Recombinant human growth hormone (GH) is approved for treatment of children with idiopathic short stature (ISS). Endocrinologists often depend on algorithms to predict adult height. As algorithm performance is often included in treatment decision, we sought to evaluate agreement among height prediction formulas.
We identified 3 commonly used algorithms for height prediction: Bayley-Pinneau (BP), Roche-Wainer-Thissen (RWT), and Khamis-Roche (KR). We constructed simulated samples of children with typical distributions of ages, heights, weights, bone ages, and parental heights seen in patients with ISS, and applied the algorithms to the simulated children to determine if predicted adult height was <160 cm for boys or <150 cm for girls, the 1.2nd height percentiles for adults.
We found substantial disagreement amongst algorithms in the percentage of simulated children with predicted adult height < 1.2nd percentile, a cut-off that may influence GH treatment decisions. Using the BP formula, 43% of boys and 81% of girls had predicted adult height below this threshold, whereas only 3% of boys and 0.2% of girls had predicted heights < 1.2nd percentile using the KR method. RWT predictions fell in between. Overall agreement of the methods was poor (kappa = 0.21) in boys and negative in girls.
Wide variation exists among formulas used to predict adult height. As these algorithms may be used in decisions about whether to initiate GH treatment and to assess GH’s efficacy in research trials, it is important for parents, pediatricians, and investigators to recognize the considerable variation involved in height prediction.
growth hormone; idiopathic short stature; height prediction
arrhythmia; cardiopulmonary resuscitation; pediatrics; resuscitation
There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans.
Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children.
Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car.
This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.
smoking; tobacco; pediatrics; family practice; parent; smoking cessation; secondhand smoke; environmental tobacco smoke; tobacco control
The purpose of this research was to report results on long-term administration of dichloroacetate in 36 children with congenital lactic acidosis who participated previously in a controlled trial of this drug.
PATIENTS AND METHODS
We conducted a randomized control trial, followed by an open-label study. Data were analyzed for each patient from the time they began treatment through May 2005.
Subject exposure to dichloroacetate totaled 110.42 years. Median height and weight increased over time, but the standardized values declined slightly and remained below the first percentile. There were no significant changes in biochemical metabolic indices, except for a 2% rise in total protein and a 22% increase in 24-hour urinary oxalate. Both the basal and carbohydrate meal-induced rises in lactate were blunted by dichloroacetate. The median cerebrospinal fluid lactate also decreased over time. Conduction velocity decreased and distal latency increased in peroneal nerves. Mean 3-year survival for all of the subjects was 79%.
Oral dichloroacetate is generally well tolerated in young children with congenital lactic acidosis. Although continued dichloroacetate exposure is associated with evidence of peripheral neuropathy, it cannot be determined whether this is attributable mainly to the drug or to progression of underlying disease.
dichloroacetate; lactic acidosis; mitochondria; pyruvate dehydrogenase; respiratory chain
Early transition from intravenous to oral antimicrobial therapy for acute osteomyelitis in children has been suggested as a safe and effective alternative to traditional prolonged intravenous therapy via central venous catheter, but no studies have directly compared these two treatment modalities. We sought to compare the effectiveness of early transition from intravenous to oral antimicrobial therapy vs. prolonged intravenous antimicrobial therapy for the treatment of children with acute osteomyelitis.
We conducted a retrospective cohort study of children ages 2 months to 17 years diagnosed with acute osteomyelitis between 2000 and 2005 at 29 free-standing children’s hospitals in the United States to confirm the extent of variation in use of early transition to oral therapy. We used a propensity scores to adjust for potential differences between children treated with prolonged intravenous therapy, and logistic regression to model the association of outcome (treatment failure rates within 6 months of diagnosis and difference in the mode of therapy within hospitals and across hospitals.
Of the 1969 children who met inclusion criteria, 1021 received prolonged intravenous therapy and 948 received oral therapy. Use of prolonged intravenous therapy varied significantly across hospitals (10% to 95%, P<0.001). The treatment failure rate was 5% (54 of 1021) in the prolonged intravenous therapy group and 4% (38 of 948) in the oral therapy group. There was no significant association between treatment failure and the mode of antimicrobial therapy (adjusted odds ratio=0.77, 95% confidence interval=0.49 to 1.22). Thirty-five children (3.4%) in the prolonged intravenous therapy group were readmitted for a catheter-associated complication.
Treatment of acute osteomyelitis with early transition to oral therapy is not associated with a higher risk of treatment failures and avoids the risks of prolonged intravenous therapy through central venous catheters.
Osteomyelitis; therapy; children
Single-center studies have suggested that hypovitaminosis D is widespread. Our objective was to determine the serum levels of 25-hydroxyvitamin D (25[OH]D) in a nationally representative sample of US children aged 1 to 11 years.
Data were obtained from the 2001–2006 National Health and Nutrition Examination Survey. Serum 25(OH)D levels were determined by radioimmunoassay and categorized as <25, <50, and <75 nmol/L. National estimates were obtained by using assigned patient visit weights and reported with 95% confidence intervals (CIs).
During the 2001–2006 time period, the mean serum 25(OH)D level for US children aged 1 to 11 years was 68 nmol/L (95% CI: 66 –70). Children aged 6 to 11 years had lower mean levels of 25(OH)D (66 nmol/L [95% CI: 64 –68]) compared with children aged 1 to 5 years (70 nmol/L [95% CI: 68 –73]). Overall, the prevalence of levels at <25 nmol/L was 1% (95% CI: 0.7–1.4), <50 nmol/L was 18% (95% CI: 16–21), and <75 nmol/L was 69% (95% CI: 65–73). The prevalence of serum 25(OH)D levels of <75 nmol/L was higher among children aged 6 to 11 years (73%) compared with children aged 1 to 5 years (63%); girls (71%) compared with boys (67%); and non-Hispanic black (92%) and Hispanic (80%) children compared with non-Hispanic white children (59%).
On the basis of a nationally representative sample of US children aged 1 to 11 years, millions of children may have suboptimal levels of 25(OH)D, especially non-Hispanic black and Hispanic children. More data in children are needed not only to understand better the health implications of specific serum levels of 25(OH)D but also to determine the appropriate vitamin D supplement requirements for children.
vitamin D; deficiency; prevalence; supplementation
The trends in hospitalization rates and risk factors for severe bronchiolitis have not been recently described, especially after the routine implementation of prophylaxis for respiratory syncytial virus (RSV) infections.
To define the burden of hospitalizations related to RSV and non-RSV bronchiolitis in a tertiary-care children’s hospital from 2002 to 2007 and to identify the risk factors associated with severe disease.
Medical records of patients hospitalized for bronchiolitis were reviewed for demographic, clinical, microbiologic, and radiologic characteristics as well as the presence of underlying medical conditions. Differences were evaluated between children with RSV and non-RSV bronchiolitis, and multivariable logistic regression analyses were performed to identify independent risk factors for severe disease.
Bronchiolitis hospitalizations in children younger than 2 years old (n =4800) significantly increased from 536 (3.3%) in 2002 to 1241 (5.5%) in 2007, mainly because of RSV infections. Patients with RSV bronchiolitis (n = 2840 [66%]) were younger at hospitalization and had a lower percentage of underlying medical conditions than children hospitalized with non-RSV bronchiolitis (27 vs 37.5%; P < .001). However, disease severity defined by length of hospitalization and requirement of supplemental oxygen, intensive care, and mechanical ventilation was significantly worse in children with RSV bronchiolitis. RSV infection and prematurity, regardless of the etiology, were identified as independent risk factors for severe bronchiolitis.
There was a significant increase in hospitalizations for RSV bronchiolitis from 2002 to 2007. A majority of the children with RSV bronchiolitis were previously healthy, but their disease severity was worse compared with those hospitalized with non-RSV bronchiolitis.
bronchiolitis; RSV; disease severity; ICD-9
To assess associations among maternal childhood experiences and subsequent parenting attitudes and use of infant spanking (IS), and determine if attitudes mediate the association between physical abuse exposure and IS.
We performed a prospective study of women who received prenatal care at community health centers in Philadelphia, Pennsylvania. Sociodemographic characteristics, adverse childhood experiences (ACEs), attitudes toward corporal punishment (CP), and IS use were assessed via face-to-face interviews, conducted at the first prenatal care visit, 3 months postpartum, and 11 months postpartum. Bivariate and multiple logistic regression analyses were conducted.
The sample consisted of 1265 mostly black, low-income women. Nineteen percent of the participants valued CP as a means of discipline, and 14% reported IS use. Mothers exposed to childhood physical abuse and verbal hostility were more likely to report IS use than those not exposed (16% vs 10%, P = .002; 17% vs 12%, P = .02, respectively). In the adjusted analyses, maternal exposure to physical abuse, other ACEs, and valuing CP were independently associated with IS use. Attitudes that value CP did not mediate these associations.
Mothers who had childhood experiences of violence were more likely to use IS than mothers without such experiences. Intergenerational transmission of CP was evident. Mothers who had experienced physical abuse as a child, when compared to those who had not, were 1.5 times more likely to use IS. Child discipline attitudes and maternal childhood experiences should be discussed early in parenting in order to prevent IS use, particularly among at-risk mothers.
physical punishment; adverse childhood experiences; positive influences in childhood; Adult-Adolescent Parenting Inventory
To determine the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency and associations between 25(OH)D deficiency and cardiovascular risk factors in children and adolescents.
With a nationally representative sample of children aged 1 to 21 years in the National Health and Nutrition Examination Survey 2001–2004 (n = 6275), we measured serum 25(OH)D deficiency and insufficiency (25[OH]D <15 ng/mL and 15–29 ng/mL, respectively) and cardiovascular risk factors.
Overall, 9% of the pediatric population, representing 7.6 million US children and adolescents, were 25(OH)D deficient and 61%, representing 50.8 million US children and adolescents, were 25(OH)D insufficient. Only 4% had taken 400 IU of vitamin D per day for the past 30 days. After multivariable adjustment, those who were older (odds ratio [OR]: 1.16 [95% confidence interval (CI): 1.12 to 1.20] per year of age), girls (OR: 1.9 [1.6 to 2.4]), non-Hispanic black (OR: 21.9 [13.4 to 35.7]) or Mexican-American (OR: 3.5 [1.9 to 6.4]) compared with non-Hispanic white, obese (OR: 1.9 [1.5 to 2.5]), and those who drank milk less than once a week (OR: 2.9 [2.1 to 3.9]) or used >4 hours of television, video, or computers per day (OR: 1.6 [1.1 to 2.3]) were more likely to be 25(OH)D deficient. Those who used vitamin D supplementation were less likely (OR: 0.4 [0.2 to 0.8]) to be 25(OH)D deficient. Also, after multivariable adjustment, 25(OH)D deficiency was associated with elevated parathyroid hormone levels (OR: 3.6; [1.8 to 7.1]), higher systolic blood pressure (OR: 2.24 mm Hg [0.98 to 3.50 mm Hg]), and lower serum calcium (OR: –0.10 mg/dL [–0.15 to –0.04 mg/dL]) and high-density lipoprotein cholesterol (OR: –3.03 mg/dL [–5.02 to –1.04]) levels compared with those with 25(OH)D levels ≥30 ng/mL.
25(OH)D deficiency is common in the general US pediatric population and is associated with adverse cardiovascular risks.
rickets; vitamin D; cardiovascular risk factors; obesity; racial disparities
automatic external defibrillator; cardiopulmonary resuscitation; pediatrics
In this study we examined the relation between mental health problems and weight in a population-based study of youth aged 12 to 17 years and whether the association between mental health problems and weight is moderated by race and ethnicity.
We used 2003 National Survey on Children’s Health data. Logistic regression was used to arrive at adjusted odds ratios showing the relation between BMI and mental health problems.
Compared with their nonoverweight counterparts, both white and Hispanic youth who were overweight were significantly more likely to report depression or anxiety, feelings of worthlessness or inferiority, behavior problems, and bullying of others. Odds ratios relating mental health problems and BMI in black subjects were not statistically significant except for physician diagnosis of depression.
Our results suggest that, when addressing youth overweight status, mental health problems also need to be addressed. Given that the relationship between mental health problems and youth overweight differs according to race/ethnic group, public health programs that target overweight youth should be cognizant of potential comorbid mental health problems and that race/ethnicity may play a role in the relationship between mental health and overweight status.
adolescent health; black; Latino health; mental health; obesity
The goal was to determine the association between cardiovascular risk factors and microalbuminuria in a nationally representative sample of adolescents and to determine whether being overweight modifies this association.
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey(1999–2004) for 2515 adolescents 12 to 19 years of age. Cardiovascular risk factors included abdominal obesity, impaired fasting glucose, diabetes mellitus, insulin resistance, high triglyceride levels, low high-density lipoprotein cholesterol levels, hypertension, smoking, and the metabolic syndrome. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30 to 299 mg/g in a random morning sample. Overweight was defined as BMI of ≥95th percentile, according to the Centers for Disease Control and Prevention 2000 growth charts.
Microalbuminuria was present in 8.9% of adolescents. The prevalence of microalbuminuria was higher among nonoverweight adolescents than among overweight adolescents. The median albumin/creatinine ratio decreased with increasing BMI z scores. The association of microalbuminuria with cardiovascular risk factors differed according to BMI category. Among nonoverweight adolescents, microalbuminuria was not associated with any cardiovascular disease risk factor except for overt diabetes mellitus. Among overweight adolescents, however, microalbuminuria was associated with impaired fasting glucose, insulin resistance, hypertension, and smoking, as well as diabetes mellitus.
For the majority of adolescents, microalbuminuria is not associated with cardiovascular risk factors. Among overweight adolescents, however, microalbuminuria is associated with cardiovascular risk factors. The prognostic importance of microalbuminuria in overweight and nonoverweight adolescents with regard to future cardiovascular and renal disease needs to be defined in prospective studies conducted specifically in children.
adolescents; obesity; cardiovascular risk factors; metabolic syndrome; albuminuria; epidemiology; National Health and Nutrition Examination Survey; Centers for Disease Control and Prevention
Exposure to organophosphate (OP) pesticides is common, and although these compounds have known neurotoxic properties, few studies examined risks for children in the general population.
To examine the association between the concentrations of urinary dialkyl phosphate (DAP) metabolites of OPs and attention deficit/hyperactivity disorder (ADHD) in children age 8 to 15 years.
Participants and Methods
Cross-sectional data from the National Health and Nutrition Examination Survey (2000–2004) were available for 1,139 children representative of the general U.S. population. A structured interview with a parent was used to ascertain ADHD diagnostic status, based on slightly modified criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV.
One hundred nineteen children met the diagnostic criteria for ADHD. Children with higher concentrations of urinary DAPs, especially dimethyl alkylphosphates (DMAP), were more likely to be diagnosed with ADHD. A 10-fold increase in DMAP concentration was associated with an odds ratio (OR) of 1.55 (95% confidence intervals [CI], 1.14–2.10), after adjusting for sex, age, race/ethnicity, poverty-income ratio, fasting duration, and urinary creatinine concentration. For the most commonly detected DMAP metabolite, dimethylthiophosphate, children with levels higher than the median of detectable concentrations had double the odds of ADHD (adjusted OR, 1.93 [95% CI, 1.23–3.02]) compared with those with non-detectable levels.
These findings support the hypothesis that OP exposure, at levels common in U.S. children, may contribute to ADHD prevalence. Prospective studies are needed to establish whether this association is causal.
attention deficit/hyperactivity disorder; ADHD; pesticides; organophosphates; OP; National Health and Nutrition Examination Survey; NHANES; Center for Health Statistics; NCHS; Centers for Disease Control and Prevention; CDC
The goal was to estimate the effectiveness of influenza vaccination against laboratory-confirmed influenza during the 2003–2004 and 2004–2005 influenza seasons in children aged 6-59 months.
We conducted a case-control study in children with a medically attended acute respiratory infection who received care in the inpatient, emergency department or outpatient clinic setting during two consecutive influenza seasons. All children resided in Monroe County, NY, Davidson County, TN or Hamilton County, OH, were prospectively enrolled at the time of acute illness, and had nasal/throat swabs tested for influenza by culture and/or polymerase chain reaction. Children with laboratory-confirmed influenza were cases and children who tested negative for influenza were controls. Child vaccination records from the parent and from the child's physician were used to determine and validate influenza vaccination status. Influenza vaccine effectiveness was calculated as (1 – adjusted odds ratio) × 100.
We enrolled 288 cases and 744 controls during the 2003–2004 season, and 197 cases and 1,305 controls during the 2004–2005 season. Six percent and 19% of all study children were fully vaccinated according to immunization guidelines in the respective seasons. Full vaccination was associated with significantly fewer influenza-related inpatient, emergency department, or outpatient clinic visits in 2004-2005 [vaccine effectiveness = 57% (95% CI: 28%-74%)], but not in 2003-2004 [vaccine effectiveness = 44% (95% CI: -42%-78%)]. Partial vaccination was not effective in either season.
Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children aged 6-59 months in one of two study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.
Children; Vaccine Effectiveness; Laboratory-confirmed; Influenza
The objective of this study was to test whether the experience of childhood sexual abuse is associated with long-term receptive language acquisition and educational attainment deficits for females.
Females with substantiated familial childhood sexual abuse (n = 84) and a nonabused comparison group (n = 102) were followed prospectively for 18 years. Receptive language ability was assessed at 6 time points across distinct stages of development, including childhood, adolescence, and young adulthood. Rates of high school graduation and total educational attainment were assessed during young adulthood.
Hierarchical linear modeling revealed that receptive language did not differ between the groups at the initial assessment point in childhood; however, a significant group by time interaction was observed across development with abused females (1) acquiring receptive language at a significantly slower rate throughout development and (2) achieving a lower overall maximum level of proficiency. Significant differences in receptive language scores emerged as early as midadolescence. In addition, abused females reported significantly lower rates of high school graduation and lower overall educational attainment when compared with their nonabused peers.
Exposure to childhood sexual abuse may be a significant risk factor for cognitive performance and achievement deficits for victims. These findings have particular public health relevance given the high prevalence of sexual abuse and that poor cognitive functioning and low levels of educational attainment can contribute to continued adversity throughout the life course. Early intervention may assist victims in improving cognitive functioning, altering deleterious trajectories, and promoting greater life successes.
childhood abuse; cognitive development; educational attainment
There is concern about the potential for negative impact of video games on youth. However the existing literature on gaming is inconsistent and has often focused on aggression. Health correlates of gaming and the prevalence and correlates of problematic gaming have not been systematically studied. We anonymously surveyed 4,028 adolescents about gaming, reported problems with gaming, and other health behaviors. 51.2% of the sample reported gaming (76.3% of boys and 29.2% of girls). There were no negative health correlates of gaming in boys, and lower odds of smoking regularly; however, girls who reported gaming were less likely to report depression, and more likely to report getting into serious fights and carrying a weapon to school. Among gamers, 4.9% reported problematic gaming, defined as reporting trying to cut back, experiencing an irresistible urge to play, and experiencing a growing tension that could only be relieved by playing. Boys were more likely to report these problems (5.8%) than girls (3.0%). Correlates of problematic gaming included regular cigarette smoking, drug use, depression, and serious fights. Results suggest that gaming is largely normative in boys and not associated with many health factors. In girls, however, gaming appears associated with more externalizing behaviors and fewer internalizing symptoms. The prevalence of problematic gaming is low but not insignificant, and problematic gaming may be contained within a larger spectrum of externalizing behaviors. More research is needed to define safe levels of gaming, refine the definition of problematic gaming, and evaluate effective prevention and intervention strategies.
impulse control disorders; adolescents; video gaming; risk behaviors; gender
To determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004–2005 influenza season, the first season for the universal influenza vaccination recommendation for all children aged 6–23 months.
Clinical and demographic data from randomly selected children aged 6–23 months were obtained by chart review from a community-based cohort study in three U.S. counties. The proportion of children vaccinated by April 5, 2005 in each practice was obtained. To assess practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics predicting complete influenza vaccination were determined using multinomial logistic regression.
Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children aged 6–23 months who were studied, 27% were completely vaccinated. The proportion of children completely vaccinated varied widely among practices (0–71%). Most practices (87%) implemented ≥ 1 vaccination strategy (year-round discussion with parents about influenza vaccine, evening/weekend influenza vaccine clinics, standing orders, or saving a second dose for children who had received the first of two recommended doses). Complete influenza vaccination was associated with three practice characteristics-- suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; and with child characteristics of younger age, existing high-risk conditions, ≥ 6 well visits to the practice by age 3 years, and any practice visit from October through January.
Modifiable factors associated with increased influenza vaccination coverage include October-January practice visits and evening/weekend vaccine clinics.
influenza vaccine; vaccine coverage; strategies; practices; children
Adult hypertension is independently associated with elevated C-reactive protein (CRP) after controlling for obesity and other cardiovascular risk factors. The objective of the current study was to determine in a nationally representative sample of children whether the relationship between elevated blood pressure and CRP may be evident prior to adulthood.
Patients and Methods
Cross-sectional data for children 8 to 17 years who participated in NHANES from 1999 to 2004 were analyzed. Bivariate analysis compared children with CRP > 3 mg/L to those with CRP ≤ 3 mg/L for BP and other cardiovascular risk factors. Multiple linear regression was used to evaluate the relation between elevated BP and CRP.
Among 6112 children, 3% had systolic BP ≥ 95th percentile and 1.3% had diastolic BP ≥ 95th percentile. Children with CRP > 3 mg/L had higher SBP compared to children with CRP ≤ 3 mg/L (109 mm vs 105 mm Hg, p < 0.001). Obesity, HDL cholesterol < 40 mg/dl, and Hispanic ethnicity were independent predictors of elevated CRP. Diastolic BP did not differ between groups. Linear regression showed that SBP ≥ 95th percentile was independently associated with CRP in males (p = 0.018), but not females (p = 0.94). Subset analysis by race/ethnicity demonstrated that the independent association of elevated SBP with CRP to be largely limited to Black males (p = 0.01).
These data indicate that there is interplay between race/ethnicity, elevated SBP, obesity, and inflammation in children, a finding that has potential implications for disparities in cardiovascular disease later in life.
C-reactive protein; inflammation; ethnicity; hypertension; NHANES
We examined whether the risk for psychiatric morbidity requiring inpatient care was higher in offspring who experienced parental suicide compared to offspring who experienced parental fatal accidents, and if the association varied by the deceased parent’s gender.
Subjects and Methods
Children and adolescents (age 0-17 years) who experienced maternal (n=5,600) or paternal suicide (n=17,847) during 1973-2003 in Sweden were identified using national, longitudinal population-based registries. Cox regression modeling was used to compare psychiatric hospitalization risks among offspring of suicide decedents with propensity-matched offspring of accident decedents.
Offspring of maternal suicide decedents had increased risk of hospitalization for suicide attempt after controlling for psychiatric hospitalization in decedents and surviving parents, compared to offspring of maternal accidental decedents. Offspring of paternal suicide decedents had similar risk of hospitalization for suicide attempt compared to offspring of accident decedents but had increased risk of hospitalization for depressive and anxiety disorders. The magnitude of risks for offspring hospitalization for suicide attempt was greater for those who experienced maternal versus paternal suicide, as compared to their respective controls (interaction p=0.05) [AHR (95%CI) = 1.80 (1.19-2.74) in offspring of maternal decedents vs. 1.14 (0.96-1.35) in offspring of paternal decedents].
Maternal suicide is associated with increased risk of hospitalization for suicide attempt in offspring, beyond the risk associated with maternal accidental death. However, paternal suicide is not associated with hospitalization for suicide attempt. Future studies should examine factors that might differ between offspring who experience maternal versus paternal suicide, including genetic or early environmental determinants.
suicide; attempted; mental disorders; parent-child relations; death; parents; mothers; fathers
To compare the health related quality of life (HRQOL) of children with chronic kidney disease (CKD) to healthy children; to evaluate the association between CKD severity and HRQOL; to identity demographic, socioeconomic and health-status variables associated with impairment in HRQOL in children with mild to moderate CKD.
Patients and Methods
This is a cross-sectional assessment of HRQOL in children aged 2-16 with mild to moderate CKD using the Varni PedsQL™. Overall HRQOL and PedsQL domain means for parents and youth were compared to previously published norms using independent sample t-tests. Study participants were categorized according to kidney disease stage (measured by iohexol based glomerular filtration rate, iGFR) and group differences in HRQOL were evaluated using ANOVA and Cuzick trend tests. The association between hypothesized predictors of HRQOL and PedsQL scores was evaluated with linear and logistic regression analyses.
The study sample was comprised of 402 participants (Mean age =11 yrs, 60% male, 70% Caucasian, 40% anemic, median iGFR=42.5 ml/min/1.73m2, median CKD duration= 7 yrs). Youth with CKD had significantly lower physical, school, emotional and social domain scores than healthy youth (p<.001). IGFR was not associated with HRQOL. Longer disease duration and older age was associated with higher PedsQL scores in the domains of physical, emotional and social functioning (p<.05). Older age was associated with lower school functioning domain scores (p<.05). Maternal education ≥16 years was associated with higher PedsQL scores in the domains of physical, school, and social functioning (p<.05). Short stature was associated with lower scores in the physical functioning domain (p<.05).
Children with mild to moderate CKD, in comparison to healthy children, report poorer overall HRQOL as well as poorer physical, school, emotional and social functioning. Early intervention to improve linear growth and to address school functioning difficulties is recommended.
HRQOL; kidney disease; QOL; short-stature
To examine the association of cigarette smoking and weight concerns in adolescents, given that adolescents may begin smoking or have difficulty quitting due to their expectancies of the effects of smoking on body weight.
The current study utilized data from a cross-sectional survey of 4,523 Connecticut high school adolescents to assess the influence of gender, smoking intensity and dietary restrictive behavior on smoking related weight concerns.
Heavy smokers were significantly less likely to engage in healthy dietary restrictions than nonsmokers; however, light smokers did not differ from nonsmokers. Both light and heavy smokers were significantly more likely to engage in unhealthy dietary restriction, when compared to nonsmokers. In the model examining smokers only, heavy smokers were significantly less likely to engage in healthy dietary restriction than light smokers, but smoking level was not associated with unhealthy dietary restrictions. Dietary restrictions are significantly associated with smoking- related weight concerns; however, this appears to be related to type of dietary restrictive behavior, with greater weight concerns observed only in those smokers who engaged in unhealthy dietary restrictions and not in those who engaged in healthy dietary restrictions or no restrictions.
Although limited by its cross-sectional nature, the findings from this large geographically diverse sample have clinical implications for smoking prevention and cessation interventions in adolescents.
Adolescence; Smoking; Dietary habits; Weight management
Our aim was to quantify contemporary infant mortality risks and to evaluate the change by plurality, gestation, and race during the most recent decade.
PATIENTS AND METHODS
The study population included live births of 20 to 43 weeks’ gestation from the 1989–1991 and 1999–2001 US Birth Cohort Linked Birth/ Infant Death Data Sets, including 11 317 895 and 11 181 095 live births and 89 823 and 67 129 infant deaths, respectively. Adjusted odds ratios and 95% confidence intervals were calculated to evaluate the change in risk by plurality and gestation and to compare the change with that for singletons.
Overall, the infant mortality risk decreased significantly for singletons, twins, and triplets but nonsignificantly for quadruplets and quintuplets. Compared with singletons, significantly greater reductions were experienced by twins overall and at <37 weeks and triplets at <29 weeks. The largest reduction was for triplets at 20 to 24 weeks and for quadruplets and quintuplets at 25 to 28 weeks. For white infants, significant reductions were achieved overall for singletons, twins, and triplets and at every gestation. For black infants, significant reductions occurred for singletons overall and at every gestation, for twins at <37 weeks, and for triplets at 25 to 28 weeks. Compared with white infants, black infants had significantly lower risks before and higher risks after 33 weeks, although between 1989–1991 and 1999–2001 this survival advantage at earlier ages diminished, and the risk at later gestations increased.
The improvements in survival were greater for multiples versus singletons and for white versus black infants. Within each plurality, at each gestation the racial disparity in mortality has widened.
infant mortality; birth weight; gestation; plurality; racial disparities
The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use.
PATIENTS AND METHODS
A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children’s hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations.
Forty-eight percent of children were ≤6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P≤.01), less decannulation (5.0% vs 11.0%; P≤.01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P≤.01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors.
Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.
tracheotomy; children; mortality; hospitalization; health services; outcomes
To explore associations of maternal prenatal smoking and child psychological problems and determine the role of causal intrauterine mechanisms.
Patients and Methods
Maternal smoking and child psychological problems were explored in 2 birth cohorts in Pelotas, Brazil (n=509; random sub-sample) and Avon Longitudinal Study of Parents and Children (ALSPAC), Britain (n=6,735). Four approaches for exploring causal mechanisms were applied: 1) cross-population comparisons between a high-income and a middle-income country, 2) multiple adjustment for socioeconomic and parental psychological factors, 3) maternal-paternal comparisons as a test of putative intrauterine effects; and 4) search for specific effects on different behavioural subscales.
Socioeconomic patterning of maternal prenatal smoking was stronger in the ALSPAC compared with the Pelotas cohort. Despite this difference in a key confounder, consistency in observed associations was found between these cohorts. In both cohorts, unadjusted, maternal smoking was associated with greater offspring hyperactivity, conduct/externalizing problems, and peer problems, but not with emotional/internalizing problems. After adjusting for confounders and paternal prenatal smoking, only the association with conduct/externalizing problems persisted in both cohorts (conduct problems in the ALSPAC cohort, odds ratio OR: 1.24 [95% confidence interval (CI): 1.07–1.46], p= .005; externalizing problems in the Pelotas cohort, OR:1.82 [95% CI:1.19–2.78], p=.005; ORs reflect ordinal ORs of maternal smokers having offspring with higher scores). Maternal smoking associations were stronger than paternal smoking associations, although statistical evidence for differences was weak in 1 cohort.
Evidence from 4 approaches suggests a possible intrauterine effect of maternal smoking on offspring conduct/externalizing problems.
ALSPAC; Pelotas; prenatal smoking; child; behavioral problems; developmental origins