Agregador de canales de noticias
In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time.METHODS
Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade).RESULTS
A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes–only classes were characterized by either e-cigarette–specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use.CONCLUSIONS
This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.
There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers.OBJECTIVE
To investigate self-perceived social functioning in adults born VP (<32 weeks’ gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born adults (≥37 weeks’ gestation) using an individual participant data (IPD) meta-analysis.DATA SOURCES
Two international consortia: Research on European Children and Adults born Preterm and Adults Born Preterm International Collaboration.STUDY SELECTION
Cohorts with outcomes assessed by using the Adult Self-Report Adaptive Functioning scales (friends, spouse/partner, family, job, and education) in both groups.DATA EXTRACTION
IPD from 5 eligible cohorts were collected. Raw-sum scores for each scale were standardized as z scores by using mean and SD of controls for each cohort. Pooled effect size was measured by difference () in means between groups.RESULTS
One-stage analyses (1285 participants) revealed significantly lower scores for relationships with friends in VP/VLBW adults compared with controls ( –0.37, 95% confidence interval [CI]: –0.61 to –0.13). Differences were similar after adjusting for sex, age, and socioeconomic status ( –0.39, 95% CI: –0.63 to –0.15) and after excluding participants with neurosensory impairment ( –0.34, 95% CI: –0.61 to –0.07). No significant differences were found in other domains.LIMITATIONS
Generalizability of research findings to VP survivors born in recent decades.CONCLUSIONS
VP/VLBW adults scored their relationship with friends lower but perceived their family and partner relationships, as well as work and educational experiences, as comparable to those of controls.
Caring for a child with a serious or life-limiting illness presents many challenges for families and health care providers. Through that experience (and, many times, as it ends), parents are compelled to find and make meaning from their ultimate loss and the many losses along the way. In this Advocacy Case Study, we describe the experiences that led a bereaved mother to seek to harness the insights from her own family’s loss to help support other families facing the challenges and complexities of a child’s serious illness. Her family initially established a family foundation to advocate for palliative care. She later partnered with her family’s general pediatrician and the American Academy of Pediatrics to educate providers and bring parent voices to health care provider discussions. This work eventually led to the development of the Courageous Parents Network, a nonprofit focused on making these parent and provider voices widely available to families and providers through a Web-based collection of videos, blogs, podcasts, and printable guides. Through these insights, the organization addresses feelings of isolation, anxiety, and grief. In addition, these voices illustrate the power and benefits of the growing acceptance of pediatric palliative care practices. Important lessons learned through these efforts include: (1) the power of stories for validation, healing, and understanding; (2) opportunity to extend the reach of pediatric palliative care through provider education and skill-building; (3) critical importance of the parent–provider advocacy collaboration; and (4) necessity of market testing and continuous improvement.
To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–associated death.METHODS
We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records.RESULTS
We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5–19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition.CONCLUSIONS
SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
Passive and active immunity transfer through human milk (HM) constitutes a key element in the infant’s developing immunity. Certain infectious diseases and vaccines have been described to induce changes in the immune components of HM.METHODS
We conducted a prospective cohort single-institution study from February 2 to April 4, 2021. Women who reported to be breastfeeding at the time of their coronavirus disease 2019 (COVID-19) vaccination were invited to participate. Blood and milk samples were collected on day 14 after their second dose of the vaccine. Immunoglobulin G (IgG) antibodies against nucleocapsid protein as well as IgG, immunoglobulin M and immunoglobulin A (IgA) antibodies against the spike 1 protein receptor-binding domain against severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2 RBD-S1) were analyzed in both serum and HM samples.RESULTS
Most of the participants (ie, 94%) received the BNT162b2 messenger RNA COVID-19 vaccine. The mean serum concentration of anti-SARS-CoV-2 RBD-S-IgG antibodies in vaccinated individuals was 3379.6 ± 1639.5 binding antibody units per mL. All vaccinated study participants had anti-SARS-CoV-2 RBD-S1-IgG, and 89% of them had anti-SARS-CoV-2 RBD-S-IgA in their milk. The antibody concentrations in the milk of mothers who were breastfeeding 24 months were significantly higher than in mothers with breastfeeding periods <24 months (P < .001).CONCLUSIONS
We found a clear association between COVID-19 vaccination and specific immunoglobulin concentrations in HM. This effect was more pronounced when lactation periods exceeded 23 months. The influence of the lactation period on immunoglobulins was specific and independent of other variables.
Surfactant Nebulization to Prevent Intubation in Preterm Infants: A Systematic Review and Meta-analysis
Surfactant nebulization (SN) may offer a safe alternative for surfactant administration in respiratory distress syndrome of preterm infants.OBJECTIVE
To evaluate the efficacy of SN for the prevention of early intubation.DATA SOURCES
Medline, Embase, The Cochrane Library, clinicaltrials.gov, published abstracts, and references of relevant articles were searched through March 23, 2021.STUDY SELECTION
Randomized clinical trials of preterm infants <37 weeks’ gestation comparing SN with noninvasive respiratory support or intratracheal surfactant application.DATA EXTRACTION
Two reviewers extracted data and assessed risk of bias from included studies separately and blinded. Data were pooled by using a fixed-effects model. Subgroups (gestational age, type of nebulizer, surfactant type, and dosage) were evaluated. Primary outcome was intubation rate at 72 hours after birth.RESULTS
Nine studies recruiting 1095 infants met inclusion criteria. SN compared with standard care significantly reduced intubation rate at 72 hours after birth (226 of 565 infants [40.0%] vs 231 of 434 infants [53.2%]; risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.63–0.84; number needed to treat: 8; 95% CI: 5–14]). Prespecified subgroup analysis identified important heterogeneity: SN was most effective in infants ≥28 weeks' gestation (RR: 0.70, 95% CI: 0.60–0.82), with a pneumatically driven nebulizer (RR: 0.52, 95% CI: 0.40–0.68) and in infants receiving ≥200 mg/kg and animal-derived surfactant (RR: 0.63, 95% CI: 0.52–0.75). No differences in neonatal morbidities or mortality were identified.LIMITATIONS
Quality of evidence was low owing to risk of bias and imprecision.CONCLUSIONS
SN reduced the intubation rate in preterm infants with a higher efficacy for specific subgroups. There was no difference in relevant neonatal morbidities or mortality.
Most young infants presenting to the emergency department (ED) with a brief resolved unexplained event (BRUE) are hospitalized. We sought to determine the rate of explanatory diagnosis after hospitalization for a BRUE.METHODS
This was a multicenter retrospective cohort study of infants hospitalized with a BRUE after an ED visit between October 1, 2015, and September 30, 2018. We included infants without an explanatory diagnosis at admission. We determined the proportion of patients with an explanatory diagnosis at the time of hospital discharge and whether diagnostic testing, consultation, or observed events occurring during hospitalization were associated with identification of an explanatory diagnosis.RESULTS
Among 980 infants hospitalized after an ED visit for a BRUE without an explanatory diagnosis at admission, 363 (37.0%) had an explanatory diagnosis identified during hospitalization. In 805 (82.1%) infants, diagnostic testing, specialty consultations, and observed events did not contribute to an explanatory diagnosis, and, in 175 (17.9%) infants, they contributed to the explanatory diagnosis (7.0%, 10.0%, and 7.0%, respectively). A total of 15 infants had a serious diagnosis (4.1% of explanatory diagnoses; 1.5% of all infants hospitalized with a BRUE), the most common being seizure and infantile spasms, occurring in 4 patients.CONCLUSIONS
Most infants hospitalized with a BRUE did not receive an explanation during the hospitalization, and a majority of diagnoses were benign or self-limited conditions. More research is needed to identify which infants with a BRUE are most likely to benefit from hospitalization for determining the etiology of the event.
Physical inactivity is an important health concern worldwide. In this study, we examined the effects of an exercise intervention on children’s academic achievement, cognitive function, physical fitness, and other health-related outcomes.METHODS
We conducted a population-based cluster randomized controlled trial among 2301 fourth-grade students from 10 of 11 public primary schools in 1 district of Ulaanbaatar between February and December 2018. Schools were allocated to an intervention or control group with 5 schools each by using urban and mixed residential area stratified block randomization. The intervention group received a 3-minute high-intensity interval exercise program that included jumps, squats, and various steps implemented twice weekly over 10 weeks for 10 to 25 minutes per session. The control group received the usual physical education class. The primary outcome was academic achievement assessed by scores on the national examination. A linear mixed-effects model was applied. The difference between preintervention and post intervention was compared by least-squares means, estimated on the basis of the interaction of group, measurement time point, and school location. Only 1 statistician, responsible for the analysis, was blinded.RESULTS
Of 2301 students, 2101 (1069 intervention; 1032 control) were included in the analysis. Intervention group members in an urban area showed an 8.36-point improvement (95% confidence interval: 6.06 to 10.66) in academic scores when compared with the control group, whereas those in a mixed residential area showed a 9.55-point improvement (95% confidence interval: 6.58 to 12.51). No intervention-associated injuries were observed.CONCLUSIONS
The exercise program significantly improved children’s academic achievement.
Patent ductus arteriosus (PDA) treatment is common among very low birth weight (VLBW) infants. Given limitations in evidence, controversy exists regarding treatment risks and benefits. In this study, we describe PDA treatment trends and variation in a large, US, multicenter VLBW infant cohort.METHODS
Data were collected through Vermont Oxford Network on 291 292 VLBW infants born 2012–2019 at 806 US NICUs. PDA diagnosis and treatment rates, further categorized as pharmacologic, invasive, or combined, were determined. NICUs were classified as capable versus noncapable of invasive PDA treatment. Infant and hospital characteristics were examined by NICU type and treatment quartile. Geographic NICU distribution and treatment rates were described in 9 US census divisions.RESULTS
Of all infants, 24.6% were diagnosed with and 20.5% were treated for PDA. Diagnosis and treatment rates decreased over the study period. Treatment was predominantly pharmacologic. Treatment rates varied widely among NICUs (0% to 67%) despite similar infant characteristics. The median treatment rate was higher at NICUs capable of pharmacologic and invasive treatment (20.3%, interquartile range 13.3–28.6) than at NICUs capable of only pharmacologic treatment (8.9%, interquartile range 2.9–14.8). Treatment rates were highest in the northeast and lowest in the west. Invasive treatment was more common in the west.CONCLUSIONS
PDA diagnosis and treatment rates are trending downward. Wide variation exists in PDA treatment despite a largely uniform VLBW infant population. This variation correlates with differences in hospital treatment capabilities and geography. Further understanding of the effects of treatment disparity could aid in guiding clinical management.
We conducted a cluster randomized controlled trial to test the a priori hypothesis that students attending an intervention middle school would be less likely to report physical adolescent relationship abuse (ARA) 1 year later compared with students attending a control school. Secondary objectives were to determine if the intervention reduced substance misuse, bullying, and fighting.METHODS
Twenty-four Texas public middle schools were matched by the size of student enrollment, number of economically disadvantaged students, and race and ethnicity of the student body and randomly assigned to the intervention (n = 12; 1237 participants) or the control (n = 12; 1531participants) group. The intervention, Fourth R, is a classroom-based curriculum delivered by existing teachers and consists of 21 lessons on injury prevention, substance use, and growth and development.RESULTS
Participants (50% female) self-reported ethnicity as Hispanic or Latinx (35%), Black or African American (24%), Asian American (17%), White (8%), and multiethnicity or other (16%). Among those who have dated, students in the intervention schools were less likely to report perpetrating physical ARA (intervention = 14.9% versus control = 18.3%) relative to students in the control schools (adjusted odds ratio, 0.66; 95% confidence interval, 0.43–1.00; P = .05). In the overall sample, no significant differences emerged between control and intervention groups with respect to substance misuse, fighting, and bullying.CONCLUSIONS
The middle school version of Fourth R is effective in reducing physical ARA perpetration over at least 1 year. The intervention did not have an effect on bullying perpetration, physical fighting with peers, and substance misuse. Long-term assessment, especially follow-up that covers the transition to high school, is needed to examine the program benefit on key outcomes.
The United Nations (UN) created the Multiple Indicator Cluster Surveys (MICS) to monitor progress toward achieving goals of the World Declaration on the Survival, Protection, and Development of Children and its plan of action. The MICS is nationally representative and internationally comparable.METHODS
In this study, we use MICS data from 51 low- and middle-income countries on 159 959 children between 36 and 59 months of age. To index national development, we used the 2013 UN Human Development Index (HDI), which provides data on country-level life expectancy, education, and income. To index child development, we used the Early Childhood Development Index (ECDI), which assesses literacy and numeracy, socioemotional development, physical health, and approaches to learning.RESULTS
Children’s literacy and numeracy, socioemotional development, and approaches to learning all increase linearly as national development on the HDI (especially education) increases. Overall, the HDI revealed a positive association (r = 0.40) with the ECDI: the HDI explained 16% of variance in children’s ECDI scores and was the most influential predictor of ECDI scores examined. HDI-ECDI relations are robust, even when we control for multiple demographic aspects of children (age, sex), mothers (age, education), and households (size variables) as covariates. No family demographic variable was a stronger predictor of child development than national development.CONCLUSIONS
To promote child development, low- and middle-income countries need to develop and implement policies that ensure national health and wealth and, particularly, the educational achievements of children’s caregivers. These findings are faithful to the World Summit for Children and inform the UN Sustainable Development Goals, which drive the international development agenda through 2030.