Design, Setting, and Participants  Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941).

Main Exposure  Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester).

Main Outcome Measure  Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders.

Results  The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect).

Conclusions  Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.

Design  Quantitative and qualitative analysis of semi-structured one-on-one interviews.

Setting  The PICUs at 2 tertiary care hospitals.

Participants  English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week.

Intervention  Semi-structured one-on-one interviews.

Results  Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition.

Conclusion  Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

Design  Thirty years of longitudinal data from the Panel Study of Income Dynamics survey data set.

Setting  Nationally representative sample of the US population.

Participants  Approximately 90 000 childhood years of information are pooled together to create a series of life tables that span the ages of 1 to 20 years.

Main Outcome Measure  Self-reporting measure of whether survey households received the Food Stamp Program during the prior year.

Results  Between the ages of 1 to 20 years, nearly half (49.2%) of all American children will, at some point, reside in a household that receives food stamps. Households in need of the program use it for relatively short periods but are also likely to return to the program at several points during the childhood years. Race, parental education, and head of household's marital status exert a strong influence on the proportion of children residing in a food stamp household.

Conclusions  American children are at a high risk of encountering a spell during which their families are in poverty and food insecure as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child's overall health.

Design  Case-control study.

Setting  Medical centers and a pregnancy care center in Reno, Nevada.

Participants  Participants (n = 14) were women who gave birth to infants with gastroschisis at either of the 2 medical centers in Reno, Nevada, from April 5, 2007, through April 4, 2008. Controls (n = 57) were selected from the same pregnancy center providing perinatal care to the cases and were matched 4:1 to the case mothers by maternal date of birth within 1 year.

Main Exposures  Environmental exposures and illnesses during pregnancy.

Outcome Measures  Association of gastroschisis with illnesses, medications, or environmental exposures.

Results  Gastroschisis was associated with the use of methamphetamine (odds ratio [OR], 7.15; 95% confidence interval [CI], 1.35-37.99) or any vasoconstrictive recreational drug (methamphetamine, amphetamine, cocaine, ecstasy) (OR, 4.46; 95% CI, 1.21-16.44) before pregnancy. When we limited self-reported illnesses to those occurring during the first trimester of pregnancy, chest colds (OR, 16.77; 95% CI, 1.88-150.27) and sore throats (OR, 12.72; 95% CI, 1.32-122.52) were associated with gastroschisis.

Conclusions  These findings add strength to the hypothesis that use of methamphetamine and related drugs is a risk factor for gastroschisis and raise questions about the risks associated with infections.

Design  Randomized, double-blind, controlled trial.

Setting  Single-center urban pediatric emergency department.

Participants  Infants younger than 12 months with mild to moderate bronchiolitis.

Interventions  Patients were randomized to receive nebulized racemic epinephrine in either hypertonic or normal saline.

Outcome Measures  The primary outcome measure was the change in respiratory distress, as measured by the Respiratory Assessment Change Score (RACS) from baseline to 120 minutes. The change in oxygen saturation was also determined. Secondary outcome measures included the rates of hospital admission and return to the emergency department.

Results  Forty-six patients were enrolled and evaluated. The 2 study groups had similar baseline characteristics. The RACS from baseline to 120 minutes demonstrated no improvement in respiratory distress in the hypertonic saline group compared with the normal saline control group. The change in oxygen saturation in the hypertonic saline group was not significant when compared with the control group. Rates of admission and return to the emergency department were not different between the 2 groups.

Conclusions  In the treatment of acute bronchiolitis, hypertonic saline and epinephrine did not improve clinical outcome any more than normal saline and epinephrine in the emergency setting. This differs from previously published results of outpatient and inpatient populations and merits further evaluation.

Trial Registration  isrctn.org Identifier: ISRCTN66632312

Design, Setting, and Participants  Cross-sectional, ecological analysis of 9268 seventh- and ninth-grade students in 19 public schools participating in The California Endowment's Healthy Eating Active Communities program.

Main Outcome Measures  Cardiorespiratory fitness (mile time) and body mass index. Independent variables included students' perceptions and behaviors related to daily physical activity opportunities, assessed via anonymous survey. Ecological analysis was used to link survey data with fitness and body mass index data within each school. Linear regression identified associations between youths' perceptions/behaviors and fitness/body mass index.

Results  As the proportion of students reporting enjoying physical education, walking to school, and spending 20 minutes or longer in exercise during physical education increased from 0% to 100%, mile time decreased overall (–2.7 minutes; P = .03), mile time decreased among seventh graders (–3.3 minutes; P = .02), and body mass index z scores decreased among ninth graders (–0.7; P = .045), respectively. Each additional day students reported being active on school grounds outside school hours was associated with decreased mile time (–0.5 minute; P = .02). Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit (odds ratio = 1.5; P < .001).

Conclusions  Physical education is a valuable policy opportunity to improve student health. Promoting active transport may improve fitness but must be done in conjunction with community partnerships to improve the food environment in the vicinity of schools. Promoting the use of school grounds outside school hours (such as after-school programs) should also be prioritized in response to youth obesity.

Design  We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood.

Setting  All participants in the study were residents of the United States enrolled in junior high school or high school during the 1994-1995 school year.

Participants  More than 20 000 adolescents from nationally representative data interviewed at wave I (1994-1995) and followed up in wave II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health when the sample was in early adulthood.

Main Exposures  Race/ethnicity, immigrant generation, and sex.

Outcome Measure  Body mass index.

Results  Findings indicate significant differences in both the level and change in BMI across age by sex, race/ethnicity, and immigrant generation. Females, second- and third-generation immigrants, and Hispanic and black individuals experience more rapidly increasing BMIs from adolescence into young adulthood. Increases in BMI are relatively lower for males, first-generation immigrants, and white and Asian individuals.

Conclusion  Disparities in BMI and prevalence of overweight and obesity widen with age as adolescents leave home and begin independent lives as young adults in their 20s.

Design  Transversal cohort study.

Setting  Hospital de São João and Hospital de Crianças Maria Pia, Porto, Portugal, between May 2006 and March 2007.

Participants  One hundred thirty-eight obese children and adolescents (62 boys; mean age, 10.8 years [range, 4-16 years]). Participants were grouped according to (1) apo E polymorphism: presence of the apo E alleles 2 or 4 in E2 (n = 11) and E4 (n = 31) carriers, respectively, or as E3/E3 (n = 94) (carriers of E2/E4 [n = 2] were excluded from apo E analysis because they carry both alleles) and (2) BMI z score: group 1, BMI z score less than 2 (n = 31); group 2, BMI z score of 2 or more and less than 2.5 (n = 65); and group 3, BMI z score of 2.5 or more (n = 42).

Main Outcome Measures  Lipid variable comparisons between apo E polymorphism and BMI z score groups and influence of BMI z score and adiponectin level, adjusted for apo E polymorphism, on total cholesterol to high-density lipoprotein cholesterol and apo A-I to apo B ratios.

Results  E4 carriers presented with a worse lipid profile when compared with E2 and E3/E3 carriers. There was also a clear risk of worsening for the group with the highest BMI z score. Apolipoprotein E polymorphism, BMI z score, and adiponectin level were significantly associated with total cholesterol to high-density lipoprotein cholesterol (standardized β coefficient = 0.283, 0.354, and –0.292, respectively; P < .001 for all) and apo A-I to apo B (standardized β coefficient = –0.372, –0.284, and 0.327, respectively; P < .001 for all) ratios.

Conclusion  Our data suggest a more atherogenic lipid profile for some apo E genotypes and for increasing BMI z score, whereas adiponectin level seems to play a protective role.

Design  The Fragile Families and Child Wellbeing Study, a prospective cohort study.

Setting  Data collected at home and by telephone from parents of children born from 1998 to 2000 from 20 cities.

Participants  Mothers who completed a 36-month in-home survey and met inclusion criteria (n = 3128).

Main Exposure  Direct child TV exposure and household TV use were the primary explanatory variables. Additional risk factors included neighborhood disorder and maternal factors like depression.

Outcome Measures  Childhood aggression was assessed with the Child Behavior Checklist/2-3. Multivariate linear regression models were used to examine associations between TV measures, additional risk factors, and childhood aggression.

Results  Children who were spanked in the past month (β = 1.24, P < .001), lived in a disorderly neighborhood (β = 2.07, P < .001), and had a mother reporting depression (β = 0.92, P < .001) and parenting stress (β = 0.16, P < .001) were significantly more likely to exhibit aggressive behavior. Direct child TV exposure (β = 0.16, P < .001) and household TV use (β = 0.09, P < .001) were also significantly associated with childhood aggression, even when controlling for other factors.

Conclusions  Three-year-old children exposed to more TV, both directly and indirectly, are at increased risk for exhibiting aggressive behavior. Further research is essential to determine whether pediatric recommendations concerning TV and children should include limits for general household TV use.

Design  Randomized controlled trial.

Setting  Home and center based.

Participants  Three hundred seventy-seven intervention (INT) and 608 nonintervention (NI) children, stratified by birth-weight categories 2001 to 2500 g and 2000 g or less.

Intervention  Educational intervention from nursery discharge until age 3 years.

Main Outcome Measures  Eight-year weight, height, head circumference, and body mass index.

Results  Complete data were available for 313 INT children and 491 NI children. Adjusting for child birth weight, birth-weight category, treatment group x birth-weight category interaction, sex, race, and Neonatal Health Index; maternal education and preconception weight; and site, the INT children at age 8 years were significantly taller (127.6 vs 126.6 cm; P = .02) and had a larger head circumference (52.5 vs 52.1 cm; P < .001) than the NI children. The prevalence of both overweight (9%) and underweight (4.5%) was the same in both treatment groups. Lighter low-birth-weight INT children had greater 8-year weight (28.0 vs 26.8 kg; P = .02), larger head circumference (52.6 vs 52.1 cm; P < .001), and larger height (127.6 vs 126.5 cm; P = .05) compared with their counterparts in the NI group.

Conclusion  Low-birth-weight preterm children, specifically the lighter low-birth-weight group, who received the Infant Health and Development Program educational intervention were heavier and taller and had greater head circumference compared with NI children in the same birth-weight category.

Data Sources  We searched PubMed for publications between March 1999 and March 2009 that created transcutaneous nomograms. We performed the same search among abstracts presented in the past 2 years at meetings of the Pediatric Academic Societies or the European Society for Paediatric Research.

Study Selection  Inclusion criteria were gestational age of at least 35 weeks among study subjects, the use of an electronic transcutaneous bilirubinometer, and creation of a nomogram based on hour-specific bilirubin values. Four articles met the selection criteria.

Data Extraction  Jaundice risk factors were analyzed, and raw data were analyzed using nonlinear regression to describe trends in bilirubin levels and kinetics. The bilirubin exaggerated rate of rise needed to cross percentile curves was calculated.

Data Synthesis  Significant differences in bilirubin values exist across populations, and there is substantial variability in rates of rise. Hispanic neonates demonstrate higher rates of rise and later plateaus. Bilirubin rates of rise tend to plateau and become null (equilibrium between bilirubin production and elimination) at about 96 hours of life. Rates of rise needed to cross percentile curves decrease over time but are lower (approximately 0.11 mg/dL/h [to convert bilirubin level to micromoles per liter, multiply by 17.104]) in the first 48 hours of life than previously thought.

Conclusions  Transcutaneous bilirubin levels plateau and then decrease after about 96 hours of life in healthy neonates, with some differences across populations. A bilirubin rate of rise higher than in the previous period implies that bilirubin production exceeds elimination and indicates high risk for subsequent hyperbilirubinemia in neonates.

Design  Retrospective cohort study.

Setting  Four US regions.

Participants  Cancer registries identified girls younger than 20 years who were diagnosed as having cancer from 1973 through 2000. Linked birth records identified the first live births after diagnosis (n = 1898). Comparison subjects were selected from birth records (n = 14 278). Survivors of genital tract carcinomas underwent separate analysis.

Main Exposure  Cancer diagnosis at younger than 20 years.

Main Outcome Measures  Infant low birth weight, preterm delivery, sex ratio, malformations, mortality, and delivery method, and maternal diabetes, anemia, and preeclampsia.

Results  Infants born to childhood cancer survivors were more likely to be preterm (relative risk [RR], 1.54; 95% confidence interval [CI], 1.30-1.83) and to weigh less than 2500 g (1.31; 1.10-1.57). For the offspring of genital tract carcinoma survivors, RRs were 1.33 (95% CI, 1.13-1.56) and 1.29 (1.10-1.53), respectively. There were no increased risks of malformations, infant death, or altered sex ratio, suggesting no increased germ cell mutagenicity. In exploratory analysis, bone cancer survivors had an increased risk of diabetes (RR, 4.92; 95% CI, 1.60-15.13), and anemia was more common among brain tumor survivors (3.05; 1.16-7.98) and childhood cancer survivors whose initial treatment was chemotherapy only (2.45; 1.16-5.17).

Conclusions  Infants born to female survivors of childhood and adolescent cancer were not at increased risk of malformations or death. Increased occurrence of preterm delivery and low birth weight suggest that close monitoring is warranted. Increased diabetes and anemia among subgroups have not been reported, suggesting areas for study.

Design  Retrospective cohort study.

Setting  Four US regions.

Participants  Cancer registries identified males younger than 20 years diagnosed with cancer from 1973 to 2000. Linked birth certificates identified first subsequent live offspring (N = 470). Comparison subjects were identified from remaining birth certificates, frequency-matched on year and age at fatherhood, and race/ethnicity (N = 4150).

Main Exposure  Cancer diagnosis before age 20 years.

Outcome Measures  Pregnancy and infant outcomes identified from birth certificates.

Results  Compared with infants born to unaffected males, offspring of cancer survivors had a borderline risk of having a birth weight less than 2500 g (relative risk, 1.43 [95% confidence interval, 0.99-2.05]) that was associated most strongly with younger age at cancer diagnosis and exposure to any chemotherapy (1.96 [1.22-3.17]) or radiotherapy (1.95 [1.14-3.35]). However, they were not at risk of being born prematurely, being small for gestational age, having malformations, or having an altered male to female ratio. Overall, female partners of male survivors were not more likely to have maternal complications recorded on birth records vs the comparison group. However, preeclampsia was associated with some cancers, especially central nervous system tumors (relative risk, 3.36 [95% confidence interval, 1.63-6.90]).

Conclusions  Most pregnancies resulting in live births among partners of male childhood cancer survivors were not at significantly greater risk of complications vs comparison subjects. However, there remains the possibility that prior cancer therapy may affect male germ cells with some effects on progeny and on female partners.

Design  Retrospective descriptive study with face-to-face interviews.

Setting  The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006.

Patients  All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths.

Outcome Measures  Presence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions.

Results  An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants.

Conclusions  Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.

Design  Cohort study.

Setting  Single academic, high-risk perinatal referral center.

Participants  All 160 women admitted to labor and delivery with a live fetus who delivered at an estimated gestational age of 220/7 weeks to 246/7 weeks.

Main Outcome Measures  Prenatal management and time between maternal admission and delivery or death of the fetus, infant resuscitation efforts, neonatal intensive care unit interventions, time of death, and morbidities in survivors.

Results  Mothers in both epochs were of similar age, race, and duration of pregnancy at hospital admission. Compared with the early epoch, women during the late epoch were more likely to be transported to a higher level of care (relative risk [RR], 2.01; 95% confidence interval [CI], 1.58-2.57) and receive sonographic surveillance (RR, 1.48; 95% CI, 1.07-2.04), antibiotics (RR, 1.60; 95% CI, 1.10-2.33), and antenatal steroids (RR, 1.61; 95% CI, 1.22-2.12). Life-sustaining interventions were provided for infants admitted to the neonatal intensive care unit more frequently during the late epoch than the early epoch, including high-frequency ventilation (RR, 3.57; 95% CI, 1.93-6.61), chest tubes (RR, 1.44; 95% CI, 1.06-1.94), dopamine administration (RR, 2.49; 95% CI, 1.24-4.97), and steroid administration for blood pressure support (RR, 2.18; 95% CI, 1.60-2.92). Gestational age–specific mortality was the same in the 2 epochs.

Conclusions  More interventions were provided for infants born at 22 to 24 weeks' gestation in the late epoch than the early epoch. Despite these changes in management, there has been no reduction in mortality in more than a decade.

Design  Cross-sectional study.

Setting  Internet-based autism registry for US residents.

Participants  Survey results from 277 twin pairs (210 dizygotic [DZ] and 67 monozygotic [MZ]) aged 18 years or younger with at least 1 affected twin.

Main Exposures  Zygosity and sex.

Outcome Measures  Concordance within twin pairs of diagnosis, natural history, and results from standardized autism screening.

Results  Pairwise ASD concordance was 31% for DZ and 88% for MZ twins. Female and male MZ twins were 100% and 86% concordant, respectively, and DZ twin pairs with at least 1 female were less likely to be concordant (20%) than were male-male DZ twin pairs (40%). The hazard ratio for ASD diagnosis of the second twin after a first-twin diagnosis was 7.48 for MZ vs DZ twins (95% confidence interval, 3.8-14.7). Affected DZ individual twins had an earlier age at first parental concern and more frequent diagnoses of intellectual disability than did MZ twins; MZ twins had a higher prevalence of bipolar disorder and Asperger syndrome and higher concordance of the latter. Results of autism screening correlated with parent-reported ASD status in more than 90% of cases.

Conclusions  Our data support greater ASD concordance in MZ vs DZ twins. Overall higher functioning, psychiatric comorbidity, and Asperger syndrome concordance among affected MZ vs DZ twins may also suggest differential heritability for different ASDs. For families in which one MZ twin is diagnosed with ASD, the second twin is unlikely to receive an ASD diagnosis after 12 months. In addition, Internet parent report of ASD status is valid.

Design  Randomized controlled trial.

Setting  Cystic fibrosis centers in the eastern, midwestern, and southern United States.

Participants  Seventy-nine children aged 4 to 12 years below the 40th percentile for weight for age were recruited. Sixty-seven completed the intervention and 59 completed a 24-month follow-up assessment.

Intervention  Comparison of a behavioral plus nutrition education intervention with a nutrition education intervention alone.

Main Outcome Measures  Primary outcomes were changes from pretreatment to posttreatment in caloric intake and weight gain. Secondary outcomes were changes from pretreatment to posttreatment in percentage of the estimated energy requirement and body mass index z score. These outcomes were also examined 24 months posttreatment.

Results  After treatment, the behavioral plus nutrition education intervention as compared with the nutrition education intervention alone had a statistically greater average increase on the primary and secondary outcomes of caloric intake (mean, 872 vs 489 cal/d, respectively), percentage of the estimated energy requirement (mean, 148% vs 127%, respectively), weight gain (mean, 1.47 vs 0.92 kg, respectively), and body mass index z score (0.38 vs 0.18, respectively). At the 24-month follow-up, children in both conditions maintained an estimated energy requirement of around 120% and did not significantly differ on any outcomes.

Conclusions  A behavioral plus nutrition education intervention was more effective than a nutrition education intervention alone at increasing dietary intake and weight over a 9-week period. However, across the 24-month follow-up, both treatments achieved similar outcomes.

Trial Registration  clinicaltrials.gov Identifier: NCT00006169

Design  Observational, repeated measures study.

Setting  National Survey of Child and Adolescent Well-being, 1999 to 2004.

Participants  Mothers who retained custody of a child aged 0 to 15 years following a maltreatment investigation and completed at least 2 of 3 surveys (n = 2386).

Main Exposure  Change in depression status between baseline and 18- and 36-month follow-ups, assessed with the Composite International Diagnostic Interview Short Form.

Main Outcome Measures  Change in psychological aggression, physical assault, and neglect between baseline and 18- and 36-month follow-ups, assessed with the Conflict Tactics Scale Parent-Child version.

Results  One-third (35.5%) of mothers experienced onset or remission of depression. Onset of depression was associated with an increase of 2.3 (95% confidence interval, 0.2-4.4) psychologically aggressive acts in an average 12-month period, but was not statistically significantly associated with change in physical assault or neglect.

Conclusion  Depression is positively associated with maternal perpetration of psychological aggression in high-risk families.

Design  A 12-month follow-up study embedded in a food and micronutrient supplementation trial.

Setting  Rural Bangladesh.

Participants  Pregnant women and their 3132 live-born children.

Main Exposure  Maternal exposure to physical, sexual, and emotional violence and level of controlling behavior in the family.

Main Outcome Measures  Infants' risk of falling ill with diarrheal diseases and respiratory tract infections in relation to mothers' exposure to different forms of violence. Adjusted for household economic conditions, mother's education level, parity, and religion.

Results  Fifty percent of the women reported lifetime experience of family violence. Infants of mothers exposed to different forms of family violence had 26% to 37% higher incidence of diarrhea. Any lifetime family violence was positively associated with increased incidence of diarrheal diseases (adjusted rate ratio, 1.20; 95% confidence interval, 1.10-1.30) and lower respiratory tract infections (adjusted rate ratio, 1.31; 95% confidence interval, 1.17-1.46). Further, all forms of family violence were also independently positively associated with infant illness, and the highest incidence rates were found among the daughters of severely physically abused mothers.

Conclusion  Family violence against women was positively associated with an increased risk of falling ill with diarrheal and respiratory tract infections during infancy. The present findings add to increasing evidence of the magnitude of public health consequences of violence against women.

Design  Internet addiction, depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were assessed by self-reported questionnaires. Participants were then invited to be assessed for Internet addiction 6, 12, and 24 months later (the second, third, and fourth assessments, respectively).

Setting  Ten junior high schools in southern Taiwan.

Participants  A total of 2293 (1179 boys and 1114 girls) adolescents participated in the initial investigation.

Main Exposure  The course of time.

Main Outcome Measure  Internet addiction as assessed using the Chen Internet Addiction Scale.

Results  Depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were found to predict the occurrence of Internet addiction in the 2-year follow-up, and hostility and attention-deficit/hyperactivity disorder were the most significant predictors of Internet addiction in male and female adolescents, respectively.

Conclusions  These results suggest that attention-deficit/hyperactivity disorder, hostility, depression, and social phobia should be detected early on and intervention carried out to prevent Internet addiction in adolescents. Also, sex differences in psychiatric comorbidity should be taken into consideration when developing prevention and intervention strategies for Internet addiction.

Design  This was a cross-sectional, anonymous Internet survey.

Setting  Four pediatric residency programs in the Baltimore, Maryland–Washington, DC, metropolitan area during April to June 2007.

Participants  One hundred forty-one pediatric residents completed the survey.

Main Exposure  Abortion attitudes were assessed by participants' level of agreement with abortion in 7 scenarios. Attitudes toward teen sex were assessed by participants' level of agreement with 5 statements about the acceptability of teens having sex.

Main Outcome Measures  Emergency contraceptive counseling behavior was assessed by reported frequency of including emergency contraception in routine contraceptive counseling. Intention to prescribe emergency contraception was assessed by reported likelihood of prescribing in 5 scenarios.

Results  When controlling for demographics and other predictors, residents with less favorable abortion attitudes were more likely to have the lowest intention to prescribe emergency contraception. Residents with more positive attitudes toward teen sex and who had a preceptor encourage emergency contraception prescription were more likely to include emergency contraception in routine contraceptive counseling most/all the time and to have the highest intention to prescribe.

Conclusion  Efforts to challenge and affect attitudes toward teen sex and to prompt residents to prescribe emergency contraception in clinical settings may be needed to encourage more proactive emergency contraceptive practice in accordance with national practice guidelines.

Design  Prospective cohort study.

Setting  Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark.

Participants  Pregnant women receiving prenatal care in our hospital from 1989 to 2006.

Main Exposure  Maternal SSRI use during pregnancy.

Outcome Measures  Gestational age, birth weight, head circumference, 5-minute Apgar score, and admission to the neonatal intensive care unit.

Results  Three hundred twenty-nine pregnant women reported treatment with SSRIs, 4902 were not treated with SSRIs but had a history of psychiatric illness, and 51 770 reported no history of psychiatric illness. Gestational age was 5 days (95% confidence interval [CI], –6 to –3) shorter and the odds ratio (OR) for preterm birth was 2.0 (95% CI, 1.3-3.2) in the women exposed to SSRIs compared with women with no history of psychiatric illness. In utero–exposed newborns had increased risk of admission to the neonatal intensive care unit (OR, 2.4; 95% CI, 1.7-3.4) and of 5-minute Apgar scores of less than 8 (OR, 4.4; 95% CI, 2.6-7.6) compared with those not exposed. Head circumference and birth weight did not differ between infants in the exposed and unexposed groups. The results were similar when compared with infants of women with a psychiatric history.

Conclusions  Exposure to SSRIs during pregnancy was associated with an increased risk of preterm delivery, a low 5-minute Apgar score, and neonatal intensive care unit admission, which was not explained by lower Apgar scores or gestational age. The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants.

Design  A Web-based national survey.

Setting  Neonatal-perinatal training programs in the United States.

Participants  Graduating fellows in their final month of fellowship.

Main Outcome Measures  Fellows' perceived training and preparedness to communicate with families about decision making.

Results  The response rate was 72%, representing 83% of accredited training programs. Fellows had a great deal of training in the medical management of extremely premature and dying infants. However, they reported much less training to communicate and make collaborative decisions with the families of these infants. More than 40% of fellows reported no communication training in the form of didactic sessions, role play, or simulated patient scenarios and no clinical communication skills training in the form of supervision and feedback of fellow-led family meetings. Fellows felt least trained to discuss palliative care, families' religious and spiritual needs, and managing conflicts of opinion between families and staff or among staff. Fellows perceived communication skills training to be of a higher priority to them than to faculty, and 93% of fellows feel that training in this area should be improved.

Conclusions  Graduating neonatology fellows are highly trained in the technical skills necessary to care for critically ill and dying neonates but are inadequately trained in the communication skills that families identify as critically important when facing end-of-life decisions.

Design  The Community Youth Development Study is the first randomized trial of CTC.

Setting  In 2003, 24 small towns in 7 states, matched within state, were randomly assigned to control or CTC conditions.

Participants  A panel of 4407 fifth-grade students was surveyed annually through eighth grade.

Intervention  A coalition of community stakeholders received training and technical assistance to install the CTC prevention system. They used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community's specific profile from a menu of effective programs for families, schools, and youths aged 10 to 14 years.

Main Outcome Measures  Incidence and prevalence of alcohol, tobacco, and other drug use and delinquent behavior by spring of grade 8.

Results  The incidences of alcohol, cigarette and smokeless tobacco initiation, and delinquent behavior were significantly lower in CTC than in control communities for students in grades 5 through 8. In grade 8, the prevalences of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last 2 weeks, and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities.

Conclusion  Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide.

Design  Randomized, placebo-controlled, double-blind trial.

Setting  Five hospitals, each working as the only pediatric hospital in its region.

Participants  A total of 231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003. The children were observed for 2 years.

Interventions  All febrile episodes during follow-up were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo.

Main Outcome Measure  Recurrence of febrile seizures.

Results  The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups in the main measure of effect, and the effect estimates were similar, as the rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, –12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7°C vs 38.9°C; difference, 0.7°C; 95% confidence interval, –0.9°C to –0.6°C; P < .001), and this phenomenon was independent of the medication given.

Conclusions  Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.

Trial Registration  clinicaltrials.gov Identifier: NCT00568217

Design  Cross-sectional.

Setting  The New York Obesity Research Center at St Luke’s–Roosevelt Hospital from 1995 to 2000.

Participants  Healthy 5- to 18-year-old children and adolescents (N = 1196) were recruited in the New York City area through newspaper notices, announcements at schools and activity centers, and word of mouth.

Main Outcome Measures  Percent body fat as determined by dual-energy x-ray absorptiometry. Body fatness cutoffs were chosen so that the number of children in each category (normal, moderate, and elevated fatness) would equal the number of children in the corresponding BMI-for-age category (<85th percentile, 85th-94th percentile, and ≥95th percentile, respectively).

Results  About 77% of the children who had a BMI for age at or above the 95th percentile had an elevated body fatness, but levels of body fatness among children who had a BMI for age between the 85th and 94th percentiles (n = 200) were more variable; about one-half of these children had a moderate level of body fatness, but 30% had a normal body fatness and 20% had an elevated body fatness. The prevalence of normal levels of body fatness among these 200 children was highest among black children (50%) and among those within the 85th to 89th percentiles of BMI for age (40%).

Conclusion  Body mass index is an appropriate screening test to identify children who should have further evaluation and follow-up, but it is not diagnostic of level of adiposity.

Design  Retrospective cohort.

Setting  General pediatrics clinics at 2 academic centers.

Participants  Adolescents with BMIs in the 85th percentile or higher aged 10 to 18 years whose cholesterol levels were screened between June 2003 and June 2005 and controls matched for age, sex, ethnicity, and BMI.

Main Exposure  Cholesterol screening.

Outcome Measures  The primary outcome was the "best" individual BMI change following screening. The secondary outcome was the trend of BMI change during follow-up.

Results  Sixty-four matched pairs met the inclusion criteria (N = 128). Subjects were followed up for 3 to 30 months after identification (mean [SD], 18 [8] months). The mean BMI changes for screened subjects did not differ from those of unscreened subjects (–0.33 vs –0.34; P = .97). However, age at time of enrollment significantly modified the results (P = .02). After cholesterol screening, younger subjects initially increased in BMI, while older subjects initially decreased. The overall trend of individual BMI change increased during the follow-up period and was not significantly different between the 2 groups (likelihood ratio test, 0.9; P = .64).

Conclusions  Cholesterol screening of overweight and obese adolescents is not associated with short-term BMI change, though age at time of screening modified subsequent BMI change. Clinicians should not assume that screening will help motivate weight loss, though the effect of age at the time of screening deserves further research.

Design  Cross-sectional study of a population-based cohort.

Setting  Saguenay Youth Study, Quebec, Canada, from November 2003 to June 2007.

Participants  A total of 425 adolescents (225 girls aged 12-18 years).

Outcome Measures  Systolic and diastolic BP measured using a Finometer. Secondary outcome measures were (1) hemodynamic parameters also measured with a Finometer, (2) body composition assessed with magnetic resonance imaging, bioimpedance, and anthropometry, and (3) metabolic indices determined from a fasting blood sample.

Results  Girls vs boys demonstrated lower systolic and diastolic BP at rest and during challenges, with the differences being greatest during a math-stress test (adjusted difference, 7 mm Hg; 95% confidence interval [CI], 4-10 mm Hg and adjusted difference, 6 mm Hg; 95% CI, 4-8 mm Hg, respectively). The differences were mainly due to girls vs boys having lower stroke volume while lying down, standing (adjusted difference, 4 mL; 95% CI, 1-7 mL), and sitting, and lower total peripheral resistance during the math-stress test (adjusted difference, 0.14 mm Hg · s/mL; 95% CI, 0.09-0.21 mm Hg · s/mL). Intra-abdominal fat was positively associated with BP, but less in girls than in boys, and fat-free mass, fat mass, and insulin resistance were also positively associated with BP, similarly in boys and girls.

Conclusions  In adolescence, BP is lower in girls than boys, with the difference being determined mainly by lower stroke volume during physical challenges and by lower total peripheral resistance during mental challenges. Body composition and insulin resistance contribute to these differences.

Objective:  To determine if an android to gynoid fat ratio is associated with the severity of insulin resistance in obese children and adolescents, whereas peripheral subcutaneous fat may have a protective effect against insulin resistance.

Setting  The pediatric department of University Hospital, Clermont-Ferrand, France.

Design  A retrospective analysis using data from medical consultations between January 2005 and January 2007.

Participants  Data from 66 obese children and adolescents coming to the hospital for medical consultation were used in this study.

Main Outcome Measures  Subjects were stratified into tertiles of android to gynoid fat ratio determined by dual-energy x-ray absorptiometry. Insulin resistance was assessed by the homeostasis model of insulin resistance (HOMA-IR) index.

Results  There were no differences in weight, body mass index, and body fat percentage between tertiles. Values of HOMA-IR were significantly increased in the 2 higher tertiles (mean [SD], tertile 2, 2.73 [1.41]; tertile 3, 2.89 [1.28]) compared with the lower tertile (tertile 1, 1.67 [1.24]) of android to gynoid fat ratio (P < .001). The HOMA-IR value was significantly associated with android to gynoid fat ratio (r = 0.35; P < .01).

Conclusions  Android fat distribution is associated with an increased insulin resistance in obese children and adolescents. An android to gynoid fat ratio based on dual-energy x-ray absorptiometry measurements is a useful and simple technique to assess distribution of body fat associated with an increased risk of insulin resistance.

Design  Analysis of 369 mother-infant dyads participating in a long-term study related to early child development.

Setting  Urban public hospital.

Participants  Low-income mothers of 6-month-old infants.

Main Exposure  Maternal literacy level was assessed using the Woodcock-Johnson III/Bateria III Woodcock-Munoz Tests of Achievement, Letter-Word Identification Test. Maternal educational level was assessed by determining the last grade that had been completed by the mother.

Main Outcome Measure  The cognitive home environment (provision of learning materials, verbal responsivity, teaching, and shared reading) was assessed using StimQ, an office-based interview measure.

Results  In unadjusted analyses, a maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of 4 subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and 3 of 4 subscales. In simultaneous multiple linear regression models including both literacy and educational levels, literacy continued to be associated with scores for the overall StimQ (adjusted mean difference, 3.7; 95% confidence interval, 1.7-5.7) and all subscales except teaching, whereas maternal educational level was no longer significantly associated with scores for the StimQ (1.8; 0.5-4.0) or any of its subscales.

Conclusions  Literacy level may be a more specific indicator of risk than educational level in low-income families. Studies of low-income families should include direct measures of literacy. Pediatricians should develop strategies to identify mothers with low literacy levels and promote parenting behaviors to foster cognitive development in these at-risk families.

Design  Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic.

Setting  The Johns Hopkins Harriet Lane Pediatric Primary Care Clinic, March 20 through April 11, 2006.

Participants  A convenience sample including all pediatric faculty preceptors supervising at the clinic during the 19 half-day sessions that occurred during the observation period (N = 15) and the pediatric residents seeing patients during these clinic sessions (N = 50).

Main Outcome Measure  Field notes of preceptor-resident discussions about patient care were made and transcribed for qualitative analysis.

Results  Qualitative analysis of the ethics content of cases presented by residents in this pediatric teaching clinic identified 5 themes for categorizing ethics challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings; (2) managing the therapeutic alliance with parents and caregivers; (3) protecting patient privacy and confidentiality; (4) balancing the dual roles of learner and health care provider; and (5) using professional authority appropriately.

Conclusions  Qualitative analysis of the ethics content of directly observed preceptor-resident case discussions yielded a set of themes describing the ethics challenges facing pediatric residents. The themes are somewhat different from the lists of residents' ethics experiences developed using recall or survey methods and may be very different from the ideas usually included in hospital-based ethics discussions. This may have implications for improving ethics education during residency training.

Design  Data were obtained from published and electronic sources. A Markov model was used to project lifetime earnings, reduced crime costs, improvements in health, and reduced welfare costs using 2 scenarios: (1) maintaining the status quo and (2) reducing the blood lead level of all children to less than 1 µg/dL.

Participants  The cohort of US children between birth and age 6 years in 2008, with economic and health outcomes projected for 65 years.

Interventions  Increased primary prevention efforts aimed at reducing lead exposure among children and pregnant women.

Main Outcome Measures  Societal costs and quality-adjusted life years (QALYs) gained.

Results  Reducing blood lead levels to less than 1 µg/dL among all US children between birth and age 6 years would reduce crime and increase on-time high school graduation rates later in life. The net societal benefits arising from these improvements in high school graduation rates and reductions in crime would amount to $50 000 (SD, $14 000) per child annually at a discount rate of 3%. This would result in overall savings of approximately $1.2 trillion (SD, $341 billion) and produce an additional 4.8 million QALYs (SD, 2 million QALYs) for US society as a whole.

Conclusion  More aggressive programs aimed at reducing childhood lead exposure may produce large social benefits.

Objective  To characterize the prevalence of sleep disorders among children and adolescents with non–dialysis-dependent CKD.

Design  Prospective, questionnaire-based, cross-sectional study.

Setting  Tertiary pediatric nephrology center.

Participants  Children aged 6 to 18 years with non–dialysis-dependent CKD. Those with renal transplants were also considered to have CKD and were included, provided it was at least 3 months after the transplant.

Interventions  A validated pediatric sleep questionnaire.

Outcome Measures  Four domains of sleep disturbance were assessed: sleep-disordered breathing, restless leg syndrome/paroxysmal leg movement (RLS/PLM), insomnia, and excessive daytime sleepiness. Positive responses to any of these signified the presence of a sleep disorder.

Results  A total of 49 non–dialysis-dependent children (30 with non–renal transplant CKD and 19 with post–renal transplant CKD; median age, 14 years; interquartile range, 6-18 years) were administered the pediatric sleep questionnaire; 71% (n = 35) of the patients were male; 37% (n = 18) were identified as having a sleep disorder; 40% (n = 12) were in the nontransplant CKD group and 32% (n = 6) in the transplant CKD group. The most common type of sleep disorder was RLS/PLM, affecting 27% (n = 8) in the nontransplant CKD group and 32% (n = 6) in the transplant CKD group. There was no correlation between stage of CKD and prevalence of sleep problems (P = .22).

Conclusions  Disordered sleep was identified in more than one-third of our study population, and the most common type was RLS/PLM. Pediatricians should be aware of the relatively high incidence of sleep disorder among children and adolescents with CKD.

Design  Face-to-face semistructured interviews and assessments.

Setting  Children and adults were interviewed in their homes 10 months and 21/2 years after the tsunami.

Participants  A volunteer sample of adults and children aged 6 to 17 years who were exposed to the 2004 tsunami (at 10 months, 133 children and 84 parents; at 21/2 years, 104 children and 68 parents).

Main Exposure  The tsunami in Southeast Asia on December 26, 2004.

Outcome Measures  University of California, Los Angeles (UCLA) PTSD Reaction Index.

Results  Two children had scores indicative of PTSD at 10 months. There was a significant decrease in symptoms after 21/2 years, and no children had scores exceeding the clinical cutoff at this time. Only the death of a family member and subjective distress were independently and significantly associated with PTSD scores at 10 months, whereas sex, need for professional mental health services prior to the tsunami, and parental sick leave owing to the tsunami were independent predictors of PTSD symptoms at follow-up.

Conclusions  The children reported fewer symptoms of PTSD compared with children in other disaster studies. Predictor variables changed from disaster-related subjective distress to factors related to general mental health at follow-up. The findings indicate the importance of secondary adversities and pretrauma functioning in the maintenance of posttraumatic stress reactions.

Design  Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex.

Setting  Grade 9 health classes.

Participants  A total of 1722 students aged 14-15 from 20 public schools (52.8% girls).

Intervention  A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials.

Main Outcome Measures  The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.

Results  The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.

Conclusion  The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.

Trial Registration  isrctn.org Identifier: ISRCTN76259226

Design  The 2004 Bangladesh Demographic Health Survey, conducted from January 1 to May 31, 2004.

Setting  Selected urban and rural areas of Bangladesh.

Participants  A total of 1592 women currently married, with at least 1 child 5 years of age or younger, each living with her husband and child(ren).

Main Exposure  Intimate partner violence (IPV) against women.

Outcomes Measures  The prevalence of past-year IPV was calculated. The risk of ARI and diarrhea within the past 2 weeks among young children was determined based on maternal experiences of IPV within the past year via analyses adjusted for demographics and environmental risks.

Results  More than 2 of 5 married Bangladeshi mothers (42.4%) with children aged 5 years and younger experienced IPV from their husbands in the past year. Mothers who experienced IPV were more likely to report recent ARI (adjusted odds ratio, 1.37; 95% confidence interval, 1.03-1.83) and diarrhea (adjusted odds ratio, 1.65; 95% confidence interval, 1.15-2.38) among their young children compared with those who did not experience IPV.

Conclusions  Large numbers of married Bangladeshi women with young children experience IPV. Associations of maternal experiences of IPV with 2 leading causes of childhood mortality strongly suggest that such abuse threatens not only the health of women but also that of their children. Prevention of IPV perpetration by men may be critical to the improvement of maternal and child health.

Design  Retrospective cohort study. Data were collected by telephone survey from December 2003 to August 2005.

Setting  Group Health Cooperative, Seattle, Washington, a health maintenance organization.

Participants  English-speaking women (N = 1288) aged 18 to 64 years enrolled at Group Health Cooperative for at least 3 years.

Measures  Abused women with children were asked about their history of having witnessed IPV as a child (1 question). Abused women were identified using 5 questions from the Behavioral Risk Factor Surveillance System Survey and using 10 items from the Women's Experience With Battering Scale. Abused women were asked if their children had ever witnessed IPV.

Results  Adjusting for mothers' race/ethnicity and education level, children of women who had witnessed IPV during childhood had 1.29 times higher odds of witnessing IPV than children of women who did not witness IPV during childhood.

Conclusion  Children of women who had witnessed IPV during childhood are more likely to witness IPV than children of women who did not witness IPV.

Design  Obese children were examined prospectively at baseline and 1 year later.

Setting  Obesity clinic.

Participants  A total of 287 untreated obese children; 53.3% were girls, the mean age was 11.4 years, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 28.2.

Main Outcome Measures  Homeostasis model assessment of insulin resistance (HOMA-IR) values and prevalence of hypertension, dyslipidemia, impaired fasting glucose level, and NAFLD.

Results  At baseline, 20.6% of obese children had hypertension, 22.3% had dyslipidemia, 4.9% had impaired fasting glucose levels, and 29.3% had NAFLD. These prevalences, as well as weight status, remained stable at the 1-year follow-up visit. Increases (SDs) in prevalence of hypertension (16.1% [51.8%]), hypertriglyceridemia (9.7% [59.3%]), and impaired fasting glucose level (8.1% [32.9%]), as well as mean HOMA-IR value (0.42 [1.22]), were observed in 62 children entering puberty. In contrast, mean decreases (SDs) in hypertension (–18.8% [53.2%]), hypertriglyceridemia (–12.5% [53.1%]), impaired fasting glucose level (–6.3% [38.1%]), and NAFLD prevalence (–18.8% [44.5%]), as well as mean HOMA-IR value (–0.83 [2.56]), were observed in 50 children entering late puberty (P < .01 for change of pubertal status in the multivariate model). Changes in HOMA-IR values were only weakly related to changes in prevalence of cardiovascular risk factors or transaminase levels (r < 0.2).

Conclusions  Cardiovascular risk factors worsened at onset of puberty and improved in late puberty in obese children whose weight status did not change. The weak correlation between HOMA-IR value and cardiovascular risk factors suggests that other characteristics may affect these disorders.

Design  Cross-sectional analysis.

Setting  National Health and Nutrition Examination Survey 1999-2004.

Participants  Population-based sample of children (aged 3-18 years) with nonfasting total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol levels and adolescents (aged 12-18 years) with fasting low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels.

Main Outcome Measures  Individuals were classified as having hypercholesterolemia if they had a TC level greater than 200 mg/dL, HDL cholesterol level less than 35 mg/dL, LDL cholesterol level greater than 130 mg/dL, or TG level greater than 150 mg/dL, and sensitivity, specificity, and likelihood ratios were calculated for specific BMI percentiles. Receiver operating characteristic curves were constructed and area under the curve (AUC) was calculated.

Results  Receiver operating characteristic curves using BMI percentiles to predict abnormal levels of TC and LDL cholesterol had AUC values (0.60 for TC level and 0.63 for LDL cholesterol level) that were less than the threshold of acceptable discrimination (between 0.7-0.8). Body mass index percentiles provided better discrimination for detecting children with abnormal HDL cholesterol and TG levels, with AUC values approaching levels of acceptable discrimination (0.69 and 0.72, respectively), although there are no specific guidelines regarding management of children with these abnormalities.

Conclusions  According to the American Academy of Pediatrics guidelines, abnormal levels of LDL cholesterol are used to determine which children require nutritional and pharmacologic therapy. Because BMI percentiles did not adequately identify children and adolescents with abnormal TC and LDL cholesterol levels, the new recommendations for targeted screening of obese children and adolescents may require further consideration.

Design  Cross-sectional study.

Setting  A rural Midwestern US community.

Participants  Children aged 3 to 8 years (N = 111).

Intervention  Adiposity was assessed using dual energy x-ray absorptiometry. Objective measurements of sedentary activity were obtained from the accelerometers that participants wore continuously for 7 days. Measurements of television (TV) viewing, computer, and screen time (TV + computer) were obtained via parent report.

Main Outcome Measures  Systolic and diastolic BP.

Results  The sample spent a mean of 5 hours per day in sedentary activities, of which 1.5 hours were screen time. Accelerometer-determined sedentary activity was not significantly related to systolic BP or diastolic BP after controlling for age, sex, height, and percentage of body fat. However, TV viewing and screen time, but not computer use, were positively associated with both systolic BP and diastolic BP after adjusting for potential confounders. Participants in the lowest tertile of TV and screen time had significantly lower levels of systolic and diastolic BP than participants in the upper tertile.

Conclusions  Sedentary behaviors, particularly TV viewing and screen time, were associated with BP in children, independent of body composition. Other factors that occur during excessive screen time (eg, food consumption) should also be considered in the context of sedentary behavior and BP development in children.

Design  Analysis of 2 large cross-sectional surveys, 1 from Germany and 1 from the United States.

Setting  Twenty-seven public schools in northern Germany; telephone interviews in the United States.

Participants  A total of 4810 German children and adolescents aged 10 to 17 years (mean age, 12.8 years); 4473 US children and adolescents aged 12 to 16 years (mean age, 14.0 years) recruited using random-digit-dial methods.

Main Exposures  Media exposure was assessed via survey questions about the presence of a television in the bedroom, television screen time, computer and video game screen time, and movie viewing. The SES was derived from type of school (German sample) or parental reports of their own education and family income (US sample).

Main Outcome Measures  The BMI was assessed by the use of self-reports in both samples, supplemented by parental reports (US sample) for height and weight.

Results  In both samples, SES was inversely associated with BMI, and media use was directly associated with BMI. The effect of SES on overweight was partially mediated by media exposure, which explained 35% of the SES-BMI association in the German sample and 16% in the US sample. In both groups, television in the bedroom and television screen time had statistically significant indirect paths, whereas video game use and movie viewing did not.

Conclusions  Students from low-SES backgrounds are at higher risk for overweight in part because of higher levels of television viewing. The change of media use habits could modify this health disparity.

Design  Nationally representative samples of US high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires.

Setting  Data were collected in public and private high schools.

Participants  The sample consisted of 5 cohorts (2002-2006) of 12 441 high school seniors.

Main Outcome Measures  Self-reports of motives for nonmedical use of prescription opioids and substance use behaviors.

Results  More than 1 in every 10 high school seniors reported nonmedical use of prescription opioids and 45% of past-year nonmedical users reported "to relieve physical pain" as an important motivation. The odds of heavy drinking and other drug use were lower among nonmedical users of prescription opioids motivated only by pain relief compared with nonmedical users who reported pain relief and other motives and those who reported non–pain relief motives only. The odds of medical use of prescription opioids were lower among nonmedical users who reported only non–pain relief motives compared with other types of nonmedical users.

Conclusions  The findings indicate motives should be considered when working with adolescents who report nonmedical use of prescription opioids. Future efforts are needed to identify adolescents who may need appropriate pain management and those at increased risk for prescription opioid abuse.

Design  Population-based prospective cohort study of pregnant women and their children.

Setting  This project was embedded in the Generation R Study.

Participants  A total of 1079 postnatal Dutch infants/children participated in the focus cohort.

Main Exposures  Nasal swabs for S aureus cultivation were taken at ages 1.5, 6, and 14 months.

Main Outcome Measure  Questionnaires that pertain to AD and confounders (birth weight, gestational age, sex, and parental eczema) were completed prenatally and postnatally. The outcome was AD in the first and second years of life.

Results  A first positive culture for S aureus at age 6 months was associated with AD prevalence in the first and second years of life (adjusted odds ratio [aOR], 2.13; 95% confidence interval [CI], 1.17-3.87; and aOR, 2.88; 95% CI, 1.60-5.19, respectively) and also with severity (aOR, 3.27; 95% CI, 1.30-8.03). Moreover, frequent colonization in the first year of life (≥2 times) held a 4.29-fold (95% CI, 1.03- to 17.88-fold) risk of moderate to severe AD in the second year of life.

Conclusion  Colonization with S aureus at age 6 months and frequent colonization in the first year of life are associated with AD and its severity in young children.

Design  A double-blinded randomized placebo-controlled allocation concealment clinical trial.

Setting  Primary care patients in the Washington, DC, metropolitan area.

Participants  A total of 125 children aged 1 to 5 years presenting to primary care physicians.

Intervention  Kefir drink or heat-killed matching placebo.

Main Outcome Measure  The primary outcome was the incidence of diarrhea during the 14-day follow-up period in children receiving antibiotics.

Results  There were no differences in the rates of diarrhea per group, with 18% in the active group and 21.9% in the placebo group (relative risk, 0.82; 95% confidence interval, 0.54-1.43). Additionally, there were no differences in any secondary outcomes among the groups. However, there were some interesting interactions among initial health at enrollment, age of participants, and sex that require further study.

Conclusions  In our trial, kefir did not prevent AAD. Further independent research on the potential of kefir needs to be conducted.

Trial Registration  clinicaltrials.gov Identifier: NCT00481507

Data Sources  Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences.

Study Selection  Eleven of 24 identified trials (n = 1459) were eligible for inclusion.

Intervention  Trials comparing formula milk supplemented with or without prebiotics, commenced at or before age 28 days and continued for 2 weeks or longer.

Main Outcome Measures  Stool colony counts (bifidobacteria, lactobacilli, and pathogens), pH, consistency, frequency, anthropometry, and symptoms of intolerance.

Results  Six trials reported significant increases and 2 reported a trend toward increases in bifidobacteria counts after supplementation. Meta-analysis estimated significant reduction in stool pH in infants who received prebiotic supplementation (weighted mean difference, –0.65; 95% confidence interval, –0.76 to –0.54; 6 trials). Infants who receive a supplement had slightly better weight gain than did controls (weighted mean difference, 1.07 g; 95% confidence interval, 0.14-1.99; 4 trials) with softer and frequent stools similar to breastfed infants. All but 1 trial reported that prebiotic supplementation was well tolerated. In that trial, diarrhea (18% vs 4%; P = .008), irritability (16% vs 4%; P = .03), and eczema (18% vs 7%; P = .046) were reported more frequently by parents of infants who received prebiotic supplements.

Conclusions  Prebiotic-supplemented formula is well tolerated by full-term infants. It increases stool colony counts of bifidobacteria and lactobacilli and results in stools similar to those of breastfed neonates without affecting weight gain. Larger trials with long-term follow-up are needed to determine whether these short-term benefits are sustained.