Child Health

�山ǿ��’s Peter Donnelly has long pushed for legal protections for child athletes: Wall Street Journal

rahul.kalvapalle — Fri, 10 Jun 2022 19:27:51 +0000

�山ǿ��’s Peter Donnelly has long pushed for legal protections for child athletes: Wall Street Journal

rahul.kalvapalle Fri, 06/10/2022 - 15:27

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(Photo courtesy of KPE)

Topic

Our Community

Child Health

Faculty of Kinesiology & Physical Education

Elite child athletes often train long hours, sacrifice a regular education and are subjected to the risk of injury, stress and in some cases, abuse – and it’s high time there are legal mechanisms in place to safeguard their rights.

That’s long been the stance of Peter Donnelly, professor emeritus of sport policy and politics at the University of Toronto’s Faculty of Kinesiology & Physical Education. Now, according to the Wall Street Journal, there are finally encouraging signs that regulatory protections for child athletes could become a reality sooner rather than later. Last month, Donnelly delivered a presentation on the topic at the Global Conference on the Elimination of Child Labour in South Africa, the Wall Street Journal reported.

“What if McDonald’s had the same accident rate, or anywhere that employs large numbers of young people, or schools? There would be huge commissions of inquiry, regulations and policies,” Donnelly told the U.S. newspaper, which noted that revelations of abuse and doping involving teenage gymnasts and figure-skaters point to possible changes in the regulatory environment, and that Canada has already adopted a new universal code of conduct for sports organizations.

“I’m going to be 79 … and I think, ‘Am I going to see it?’” Donnelly told the Journal. “It’s probably the best moment that I’ve seen.”

Read the story in the Wall Street Journal (paywall)

How effective are school food programs? �山ǿ�� researchers launch nationwide study

lanthierj — Fri, 10 Dec 2021 11:50:38 +0000

How effective are school food programs? �山ǿ�� researchers launch nationwide study

lanthierj Fri, 12/10/2021 - 06:50

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(Photo by Siarhei Shuntsikau/Dreamstime)

Jim Oldfield

Topic

Breaking Research

Temerty Faculty of Medicine

Joannah & Brian Lawson Centre for Child Nutrition

Child Development

Child Health

Dalla Lana School of Public Health

Research & Innovation

St. Michael's Hospital

Researchers at the University of Toronto have begun studying school-based meal programs across Canada to better understand which programs work well, how they have functioned during the COVID-19 pandemic – and whether a long-discussed national program could improve child nutrition in this country.

School food programs in Canada number in the thousands, reaching an estimated one-fifth of the country's five million students. Researchers will identify and evaluate the programs and explore opportunities to pilot improvements, with a focus on vulnerable groups in urban and rural schools and underserved communities.

Daniel Sellen

“Many people and organizations put huge effort into feeding children in schools every day across this country,” says Daniel Sellen, the study lead and director of the Joannah & Brian Lawson Centre for Child Nutrition in the Temerty Faculty of Medicine at �山ǿ��. “We need a much fuller picture of this work to guide policy and program development, and to improve delivery at the community level.”

School-based food programs in Canada vary greatly in design and are delivered by many organizations including charities, school boards, governments, churches and corporations. Despite these efforts, Canada ranked 37^th of 41 wealthy countries in a recent UNICEF report on children’s access to healthy food.

The �山ǿ�� study, called Feeding Kids, Nourishing Minds, will inform discussion of a more cohesive, national program – an approach endorsed by more than 180 organizations through the Coalition for Health School Food, and an idea to which the federal Liberal government committed $1 billion in its election platform this year.

Katerina Maximova

“Canada is the only G7 nation without a national school food program,” says Katerina Maximova, a member of the study’s steering committee and an associate professor at �山ǿ��’s Dalla Lana School of Public Health. “The timing is right for policy development on a national program, and this study will provide a strong evidence base for those efforts.”

Policymakers are now working to develop a framework for a National School Food Policy, laying the groundwork to establish a national program, says Maximova, who holds a Chair in Early Life Interventions at MAP Centre for Urban Health Solutions with St. Michael’s Hospital, Unity Health Toronto.

But the many groups involved with design and delivery of a national program will need finer detail in the coming years.

“What should a national program look like, and how best to implement it while building on existing capacity? We need to answer these questions,” Maximova says.

Further concerns include which foods should be on the menu and how to source them, and how best to monitor and regulate a program to national standards.

The new study will address these and other issues over a four-year span, and will include researchers from medicine, public health, social work, engineering, humanities and early child development.

The researchers will begin to share findings in 2022, including a planned review of all Canadian programs with information on school meal program format and nutritional quality, and the ages, socioeconomic and health status of children served.

Later phases of the study will employ workshops and consultations with local educators, school nutritionists and public health units, followed by trials, cohort studies and a national knowledge-sharing campaign.

The need for better data and a more effective approach to school food programs across Canada is pressing.

Pre-pandemic studies showed that fewer than one-third of Canadian children consumed enough fruits and vegetables, and that almost one-third were overweight or obese. Global research has long linked child diets to academic performance and health, and shown that school food programs such as breakfasts, lunches and snacks can be effective interventions.

In the first few months of the pandemic, Statistics Canada reported a jump in food insecurity, or the inadequate access to affordable and nutritious food, from 12.7 to 14.6 per cent of households. Global studies have also shown weight gain among children of all ages during the pandemic – a trend some experts have noticed in Canada.

Sloane Freeman

“Anecdotally, I’ve seen both worsening nutrition and growing weight gain,” says research team member Sloane Freeman, an assistant professor of paediatrics at �山ǿ�� and a clinician-scientist at St. Michael’s Hospital, Unity Health Toronto. “More children have missed meals they would have had at school. Many were home all day and snacked on less nutritious food.”

The new study will help quantify those impacts on child nutrition, and on school-based food programs – many of which responded to the pandemic with new food safety measures and creative delivery options such as food boxes and cards.

This new data should inform COVID recovery planning in 2022, and the broader goal of better child nutrition through more effective school-based programs in the long-term, says Freeman, who is also the founder of the Model Schools Pediatric Health Initiative.

The scope of the project is unprecedented. Some Canadian research groups have detailed the need for a more integrated approach to school-based nutrition, including the Arrell Food Institute at the University of Guelph. But Feeding Kids, Nourishing Minds will be the largest and most comprehensive study of the topic to date.

“It’s a really big project, that’s one reason it hasn’t been done before,” says Freeman. “It requires a Herculean effort from a multidisciplinary, dedicated team with robust funding. We are that team, and I’m excited to see what we can do.”

Feeding Kids, Nourishing Minds is funded by a $2-million investment from President’s Choice Children’s Charity, and by the Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto.

�山ǿ��’s Lawson Centre for Child Nutrition names new chair in patient engagement

noreen.rasbach — Wed, 23 Oct 2019 04:00:00 +0000

�山ǿ��’s Lawson Centre for Child Nutrition names new chair in patient engagement

noreen.rasbach Wed, 10/23/2019 - 00:00

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“I would like to see networks of families, which could join research teams to help us do research better so that we all learn from each other,” says Jonathon Maguire about patient engagement (photo courtesy of St. Michael’s Hospital Foundation)

Topic

Faculty of Arts & Science

Faculty of Medicine

Health

Research & Innovation

Jonathon Maguire is the new Lawson Chair in Patient Engagement in Child Nutrition at the University of Toronto.

Maguire, an associate professor of paediatrics and nutritional sciences at �山ǿ�� and a staff pediatrician and scientist with St. Michael’s Hospital at Unity Health Toronto, will hold the chair over a five-year term through the Joannah & Brian Lawson Centre for Child Nutrition.

“I’m very grateful to the university and the Lawson Centre for choosing to support patient engagement in the research process,” says Maguire. “It’s forward-thinking because it will enable children and families to co-design research with us and help us produce results that are most meaningful to them.”

Patient-oriented research has garnered strong interest from medical researchers recently. The approach shares some of the goals of applied and practice-based research, but differs in that patients provide input throughout the research process – on which questions they want answered, the content and format of findings they are most likely to use, and even on how to share research results broadly with the public.

Maguire has worked to develop that process for more than a decade as a co-principal investigator of TARGet Kids!, the largest children’s cohort study in Canada. That group has generated several findings of note for parents, including that 10 per cent of the TARGet Kids! cohort have low iron levels, 30 per cent are low in vitamin D and one quarter are at risk for future health problems on account of body weight.

“We are delighted to welcome Jonathon to this role. He has a well-connected and established research program in patient-oriented research and will hit the ground running,” says Daniel Sellen, director of the Lawson Centre and distinguished professor of anthropology and global health at �山ǿ��. “He and his team are asking relevant research questions to help practitioners and families agree on healthy and feasible child-feeding options in a rapidly changing dietary and child-care landscape.”

In the near term, Maguire hopes to involve more patients in research, in the form of a family advisory panel set up through the Lawson Centre. “I would like to see networks of families, which could join research teams to help us do research better so that we all learn from each other,” he says.

Creating that process is difficult, Maguire stresses. “If this approach was easy, you would see it more often. It takes a lot of listening, thought and effort to understand the priorities of young families and patients and to familiarize them with the research process. But the reward is well worth the effort.”

A recent case in point is parent and physician perspectives on fat content in cow’s milk. The current guidelines recommend that children switch to reduced-fat milk after the age of two. But many countries have seen a huge rise in childhood obesity since the introduction of those guidelines in the 1990s, and some recent studies suggest that high-fat milk can help reduce obesity, perhaps by increasing satiety.

“It seems unbelievable that in this age we don’t know for sure what types of cow’s milk are best for kids,” says Maguire. “Views vary widely among parents and physicians. By sitting down and talking with them, we learned about some of the reasons why.”

Many patients rely on guidance from health-care providers, Maguire and his colleagues found. Providers in turn rely on professional guidelines, which in this case were not based on the best evidence. The researchers published their findings this fall in the Public Health Nutrition journal.

“The study confirmed what we had suspected for some time,” says Maguire. “Professional recommendations become reinforced over many years, and it’s talking with patients and families that can show us why the train may be on the wrong track.”

Maguire is now working with other colleagues on a clinical trial that will test which type of milk works best for weight control. With better evidence in hand, Maguire hopes that tangible recommendations from clinicians will influence parents’ choices.

“This is exactly the kind of multidisciplinary, practitioner scholarship needed to strengthen patient engagement in child nutrition,” says Sellen. “Everybody gains from involving patient ideas and experience, and we think this is one of several fresh approaches to protecting and improving child nutrition in Canada and globally.”

Better patient engagement will help further address multiple issues in child nutrition, Sellen says – from micronutrient deficiencies and obesity to malnutrition, unhealthy food environments and region-specific policy challenges.

“I look forward to seeing what we can achieve together through the leadership this new chair will provide,” he says.

Leong Centre for Healthy Children will help improve child health through new precision prevention

noreen.rasbach — Fri, 08 Mar 2019 17:07:06 +0000

Leong Centre for Healthy Children will help improve child health through new precision prevention

noreen.rasbach Fri, 03/08/2019 - 12:07

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(photo by Shutterstock)

Topic

Global Lens

Pediatrics

Alumni

Artificial Intelligence

Research & Innovation

Subheadline

By applying innovative tools and targeted strategies, researchers can better predict and enhance health outcomes for children around the world

Thanks to a $25-million gift, the University of Toronto is creating the Edwin S.H. Leong Centre for Healthy Children, which will develop innovative approaches to improving child health.

The gift from alumnus Dr. Edwin S.H. Leong and the Tai Hung Fai Charitable Foundation will help researchers at U of T and The Hospital for Sick Children (SickKids) to harness the latest advances in the science of child health, and pair them with developments in artificial intelligence and machine learning technologies.

Leong Centre experts in genomics, pediatrics and public health will use this approach to develop powerful predictive models based on �山ǿ��’s distinctive access to child health and demographic data sets.

As the first project of its kind in the world, the Leong Centre will address a global rise in chronic disease among children – with a particular focus on those who are underprivileged and at risk. It will do this by developing effective evidence-based practices, interventions and policies to prevent disease before it starts, while also improving outcomes for those with disabilities and chronic conditions. Ultimately, this will lead to solutions that help children to set a trajectory of health throughout their life.

“The Edwin S.H. Leong Centre for Healthy Children will enable both groundbreaking scientific discoveries and scalable policy solutions that have the potential to benefit all children,” says U of T President Meric Gertler.

“It will draw on the University of Toronto’s expertise in childhood health and development, and its position at the centre of one of the world’s strongest biomedical clusters. The Leong Centre is truly a game-changing initiative with potential to improve the lives of young people around the world.”

Leong’s benefaction, together with matching funds from the University of Toronto and SickKids Hospital, will support the centre’s work over an 11-year period.

A champion of the most vulnerable

This gift from Leong is the largest benefaction that �山ǿ�� has ever received from outside of Canada; one that builds on the connection between Hong Kong and the University of Toronto.

“Raising children requires a holistic approach,” says Leong. “We cannot even begin broad conversations about prosperity, education or innovation without building from a healthy populace – which begins in childhood. I am proud to be able to give back to the institution that helped enable my own success, and improve health outcomes among society’s most vulnerable people. This centre is a chance to fulfill the promise of health for children everywhere.”

Both Leong and the Tai Hung Fai Charitable Foundation that he chairs have an impressive record of international philanthropy. Among many different initiatives around the world, Leong funded the Henry G. Leong Program for Enhanced Training and Research on Holistic Care of the Elderly at Hong Kong University, as well as the Henry G. Leong Mobile Integrative Health Centre Program at Hong Kong Polytechnic University. Both of these programs were named in honour of Leong’s father.

Alongside these are five other endowed professorships, also named for Leong’s father: at Chinese University of Hong Kong, a professorship in gerontology and geriatrics; two professorships at Hong Kong University, one in social work and administration and one in neurology; and at Hong Kong Polytechnic University, a professorship in elderly vision health and another in in biomedical engineering.

In 2018, Leong made a remarkable gift of $24 million to the University of British Columbia to establish the Leong Healthy Aging Program at the Faculty of Medicine – the largest individual gift in that faculty’s history.

At the University of Toronto, in 2016 Leong created the Edwin S.H. Leong Scholarship, which recognizes academic excellence and leadership for international students in financial need, helping them to fulfil their goals in higher education.

Innovative solutions to child health outcomes

The Leong Centre will be centred at �山ǿ��, but its researchers will collaborate with peers at sister institutions in Canada and around the world, including in Hong Kong, British Columbia and the United Kingdom. Through these collaborations, the Leong Centre will draw on world-class resources to develop targeted, effective and affordable child health interventions, resulting in improved health outcomes for everyone, and especially those with few health-care resources.

“We are profoundly grateful to Dr. Leong for this visionary support that will have a global impact in raising healthy, flourishing children in Canada and internationally,” says Professor Trevor Young, dean of the Faculty of Medicine. “The Leong Centre for Healthy Children will further develop our understanding of the social and environmental influences on child health. It will, ultimately, have a transformative impact across the lifespan since thriving children are more likely to become healthy, productive adults.”

Important research partnerships

SickKids is a central partner with the Leong Centre. It is one of the world’s foremost pediatric health-care institutions and a leader in advanced pediatric research that has generated innovative discoveries in children’s health care with global impact. Pediatric research performed at SickKids spans the applied health science range from detection, to solution, to prevention. Its researchers and resources will be a key component of the Leong Centre’s long-term success.

An international expert will lead the Leong Centre and report to �山ǿ��'s chair of the department of paediatrics, currently held by Dr. Ronald Cohn, who is the incoming president and CEO of SickKids.

“We are at an unprecedented time in scientific discovery and computational technology,” says Cohn. “And we have a unique opportunity to improve human health by focusing on our most vulnerable time – childhood. The Leong Centre is taking a truly innovative approach to enhancing child health through precision prevention that will have local, national and global impact.”

As well, through its partnership with the Institute for Clinical Evaluative Studies, �山ǿ�� benefits from access to a robust dataset of health information across the lifespan, giving it a competitive global advantage in demographic health research. The Leong Centre’s approach will build from this data, derived from the world’s most multicultural urban region, allowing it to create scalable programs and policies with global application.

Researchers at the Leong Centre aim to work in both theory and practice to lead exciting breakthroughs: from finding new and better ways to help low-income families effectively support children with long-term disabilities, to preventing the onset of cardiovascular disease in at-risk children, to helping immigrant families avoid chronic illnesses through better integration.

“The Leong Centre represents a paradigm shift in how we approach child health,” says David Palmer, vice-president advancement. “Dr. Leong has long been a champion of society’s most vulnerable and this new centre will carry on his global legacy. We are honoured and grateful to have his support in this far-sighted undertaking that will have positive implications for children around the world.”

As Ghana gets ready to set standards for child nutrition, �山ǿ�� researcher shares his science on brain health

noreen.rasbach — Wed, 31 Oct 2018 04:00:00 +0000

As Ghana gets ready to set standards for child nutrition, �山ǿ�� researcher shares his science on brain health

noreen.rasbach Wed, 10/31/2018 - 00:00

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A group of children in their classroom in the village of Kpalong, 50 kilometres outside Tamale in northern Ghana (photo by Marcus Valance/SOPA Images/LightRocket via Getty Images)

Topic

Research & Innovation

Ghana will soon adopt new standards on food and nutritional products for children, and the coming guideline on dietary fats for infants will be informed in part by a University of Toronto researcher.

Associate Professor Richard Bazinet (pictured left) recently spent two days at the University of Ghana presenting the latest science on the role of fats in the developing brain, to policy-makers, nutritionists and others with a stake in food science and health in Africa.

Bazinet holds the Canada Research Chair in Brain Lipid Metabolism in the department of nutritional sciences at the Faculty of Medicine, and he is a researcher in the Joannah & Brian Lawson Centre for Child Nutrition. He spoke with Faculty of Medicine writer Jim Oldfield about infant feeding, the African diet and what research might do for mental health in the country of nearly 30 million.

Who organized the meetings in Ghana?

They were sponsored in part by Codex Alimentarius, which is the food standards program of the World Health Organization and the Food and Agriculture Organization of the United Nations. It acts as a kind of ‘food code’ for the world, especially in developing countries that haven’t established their own guidelines on nutritional requirements and food safety. I talked about the state of the science on two fats, ARA from Omega-6s and DHA from Omega 3s – and what a child would need to eat to get optimal values of those fats in the brain.

Why are these fats important?

There are several fats in the brain, but ARA and DHA are called essential fatty acids because the body can’t make them. So we have to get them from food or supplements. There is evidence these fats improve cognitive and visual development, and central nervous system function. They are important in adults, but even more so in a growing brain, for healthy development. The complicated thing is that it’s impossible to do perfect studies showing how much a person needs because we can’t access the brain. So we look at models instead and estimate the intake requirements to get ideal brain levels.

How do you do that?

We actually have pretty good estimates on how much the brain needs, relative to dietary intake. The amounts in breast milk provide a good guide, although they can vary depending on the mother’s nutrition. But breast milk is a kind of gold standard. We can also look at infants post-mortem over time for some measurements in the body and brain, and then do back-calculations. These and other sources of data give us roughly similar answers.

How might these estimates inform Ghana’s guidelines on infant feeding?

They might reinforce the importance of breast milk. Breastfeeding rates have been declining in Ghana, and I think well under half of infants are exclusively breastfed at six months. Formula is another big issuebecause not all of it contains ARA and DHA, whereas those are standard in most developed countries. But including them in formula can increase its cost, so that’s an added challenge.

As for complementary feeding and infant diets broadly, there is a big knowledge gap. Almost all the available studies were done in the U.S. or Europe, or Canada. These countries have relatively good nutrition, and so the worry is that in countries with nutritional challenges – and one-third of children in Ghana are stunted or wasted or underweight – the role of essential fats could be even more important. It’s a theoretical argument, but chronic malnutrition in children without fat stores could pose really significant developmental risks, especially in those born premature and in need of more growth. Africa is really understudied in this context.

Are you looking to collaborate on research there?

Yes, and these meetings were helpful for making contacts with local scientists who want to look at fatty acid composition in the traditional African diet. It’s challenging because there isn’t a lot of funding for research. But it might be realistic to start categorizing the African diet and lipids. Ideally we would like to help set them up the equipment and skills to do this work on their own. They could pack up foods and ship them to us to start, but it would be more sustainable to train their students to do it.

I’ve also been emailing with psychiatrists I met at the University of Ghana. Their field is under-resourced, and the setbacks they see in infants can last a lifetime. Some of my work suggests Omega 3s are protective against brain inflammation, which increasingly appears to be at the root of depression and other neurological disorders. Medications to treat these conditions are often unaffordable in Ghana, but maybe we can work with nutrition to limit the burden of mental illness across the lifespan.

�山ǿ�� expert in children’s pain wins million-dollar CIHR grant for work reducing fear of needles in youth

noreen.rasbach — Wed, 25 Jul 2018 17:44:06 +0000

�山ǿ�� expert in children’s pain wins million-dollar CIHR grant for work reducing fear of needles in youth

noreen.rasbach Wed, 07/25/2018 - 13:44

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Anna Taddio on using needles on children: “Not managing pain and fear can have serious long-term consequences, including less uptake of vaccines and avoidance of health care throughout life” (photo by Chris Sorensen)

Topic

Leslie Dan Faculty of Pharmacy

Research & Innovation

In health care, needles are used to prevent, diagnose, treat and monitor illness. Despite their critical importance, needle procedures are one of the most frightening and painful aspects of health care for children.

“Not managing pain and fear can have serious long-term consequences, including less uptake of vaccines and avoidance of health care throughout life,” says Anna Taddio, a professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy and a senior associate scientist at SickKids hospital. “Making people afraid can cause a lifelong problem.”

Taddio is an internationally recognized expert in children’s pain whose current work is centred on improving the experience of children and youth undergoing needle procedures in order to improve overall health.

In previous research, Taddio showed that up to 20 per cent of unvaccinated youth aged 6-18 refuse vaccination due to fear of needle-related pain, leaving them at greater risk of acquiring and spreading disease to others.

“Vaccine refusal makes people vulnerable and it can also spiral beyond an individual’s health when disease is spread in the broader community,” she says.

This month Taddio received more than $1 million from the Canadian Institutes of Health Research (CIHR) to support continuing research and targeted efforts to reduce fear of needles in youth.

So how do we get needles to hurt kids less? Start with identifying best practices for injection techniques so that health providers delivering needles know how to prevent avoidable pain, she says. Next, work with kids themselves to develop effective strategies that will reduce fear and pain.

“We typically don’t involve youth in a meaningful way in these procedures," says Taddio. "We decide what to do and we don’t give them choices. But they are often the best sources for what strategies will work best. Engaging youth in their own health care is also empowering and builds trust."

Over the last two years, Taddio and her team led a small implementation project that showed incorporating evidence-based interventions and accommodating preferences of youth receiving school-based vaccines reduced pain, fear and dizziness associated with getting the needles. Developed for youth by youth, CARD (Comfort, Ask, Relax, Distract) is a game where students select interventions they want to “play” from within each category and then share them with adults who help support their choices. For example, a student may wish to play from category “A” and ask to be vaccinated in a private place, or “D” and bring an electronic device to serve as a distraction.

“CARD is a major breakthrough,” says Taddio. “It is the first knowledge translation tool to integrate all that is known about pain, fear and fainting mitigation into a simple, low-cost, appealing training approach for youth.”

The newest CIHR grant will help Taddio expand her investigation of CARD in schools across Ontario and Alberta with the aim of standardizing a new approach that would update current practice guidelines to be used across Canada and internationally.

The skills youth learn through CARD can reach beyond the immediate needle procedure and help them better manage other stressful situations. Taddio says those skills can translate into more positive health behaviours overall.

“School-based vaccines occur at a time in life when kids start to make their own decisions about their health and health care. If they have a good experience with vaccinations and public health they will bring that into adulthood,” says Taddio.

“My vision is to make children all over the world healthier by improving their experiences during needle procedures."

�山ǿ�� researcher plugs data gaps on food and global child health

ullahnor — Thu, 12 Jul 2018 20:24:33 +0000

�山ǿ�� researcher plugs data gaps on food and global child health

ullahnor Thu, 07/12/2018 - 16:24

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Professor Zulfiqar Bhutta and his team are looking into the “food environment” in Brazil, India, Ethiopia and other low- and middle-income countries and link them to health outcomes of school-age children (photo by Thomas Young on Unsplash)

Topic

Half of adolescents in some low-income countries are stunted from malnutrition, while school-age children in many of these same countries face a growing problem of excess body weight.

How do the conditions that influence food choices in these countries affect the health of school-age children? We don’t know.

Zulfiqar Bhutta, a professor at the University of Toronto's Faculty of Medicine and a co-director of the Centre for Global Child Health at the Hospital for Sick Children, and his team are trying to answer that question.

They're trying to define the “food environment” in Brazil, India, Ethiopia and other low- and middle-income countries and link it to the health outcomes of school-age children and adolescents.

Bhutta spoke with writer Jim Oldfield about what his research could mean for food policy, child nutrition and global health.

“My hope is that our research helps provide a starting point for the world to achieve the Sustainable Development Goal for nutrition, which is zero hunger by 2030,” he says. “We can’t get there without filling some key knowledge gaps.”

What will this project do?

There is a paucity of evidence on how food systems affect child health in low- and middle-income countries. This research will help us better understand the relationships between these systems and diet-related health outcomes among school-age children. Secondarily, it will enable us to develop a set of indicators to assess and monitor these food environments. We can then test the predictive validity of those indicators in country-specific case studies, with an eye to creating national recommendations to inform programmatic interventions and nutrition policies.

Why is there such a strong need for this data?

The health and nutritional status of young children has improved dramatically over the past 50 years, but we’ve seen much less improvement among adolescents. The Lancet published a series of papers on maternal and child nutrition in 2013, and although it was clear there has been a productive focus on children under age five, it was also clear that data on adolescence was patchy. It looked as though it would take another 15 to 20 years compile solid data – which was basically the time frame of the United Nations Sustainable Development Goals. Some of us felt that was just too long to wait, and that we could shorten the timeline by synthesizing existing data and developing ways to measure these food systems and more specifically the food environment.

What kind of specifics do you hope to uncover?

Given the World Health Organization’s effort to minimize mass media, marketing and promotion of unhealthy food to children, we know that these aspects of the food environment do influence dietary intake. But to what extent?

Moreover, what about the physical and economic access to food for school-age children and adolescents? These other dimensions, what is termed food availability, food accessibility and food affordability, have been less commonly quantified and associated to diet-related health outcomes in school-age children and adolescents. These are potential environmental entry points for interventions, and there is a dire need for evidence to guide those strategies.

What stage are you at with this project?

At this point, we have reviewed nearly 25,000 articles and have narrowed it down to 700 that relate to the food environment in low- and middle-income countries – at the household, community and school level. We have divided our efforts into two systematic reviews of literature on school-age children and adolescents; one that will synthesize the impact of food environment interventions on children and diet-related health, and another that will synthesize observational associations between the food environment and diet-related health. We hope to have results for these reviews by the end of the summer.

What are your next steps?

From these reviews, we hope to identify a pool of indicators on which we will seek stakeholder feedback, then test their predictability through a series of country case studies.

What are your long-term hopes for this work?

We’ve witnessed a huge drop in the number of undernourished people globally over the last 20 years, and great progress on maternal and early child mortality. And we’ve seen successful efforts to confront specific nutrient deficiencies. Iodine deficiency is a good example – salt fortification has limited this problem in many parts of the world. Folate deficiency is well-controlled in high-income settings.

But we need more successes like these. My hope is that our research helps provide a starting point for the world to achieve the Sustainable Development Goal for nutrition, which is zero hunger by 2030. We can’t get there without filling some key knowledge gaps.

And you know, this work will be just as important for Canada as for the rest of the world. There are many second-generation immigrants here who come from other places to overcome health issues related to malnutrition. As well, our knowledge of food environments and Indigenous populations is extremely limited. So as our work points out disparities abroad, it should help us fix them at home.

The research is funded by a Public Policy and Child Nutrition Collaborative Grant from the Joannah & Brian Lawson Centre for Child Nutrition.

'The solutions aren’t complicated': �山ǿ�� expert on Canada's failing grade in children's physical activity

Christopher.Sorensen — Tue, 10 Jul 2018 18:38:56 +0000

'The solutions aren’t complicated': �山ǿ�� expert on Canada's failing grade in children's physical activity

Christopher.Sorensen Tue, 07/10/2018 - 14:38

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The University of Toronto's John Cairney, a professor in the Faculty of Kinesiology & Physical Education, contributed to an expert statement that accompanied ParticipAction's report card for children and youth (photo by Seednine photography)

Topic

Faculty of Kinesiology & Physical Education

Youth

The recent 2018 ParticipAction report card on physical activity for children and youth isn't something to brag about. The non-profit organization's report found only 35 per cent of children aged five to seven, and 62 per cent of children aged three to four, are achieving the recommended physical activity levels for their age group, earning them a D-plus for overall physical activity.

John Cairney, a professor in the University of Toronto’s Faculty of Kinesiology & Physical Education, believes there are a number of reasons for the low grade, despite growing awareness about the benefits of physical activity to overall health.

“Children and youth spend too much time on their tablets and smart phones and a lot less time playing active games and moving. They are not engaging in active transport like riding or walking to school like we used to see in the past,” he says.

“When I was a child, I used to play outside with my friends all day without parental supervision. Concerns over safety have significantly reduced that kind of play. Free play and risky play in general have declined. Finally, many children lack the skills, competence and confidence to be physically active – what we call collectively physical literacy.”

Cairney, whose research interests include pediatric exercise science and mental health, was an expert panel member for the physical activity and brain health supplement for the report card, which found that all children and youth need to be physically active on a regular basis for better brain health.

“There is no question that physical activity is key to child and youth health and development. Evidence in the report shows this is not only true for heart, muscles and bone, but also for the brain,” he says.

“Physical activity improves learning, mental processing and mental health and well-being for typically developing children and for those with disabilities,” says Cairney.

The researchers found that children and youth who participate in physical activity have more focused and longer attention spans, compared to their less active peers. They are less stressed and have improved self-esteem, which may lead to better moods. And regular physical activity was found to improve cognitive function in children and youth who have brain-based disabilities, such as autism spectrum disorder or Attention Deficit Hyperactivity Disorder (ADHD).

“This is critical information for parents, educators and everyone who works with or cares for children and youth,” says Cairney.

The report advises parents to be active as a family and to encourage daily activity. It recommends health-care professionals prescribe physical activity to complement any prescribed medical course of treatment for anxiety, depression and focus-related conditions, such as ADHD. Educators are encouraged to teach an active curriculum and not take away play time as a form of punishment, and the government is urged to make physical activity more accessible for low-income families and families with children with disabilities.

“The solutions aren’t complicated. I am optimistic that the message is getting through. We need to work together to make positive changes,” says Cairney.

“Certainly at �山ǿ�� KPE, we are committed to working with parents, schools and the community to use the knowledge we have to make a difference.”

No more tears: Publicly funded research by �山ǿ��'s Anna Taddio is taking the pain out of vaccinations in Canada and around the world

Christopher.Sorensen — Fri, 15 Dec 2017 15:46:46 +0000

No more tears: Publicly funded research by �山ǿ��'s Anna Taddio is taking the pain out of vaccinations in Canada and around the world

Christopher.Sorensen Fri, 12/15/2017 - 10:46

Cutline

Anna Taddio, a professor at �山ǿ��'s Leslie Dan Faculty of Pharmacy and a senior associate scientist at SickKids, researches childhood pain. Her vaccination recommendations have been adopted in WHO guidelines (photo by Chris Sorensen)

Topic

Fundamental Science Review

Global

Health

Leslie Dan Faculty of Pharmacy

Naylor Report

Research and Innovation

It was in the neonatal intensive care unit at Toronto’s SickKids Hospital in the late 1990s that Anna Taddio witnessed the consequences of infant pain first-hand.

The University of Toronto childhood pain researcher says newborns would frequently start crying as soon as nurses approached their incubators – particularly those who had been in the unit for an extended period.

“It’s almost like they anticipated something bad was going to happen,” says Taddio, a senior associate scientist at SickKids and a professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy.

“And that’s probably because you were about to do something unpleasant – you didn’t go in there just to cuddle them.”

The observation was later affirmed by a 2002 paper, one of nearly 200 Taddio has authored over two decades, that showed babies pricked with multiple needles within the first several hours of being born reacted much more strongly to a standard screening test that involved drawing blood. Other research showed that negative health care experiences early in a child's life – involving needles or other painful procedures – could haunt them as they grew older.

Making needles and vaccinations more tolerable became a focus of Taddio’s ground-breaking pain research, the vast majority of which was funded by the Canadian Institutes of Health Research, or CIHR. Both are critical preventative medicine tools and represent most people’s first interaction with the health-care system, helping to shape long-term attitudes about it in the process.

Taddio's work is already having a big impact. In 2015, vaccine-administering recommendations developed by her team were written into Canadian clinical practice guidelines. Several were also adopted the same year by the World Health Organization.

It's yet another example how investing in fundamental research can dramatically improve the lives of Canadians and others around the world. Moreover, Taddio's research underscores the importance of adopting the recommendations of Canada’s Fundamental Science Review, which was led by �山ǿ�� President Emeritus David Naylor, and calls for a $1.3-billion increase in federal research funding over four years, as well as sweeping changes to how it is administered.

Why? If CIHR's public funding didn't exist, Taddio may never have had the opportunity to conduct research into a problem many in the medical community previously believed was a non-issue – to the extent they thought about it at all.

A child is vaccinated in North Darfur in 2012. Recommendations by Taddio's team were adopted by the WHO three years later (photo by UNAMID via Flickr)

Statistics show that roughly one out of every four people is scared of needles, albeit to differing degrees. And Taddio estimates that as many as 10 per cent of people avoid getting vaccinations because of a fear of needles or concern about injection pain, a situation that poses an obvious personal and community health risk.

What's more, those same fears can prevent people from going to doctors for other routine procedures and tests until it's too late.

Taddio explains that we have a medical culture that has historically viewed needles and vaccinations, and the pain associated with them, as a necessary evil – something that patients must simply grin and bear.

“Most needle fears develop between the ages of four and eight, and it’s usually in the context of a bad procedure where somebody held you down and you were struggling,” she says, noting that about half of all people who are scared of needles and vaccinations had a negative childhood experience.

The rest is due to simple apprehension. “Somebody scares you – or you see somebody else, say you see your brother get a needle – and it’s very traumatic,” says Taddio. “Then you become very afraid.”

Taddio speaks from both professional and personal experience. She recalls taking her eldest son to a Toronto clinic for a blood test when he was four. The nurse jabbed his arm, missed the vein, and jabbed again as he struggled and screamed.

He understandably left the clinic with a fear of needles, Taddio says.

But it doesn't have to be this way.

Taddio's work has shown a number of relatively simple measures that can be taken to reduce the pain and fear associated with vaccinations. They include: injecting the most painful vaccine last during a series of injections; ensuring older children and adults are sitting upright; breastfeeding infants before or after the injection; and using topical anesthetics.

Taking steps to acknowledge children's pain and distracting them during injections can also be effective.

“Many people are afraid of needles and so avoid getting vaccinated, which is such an important preventative intervention,” says Professor Heather Boon, the dean of the Leslie Dan Faculty of Pharmacy.

“Dr. Taddio’s work helps us understand why that fear develops so we can take simple steps to prevent it.”

Taddio began looking at childhood and infant pain back in the 1990s and was immediately struck at how little research existed on the subject. “People laughed at me,” she recalls. “They thought it was much ado about nothing.”

When it came to infants, she recounts the prevailing thinking at the time as follows: It’s too difficult to assess pain in babies because they’re incapable of communicating; even if their nervous systems are developed enough to feel pain, they’re too small to be administered drugs without side-effects; and, regardless of how much pain they feel, it doesn’t really matter because there are no long-term consequences.

Needless to say, Taddio found such justifications wanting, particularly when it came to “invasive” procedures like circumcision.

“If you were doing something like that in an adult, there’s just no way you would just strap someone down and proceed,” she says. “So I would watch these procedures and these babies were just crying – they had so much pain they would actually stop breathing.

“I thought, ‘This is ridiculous.'’’

So Taddio, who did her PhD in pain management at �山ǿ��, began researching ways to reduce the suffering of babies undergoing circumcision and the safety of associated drugs. Then something unexpected happened while she was working on a study that looked at topical anesthetics and children receiving vaccines. She found, to her surprise, boys often had a higher pain score than girls, which, initially, made little sense.

“We later had this a-ha moment which was: Their experience with pain is different because boys are more likely to have been circumcised than girls,” she says.

The finding was bolstered by looking at the differences in pain scores between circumcised and uncircumcised boys in the same study, and another longer-term study that tracked boys who had been given an anesthetic during circumcision and those who hadn’t.

Interested in publicly funded research in Canada? Learn more at �山ǿ��’s #supportthereport advocacy campaign

Taddio continued her research in a similar vein until 2007, when she decided to do a survey on vaccinations in Greater Toronto to see how her work and that of fellow pain researchers had influenced clinical practice.

It hadn’t.

That’s when Taddio decided to add translational research to her fundamental research. She assembled an interdisciplinary team of clinicians, scientists and policy-makers from across Canada to promote better pain care during vaccine injections. They called the initiative Help ELiminate Pain in Kids, or HELPinKids for short. “I thought it would be a good gateway to talking about pain,” she says.

The HELPinKids team published its first clinical practice guideline on reducing vaccine injection pain in 2010 in the Canadian Medical Association Journal. In 2015, they published an updated and expanded guideline in the same journal. Taddio was also invited to Geneva the same year to present at the WHO, which later adopted about half of the recommendations (some, like the use of topical anesthetics, aren’t applicable in developing countries because of the high costs).

Taddio stresses that her research, and the global vaccine guidelines that ultimately sprung from it, were heavily reliant on public funding. “I primarily depended on CIHR because I couldn’t have the work associated with any conflicts of interest,” she says. “That was really important for the guideline panel, who are all working with governments.”

Even so, she says it remains difficult to get funding as a pain researcher, a field that she describes as relatively un-sexy.

“What I achieved with the money I received is actually amazing,” she says, adding that the full adoption of the Naylor report’s 35 recommendations would likely make it easier to attain funding.

The problem of pain and vaccinations is hardly fixed. Despite her research, Taddio says health-care delivery has been slow to change and pain management is still not optimally incorporated into medical procedures – a point that was hammered home when staff at a local hospital politely refused to give her needle-wary son a topical anesthetic before administering an injection.

“People were telling me not to use it because it didn’t work and I was like, ‘Uh, no. I will show you the paper.’”

Anna Taddio is creating tools that can be used to help children deal more effectively with pain during vaccination campaigns in schools (photo by Chris Sorensen)

With the guidelines now in place, Taddio intends to continue with her pain research and find ways to generate further awareness. She’s now focusing on vaccination programs in schools, which represent many children’s first interaction with the health-care system without the assistance of their parents.

One strategy involves creating an easy-to-remember acronym to remind children their options when it comes to vaccination. For example, they might request being vaccinated in private rather than in front of peers, or they might bring a video game or smartphone into the vaccination room to serve as a distraction.

“In the past, we’ve burdened the health-care provider with everything,” says Taddio. “But I think it’s better to show the kids and then they can choose how to best cope.”

In the end, Taddio says it’s all about medical community acknowledging the existence of pain and working with patients to reduce its impact during injections and other procedures.

“Treating pain has many benefits,” she says. “It not only prevents unnecessary suffering, it ensures we are delivering the best care possible, improves everyone’s satisfaction with the experience, and improves health because people are more likely to participate in positive health behaviours like getting vaccinated and going to a doctor to get a blood test to look for high cholesterol and these sorts of things.”

India has avoided one million child deaths since 2005, new �山ǿ�� study concludes

rasbachn — Thu, 21 Sep 2017 19:12:48 +0000

India has avoided one million child deaths since 2005, new �山ǿ�� study concludes

rasbachn Thu, 09/21/2017 - 15:12

Cutline

Child mortality is a huge issue in India: About six million children die around the world each year and progress in reducing that number depends greatly on India, which accounts for about a fifth of the deaths (photo by Venkataramesh Kommoju)

Leslie Shepherd

Author legacy

Leslie Shepherd

Topic

Global Lens

Dalla Lana School of Public Health

Child Health

Subheadline

India has avoided about one million deaths of children under the age of five since 2005, driven by significant reductions in mortality from pneumonia, diarrhea, tetanus and measles, according to new University of Toronto research.

But nearly three times that number could have been saved if national progress in child health matched that reached in some states, Dr. Prabhat Jha, a professor in the �山ǿ��'s Dalla Lana School of Public Health and head of the Centre for Global Health Research of St. Michael’s Hospital.

The study was published in The Lancet.

A steeper decline in the number of girls dying narrowed a previously observed girl-boy mortality gap, said Jha. An almost equal number of boys and girls under the age of five died in 2015.

This research is part of the Million Death Study, one of the largest studies of premature deaths in the world. Jha is the lead investigator of the survey, based in India, where most deaths occur at home and without medical attention. Hundreds of specially trained census staff in India knocked on doors of more than 1.3 million homes to interview household members about deaths. Two physicians independently examined these “verbal autopsies” to establish the most probable cause of death.

Read the study in The Lancet

Dr. Prabhat Jha, a professor in �山ǿ��'s Dalla Lana School of Public Health and head of the Centre for Global Health Research of St. Michael’s Hospital.

“You get the truth when you knock on doors and talk to parents,” said Jha. “We knocked on the doors of 100,000 homes where children died. If the health system failed these families, they will tell you all about it. These are far more reliable numbers than models or projections from small studies.”

The study found a 3.3 per cent annual decline in mortality rates of neonates (infants less than one month old) and 5.4 per cent for those ages one month to 59 months. The declines accelerated starting in 2005 and were fastest between 2010 and 2015, and in urban areas and richer states.

Per 1,000 live births, the mortality rates among neonates fell from 45 in 2000 to 27 in 2015. The one-59 month mortality rate fell from 45.2 to 19.6.

Looking at specific causes of death, mortality rates from neonatal tetanus and measles fell by at least 90 per cent; neonatal infection and birth trauma fell more than 66 per cent. For children ages one to 59 months, mortality rates from pneumonia and diarrhea fell more than 60 per cent.

About six million children die around the world each year and progress in reducing that number depends greatly on India, which accounts for about a fifth of the deaths. About 29 million Indian children died between 2000 and 2015. Had the mortality rates of 2000 continued unchanged, about 39 million children would have died.

The authors noted that in the last decade the government of India has modestly increased its traditionally low level of public spending on health. The government launched a program to encourage women to give birth in hospitals and for children to have a second dose of measles vaccine.

Read about the study in the Hindustan Times

Jha said that to meet the United Nations' sustainable development goals of halving its child mortality rates by 2030, India must maintain its current trajectory for children ages one to 59 months and accelerate declines in neonatal mortality.

Reducing the number of neonatal deaths will require efforts to reduce deaths caused by premature delivery and low birthweights, especially in poorer states, he said. Both are strongly linked to largely modifiable maternal and prenatal factors, such as health care during pregnancy, education, nutrition, anemia and tobacco use.

In an accompanying commentary for The Lancet, leading scientists from Bangladesh and Tanzania wrote that the “Million Death Study can be a model for other countries where vital registration systems are still fragmented.”

This work received funding from the U.S. National Institutes of Health, the Disease Control Priorities Network, the Maternal and Child Epidemiology Estimation Group and the University of Toronto.

Leslie Shepherd is a writer with St. Michael's Hospital, where this article originally appeared.