented today at the American Association for Aerosol Research annual meeting in Orlando, Fla.

“Autism spectrum disorders are a major public health problem, and their prevalence has increased dramatically,” said Evelyn Talbott, Dr.P.H., principal investigator of the analysis and professor of epidemiology at Pitt Public Health. “Despite its serious social impact, the causes of autism are poorly understood. Very few studies of autism have included environmental exposures while taking into account other personal and behavioral risk factors. Our analysis is an addition to the small but growing body of research that considers air toxics as one of the risk factors for ASD.”

Dr. Talbott and her colleagues performed a population-based study of families with and without ASD living in six southwestern Pennsylvania counties. The researchers found links between increased levels of chromium and styrene and childhood autism spectrum disorder, a condition that affects one in 68 children.

“This study brings us a step closer toward understanding why autism affects so many families in the Pittsburgh region and nationwide – and reinforces in sobering detail that air quality matters,” said Grant Oliphant, president of The Heinz Endowments. “Our aspirations for truly becoming the most livable city cannot be realized if our children’s health is threatened by dangerous levels of air toxics. Addressing this issue must remain one of our region’s top priorities.”

Autism spectrum disorders are a range of conditions characterized by social deficits and communication difficulties that typically become apparent early in childhood. Reported cases of ASD have risen nearly eight-fold in the last two decades. While previous studies have shown the increase to be partially due to changes in diagnostic practices and greater public awareness of autism, this does not fully explain the increased prevalence. Both genetic and environmental factors are believed to be partially responsible.

Dr. Talbott and her team interviewed 217 families of children with ASD and compared these findings with information from two separate sets of comparison families of children without ASD born during the same time period within the six-county area. The families lived in Allegheny, Armstrong, Beaver, Butler, Washington and Westmoreland counties, and the children were born between 2005 and 2009.

One of the strengths of the study was the ability to have “two types of controls, which provided a comparison of representative air toxics in neighborhoods of those children with and without ASD,” said Dr. Talbott.

For each family, the team used the National Air Toxics Assessment (NATA) to estimate the exposure to 30 pollutants known to cause endocrine disruption or neurodevelopmental issues. NATA is the Environmental Protection Agency’s (EPA) ongoing comprehensive evaluation of air toxics in the U.S., most recently conducted in 2005.

Based on the child’s exposure to concentrations of air toxics during the mother’s pregnancy and the first two years of life, the researchers noted that children who fell into higher exposure groups to styrene and chromium were at a 1.4- to two-fold greater risk of ASD, after accounting for the age of the mother, maternal cigarette smoking, race and education. Other NATA compounds associated with increased risk included cyanide, methylene chloride, methanol and arsenic. As these compounds often are found in combination with each other, further study is needed.

Styrene is used in the production of plastics and paints, but also is one of the products of combustion when burning gasoline in vehicles. Chromium is a heavy metal, and air pollution containing it typically is the result of industrial processes and the hardening of steel, but it also can come from power plants. Cyanide, methylene chloride, methanol and arsenic are all used in a number of industries or can be found in vehicle exhaust.

“Our results add to the growing body of evidence linking environmental exposures, such as air pollution, to ASD,” said Dr. Talbott. “The next step will be confirming our findings with studies that measure the specific exposure to air pollutants at an individual level to verify these EPA-modeled estimates.”

Additional investigators on this study were Vincent Arena, Ph.D., Judith Rager, M.P.H., Ravi Sharma, Ph.D., and Lynne Marshall, M.S., all of Pitt.

Children’s Brain Care Institute Researcher to Be Featured in Documentary on Multiple Sclerosis

PITTSBURGH, Oct. 15, 2014 – A researcher from the Division of Child Neurology at Children’s Hospital of Pittsburgh of UPMC, will be profiled in an upcoming documentary produced by the National Multiple Sclerosis (MS) Society. Sharyl L. Fyffe-Maricich, PhD, assistant professor of pediatrics at the University of Pittsburgh School of Medicine, will be one of four female researchers who work in MS featured in the film.

MS is the most prevalent neurodegenerative disease in young adults, affecting more than 2 million people worldwide. The mission of the National MS Society is to mobilize people and resources to drive research for a cure and address the challenges of everyone affected by MS.

Dr. Fyffe-Maricich’s lab is interested in understanding the molecules and signaling pathways that are essential for controlling the onset of myelination and determining the thickness of the myelin sheaths that are generated. The importance of myelination becomes obvious in diseases such as multiple sclerosis where autoimmune-mediated demyelination throughout the central nervous system (CNS) results in devastating functional disability. Her lab is interested in learning more about these processes both during development and after demyelinating injuries in the adult.

To investigate, Dr. Fyffe-Maricich and her colleagues use a variety of techniques, including rodent behavioral analysis, immunohistochemistry, electron microscopy, cell culture, and biochemistry to analyze various genetic mouse mutants. The ultimate goal of Dr. Fyffe-Maricich’s work is to develop new treatment approaches for patients with MS.

Children’s Hospital of Pittsburgh of UPMC Partners with Tampa Hospital to Provide Cardiothoracic Services

PITTSBURGH, Oct. 2, 2014 Children’s Hospital of Pittsburgh of UPMC today announced a partnership with St. Joseph’s Children’s Hospital in Tampa, Fla., to assist their team with pediatric cardiothoracic services. Surgeons from the Heart Institute at Children’s Hospital of Pittsburgh will provide highly specialized cardiovascular care for patients.

The partnership will be led by Victor Morell, M.D., co-director of the Heart Institute at Children’s Hospital of Pittsburgh of UPMC and chief of the Division of Pediatric Cardiothoracic Surgery.

Children’s Hospital of Pittsburgh’s pediatric cardiovascular surgery program has the lowest overall four-year surgical mortality rate among all medium- and high-volume programs with a rate of 1.1 percent, according to the latest data compiled by the Society of Thoracic Surgeons (2008-2012).

“We are grateful for the opportunity to bring our unique expertise in pediatric heart surgery to families in Florida,” said Dr. Morell. “We share a commitment with St. Joseph’s Children’s Hospital to provide the absolute best possible pediatric care to patients and families from the Tampa area and beyond.”

In addition to collaborating with St. Joseph’s Children’s Hospital’s cardiac team on surgical and non-invasive cardiology services, Children’s Hospital of Pittsburgh’s experts will provide support to patients, families and caregivers in St. Joseph’s Children’s Hospital’s cardiac intensive care unit via telemedicine.

Children’s Hospital of Pittsburgh is leading the way in the development of telemedicine services to meet the needs of young patients regionally and around the world with video conferencing technologies that provide complex pediatric cardiac care through remote and virtual examinations — whenever and wherever expertise is needed.

For nearly two decades, St. Joseph’s Children’s Hospital has provided a full spectrum of pediatric cardiac services, from less-invasive diagnostic catheterization, nonsurgical valve replacement and electrophysiology studies, to cardiovascular surgery for the rarest and most complex congenital heart defects. St. Joseph’s Children’s Hospital has been home to one of the largest pediatric cardiovascular programs in the southeast and is a regional referral center for the diagnosis and treatment of congenital heart defects.

Prior to joining Children’s Hospital of Pittsburgh of UPMC in 2004, Dr. Morell led the pediatric cardiac surgical team at St. Joseph’s Children’s Hospital.

“This partnership brings the expertise of some of the country’s top-ranking pediatric heart physicians to our community, providing families across Florida with unprecedented access to the highest level of pediatric heart care available,” said Kimberly Guy, president, St. Joseph’s Children’s Hospital.

Third Mellon Scholar Appointed to The Richard King Mellon Foundation Institute for Pediatric Research at Children’s Hospital of Pittsburgh of UPMC

PITTSBURGH, Sept. 17, 2014 – Bernhard Kühn, M.D., a physician-scientist whose research focuses on heart failure, has been named a Scholar within the Richard King Mellon Foundation Institute for Pediatric Research and Director of Research for the Division of Cardiology at Children’s Hospital of Pittsburgh of UPMC.

Dr. Kühn is the third physician-scientist in the Mellon Scholars Program, which enables promising researchers in the early stages of their careers to pursue potential breakthrough research projects in biomedicine.

Dr. Kühn is a board-certified and practicing pediatric cardiologist whose research focuses on regenerative therapies for the heart. The long-term objective of his research is to provide novel approaches and molecular targets for the treatment of heart failure, primarily by studying the mechanisms of growth and regeneration of the myocardium, the muscle tissue of the heart.

“The recruitment of Dr. Kühn will bring in one of the leading researchers in heart regeneration to further explore heart cell growth and to give hope to advancing  treatments for heart failure, said Jay Kolls, M.D., director. “He will be an outstanding addition to the Mellon Scholar Program to continually increase our understanding of the causes and treatment of pediatric diseases.”

Dr. Kühn, also associate professor of pediatrics at the University of Pittsburgh School of Medicine, earned his medical and doctoral degrees from Freie Universität Berlin in Germany. He completed his post-doctoral fellowship at Boston Children’s Hospital where he then established an independent research lab in 2005.

In a landmark paper published in the highly prestigious journal Cell, Dr. Kühn showed that heart muscle cells, previously thought to be incapable of proliferating, could be induced to divide with the growth factor neuregulin1. This research has opened up the possibility of using this growth factor to stimulate heart regeneration. In a follow up study published in the Proceedings of the National Academy of Sciences, the Kühn lab showed that in humans, heart muscle cell proliferation is a mechanism of heart growth in infants and children. Together, these two papers provide the foundation for administering the growth factor to stimulate heart regeneration in pediatric patients with heart failure.

Scholars are selected on the basis of work that is highly innovative, delivering new expertise to the biomedical research community; likely to lead to major breakthroughs; and capable of having a long-lasting impact on the practice of medicine.

Stephen Maricich, M.D., Ph.D., and Timothy Sanders, M.D., Ph.D., were the first two physician-scientists recruited for the Mellon Scholars Program.

Established through a groundbreaking gift from the Richard King Mellon Foundation, the Institute is an incubator for research that challenges conventional wisdom and can lead to paradigm shifts in pediatric medicine. This kind of high-risk, high-impact investigation is not typically funded through government or conventional sources, placing Children’s Hospital in a unique realm of pediatric research centers. Dr. Kolls’ goal is to recruit a total of five scholars.

Located within the John G. Rangos Sr. Research Center on Children’s main campus, the Institute’s faculty and programs are a part of the University of Pittsburgh School of Medicine. For more information on The Richard King Mellon Foundation Institute for Pediatric Research, please visit www.chp.edu/mellon.

UPMC Residency Programs Rank Nationally

Physician network Doximity, along with U.S. News & World Report, announced the first comprehensive national evaluation of residency programs. In these results, 11 UPMC programs ranked in the top 10.

To determine the rankings, 3,691 residency training programs were evaluated by combining over 50,000 peer nominations from board-certified US physicians. U.S. News & World Report, nationally known for their education and health care rankings, consulted on the methodology.

Here is a listing of UPMC programs in the top 10:

  • Anesthesiology: No. 10
  • Obstetrics and gynecology: No. 3
  • Plastic surgery (integrated): No. 3
  • Otolaryngology: No. 4
  • Emergency medicine: No. 7
  • Physical medicine and rehabilitation: No. 7
  • Psychiatry: No. 7
  • Orthopaedic surgery: No. 8
  • Pediatrics: No. 8
  • Neurological surgery: No. 9
  • Surgery: No. 10

The results are used in a free tool from Doximity called Residency Navigator. The tool is designed for third- and fourth-year medical students.

Children’s Brain Care Institute Experts Publish Paper that Supports Newborn Screening for Hurler Syndrome

PITTSBURGH, August 28, 2014 — Members of the Program for the Study of Neurodevelopment in Rare Disorders (NDRD) at Children’s Hospital of Pittsburgh of UPMC will have an article published in an upcoming issue of Annals of Neurology. The article, “Early Treatment is Associated With Improved Cognition in Hurler Syndrome,” was authored by Michele Poe, PhD, Sarah Chagnon, MD, and Maria Escolar, MD, of the Brain Care Institute.

Hurler syndrome is the most clinically severe form of an autosomal recessive lysosomal disorder characterized by the deficiency of α-L-iduronidase and is often fatal during childhood. Umbilical cord blood transplantation from unrelated donors has been shown to improve neurological outcomes of children younger than 2 years old, and extend the lives of these patients.

The authors followed 31 patients with Hurler syndrome who underwent umbilical cord blood transplantation between June 1997 and February 2013. Patients were evaluated at baseline and every six to 12 months thereafter. All 31 patients underwent complete neurodevelopmental evaluation and a median of seven evaluations. The authors found that younger age at transplantation was associated with improved cognitive function, receptive and expressive language, and adaptive behavior. Children younger than 9 months at the time of transplant showed normal cognitive development. These findings demonstrate that early diagnosis may be necessary for optimal outcomes and — because most patients are not identified at a young age — support the need for newborn screening.

Children’s Physician Receives PCORI Funding for Study on Early Rehabilitation in Pediatric Patients with Acute Brain Injury

PITTSBURGH, August 19, 2014 – Led by a Children’s Hospital of Pittsburgh of UPMC physician, a multidisciplinary research project to improve outcomes for children with acute brain injury was recently approved for a $1.9 million funding award by the Patient-Centered Outcomes Research Institute (PCORI).

The study, “Early Rehabilitation Protocol (ERP) in the Pediatric ICU for Children with Acute Brain Injury (ABI),” led by Ericka Fink, MD, of the Department of Pediatric Critical Care Medicine, will perform a needs assessment to further characterize the current practices, barriers to care, and resources for physical, occupational, speech, and behavioral assessment and therapies needed for ERP implementation in pediatric intensive care units (ICUs). It will also evaluate ERP versus usual care to improve outcomes for children admitted to the ICU with ABI.

The two-center, randomized, controlled trial and resource survey is one of 33 proposals PCORI approved for funding to advance the field of patient-centered comparative effectiveness research and provide patients, health care providers, and other clinical decision makers with information that will help them make better-informed choices.

Dr. Fink and Craig Smith, MD, a former pediatric ICU fellow at Children’s and the principal investigator at Lurie Children’s Hospital, expect that participating sites will perceive an inadequate use of rehabilitation in pediatric ICU patients with ABI and predict that children with ABI will benefit from early ICU rehabilitation rather than usual care.

Childhood Disability Rates Highest Recorded, Children’s Hospital of Pittsburgh of UPMC Finds

PITTSBURGH, Aug. 18, 2014 – The percentage of children with disabilities due to neurodevelopmental or mental health conditions continues to rise, particularly among children in more socially advantaged households, according to a Children’s Hospital of Pittsburgh of UPMC analysis that appears in the September issue of Pediatrics.

Results of the study, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital, found that while there has been a decline in physical health-related disabilities by approximately 12 percent, there was a large, nearly 21 percent rise in disabilities classified as neurodevelopmental or mental health in nature.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention between 2001 and 2011, evaluating each child’s ability to perform activities at home and school.

Although children living in poverty have the highest rates of disability, children living in families at or above 400 percent of the federal poverty level reported a 28.4 percent increase in disabilities over the past 10-year period.

Dr. Houtrow and the researchers offered four reasons that may explain the increased rates of disability related to neurodevelopmental or mental health conditions:

  • shifts in diagnostic criteria
  • overall increases in rates of certain problems including autism
  • increased awareness of these conditions
  • the need for a specific diagnosis to receive services such as early intervention

“This study demonstrates what a lot of pediatricians have been noticing for several years – that they are seeing more neurodevelopmental and mental health problems in their clinical practices,” said Dr. Houtrow, who also is an associate professor of Physical Medicine & Rehabilitation and Pediatrics and vice chair in the University of Pittsburgh School of Medicine’s Department of Physical Medicine and Rehabilitation. “As we look toward the future, the pediatric health care workforce and system needs to adapt to assure the best possible health and functional outcomes for children with disabilities related to neurodevelopmental and mental health conditions.”

The authors concluded that documenting the changes in childhood disabilities is an important step in developing better prevention and treatment strategies and in determining how to create and deliver services to best meet the needs of all children.

Co-investigators were: Kandyce Larson, Ph.D., and Lynn M. Olson, Ph.D., American Academy of Pediatrics; Paul Newacheck, Dr.P.H., University of California San Francisco; and Neal Halfon M.D., M.P.H., University of California Los Angles.

The research was funded by grants K12H133B031102 and T76MC000141900 from the National Institutes of Health and Department of Health and Human Services.

For more information on Dr. Houtrow and the Division of Pediatric Rehabilitation Medicine, visit http://www.chp.edu/rehab.

Children’s Brain Care Institute Expert Receives Grant for Mitochondrial Disease Research

PITTSBURGH, July 28, 2014 — The United Mitochondrial Disease Foundation (UMDF) recently awarded nearly $500,000 in grants to researchers investigating potential treatments for mitochondrial disease. The research grant awards were presented at the UMDF’s annual symposium, Mitochondrial Medicine 2014: Pittsburgh.

Michael Bell, MD, of the Brain Care Institute (BCI) at Children’s Hospital of Pittsburgh of UPMC, received a grant of $25,000 for his project, “Improving CNS delivery of brain antioxidants after acute metabolic decompensation in mitochondrial disease,” which will investigate a combination of two FDA-approved drugs for their effectiveness in treating children and young adults with Leigh’s Syndrome. This work has the potential to improve brain function in patients with a mitochondrial disease for which there are currently no proven treatments. Dr. Bell is working on this project with Amy Goldstein, MD, of the Division of Child Neurology, and Bob Clark, MD, and Hülya Bayir, MD, from the Department of Pediatric Critical Care Medicine, who all are part of the Brain Care Institute.

Dr. Bell is also director of Pediatric Neurocritical Care and the Pediatric Neurotrauma Center at Children’s. He is associate director of Pediatric Neurointensive Care and Perinatal Brain Injury at the Safar Center for Resuscitation Research at the University of Pittsburgh, and associate professor of Critical Care Medicine and Neurological Surgery at the University of Pittsburgh School of Medicine.

The UMDF is the largest, non-governmental contributor of grants focused on mitochondrial disease research. Since 1996, the UMDF has funded more than $13 million dollars in research projects.

UPMC Clinicians Win Beckwith Institute Grants to Engage Patients, Improve Care

PITTSBURGH, July 25, 2014 –To experiment with changes big and small that might better engage patients and improve health care, The Beckwith Institute recently awarded 11 new grants to UPMC clinicians and other staff.

The wide-ranging projects include an effort to develop a shared decision-making tool for family members of patients in intensive care units (ICUs) and the creation of an interactive, Web-based “thermometer” to monitor the mood and energy of adolescents with bipolar disorder.

Supported by UPMC Chairman G. Nicholas Beckwith and his wife, Dotty, with matching funds from UPMC, the Beckwith Institute annually provides grants to improve clinical outcomes by empowering both clinicians and patients to explore innovative ways of transforming health care.

“Through the inspiring leadership and generous financial assistance of Nick and Dotty Beckwith, we are able to empower clinicians and other staff to experiment with new methods for transforming care delivery,” said Tami Minnier, UPMC chief quality officer. “At the heart of every project chosen for this program is an emphasis on engaging and educating patients and families so that they can play a meaningful role in the health care decisions that affect them.”

The grants are administered through two complementary efforts: The Frontline Innovation Program, which focuses on improving the patient bedside experience, and the Clinical Transformation Program, which supports comprehensive redesign of processes to put the involvement of the patient and their loved ones at the core.

The projects awarded 2014-2015 grants include:

  • a novel “mood and energy” tracking application for patients with pediatric bipolar disorder
  • a mobile application that allows patients to track and navigate the complex organ transplant process
  • a Web-based communication and decision support tool to improve the quality of shared decision-making in the ICU and to prepare family members for the role of surrogate decision maker
  • use of personal health monitoring devices for elderly patients with heart disease to promote patient engagement and prevent complications
  • an effort to assess patients for readmission risk and to ensure appropriate outreach after hospital discharge
  • resources to engage pediatric patients in diabetes care
  • standardization of sexual assault care at UPMC facilities
  • an asthma education program for children that includes a nurse hotline and online patient portal
  • a decision-making tool to help patients with chronic obstructive pulmonary disease make informed treatment decisions
  • development of a protocol that can be used to safely identify and discharge blunt trauma patients who have sustained no significant injury
  • a multidisciplinary effort to reduce unnecessary hospital readmissions for patients with complex health needs
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