Saturday, April 19, 2014
Inquirer Daily News

Gary A. Emmett

POSTED: Tuesday, April 15, 2014, 5:30 AM
Filed Under: Gary A. Emmett
(iStockphoto)

The health benefits of infant male circumcision far exceeds the risks associated with the procedure, according to a recent article that reviewed studies in the Mayo Clinic Proceedings, an online journal.

In the United States, the rate of circumcision in men ages 14 to 59 has increased to 81 percent over the past decade from 79 percent. However, the study authors found an alarming decrease in infants, which showed that circumcision had declined from a high of 83 percent in the 1960s to 77 percent today.

They worry that a falling rate of newborn circumcision will result in a marked increase in overwhelming infection in newborn males in the U.S. and long-term increased rate of venereal disease in them and cervical and anal cancer in their sexual partners. The evidence given by Brian Morris, DSc, PhD, and his colleagues is very strong, but like everything involved with sex and sexual organs – the emotions and religious feeling the subject releases will lead to controversy.

POSTED: Thursday, April 3, 2014, 9:36 AM

Editor’s note: Last week, we took a more in-depth look at meningitis and local cases in the Philadelphia region. Here’s a look at how the disease affects those in the United Kingdom. Our regular contributor Gary Emmett, MD, recently traveled to London.

The world is too small. That was my first thought last week when an undergraduate at Drexel University died of meningococcal meningitis B. People are always surprised when this happens since many know that all children are supposed to get a meningococcal immunization at age 11 and then again before college.  

However, the "B" strain of this germ is still very rare in the United States and the U.S. shot (or "jab" as they say in Britain) contains four other strains:  A, C, W-135 and Y.  These strains accounted for over 90 percent of the approximately 1500 cases of meningococcal meningitis and meningococcal septicemia (blood infection) seen in the U.S. yearly and the most widely strain seen in Sub-Saharan Africa.

POSTED: Tuesday, March 18, 2014, 6:00 AM
Filed Under: Gary A. Emmett | Smoking
(iStockphoto)

Are e-cigarettes dangerous? Good data on long-term consequences is not available yet, but no one is talking about addiction and that is the undeniable problem for our children. This is why we need to support a proposal passed by a Philadelphia City Council committee last week that would add e-cigarettes to city's smoke-free law and ban sales to minors, joining dozens of states and localities that are trying to slow the fast-growing sales of a largely unregulated product.

In addition, I would equally tax e-cigarettes like cigarettes since we know that children are more price sensitive than adults. One of the best facets of the heavy taxation of cigarettes is that it discourages the start of smoking and therefore brings down the percent of children and teens using tobacco products (cigars, snuff and snus are not taxed as heavily), which have become gateways to nicotine addiction.

Nicotine is addictive. I have seen newborn babies born to mothers who smoke (or just have a nicotine patch) get very irritable, shaky and breathe rapidly seeming like babies withdrawing from heroin.  You rarely have to treat these babies, but it often takes a day or two before they look or act like normal, healthy babies.  About 18 percent of pregnant women in Pennsylvania smoke and their babies are born with carbon monoxide levels so high and oxygen levels so low that a doctor who did not know about the smoking exposure would think that they were in a house fire and hospitalize them.

POSTED: Wednesday, March 5, 2014, 5:30 AM

The media was obsessed when famous actor, Phillip Seymour Hoffman, apparently died of a heroin overdose last month. I was saddened last week when I worked a shift at Thomas Jefferson University Hospital nursery when a new baby was born having lost the father to an opiate overdose before the birth, and an acquaintance’s young adult son recently died of overdose.

So I was frightened when the Federal Drug Administration approved a new very potent pain killer named Zohydro.  The hydrocodone medication is five times more potent than what is on the market at present. Legal prescription opiates are a gateway into addiction for millions of Americans. These drugs directly led to 16,000 deaths in users in 2012 – whether legally prescribed and used for good reasons such as chronic severe pain (often in Sickle Cell Disease for a pediatrician), or illegally diverted into a street drug for widespread use in the United States. This is up from about 4,000 deaths in 1999.  Many users after addiction start heroin by injection because it is markedly cheaper than diverted pills, and another 4000, at least, died from heroin last year.

As a pediatrician who works in well baby nurseries, I am even more directly involved in the over 20,000 babies born to opiate and methadone using mothers last year in the U.S., half of whom will have drug withdrawal and have extended stays in the hospital. In 1999, about one in a 1,000 babies in the U.S. was born in danger of withdrawal (officially Neonatal Abstinence Syndrome or NAS), but now almost six in 1000 have a mother on opiates or opiate substitutes such as methadone.  In less than 15 years, the number of NAS babies has gone up more than fivefold and many are being born in very poor rural areas such as inland Maine or Appalachian Tennessee and Kentucky where there are limited resources to take care of these babies in small rural hospitals .

POSTED: Tuesday, February 25, 2014, 6:00 AM
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Why is having a “medical home” important for your child? Having one pediatric practitioner or group of practitioners see your child regularly can help identify any patterns of illness and promote a healthy lifestyle, according to the American Academy of Pediatrics.

The AAP made its case this week through a series of policy recommendations that support the concept of the “medical home” for every child. Yesterday, I discussed the AAP’s concerns with families using retail-based clinics instead of pediatrician’s office for their child’s care.  Today, I will take a look at the AAP’s recommendations for preventive care for children and off-label use of drugs in children.

In spite of spending much more on health care per patient than any other nation, the health of Americans is no longer better than other developed nations. One major reason in the opinion of organized medicine in the United States and others is that our system is reactive rather than preventive. Lifestyle issues such as obesity, lack of exercise, inappropriate nutrition and safe sex are not being emphasized to prevent illness before it occurs, and we are reacting with disorganization to illnesses with multiple medical providers not communicating with each other and no one seeing the big picture

POSTED: Monday, February 24, 2014, 6:00 AM
Andy Duppler, 16, awaits his turn at a MinuteClinic in Maple Grove, Minn. on Tuesday, May 31, 2005. MinuteClinics are cropping up in grocery stores and CVS Pharmacies, offering medical attention for minor ailments, such as flu, sore throats and colds. (AP Photo/Janet Hostetter)

Retail-based health clinics in pharmacies or big box stores may seem more convenient and less expensive compared to seeing a pediatrician, but these clinics do not provide children with the high-quality, regular preventive health care that they need, according to the American Academy of Pediatrics in an updated policy statement released online today.

Retail-based clinics or convenient care clinics are usually run by nurse practitioners or physician assistants that see patients quickly without appointments and often for less money than pediatric offices or emergency departments.  This policy statement is not totally unbiased since these establishments compete with pediatricians for patients and profits, but the criticisms of these offices still has validity.

The following is a list of the AAP’s concerns and my thoughts on them:

POSTED: Wednesday, February 5, 2014, 5:30 AM
Filed Under: Fitness | Gary A. Emmett | Obesity
(iStockphoto)

Only about one-quarter of American teens aged 12–15 years engaged in moderate-to-vigorous physical activity for at least 60 minutes daily, according to recently released data from the National Center for Health Statistics.

The findings from the 2012 National Health and Nutrition Examination Survey (NHANES) and the NHANES National Youth Fitness Survey also showed that the percentage of male teens who were physically active for at least 60 minutes daily decreased as weight status increased.

These numbers are troubling to me because Inactivity is the hidden bomb that will hurt our children as they age.  Exercise when young makes one’s bones thicker and sturdier and will delay osteoporosis later in life.  Regular exercise prevents, to some extent, obesity, and definitely makes the muscles better developed and the cardiovascular system more able to deal with stress.

POSTED: Tuesday, January 28, 2014, 9:34 AM

Johnson & Johnson announced last week that it was taking conjugated aldehydes such as formaldehyde out of all of its products as it had promised to do two years ago, and it was working on getting parabens out next.  Why is this news?  Formaldehyde has been used to preserve dead bodies for over a century and is used in many household products in more complex forms as a preservative.

One of the problems with trying to deal with formaldehyde is that it is found in many interchangeable forms and it is intrinsically not very stable. It is called formalin if dissolved in water – the substance used in mortuaries.  Three molecules of formaldehyde join to become metaformaldehyde in many solutions –the preservation agent for many industrial chemicals.  By itself, formaldehyde is a gas that is very unstable and becomes safer compounds within minutes of release into the atmosphere.

Formaldehyde is made in nature all the time as methane gas (generated from the breakdown of organic material in swamps or composts or from the intestinal gas of grazing animals such as cattle) is hit by sunlight in the upper atmosphere.  The formaldehyde reacts chemically with other gases when it drifts down to the lower atmosphere and is one of the most important components of smog.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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