Leena Nahata, MD, principal investigator in the Center for Biobehavioral Health and medical director of the Fertility and Reproductive Health Program at Nationwide Children's Hospital, was recently published in the Journal of Adolescent Medicine and interviewed by Reuters Health on fertility preservation among transgender youth.
Most research to date on fertility preservation has focused on young patients undergoing cancer treatment, Dr. Nahata explains. In this specific publication, she and her colleagues note that there are many other medical situations where a discussion of fertility preservation could be warranted, including for transgender individuals undergoing gender-affirming hormone therapy.
"More research needs to be done to understand parenthood goals and barriers to fertility-preservation utilization specific to this transgender population," says Dr. Nahata. "Our findings suggest that parenthood goals among transgender individuals may not be the same as they are in other populations."
Researchers studied 73 adolescent patients treated at their center (50 transgender males and 23 transgender females). All but one received fertility counseling, while only two - both transgender females - opted for fertility preservation. By comparison, about 25 percent of pubertal males diagnosed with cancer will bank their sperm, while pubertal females may be less likely to choose fertility preservation.
"Many of the adolescents in this study said, 'I don't ever want to have kids,' or 'I want to adopt,' and we don't know if that attitude persists into adulthood for these kids," says Dr. Nahata." We intend to pursue prospective work in those areas to examine if and how parenting goals may change over time, and what the perceived benefits and barriers to fertility preservation are in this population at different ages and developmental stages."
Reference: Reuters - Few Transgender Teens Opt for Fertility Preservation (February 2017)
Sarah A. Keim, PhD, principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children's Hospital, was recently awarded two research grants to develop new breastfeeding questions applicable to multiple national surveys (July 2016) and to study the development of early childhood obesity in children born preterm (September 2016).
The first grant, which was awarded to Dr. Keim from the CDC's National Center for Health Statistics (NCHS), will be used to develop and evaluate a brief set of survey questions to accurately capture contemporary infant feeding and lactation practices among respondents. The second grant, an R03 awarded from the National Institutes of Health (NIH), will apply cutting-edge statistical methods to determine the prevalence and timing of the development of overweight and obesity in early childhood among preterm children, as compared to term children, to identify optimal intervention windows, and to document th eextent of under-recognition of obesity during clinical care in a longitudinal sample of more than 16,000 children.
Breastfeeding in the United States has radically changed over the past two decades, with more than 85% of infants fed human milk being fed expressed milk from a bottle at least some of the time, and 5-7% of human-milk fed infants never fed at the breast at all.
"Data from national surveys are routinely used to inform and evaluate breastfeeding promotion efforts at the national and local levels and are also the basis for research, but the questions currently in use in NCHS surveys no longer reflect contemporary infant feeding and lactation practices, resulting in significant measurement error," said Dr. Keim. "Our long-term goal is to contribute to a new understanding of the impact of these practices on maternal and child health."
Preliminary data suggests that obesity is a major, under-recognized problem in the preterm population and likely emerges differently than for children born at term. Obesity has harmful consequences for children born preterm, far greater than the consequences for children born at term.
"Without knowledge to fill gaps about the extent, nature, and timing of obesity development and how consistently obesity is recognized in clinical care, tailored prevention strategies cannot be developed to help clinicians and families promote adequate growth while preventing excess growth among preterm children," said Dr. Keim. "The long-term goal, which will be the subject of a subsequent R01 application, is to develop evidence-based strategies tailored to preterm children to guide clinicians and families in preventing overweight and obesity."
Congenital heart disease (CHD) is the most prevalent congenital health condition, and due to advancements in medicine, over 2 million children, adolescents and adults currently live with CHD in the United States. CHD survivors are at risk for cardiovascular complications as they age, many of which are preventable or amenable to lifestyle changes, such as increasing physical activity. Despite this, evidence suggests that adolescent CHD survivors are less active than healthy controls, placing them at an elevated risk for preventable morbidity and premature mortality.
Jamie L. Jackson, PhD, principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children's Hospital, was recently awarded a K23 grant from the National Institutes of Health (NIH) to evaluate the feasibility and preliminary efficacy of a randomized behavioral clinical trial to increase physical activity among adolescents with congenital heart disease. The 5-year Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Jackson with vital mentorship training on (1) randomized clinical trial methodology and analysis, and (2) CHD pathophysiology. The study will adapt a physical activity lifestyle intervention for adolescent survivors of moderate and complex CHD.
Kathryn A. Vannatta, PhD, principal investigator in the Center for Biobehavioral Health, will serve as Dr. Jackson's primary mentor. Co-mentors include Joseph R. Rausch, PhD, principal investigator in the Center for Biobehavioral Health, and Vidu Garg, MD, director of the Center for Cardiovascular Research at The Research Institute and pediatric cardiologist in The Heart Center at Nationwide Children's. The results of the current study are expected to inform a future, larger R01 study, which will establish efficacy and determine the long-term effects of this intervention.
Nearly 16,000 individuals under the age of 20 are diagnosed with cancer each year in the United States, and the five-year survival now exceeds 80%. As a consequence, many of these individuals will soon be entering their reproductive years. Despite evidence that 35-55% of male childhood cancer survivors experience infertility, efforts to standardize pre-treatment fertility counseling, and the relative ease of sperm banking, a minority of males bank sperm prior to cancer treatment.
Studies have shown that those who do not pursue fertility preservation often report distress about potential infertility and regret about missed opportunities for banking, yet factors impacting decisions about fertility preservation remain poorly understood. Leena Nahata, MD, principal investigator in the Center for Biobehavioral Health and medical director of the Fertility and Reproductive Health Program at Nationwide Children's Hospital, was recently awarded an intramural grant to assess whether a second window of opportunity for fertility preservation may exist for some male adolescent and young adult survivors, and to examine predictors of fertility preservation decisions in this population.
Dr. Nahata will be working with Nicholas Yeager, MD, director of the Adolescent and Young Adult Program for Hematology/Oncology & BMT at Nationwide Children's and co-principal investigator of the grant, as well as Cynthia A. Gerhardt, PhD, director of the Center for Biobehavioral Health, and Joseph R. Rausch, PhD, principal investigator in the Center for Biobehavioral Health.
This innovative mixed-methods multi-informant study will integrate biological assessments, questionnaires, and qualitative interviews to determine if post-treatment fertility preservation is biologically possible, and feasible, in male cancer survivors 15-25 years of age, 1-5 years after completion of cancer treatment.
“Our ultimate goal is to improve care for youth with cancer before and after treatment, and fertility is important to the majority of our survivors” said Dr. Nahata. “Fertility is often overlooked in pediatric care - the goal of our clinical and research programs is to improve reproductive health related quality of life for all at-risk pediatric populations.”
Cynthia A. Gerhardt, PhD, director of the Center for Biobehavioral Health and co-director for the Patient-Centered Pediatric Research Fellowship (PC-PReP) in The Research Institute at Nationwide Children's Hospital, received the Dennis Drotar Distinguished Research Award in Pediatric Psychology from Division 54 (the Society of Pediatric Psychology) of the American Psychological Association (APA) at the Society for Pediatric Psychology Annual Conference in April 2016. The award recognizes "excellence and significant contributions in establishing the scientific base of pediatric psychology" and is a testament to Dr. Gerhardt's many accomplishments as a researcher, leader and mentor in the field.
Dr. Gerhardt is also an associate professor of Pediatrics and Psychology at The Ohio State University. Her work is focused on identifying risk and resilience factors associated with family adjustment to childhood chronic illnesses, particularly cancer. Her early studies highlighted considerable resilience among long-term survivors of childhood cancer, while more recent research has identified vulnerabilities among bereaved parents and siblings.
Dr. Gerhardt's current efforts involve international collaborations aimed at understanding trajectories of symptom burden and decision making at the end of a child’s life, fertility and psychosexual development in survivorship, interventions to improve family coping and communication, as well as the evaluation of innovative healthcare and community-based programming to improve outcomes for providers and families. She has published nearly 100 papers and book chapters in this area, and has received multiple grants from the National Institutes of Health and the American Cancer Society to support her research.
In addition, Dr. Gerhardt has contributed to the development of international standards for psychosocial care for children with cancer and their families, and she has been actively involved in the mentoring of students and trainees in her lab for almost 20 years.
Individuals with disorders/differences of sex development (DSD) often report decreased satisfaction with health care and are at risk for psychological comorbidities including depression and anxiety. While current guidelines state that the interdisciplinary care of DSD patients should include psychosocial services, knowledge gaps limit the ability of healthcare providers to provide anticipatory guidance and promote positive psychosocial outcomes.
Canice Crerand, PhD, principal investigator in the Center for Biobehavioral Health in The Research Institute at Nationwide Children's Hospital, was recently awarded a grant from the National Institutes of Health (NIH) to investigate mediators and moderators of positive outcomes in individuals with DSD between the ages of 12-26 years old. Dr. Crerand will be working with the following collaborators in the Center for Biobehavioral Health: Leena Nahata, MD, principal investigator; Joseph R. Rausch, PhD, principal investigator; and Jennifer Hansen-Moore, PhD, pediatric psychologist with the THRIVE Program at Nationwide Children's. She will also be working with a team of investigators at Boston Children's Hospital, including Amy Tishelman, PhD, a psychologist and co-principal investigator of the grant.
The objectives of this study are to examine the potential diagnosis-related and developmental mediators (satisfaction with clinical communication, healthy family functioning, family and peer acceptance, and body image) and moderators (age of diagnosis, desire for biological children, congruence between gender assignment and gender identity) of psychosocial outcomes.
"Our goal is to develop a clinically useful paradigm for fostering well-being in youth and young adults with DSD," said Dr. Crerand. "The mixed-methods approach will also enable us to examine themes related to medical factors unique to specific DSD conditions, and to understand nuanced aspects of interactions with providers, consent and control over medical care, family dynamics, fertility status, and intimacy along the developmental spectrum."
Cynthia A. Gerhardt, PhD, director of the Center for Biobehavioral Health and a psychologist in the Pediatric Psychology and Neuropsychology Program at Nationwide Children’s Hospital, has been selected by the American Psychological Association (APA) to participate in the 2014-2015 Leadership Institute for Women in Psychology. Dr. Gerhardt is a principal investigator in the Center for Biobehavioral Health, as well as program director for the Patient-Centered Pediatric Research Program.
Dr. Gerhardt was selected in recognition of her outstanding career achievements and demonstrated leadership potential in academic, clinical, consulting, and other professional settings. The mission of the APA’s Leadership Institute for Women in Psychology is to prepare, support, and empower women psychologists as leaders to promote positive changes, and to increase the diversity, number, and effectiveness of women psychologists as leaders.
Dr. Gerhardt also serves on the physician team for Pediatric Psychology and is a faculty member for the pediatric psychology postdoctoral fellowship and the psychology pre-doctoral internship programs at Nationwide Children’s. In addition, Dr. Gerhardt is an associate professor of pediatrics at The Ohio State University College of Medicine. Her primary research focus is on risk and resilience factors associated with family adjustment to bereavement and childhood chronic illnesses, such as cancer.
Sarah Keim, PhD, a principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s Hospital, was recently awarded a general research grant from the March of Dimes to study the efficacy of dietary supplementation in improving cognitive and behavioral outcomes for toddlers who were born prematurely. Specifically, the March of Dimes will fund the project for $270,000 over a period of three years.
"Preliminary data demonstrate that this study is feasible and that the intervention will be beneficial in toddlers, especially since children's dietary intakes of DHA at baseline are positively correlated with cognitive ability," explained Dr. Keim. "Toddlerhood is a critical period for neurodevelopment, and early intervention is critical to long-term outcomes."
Dr. Keim and her team will be conducting a randomized, placebo-controlled trial to evaluate the efficacy of dietary docosahexaenoic acid (DHA) supplementation during the second year of life, for children born very or extremely preterm. The benefits of DHA supplementation for cognitive development during early infancy is fairly well-established, but studies have not yet been conducted to determine if supplementation during the active period of neurodevelopment in the second year of life would benefit children born preterm.
Research conducted by Sarah Keim, PhD, and her team, in collaboration with Cincinnati Children's Hospital Medical Center and The Ohio State University, found more than three-fourths of breast milk samples purchased over the Internet contained bacteria that can cause illness, and frequently exhibited signs of poor collection, storage or shipping practices. The study, published in the November 2013 issue of Pediatrics, is the first to examine the safety of selling breast milk to others over the Internet, a trend that has become more frequent in the past several years.
Cynthia A. Gerhardt, PhD, a pediatric psychologist and director of the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s Hospital is studying the impact of stress on children and families, especially related to chronic childhood illnesses like cancer. She hopes that her findings will help healthcare providers and families learn how to best support children after treatment. “As we cure more children with cancer, it becomes even more important to understand how treatment affects their development and quality of life in the long-term,” said Dr. Gerhardt. “In addition, many families don’t realize that survivors may have long-term side effects and need close screening after treatment.”
To help guide best practice in supporting families of children with cancer, Dr. Gerhardt and her colleague, Kathryn Vannatta, PhD, a principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s, have been collaborating on a multi-center study led by Bruce Compas, PhD, at Vanderbilt University Medical Center. Funded by the National Cancer Institute, over 350 families have participated in this study after their child’s diagnosis of cancer.
Dr. Gerhardt’s team initially worked with families within the first few weeks of diagnosis to document how they coped and talked about cancer with the child. The research team then evaluated associations between coping, communication, and adjustment over the first year of the illness, sometimes asking the families to come to the lab to be observed while talking about cancer. A continuation of this study, also funded by the National Cancer Institute, will assess similar outcomes for families in early survivorship, at three and five years following diagnosis.
Dr. Gerhardt says that studying how families cope during the entire spectrum of childhood cancer, from diagnosis to survivorship or end-of-life, will facilitate improved quality of life for all family members even after they have left the hospital. “Many families are quite resilient over the long-term,” said Dr. Gerhardt. “But it’s important to support families through all phases of the illness and ensure survivors have the best care and quality of life possible.”
Canice E. Crerand, PhD, a principal investigator at the Center for Biobehavioral Health and a psychologist at the Center for Complex Craniofacial Disorders and the Cleft Lip and Palate Center, was recently awarded a K23 award from the National Institutes of Health to conduct a three-part study on body image in adolescents with craniofacial conditions.
Youth with craniofacial conditions are vulnerable to specific psychosocial problems, including social inhibition, social anxiety, negative self-appraisal, depression, and lower quality of life. The psychosocial problems reported by adolescents with craniofacial conditions are often associated with negative body image. Negative body image is a known risk factor for depression, social anxiety, and eating disorders, and it is consistently associated with lower quality of life and self-esteem.
The proposed studies supported by this NIH K23 award will address gaps in the literature by 1) characterizing and evaluating the multiple dimensions of body image; 2) examining psychosocial correlates of body image disturbance and body image satisfaction in adolescents with and without craniofacial conditions; and 3) developing and piloting a cognitive-behavioral body image and social skills intervention for adolescents with craniofacial conditions.
The overall aim of these studies is to improve our understanding of risk and protective factors for psychosocial problems in youth with craniofacial conditions. These studies will also lay the foundation for the development of an empirically supported intervention designed to improve body image, psychosocial functioning, and quality of life in adolescents with craniofacial conditions.