Showing papers in "JAMA Pediatrics in 2011"

Whole-Body Hypothermia for Term and Near-Term Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Controlled Trial

Abstract: Objective: To determine the effectiveness and safety of moderate whole-body hypothermia in newborns with hypoxic-ischemic encephalopathy born in hospitals with and without newborn intensive care facilities or complicated hypothermia equipment.

A National Profile of Caregiver Challenges Among More Medically Complex Children With Special Health Care Needs

Abstract: Objectives To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront. Design Secondary analysis of the 2005-2006 National Survey of Children With Special Health Care Needs (unweighted n = 40 723). Setting United States–based population. Participants National sample of CSHCN. Main Exposure More complex CSHCN were defined by incorporating components of child health and family need, including medical technology dependence and care by 2 or more subspecialists. Main Outcome Measures Caregiver challenges were defined by family-reported care burden (including hours providing care coordination and home care), medical care use (on the basis of health care encounters in the last 12 months), and unmet needs (defined by 15 individual medical care needs and a single nonmedical service need). Results Among CSHCN, 3.2% (weighted n = 324 323) met criteria for more complex children, representing 0.4% of all children in the United States. Caregivers of more complex CSHCN reported a median of 2 (interquartile range, 1-6) hours per week on care coordination and 11 to 20 (interquartile range, 3->21) hours per week on direct home care. More than half (56.8%) reported financial problems, 54.1% reported that a family member stopped working because of the child's health, 48.8% reported at least 1 unmet medical service need, and 33.1% reported difficulty in accessing nonmedical services. Conclusions Extraordinary and diverse needs are common among family caregivers of more complex CSHCN. Enhanced care coordination support, respite care, and direct home care may begin to address the substantial economic burden and the multiple unmet needs that many of these families face.

Community Treatment of Posttraumatic Stress Disorder for Children Exposed to Intimate Partner Violence: A Randomized Controlled Trial

Abstract: OBJECTIVE: To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms. DESIGN: Randomized controlled trial conducted using blinded evaluators. SETTING: Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009. PARTICIPANTS: Of 140 consecutively referred 7- to 14-year-old children, 124 participated. INTERVENTIONS: Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy). MAIN OUTCOME MEASURES: Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems). RESULTS: Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events. CONCLUSIONS: Community TF-CBT effectively improves children's IPV-related PTSD and anxiety. Trial Registration clinicaltrials.gov Identifier: NCT00183326. Language: en

Post–High School Service Use Among Young Adults With an Autism Spectrum Disorder

Abstract: Objectives To produce nationally representative population estimates of rates of service use among young adults with an autism spectrum disorder during their first few years after leaving high school and to examine correlates of use. Design Nationally representative telephone survey from April 2007 to February 2008. Setting United States. Participants Parents and guardians of young adults with autism spectrum disorders aged 19 to 23 years. Main Exposure Autism spectrum disorder. Main Outcome Measures Use of the following services in the prior 2 years or since leaving high school: mental health services, medical evaluation and assessment, speech therapy, and case management. Results Rates of service use ranged from 9.1% for speech therapy to 41.9% for case management; 39.1% of youths with an autism spectrum disorder represented by the survey received no services. The adjusted odds of no services were higher among African American participants and those with low incomes. The adjusted odds of case management were lower among youths with high functional skills and those with low incomes. Conclusions Rates of service disengagement are high after exiting high school. Disparities by race and socioeconomic status indicate a need for targeted outreach and services.

Corticostriatal-Limbic Gray Matter Morphology in Adolescents With Self-reported Exposure to Childhood Maltreatment

Abstract: Objective To study the relationship between self-reported exposure to childhood maltreatment (CM) and cerebral gray matter (GM) morphology in adolescents without psychiatric diagnoses. Design Associations were examined between regional GM morphology and exposure to CM (measured using a childhood trauma self-report questionnaire for physical, emotional, and sexual abuse and for physical and emotional neglect). Setting University hospital. Participants Forty-two adolescents without psychiatric diagnoses. Main Outcome Measures Correlations between childhood trauma self-report questionnaire scores and regional GM volume were assessed in voxel-based analyses of structural magnetic resonance images. Relationships among GM volume, subtypes of exposure to CM, and sex were explored. Results Childhood trauma self-report questionnaire total scores correlated negatively (P Conclusions Exposure to CM was associated with corticostriatal-limbic GM reductions in adolescents. Even if adolescents reporting exposure to CM do not present with symptoms that meet full criteria for psychiatric disorders, they may have corticostriatal-limbic GM morphologic alterations that place them at risk for behavioral difficulties. Vulnerabilities may be moderated by sex and by subtypes of exposure to CM.

Maternal influenza vaccination and effect on influenza virus infection in young infants.

Abstract: Objective To assess the effect of seasonal influenza vaccination during pregnancy on laboratory-confirmed influenza in infants to 6 months of age. Design Nonrandomized, prospective, observational cohort study. Setting Navajo and White Mountain Apache Indian reservations, including 6 hospitals on the Navajo reservation and 1 on the White Mountain Apache reservation. Participants A total of 1169 mother-infant pairs with mothers who delivered an infant during 1 of 3 influenza seasons. Main Exposure Maternal seasonal influenza vaccination. Main Outcome Measures In infants, laboratory-confirmed influenza, influenzalike illness (ILI), ILI hospitalization, and influenza hemagglutinin inhibition antibody titers. Results A total of 1160 mother-infant pairs had serum collected and were included in the analysis. Among infants, 193 (17%) had an ILI hospitalization, 412 (36%) had only an ILI outpatient visit, and 555 (48%) had no ILI episodes. The ILI incidence rate was 7.2 and 6.7 per 1000 person-days for infants born to unvaccinated and vaccinated women, respectively. There was a 41% reduction in the risk of laboratory-confirmed influenza virus infection (relative risk, 0.59; 95% confidence interval, 0.37-0.93) and a 39% reduction in the risk of ILI hospitalization (relative risk, 0.61; 95% confidence interval, 0.45-0.84) for infants born to influenza-vaccinated women compared with infants born to unvaccinated mothers. Infants born to influenza-vaccinated women had significantly higher hemagglutinin inhibition antibody titers at birth and at 2 to 3 months of age than infants of unvaccinated mothers for all 8 influenza virus strains investigated. Conclusions Maternal influenza vaccination was significantly associated with reduced risk of influenza virus infection and hospitalization for an ILI up to 6 months of age and increased influenza antibody titers in infants through 2 to 3 months of age.

Randomized Controlled Trial to Improve Primary Care to Prevent and Manage Childhood Obesity: The High Five for Kids Study

Abstract: Objective To examine the effectiveness of a primary care–based obesity intervention over the first year (6 intervention contacts) of a planned 2-year study. Design Cluster randomized controlled trial. Setting Ten pediatric practices, 5 intervention and 5 usual care. Participants Four hundred seventy-five children aged 2 to 6 years with body mass index (BMI) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight; 445 (93%) had 1-year outcomes. Intervention Intervention practices received primary care restructuring, and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake. Outcome Measures Change in BMI and obesity-related behaviors from baseline to 1 year. Results Compared with usual care, intervention participants had a smaller, nonsignificant change in BMI (−0.21; 95% confidence interval [CI], −0.50 to 0.07; P = .15), greater decreases in television viewing (−0.36 h/d; 95% CI, −0.64 to −0.09; P = .01), and slightly greater decreases in fast food (−0.16 serving/wk; 95% CI, −0.33 to 0.01; P = .07) and sugar-sweetened beverage (−0.22 serving/d; 95% CI, −0.52 to 0.08; P = .15) intake. In post hoc analyses, we observed significant effects on BMI among girls (−0.38; 95% CI, −0.73 to −0.03; P = .03) but not boys (0.04; 95% CI, −0.55 to 0.63; P = .89) and among participants in households with annual incomes of $50 000 or less (−0.93; 95% CI, −1.60 to −0.25; P = .01) but not in higher-income households (0.02; 95% CI, −0.30 to 0.33; P = .92). Conclusion After 1 year, the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI. Trial Registration clinicaltrials.gov Identifier: NCT00377767

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools: Cluster Randomized Controlled Trial

Abstract: Objective To determine the effectiveness of coach-led neuromuscular warm-up on reducing lower extremity (LE) injuries in female athletes in a mixed-ethnicity, predominantly low-income, urban population. Design Cluster randomized controlled trial. Setting Chicago public high schools. Participants Of 258 coaches invited to participate, 95 (36.8%) enrolled (1558 athletes). Ninety coaches and 1492 athletes completed the study. Interventions We randomized schools to intervention and control groups. We trained intervention coaches to implement a 20-minute neuromuscular warm-up. Control coaches used their usual warm-up. Main Outcome Measures Coach compliance was tracked by self-report and direct observation. Coaches reported weekly athlete exposures (AEs) and LE injuries causing a missed practice or game. Research assistants interviewed injured athletes. Injury rates were compared between the control and intervention groups using χ 2 and Fisher exact tests. Significance was set at P Results There were 28 023 intervention AEs and 22 925 control AEs. Intervention coaches used prescribed warm-up in 1425 of 1773 practices (80.4%). Intervention athletes had lower rates per 1000 AEs of gradual-onset LE injuries (0.43 vs 1.22, P P P = .01), and LE injuries treated surgically (0 vs 0.17, P = .04). Regression analysis showed significant incidence rate ratios for acute-onset noncontact LE injuries (0.33; 95% CI, 0.17-0.61), noncontact ankle sprains (0.38; 95% CI, 0.15-0.98), noncontact knee sprains (0.30; 95% CI, 0.10-0.86), and noncontact anterior cruciate ligament injuries (0.20; 95% CI, 0.04-0.95). Conclusion Coach-led neuromuscular warm-up reduces noncontact LE injuries in female high school soccer and basketball athletes from a mixed-ethnicity, predominantly low-income, urban population. Trial Registration clinicaltrials.org Identifier:NCT01092286

Energy Cost of Exergaming A Comparison of the Energy Cost of 6 Forms of Exergaming

Abstract: Objective To determine the relative effect of interactive digital exercise that features player movement (ie, exergames) on energy expenditure among children of various body mass indexes (BMIs; calculated as weight in kilograms divided by height in meters squared). Design Comparison study. Setting GoKids Boston, a youth fitness research and training center located at University of Massachusetts, Boston. Participants Thirty-nine boys and girls (mean [SD] age, 11.5 [2.0] years) recruited from local schools and after-school programs. Main Exposure Six forms of exergaming as well as treadmill walking. Main Outcome Measures In addition to treadmill walking at 3 miles per hour (to convert miles to kilometers, multiply by 1.6), energy expenditure of the following exergames were examined: Dance Dance Revolution, LightSpace (Bug Invasion), Nintendo Wii (Boxing), Cybex Trazer (Goalie Wars), Sportwall, and Xavix (J-Mat). Energy expenditure was measured using the CosMed K4B2 portable metabolic cart. Results All forms of interactive gaming evaluated in our study increased energy expenditure above rest, with no between-group differences among normal (BMI Conclusion All games used in our study elevated energy expenditure to moderate or vigorous intensity. Exergaming has the potential to increase physical activity and have a favorable influence on energy balance, and may be a viable alternative to traditional fitness activities for children of various BMI levels.

Comparative efficacy and safety of 4 randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis.

Abstract: Objective To investigate the efficacy and safety of 4 antipseudomonal treatments in children with cystic fibrosis with recently acquired Pseudomonas aeruginosa infection. Design Randomized controlled trial. Setting Multicenter trial in the United States. Participants Three hundred four children with cystic fibrosis aged 1 to 12 years within 6 months of P aeruginosa detection. Interventions Participants were randomized to 1 of 4 antibiotic regimens for 18 months (six 12-week quarters) between December 2004 and June 2009. Participants randomized to cycled therapy received tobramycin inhalation solution (300 mg twice a day) for 28 days, with oral ciprofloxacin (15-20 mg/kg twice a day) or oral placebo for 14 days every quarter, while participants randomized to culture-based therapy received the same treatments only during quarters with positive P aeruginosa cultures. Main Outcome Measures The primary end points were time to pulmonary exacerbation requiring intravenous antibiotics and proportion of P aeruginosa –positive cultures. Results The intention-to-treat analysis included 304 participants. There was no interaction between treatments. There were no statistically significant differences in exacerbation rates between cycled and culture-based groups (hazard ratio, 0.95; 95% confidence interval [CI], 0.54-1.66) or ciprofloxacin and placebo (hazard ratio, 1.45; 95% CI, 0.82-2.54). The odds ratios of P aeruginosa– positive culture comparing the cycled vs culture-based group were 0.78 (95% CI, 0.49-1.23) and 1.10 (95% CI, 0.71-1.71) comparing ciprofloxacin vs placebo. Adverse events were similar across groups. Conclusions No difference in the rate of exacerbation or prevalence of P aeruginosa positivity was detected between cycled and culture-based therapies. Adding ciprofloxacin produced no benefits. Trial Registration ClinicalTrials.gov Identifier: NCT00097773.

Problematic Internet Use Among US Youth: A Systematic Review

Abstract: Objective To investigate study quality and reported prevalence among the emergent area of problematic Internet use (PIU) research conducted in populations of US adolescents and college students. Data Sources We searched PubMed, PsycINFO, and Web of Knowledge from inception to July 2010. Study Selection Using a keyword search, we evaluated English-language PIU studies with populations of US adolescents and college students. Main Outcome Measures Using a quality review tool based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, 2 reviewers independently extracted data items including study setting, subject population, instrument used, and reported prevalence. Results Search results yielded 658 articles. We identified 18 research studies that met inclusion criteria. Quality assessment of studies ranged between 14 and 29 total points of a possible 42 points; the average score was 23 (SD 5.1). Among these 18 studies, 8 reported prevalence estimates of US college student PIU; prevalence rates ranged from 0% to 26.3%. An additional 10 studies did not report prevalence. Conclusions The evaluation of PIU remains incomplete and is hampered by methodological inconsistencies. The wide range of conceptual approaches may have impacted the reported prevalence rates. Despite the newness of this area of study, most studies in our review were published more than 3 years ago. Opportunities exist to pursue future studies adhering to recognized quality guidelines, as well as applying consistency in theoretical approach and validated instruments.

Crossing growth percentiles in infancy and risk of obesity in childhood

Abstract: Objective To examine the associations of upward crossing of major percentiles in weight-for-length in the first 24 months of life with the prevalence of obesity at ages 5 and 10 years. Design Longitudinal study. Setting Multisite clinical practice. Participants We included 44 622 children aged from 1 month to less than 11 years with 122 214 length/height and weight measurements from January 1, 1980, through December 31, 2008. Main Exposure The number of major weight-for-length percentiles crossed during each of four 6-month intervals, that is, 1 to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months. Main Outcome Measures Odds and observed prevalence of obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥95th percentile) at ages 5 and 10 years. Results Crossing upwards 2 or more weight-for-length percentiles was common in the first 6 months of life (43%) and less common during later age intervals. Crossing upwards 2 or more weight-for-length percentiles in the first 24 months was associated with elevated odds of obesity at ages 5 years (odds ratio, 2.08; 95% CI, 1.84-2.34) and 10 years (1.75; 1.53-2.00) compared with crossing less than 2 major percentiles. Obesity prevalence at ages 5 and 10 was highest among children who crossed upwards 2 or more weight-for-length percentiles in the first 6 months of life. Conclusions Crossing upwards 2 or more major weight-for-length percentiles in the first 24 months of life is associated with later obesity. Upward crossing of 2 weight-for-length percentiles in the first 6 months is associated with the highest prevalence of obesity 5 and 10 years later. Efforts to curb excess weight gain in infancy may be useful in preventing later obesity.

Clostridium difficile Infection in Hospitalized Children in the United States

Abstract: Clostridium difficile is a gram-positive, spore-forming, anaerobic bacillus that can colonize the gastrointestinal tract and can lead to Clostridium difficile infection (CDI). CDI has a wide variation in severity, ranging from asymptomatic colonization to severe diarrhea, pseudomembranous colitis, toxic megacolon, bowel perforation and death. In recent years, the incidence, number of hospitalizations, associated deaths and severity of CDI in adults has been increasing.1, 2 The increased rate and severity of CDI have been observed in conjunction with the description of hypervirulent strains of C. difficile that have resistance to antibiotics such as fluoroquinolones and third generation cephalosporins, hypersecrete toxins A and B, and secrete an additional toxin known as binary toxin.3, 4 The hypervirulent strain known as North American Pulsed Field type 1 (NAP1) occurs in 19.4 percent of pediatric patients and is associated with more complications in children.5–8 However, much of the increased frequency and severity of CDI may be due to factors other than the emergence of hypervirulent strains. In previous nationwide studies, CDI rates have been highest in elderly and urban populations.1, 9 More recent reports describe severe CDI in children and young, previously healthy patients without hospital exposure.10, 11 There have been two studies showing an increasing CDI trend in children over recent years.12, 13 However, little is known about the impact and trend in severity of CDI in children. There are several known risk factors for the development of CDI, including medication administration, i.e., antibiotics, acid suppression medication, and chemotherapy.14–17 In adults, conditions such as inflammatory bowel disease (IBD) and human stem cell transplantation are associated with CDI.18, 19 Children with solid tumors, organ transplantation, and IBD are also at increased risk.20–22 While these studies have examined the relationship of CDI in subgroups of patients, there have been no broad investigations of clinical and demographic risk factors for CDI in children. Utilizing a large national database, we sought to identify risk factors associated with CDI in hospitalized children and to evaluate the impact and trends on the incidence and severity of the disease.

Physical activity during youth sports practices

Abstract: OBJECTIVE: To document physical activity (PA) during organized youth soccer and baseball/softball practices. DESIGN: Cross-sectional study. SETTING: Community sports leagues in San Diego County, California. PARTICIPANTS: Two hundred youth aged 7 to 14 years were recruited from 29 teams in 2 youth sports in middle-income cities with an approximately equal distribution across sports, sex, and age groups. Main Exposure Youth sports practices. OUTCOME MEASURES: A sample of players wore accelerometers during practices. Minutes of PA at multiple intensity levels were calculated using established cutoff points. Participants were categorized as meeting or not meeting guidelines of at least 60 minutes of moderate to vigorous PA (MVPA) during practice. RESULTS: The overall mean for MVPA was 45.1 minutes and 46.1% of practice time. Participants on soccer teams (+13.7 minutes, +10.6% of practice time), boys (+10.7 minutes, +7.8% of practice time), and those aged 7 to 10 years (+7.0 minutes, +5.8% of practice time) had significantly more MVPA than their counterparts. Participants on soccer teams spent an average of 17.0 more minutes and 15.9% more of practice time in vigorous-intensity PA than those on baseball/softball teams. Overall, 24% of participants met the 60-minute PA guideline during practice, but fewer than 10% of 11-to 14-year-olds and 2% of girl softball players met the guideline. CONCLUSIONS: Participation in organized sports does not ensure that youth meet PA recommendations on practice days. The health effects of youth sports could be improved by adopting policies that ensure participants obtain PA during practices. Language: en

Interventions to Reduce Sexual Risk for Human Immunodeficiency Virus in Adolescents: A Meta-analysis of Trials, 1985-2008

Abstract: Objective To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents. Design We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included. Setting Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes. Participants Data from 98 interventions (51 240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it. Main Outcome Measures Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs). Results Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time. Conclusions Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Effectiveness of interventions aimed at reducing screen time in children: a systematic review and meta-analysis of randomized controlled trials.

Abstract: Objective To evaluate the impact of interventions focused on reducing screen time. Data Sources Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, and CINAHL through April 21, 2011. Study Selection Included studies were randomized controlled trials of children aged 18 years or younger with interventions that focused on reducing screen time. Intervention Efforts to reduce screen time. Main Outcome Measures The primary outcome was body mass index (BMI); the secondary outcome was screen time (hours per week). Results A total of 1120 citations were screened, and 13 studies were included in the systematic review. Study samples ranged in age (3.9-11.7 years) and size (21-1295 participants). Interventions ranged in length (1-24 months) and recruitment location (5 in schools, 2 in medical clinics, 1 in a community center, and 5 from the community). For the primary outcome, the meta-analysis included 6 studies, and the difference in mean change in BMI in the intervention group compared with the control group was −0.10 (95% confidence interval [CI], −0.28 to 0.09) (P = .32). The secondary outcome included 9 studies, and the difference in mean change from baseline in the intervention group compared with the control group was −0.90 h/wk (95% CI, −3.47 to 1.66 h/wk) (P = .49). A subgroup analysis of preschool children showed a difference in mean change in screen time of −3.72 h/wk (95% CI, −7.23 to −0.20 h/wk) (P = .04). Conclusions Our systematic review and meta-analysis did not demonstrate evidence of effectiveness of interventions aimed at reducing screen time in children for reducing BMI and screen time. However, interventions in the preschool age group hold promise.

Secondhand smoke exposure and mental health among children and adolescents

Abstract: Objective To examine a potential association between biologically confirmed secondhand smoke exposure and symptoms of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) major depressive disorder, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, and conduct disorder using a nationally representative sample of US children and adolescents.

Developmental Trajectories of Body Mass Index in Early Childhood and Their Risk Factors: An 8-Year Longitudinal Study

Abstract: Objectives To identify groups of children with distinct developmental trajectories of body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, between the ages of 5 months and 8 years and identify early-life risk factors that distinguish children in an atypically elevated BMI trajectory group. Design Prospective cohort study. Setting Families with a child born between October 1997 and July 1998 in the province of Quebec, Canada. Participants A representative sample of children (N = 2120) selected through birth registries for the Quebec Longitudinal Study of Child Development. Children for whom BMI data were available for at least 5 time points were retained in the present study (n = 1957). Main Exposures Early-life factors putatively associated with BMI, assessed by maternal report. Outcome Measure Group-based trajectories of children's BMI, identified with a semiparametric modeling method from raw BMI values at each age. Results Three trajectories of BMI were identified: low-stable (54.5% of children), moderate (41.0%), and high-rising (4.5%). The high-rising group was characterized by an increasing average BMI, which exceeded international cutoff values for obesity by age 8 years. Two maternal risk factors were associated with the high-rising group as compared with the low-stable and moderate groups combined: maternal BMI (odds ratio, 2.38; 95% confidence interval, 1.38-4.54 for maternal overweight and 6.33; 3.82-11.85 for maternal obesity) and maternal smoking during pregnancy (2.28; 1.49-4.04). Conclusions Children continuing on an elevated BMI trajectory leading to obesity in middle childhood can be distinguished from children on a normative BMI trajectory as early as age 3.5 years. Important and preventable risk factors for childhood obesity are in place before birth.

A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure.

Abstract: Objective: To test an air cleaner and health coach intervention to reduce secondhand smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter (PM), air nicotine, and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker Design: Randomized controlled trial, with randomization embedded in study database Settings: The Johns Hopkins Hospital Children’s Center and homes of children Participants: Children with asthma, residing with a smoker, randomly assigned to interventions consisting of air cleaners only (n=41), air cleaners plus a health coach (n=41), or delayed air cleaner (control) (n=44) Main Outcome Measures: Changes in PM, air nico

Nonmedical Prescription Drug Use in a Nationally Representative Sample of Adolescents Evidence of Greater Use Among Rural Adolescents

Abstract: OBJECTIVES: To compare the prevalence of nonmedical prescription drug use among adolescents residing in urban, suburban, and rural areas of the United States and to determine factors independently associated with rural nonmedical prescription drug use among adolescents aged 12 to 17 years. DESIGN: Cross-sectional, population-based survey. SETTING: Noninstitutionalized residents in the United States. PARTICIPANTS: Participants included adolescents aged 12 to 17 years (N = 17 872), most of whom were residing in urban areas (53.2%), male (51%), and white (59%). Main Exposure Living in rural compared with urban area. MAIN OUTCOME MEASURES: Nonmedical use of prescription drugs (pain relievers, tranquilizers, sedatives, and stimulants). Data were from the 2008 National Survey on Drug Use and Health. RESULTS: Rural adolescents were 26% more likely than urban adolescents to have used prescription drugs nonmedically (adjusted odds ratio, 1.26; 95% confidence interval, 1.01-1.57) even after adjustment for race, health, and other drug and alcohol use. When examining the rural adolescents in particular, factors positively associated with nonmedical use of prescription drugs included decreased health status, major depressive episode(s), and other drug (marijuana, cocaine, hallucinogens, and inhalants) and alcohol use. Protective factors for nonmedical prescription drug use among rural adolescents included school enrollment and living in a 2-parent household. CONCLUSIONS: Rural adolescents were significantly more likely than urban adolescents to report nonmedical prescription drug use. However, these results suggest there are multiple potential points of intervention to prevent initiation or progression of use among rural adolescents including preventing school dropout, increased parental involvement, and increased access to health, mental health, and substance abuse treatment. Language: en

Cultural and Gender Convergence in Adolescent Drunkenness Evidence From 23 European and North American Countries

Abstract: To investigate time-trend changes in the frequency of drunkenness among European and North American adolescents.

Incidence and Age-Specific Presentation of Restrictive Eating Disorders in Children: A Canadian Paediatric Surveillance Program Study

Abstract: Objectives To document and describe the incidence and age-specific presentation of early-onset restrictive eating disorders in children across Canada. Design Surveillance study. Cases were ascertained through the Canadian Paediatric Surveillance Program by surveying approximately 2453 Canadian pediatricians (a 95% participation rate) monthly during a 2-year period. Setting Canadian pediatric practices. Participants Pediatricians and pediatric subspecialists. Main Outcome Measures A description of clinical presentations and characteristics of eating disorders in this population and the incidence of restrictive eating disorders in children. Results The incidence of early-onset restrictive eating disorders in children aged 5 to 12 years seen by pediatricians was 2.6 cases per 100 000 person-years. The ratio of girls to boys was 6:1, and 47.1% of girls and 54.5% of boys showed signs of growth delay. Forty-six percent of children were below the 10th percentile for body mass index, 34.2% were initially seen with unstable vital signs, and 47.2% required hospital admission. Only 62.1% of children met criteria for anorexia nervosa. Although children with anorexia nervosa were more likely to be medically compromised, some children who did not meet criteria for anorexia nervosa were equally medically unstable. Conclusions Young children are seen with clinically significant restrictive eating disorders, with the incidence exceeding that of type 2 diabetes mellitus. These eating disturbances can result in serious medical consequences, ranging from growth delay to unstable vital signs, which can occur in the absence of weight loss or other restrictive eating disorder symptoms.

Trends in the Nutritional Content of Television Food Advertisements Seen by Children in the United States: Analyses by Age, Food Categories, and Companies

Abstract: Objective To examine trends in children's exposure to food-related advertising on television by age, product category, and company. Design Nutritional content analysis using television ratings data for 2003, 2005, 2007, and 2009 for children. Setting Annual age-specific television ratings data captured children's exposure to broadcast network, cable network, syndicated, and spot television food advertising from all (except Spanish-language) programming. Participants Children aged 2 to 5 and 6 to 11 years. Main Exposure Television ratings. Main Outcome Measures Children's exposure to food-related advertising on television with nutritional assessments for food and beverage products for grams of saturated fat, sugar, and fiber and milligrams of sodium. Results Children aged 2 to 5 and 6 to 11 years saw, respectively, on average, 10.9 and 12.7 food-related television advertisements daily in 2009, down 17.8% and 6.9% from 2003. Exposure to food and beverage products high in saturated fat, sugar, or sodium fell 37.9% and 27.7% but fast-food advertising exposure increased by 21.1% and 30.8% among 2- to 5- and 6- to 11-year-olds, respectively, between 2003 and 2009. In 2009, 86% of ads seen by children were for products high in saturated fat, sugar, or sodium, down from 94% in 2003. Conclusions Exposure to unhealthy food and beverage product advertisements has fallen, whereas exposure to fast-food ads increased from 2003 to 2009. By 2009, there was not a substantial improvement in the nutritional content of food and beverage advertisements that continued to be advertised and viewed on television by US children.

Primary care strategies for promoting parent-child interactions and school readiness in at-risk families: the Bellevue Project for Early Language, Literacy, and Education Success.

Abstract: Objective To determine the effects of pediatric primary care interventions on parent-child interactions in families with low socioeconomic status. Design In this randomized controlled trial, participants were randomized to 1 of 2 interventions (Video Interaction Project [VIP] or Building Blocks [BB]) or the control group. Setting Urban public hospital pediatric primary care clinic. Participants Mother-newborn dyads enrolled post partum from November 1, 2005, through October 31, 2008. Interventions In the VIP group, mothers and newborns participated in 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading by reviewing videos made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. In the BB group, parenting materials, including age-specific newsletters suggesting interactive activities, learning materials, and parent-completed developmental questionnaires, were mailed to the mothers. Main outcome measures Parent-child interactions were assessed at 6 months with the StimQ-Infant and a 24-hour shared reading recall diary. Results A total of 410 families were assessed. The VIP group had a higher increased StimQ score (mean difference, 3.6 points; 95% confidence interval, 1.5 to 5.6 points; Cohen d, 0.51; 0.22 to 0.81) and more reading activities compared to the control group. The BB group also had an increased overall StimQ score compared with the control group (Cohen d, 0.31; 95% confidence interval, 0.03 to 0.60). The greatest effects for the VIP group were found for mothers with a ninth-grade or higher reading level (Cohen d, 0.68; 95% confidence interval, 0.33 to 1.03). Conclusions The VIP and BB groups each led to increased parent-child interactions. Pediatric primary care represents a significant opportunity for enhancing developmental trajectories in at-risk children. Trial registration clinicaltrials.gov Identifier: NCT00212576.

Use of Medical Imaging Procedures With Ionizing Radiation in Children: A Population-Based Study

Abstract: Objective To determine population-based rates of use of diagnostic imaging procedures with ionizing radiation in children, stratified by age and gender.

Deployment and mental health diagnoses among children of US Army personnel.

Abstract: Objective To characterize the risk of mental health diagnoses among children of US military personnel associated with parental deployment in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Design Nonrandomized, retrospective cohort study (2003-2006). Setting Electronic medical record data for outpatient care. Participants Children (N = 307 520) aged 5 to 17 years with at least 1 active-duty US Army parent. Main Exposure Number of months of parental deployment for OIF and OEF. Main Outcome Measures A mental health diagnosis was defined as having at least 1 mental health-related International Classification of Diseases, Ninth Revision, code out of 4 possible codes for a given outpatient medical visit. Diagnoses were further classified into 1 of 17 disorder categories. Results Overall, children with parental deployment represented an excess of 6579 mental health diagnoses during the 4-year period compared with children whose parents did not deploy. After the children's age, sex, and mental health history were adjusted for, excess mental health diagnoses associated with parental deployment were greatest for acute stress reaction/adjustment, depressive, and pediatric behavioral disorders and increased with total months of parental deployment. Boys and girls showed similar patterns within these same categories, with more diagnoses observed in older children within sex groups and in boys relative to girls within age groups. Conclusions A dose-response pattern between deployment of a parent for OIF and OEF and increased mental health diagnoses was observed in military children of all ages. Findings may be used to inform policy, prevention, and treatment efforts for military families facing substantial troop deployments.

Management of the Transgender Adolescent

Abstract: Transgender individuals are people whose self-identification as male, female, both, or neither (gender identity) does not match their assigned gender (identification by others as male or female based on natal sex). The phenomenon of transgender is uncommon, but as more media attention is directed toward the subject, more adolescents and young adults are "coming out" at an earlier age. Transgender adolescents are an underserved and poorly researched population that has very specific medical and mental health needs. Primary care physicians are in a unique and powerful position to promote health and positive outcomes for transgender youth. While not all transgender adolescents desire phenotypic transition to match their gender and physical body, most do. The process of transitioning is complex and requires the involvement of both a mental health therapist specializing in gender and a physician. Finding comprehensive medical and mental health services is extremely difficult for these youth, who are at risk for multiple psychosocial problems including family and peer rejection, harassment, trauma, abuse, inadequate housing, legal problems, lack of financial support, and educational problems. This review supports and describes timely medical intervention to achieve gender/body congruence paired with affirmative mental health therapy as an appropriate approach to minimize negative health outcomes and maximize positive futures for transgender adolescents.

Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome.

Abstract: Objectives To determine if interventions during the pre–hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. Design Prospective observational cohort study. Settings Eleven pediatric hospitals in the United States and Scotland. Participants Children younger than 18 years with diarrhea-associated HUS (hematocrit level 3 /mm 3 ), and impaired renal function (serum creatinine concentration >> upper limit of reference range for age). Interventions Intravenous fluid was given within the first 4 days of the onset of diarrhea. Outcome Measure Presence or absence of oligoanuria (urine output ≤0.5 mL/kg/h for >1 day). Results The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = −0.32; P = .02) and sodium (r = −0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. Conclusions Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.

Influence of licensed spokescharacters and health cues on children's ratings of cereal taste.

Abstract: Objective To investigate whether licensed media spokescharacters on food packaging and nutrition cues affect young children's taste assessment of products. Design In this experimental study, children viewed 1 of 4 professionally created cereal boxes and tasted a “new” cereal. Manipulations included presence or absence of licensed cartoon spokescharacters on the box and healthy or sugary cereal name. Setting Shopping center in a large northeastern city in December 2007. Participants Eighty children (mean [SD] age, 5.6 [0.96] years; 53% girls) and their parents or guardians. Main Exposure Licensed cartoon characters and nutrition cues in the cereal name. Outcome Measures Children rated the cereal's taste on a 5-point smiley face scale (1, really do not like; 5, really like). Results Children who saw a popular media character on the box reported liking the cereal more (mean [SD], 4.70 [0.86]) than those who viewed a box with no character on it (4.16 [1.24]). Those who were told the cereal was named Healthy Bits liked the taste more (mean [SD], 4.65 [0.84]) than children who were told it was named Sugar Bits (4.22 [1.27]). Character presence was particularly influential on taste assessments for participants who were told the cereal was named Sugar Bits. Conclusions The use of media characters on food packaging affects children's subjective taste assessment. Messages encouraging healthy eating may resonate with young children, but the presence of licensed characters on packaging potentially overrides children's assessments of nutritional merit.

Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial.

Abstract: Objective To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. Design Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. Setting Rochester, New York. Participants Children aged 3 to 10 years with persistent asthma. Interventions Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. Main Outcome Measure Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. Results We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference = 0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P Conclusions The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities. Trial Registration clinicaltrials.gov Identifier:NCT00296998