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Cheston M Berlin

Publications and source records attributed to Cheston M Berlin.

18 recordsLinked to original sources
PubMed2006

Hershey Medical Center Technical Workshop Report: optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure.

Neurodevelopmental disabilities affect 3-8% of the 4 million babies born each year in the U.S. alone, with known etiology for less than 25% of those disabilities. Numerous investigations have sought to determine the role of environmental exposures in the etiology of a variety of human neurodevelopmental disorders (e.g., learning disabilities, attention deficit-hyperactivity disorder, intellectual disabilities) that are manifested in childhood, adolescence, and young adulthood. A comprehensive critical examination and discussion of the various methodologies commonly used in investigations is needed. The Hershey Medical Center Technical Workshop: Optimizing the design and interpretation of epidemiologic studies for assessing neurodevelopmental effects from in utero chemical exposure provided such a forum for examining these methodologies. The objective of the Workshop was to develop scientific consensus on the key principles and considerations for optimizing the design and interpretation of epidemiologic studies of in utero exposure to environmental chemicals and subsequent neurodevelopmental effects. (The Panel recognized that the nervous system develops post-natally and that critical periods of exposure can span several developmental life stages.) Discussions from the Workshop Panel generated 17 summary points representing key tenets of work in this field. These points stressed the importance of: a well-defined, biologically plausible hypothesis as the foundation of in utero studies for assessing neurodevelopmental outcomes; understanding of the exposure to the environmental chemical(s) of interest, underlying mechanisms of toxicity, and anticipated outcomes; the use of a prospective, longitudinal cohort design that, when possible, runs for periods of 2-5 years, and possibly even longer, in an effort to assess functions at key developmental epochs; measuring potentially confounding variables at regular, fixed time intervals; including measures of specific cognitive and social-emotional domains along with non-cognitive competence in young children, as well as comprehensive measures of health; consistency of research design protocols across studies (i.e., tests, covariates, and analysis styles) in an effort to improve interstudy comparisons; emphasis on design features that minimize introduction of systematic error at all stages of investigation: participant selection, data collection and analysis, and interpretation of results; these would include (but not be limited to) reducing selection bias, using double-blind designs, and avoiding post hoc formulation of hypotheses; a priori data analysis strategies tied to hypotheses and the overall research design, particularly for methods used to characterize and address confounders in any neurodevelopmental study; actual quantitative measurements of exposure, even if indirect, rather than methods based on subject recall; careful examination of standard test batteries to ensure that the battery is tailored to the age group as well as what is known about the specific neurotoxic effects on the developing nervous system; establishment of a system for neurodevelopmental surveillance for tracking the outcomes from in utero exposure across early developmental time periods to determine whether central nervous system injuries may be lying silent until developmentally challenged; ongoing exploration of computerized measures that are culturally and linguistically sensitive, and span the age range from birth into the adolescent years; routine incorporation of narrative in manuscripts concerning the possibility of spurious (i.e., false positive and false negative) test results in all research reportage (this can be facilitated by detailed, transparent reporting of design, covariates, and analyses so that others can attempt to replicate the study); forthright, disciplined, and intellectually honest treatment of the extent to which results of any study are conclusive--that is, how generalizable the results of the study are in terms of the implications for the individual study participants, the community studied, and human health overall; confinement of reporting to the actual research questions, how they were tested, and what the study found, and avoiding, or at least keeping to a minimum, any opinions or speculation concerning public health implications; education of clinicians and policymakers to critically read scientific reports, and to interpret study findings and conclusions appropriately; and recognition by investigators of their ethical duty to report negative as well as positive findings, and the importance of neither minimizing nor exaggerating these findings.

Biomedical Research↗
PubMed2006

Contemporary assessment and pharmacotherapy of Tourette syndrome.

To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Alternative modified infant-feeding practices to prevent postnatal transmission of human immunodeficiency virus type 1 through breast milk: past, present, and future.

Preventing mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) through breastfeeding is important to reduce the number of infected children. Research on making breastfeeding safer is a high priority. The authors reviewed the attempts to develop alternative methods, other than antiretroviral (ARV) therapy of mothers and/or babies, to decontaminate breast milk of infectious HIV-1 (free and associated with lymphocytes). They also review how these methods affect milk constituents, as well as their current and prospective status. A PubMed search for English publications on methods to prevent MTCT through breast milk was completed. Methods that have been tested, other than systemicuse or ARV or immunoprophylaxis, to reduce or prevent MTCT of HIV-1 through breast milk were broadly classified into 5 groups: (1) modified feeding practices, (2) heat treatment of milk, (3) lipolysis, (4) antimicrobial treatment of the breastfeeding mother, and (5) microbicidal treatment of infected milk. Their advantages and disadvantages are discussed, as well as future directions in the prevention of MTCT through breastfeeding.

Adult↗
PubMed2006

Biochemical analysis of human milk treated with sodium dodecyl sulfate, an alkyl sulfate microbicide that inactivates human immunodeficiency virus type 1.

Reduction of transmission of human immunodeficiency virus type 1 (HIV-1) through human milk is needed. Alkyl sulfates such as sodium dodecyl sulfate (SDS) are microbicidal against HIV-1 at low concentrations, have little to no toxicity, and are inexpensive. The authors have reported that treatment of HIV-1-infected human milk with < or = 1% (10 mg/mL) SDS for 10 minutes inactivates cell-free and cell-associated virus. The SDS can be removed with a commercially available resin after treatment without recovery of viral infectivity. In this article, the authors report results of selective biochemical analyses (ie, protein, immunoglobulins, lipids, cells, and electrolytes) of human milk subjected to SDS treatment and removal. The SDS treatment or removal had no significant effects on the milk components studied. Therefore, the use of alkyl sulfate microbicides to treat milk from HIV-1-positive women may be a simple, practical, and nutritionally sound way to prevent or reduce transmission of HIV-1 while still feeding with mother's own milk.

Female↗
PubMed2005

Methodologic considerations for improving and facilitating human milk research.

Over the past several decades, interest in using human milk as a biomonitoring matrix has increased. However, it is not always an easy matter for a new mother to provide a milk sample. In this article, guidance on facilitating collection of human milk is provided. This includes addressing the mother's ease in expressing a milk sample, and engaging with many audiences to reduce the likelihood of negatively impacting the already low breastfeeding rates in the United States. In addition, this article covers concepts regarding long-term storage and integrity of human milk samples to maximize the utility of those samples, and proposed methods for improving public access to the full spectrum of human milk biomonitoring data, with context to understand the information presented. The environmental chemicals and chemical classes for which robust analytical methods exist are enumerated, and a process for prioritizing the development of analytical methods for additional environmental chemicals is described.

Adult↗
PubMed2005

Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium dodecyl sulfate (SDS).

BACKGROUND: Reducing transmission of HIV-1 through breast milk is needed to help decrease the burden of pediatric HIV/AIDS in society. We have previously reported that alkyl sulfates (i.e., sodium dodecyl sulfate, SDS) are microbicidal against HIV-1 at low concentrations, are biodegradable, have little/no toxicity and are inexpensive. Therefore, they may be used for treatment of HIV-1 infected breast milk. In this report, human milk was artificially infected by adding to it HIV-1 (cell-free or cell-associated) and treated with or=0.1%) was virucidal against cell-free and cell-associated HIV-1 in breast milk. SDS could be substantially removed from breast milk, without recovery of viral infectivity. Viral load in artificially infected milk was reduced to undetectable levels after treatment with 0.1% SDS. SDS was virucidal against HIV-1 in human milk and could be removed from breast milk if necessary. Milk was not infectious after SDS removal. CONCLUSION: The proposed treatment concentrations are within reported safe limits for ingestion of SDS by children of 1 g/kg/day. Therefore, use of alkyl sulfate microbicides, such as SDS, to treat HIV1-infected breast milk may be a novel alternative to help prevent/reduce transmission of HIV-1 through breastfeeding.

Adult↗
PubMed2004

Drugs and chemicals in human milk.

There is continuing emphasis by many professionals and organizations on the importance of breastfeeding as optimal infant nutrition. Pediatricians are frequently asked about the safety of medications taken by the nursing mother and the risk to the infant. Most drugs and many chemicals will be transferred into milk. For a vast majority of these compounds, there is no risk to the infant. It is almost always possible for the mother to continue nursing while taking the necessary medication. This article presents an introduction to the pharmacology of the transfer of drugs into milk, discusses the importance of the infant's age in assessing safety and presents a number of maternal conditions for which drugs need to be used.

Biological Transport↗
PubMed2004

Environmental chemicals in human milk: a review of levels, infant exposures and health, and guidance for future research.

The aim of this review is to introduce the reader to various science and policy aspects of the topic of environmental chemicals in human milk. Although information on environmental chemicals in human milk has been available since the 1950s, it is only relatively recently that public awareness of the issue has grown. This review on environmental chemicals in human milk provides a resource summarizing what is currently known about levels and trends of environmental chemicals in human milk, potential infant exposures, and benefits of breast-feeding relative to the risks of exposures to environmental chemicals. The term "environmental chemicals," as it pertains to human milk, refers to many classes of exogenous chemicals that may be detected in human milk. For example, pharmaceutical agents and alcohol are environmental chemicals that have been found in human milk. Other chemicals, such as heavy metals and volatile organic compounds, have also been detected in human milk. Most research on environmental chemicals in human milk has concentrated on persistent, bioaccumulative, and toxic (PBT) chemicals. In this review, a description of human milk is provided, including a brief review of endogenous substances in human milk. Determinants of levels of PBTs are discussed, as are models that have been developed to predict levels of PBTs in human milk and associated body burdens in breast-feeding infants. Methodologies for human milk sampling and analysis, and concepts for consideration in interpretation and communication of study results, as developed by the Technical Workshop on Human Milk Surveillance and Research for Environmental Chemicals in the United States are described. Studies which have compared the health risks and benefits associated with breast-feeding and formula-feeding are discussed.

Databases, Factual↗
PubMed2004

Dose-response relationship with increasing doses of dextromethorphan for children with cough.

BACKGROUND: The efficacy of dextromethorphan (DM) for treating acute cough is uncertain, and its use is not supported by the American Academy of Pediatrics. Nevertheless, DM is often administered to children as an antitussive. DM dosages are based on age rather than body weight, resulting in substantial variability in the relative amount of drug administered. OBJECTIVE: The aim of this work was to determine whether a dose-response relationship existed among a group of children administered a single nocturnal dose of DM for cough due to an upper respiratory tract infection. METHODS: As part of a larger double-blind, placebo-controlled trial of over-the-counter cough medications, children received DM. The administered doses (per manufacturer recommendations) were as follows: ages 2 to 5 years, 7.5 mg; ages 6 to 11 years, 15 mg; and ages 12 to 18 years, 30 mg. This resulted in a range of 0.35 to 0.94 mg/kg per dose. Subjective parental assessments of cough and sleep were obtained using a 7-point Likert-type scale that compared symptoms after medication with symptoms during the prior night (without medication). Three dose ranges were compared as a subset analysis of the group that received DM. RESULTS: Thirty-three patients (19 girls, 14 boys; median [interquartile range] age, 4.90 [2.90-6.80] years; age range, 2.10-16.50 years) received DM and completed the study. No significant differences were found for any of the outcome measures when comparing the effects of different doses of DM, but our observations suggested somewhat more symptomatic relief for patients receiving medium-dose DM (0.45 to <0.60 mg/kg per dose) or high-dose (HD) DM (0.60-0.94 mg/kg per dose) compared with low-dose DM (0.35 to <0.45 mg/kg per dose). Adverse events occurred most often in the HD group. CONCLUSIONS: Although no statistically significant differences were detectable for the outcomes studied, our observations suggest the potential for improved clinical symptom control with increasing doses of DM. Our findings may further suggest that a dose of 0.5 mg/kg should be considered in future assessments of the antitussive effect of DM in pediatric studies, to balance symptomatic relief with the avoidance of adverse events.

Adolescent↗
PubMed2004

Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents.

OBJECTIVES: To determine whether the commonly used over-the-counter medications dextromethorphan and diphenhydramine are superior to placebo for the treatment of nocturnal cough and sleep difficulty associated with upper respiratory infections and to determine whether parents have improved sleep quality when their children receive the medications when compared with placebo. METHODS: Parents of 100 children with upper respiratory infections were questioned to assess the frequency, severity, and bothersome nature of the nocturnal cough. Their answers were recorded on 2 consecutive days, initially on the day of presentation, when no medication had been given the previous evening, and then again on the subsequent day, when either medication or placebo was given before bedtime. Sleep quality for both the child and the parent were also assessed for both nights. RESULTS: For the entire cohort, all outcomes were significantly improved on the second night of the study when either medication or placebo was given. However, neither diphenhydramine nor dextromethorphan produced a superior benefit when compared with placebo for any of the outcomes studied. Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine. CONCLUSIONS: Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families.

Adolescent↗
PubMed2003

Sensitivity of the young infant to drug exposure through human milk.

In spite of significant exposure to drugs and chemicals through breast milk, there are very few reports of documented adverse effects on the infant. It is perhaps appropriate to consider that the presence of drugs and chemicals in milk may have a positive effect on developmental processes of the young infant. New experimental techniques coupled with increasing sensitive assays for chemical moieties present opportunities for measuring the effect of such chemicals on development processes in the neonate and young infant.

Breast Feeding↗
PubMed2002

Technical workshop on human milk surveillance and research on environmental chemicals in the United States: an overview.

Interest in human milk research and monitoring for environmental chemicals is growing, and as studies of chemicals in human milk are initiated, it is of the utmost importance that these studies be conducted using harmonized methods. Due to numerous limitations in previous studies and the fact that few studies on environmental chemicals in human milk have been conducted in the United States, there is a growing need for a human milk sampling and analysis protocol in this country. The Technical Workshop on Human Milk Surveillance and Research on Environmental Chemicals in the United States was organized to develop state-of-the-science protocols describing the various aspects of such a program. An expert panel, comprised of specialists in the fields of pediatrics, family medicine, nursing, lactation, human milk sampling, analytical chemistry, epidemiology, pharmacology, toxicology, nutrition, and risk evaluation and communication, was assembled to participate in a 2-day workshop at the Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine. The expert panel was tasked with carefully describing and defining the components of well-conducted human milk surveillance and research studies, including participant selection, sample collection and analysis techniques, questionnaire development, chemical selection, and data reporting and interpretation, especially for use in the United States. The articles that follow this overview describe the results of the expert panel's deliberations on the components of human milk surveillance and research programs.

Adult↗
PubMed2002

Criteria for chemical selection for programs on human milk surveillance and research for environmental chemicals.

The people of the United States is exposed to a large number of chemicals in their daily lives. In order to prioritize chemicals that should be considered for surveillance of and/or research in human milk, criteria were developed at the Technical Workshop on Human Milk Surveillance and Research on Environmental Chemicals in the United States. The criteria include (1) lipid solubility and/or persistence in the environment; (2) extensive exposure (e.g., high-production-volume chemicals and chemicals in personal care products); (3) known or suspected toxicity in a biological system; (4) historical interest, trend information; (5) chemicals of emerging concern; and (6) chemicals for medicinal use and chemicals in occupational settings. A working list of chemicals was developed for each of the criteria. It should be noted that more than one criterion may be applicable to a selected chemical, but the selected chemical should possess at least one of these designated criteria. It is hoped that by following a cohort of nursing women through their lactational cycle for a group of these chemicals, data generated will indicate the extent of infant exposure and may suggest methods for risk management to decrease inadvertent exposure for breast-feeding mothers and infants. While not the focus of this article, certain endogenous chemicals in human milk beneficial to the health of the infant warrant study as well.

Adult↗
PubMed2002

Weight and height deficits in children with brain stem tumors.

Weight deficit is common among children with brain stem tumors and is often accompanied by height deficit. Among 22 consecutive children (< or =18 years) with brain stem tumor, 16 had weight deficit (< or =20th percentile) (p<1.4e-7). Eleven were at or less than the 5th percentile, and 5 were less than the 1st weight percentile. Eight also had height deficit (< or =20th percentile) (p<0.06). Misdiagnoses occurred: failure to thrive in 5, growth retardation in 2, and anorexia nervosa in 2. Delay between these diagnoses and that of brain tumor averaged 4.5 years. Detailed neuroradiologic study seems worthwhile if weight deficit is extreme and either unexplained or uncorrectable, or if the weight deficit is accompanied by an abnormality suggestive of intracranial disease.

Adolescent↗