Children In Metropolitan Areas Research Articles

Radiation Implication in Pediatric Second Primary Thyroid Malignancy (SPTM) Cumulative Incidence and Mortality in the United States: Large Cohort Evidence

Objective: To assess racial and sex variances in second primary thyroid malignancy (SPTM) cumulative incidence and temporal trends and the radiation exposure effect in pediatric SPTM. Materials and Methods: A retrospective cohort study, a non-experimental epidemiologic design, was used to assess the cumulative incidence (CmI) and temporal trends as well as the exposure effect of radiation in SPTM among children, 0–19 years, in the Surveillance, Epidemiology, and End Results (SEER) registry, National Cancer Institute (NCI), USA. Percent change (PC) and annual percent change (APC) were used to examine CmI rates and temporal trends, while chi-square statistics and binomial regression models were used to examine variable distribution by race and to determine the exposure effect of radiation on SPTM as well as mortality, respectively. Results: The frequency of pediatric thyroid cancer was (n = 3457) between 1973 and 2013/14, while the PC was 151.2 for all races but 99.8 among whites. Of all pediatric thyroid cancers diagnosed during this period, SPTM accounted for 3% (n = 99). Compared to whites, blacks/AA were 60% less likely to present with SPTM, adjusted risk ratio, aRR = 0.40, 99% CI 0.06–2.47, while other races were 18% more likely to develop SPTM, aRR = 1.18, 99% CI 0.48–2.87. Additionally, females relative to males were 63% less likely to be diagnosed with SPTM, aRR = 0.37, 99% CI 0.22–0.61. With respect to urbanicity, compared to children in rural areas, those in urban areas were 21% less likely to develop SPTM, aRR = 0.79, 99% CI, 0.12–5.35, while children in metropolitan areas were 40% less likely to develop SPTM, aRR = 0.60, 99% CI, 0.10–3.59. Although imprecise, there was a 5% increased risk of SPTM, with radiation as an exposure effect, aRR = 1.05, 99% CI 1.01–1.75. Conclusions: There are increasing temporal trends in pediatric SPTM with blacks relative to whites having observed lower incidence, despite an increasing percent change among blacks/AA, indicative of the disproportionate burden of this malignant neoplasm. SPTM risk was higher among males and in rural areas, while radiation as a risk for SPTM was clinically and biologically meaningful, albeit an observed statistically insignificant inference due to sampling variability, requiring intervention mapping in radiation exposure margination among children.

Geographic proximity to immunization providers and vaccine series completion among children ages 0-24months.

In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations. We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24months. Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median=1.7; IQR=3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92). Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.

Association Between Resilience and Psychological Morbidity in Parents of Critically Ill Children.

To determine whether parental resilience, measured at ICU admission, is associated with parent-reported symptoms of depression, anxiety, posttraumatic stress, and satisfaction with ICU care 3-5 weeks following ICU discharge. Planned prospective, observational study nested in a randomized comparative trial. PICUs and cardiac ICUs in two, free-standing metropolitan area children's hospitals. English- and Spanish-speaking parents whose children were younger than 18 years old and had anticipated ICU stay of greater than 24 hours or Pediatric Index of Mortality score of greater than or equal to 4 at the time of consent. All ICU admissions were screened for inclusion. Of 4,251 admissions reviewed, 1,360 were eligible. Five hundred families were approached and 382 enrolled. Two hundred thirty-two parents from 210 families with complete data were included in analysis. All participating parents completed the Connor-Davidson Resilience Scale at the time of consent and outcome measures 3-5 weeks after ICU discharge. All parents completed the Patient-Reported Outcome Measurement Information System Short Forms 8a for Depression and Anxiety, Impact of Event Scale-Revised for posttraumatic stress, and Pediatric Family Satisfaction-ICU 24 for parental satisfaction 3-5 weeks after ICU discharge. Higher parental resilience was associated with fewer symptoms of depression, anxiety, and posttraumatic stress in the final model (all p < 0.0001). Shorter length of stay, early mechanical ventilation, Latino ethnicity, and lower illness severity (both objective and parental perceptions) were associated with less morbidity in some or all measured mental health outcomes. Higher parental resilience is associated with fewer reported symptoms of anxiety, depression, and posttraumatic stress 3-5 weeks after ICU discharge. Parental resilience may impact parental post-ICU psychological morbidity. Measuring parental resilience could be one approach to identify parents at risk for post-ICU psychological morbidity. Future research into the impact of interventions designed to boost parental resilience is warranted.

Authentic Parental Competence, Awareness of Educational Community, and Life Satisfaction in Mothers with Young Children in Korea

Objectives The study aimed to examine the effect of authentic parental competence and parental awareness of educational community on mothers’ life satisfaction and the magnitude of the direct and indirect effects of those variables. Given the increasing interest in parental life satisfaction, emphasis on parental involvement to educational community and its connection to the competence as a parent, there is much need to investigate the relationship among these in order to achieve a happy family via happy parents, the fundamental and ultimate goal of a society. Methods A non-clinical sample of 276 mothers of early childhood children in metropolitan areas of Korea completed Likert questionnaires. The age of participants ranged from 25 to 47 years, and the majority of participants were middle-class. Results In addition to the positive correlations among the variables, regression analyses indicated that authentic parental competence predicted maternal life satisfaction directly and indirectly via awareness of educational community. Conclusion Life satisfaction of mothers of young children is not only directly affected by authentic parental competence, but also indirectly through the extent of how they aware their children’s education institutions as educational communities. This suggests the necessity to enhance awareness of early childhood education community as well as authentic parental competence in order to improve life satisfaction of mothers. Therefore, in early childhood education institutions and local communities it is required to implement parent education programs in order to increase authentic parental competence beyond parenting capability, and to make efforts together in establishing early childhood education institutions as educational community. Keywords: authentic parental competence, awareness of educational community, life satisfaction, mothers, early childhood

Online communities as childcare resources among households with young children in metropolitan areas in Japan

This paper examines the relation between the the role of the use of the Internet, online communities, and households with young children. As parentiyoung networks have changed the Internet has been drawing attention as a source for providing childcare information and for networking with other parents. Since the 1990s, the deregulation of childcare services has increased the importance of immediate and abundant childcare information. The online community for households with young children has great importance in metropolitan areas in Japan.

Asthma hospitalisation trends from 2010 to 2015: variation among rural and metropolitan Australians

BackgroundAsthma remains a leading cause of illness, where primary care can assist to reduce hospitalisations through prevention, controlling acute episodes, and overall management of asthma. In Victoria, Asthma hospitalisations were as high as 3.1 hospitalisations per 1000 population in 1993–94. The primary aims of this study are to: determine if changes in asthma hospitalisations have occurred between 2010 and 2015; determine the key factors that impact asthma hospitalisation over time; and verify whether rural and urban asthma hospitalisations are disparate. A secondary aim of the study is to compare 2010–2015 results with asthma data prior to 2010.MethodsHospital separation data from 1 July 2010 to 30 June 2015 were obtained through the Victorian Admitted Episodes Dataset and other agencies. Data included sex, age, Local Government Area, private or public patient, length of stay, and type of discharge. Asthma and predictor variables were analysed according to hospital separation rates after adjusting for smoking and sex. Hierarchical multiple regression examined the association between asthma and predictor variables.ResultsDuring the study period, 49,529 asthma hospital separations occurred, of which 77.5% were in metropolitan hospitals, 55.4% hospital separations were aged 0–14 years, and 21.7% were privately funded. State-wide hospital separations were 1.85 per 1000 population and were consistently higher in metropolitan compared to rural areas (1.93 vs 1.64 per 1000 population). When data among metropolitan adults aged 15 and over were analysed, an increase in the proportion of smokers in the population was reflected by an increase in the number of hospital separations (Adj OR 1.035). Further, among rural and metropolitan children aged 0–14 the only predictor of asthma hospital separations was sex, where metropolitan male children had higher odds of separation than metropolitan females of the same age (Adj OR 4.297). There was no statistically meaningful difference for separation rates between males and females in rural areas.ConclusionsWe demonstrated a higher overall hospital separation rate in metropolitan Victoria. For children in metropolitan areas, males were hospitalised at higher rates than females, while the inverse was demonstrated for children residing in rural areas. Therefore, optimising asthma management requires consideration of the patient’s age, gender and residential context. Primary health care may play a leading role in increasing health literacy for patients in order to improve self-management and health-seeking behaviour.

Physical activity of rurally residing children with a disability: A survey of parents and carers

BackgroundChildren residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child. ObjectiveThe aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area. MethodsA mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis. ResultsThere were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child. ConclusionThe children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development.

The impact of caregiver treatment satisfaction upon child and parent outcomes.

Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors. The purpose of this study was to examine caregiver treatment satisfaction amongst 320 youth of color aged 7 to 11 and their families who were assigned to either a Multiple Family Group intervention or services as usual condition. Caregiver stress was measured by the Parenting Stress Index Short-Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale-Oppositional/Defiant subscale both at baseline and post-test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post-test. The two main effects models that focused on satisfaction with treatment was predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time holding all covariates constant. Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with DBDs as well as parental emotional health. Further, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.

Mexico City normal weight children exposed to high concentrations of ambient PM2.5 show high blood leptin and endothelin-1, vitamin D deficiency, and food reward hormone dysregulation versus low pollution controls. Relevance for obesity and Alzheimer disease

Millions of Mexico, US and across the world children are overweight and obese. Exposure to fossil-fuel combustion sources increases the risk for obesity and diabetes, while long-term exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is associated with increased risk of Alzheimer's disease (AD). Mexico City Metropolitan Area children are chronically exposed to PM2.5 and O3 concentrations above the standards and exhibit systemic, brain and intrathecal inflammation, cognitive deficits, and Alzheimer disease neuropathology. We investigated adipokines, food reward hormones, endothelial dysfunction, vitamin D and apolipoprotein E (APOE) relationships in 80 healthy, normal weight 11.1±3.2 year olds matched by age, gender, BMI and SES, low (n: 26) versus high (n:54) PM2.5 exposures. Mexico City children had higher leptin and endothelin-1 (p<0.01 and p<0.000), and decreases in glucagon-like peptide-1 (GLP 1), ghrelin, and glucagon (<0.02) versus controls. BMI and leptin relationships were significantly different in low versus high PM2.5 exposed children. Mexico City APOE 4 versus 3 children had higher glucose (p=0.009). Serum 25-hydroxyvitamin D<30ng/mL was documented in 87% of Mexico City children. Leptin is strongly positively associated to PM 2.5 cumulative exposures. Residing in a high PM2.5 and O3 environment is associated with 12h fasting hyperleptinemia, altered appetite-regulating peptides, vitamin D deficiency, and increases in ET-1 in clinically healthy children. These changes could signal the future trajectory of urban children towards the development of insulin resistance, obesity, type II diabetes, premature cardiovascular disease, addiction-like behavior, cognitive impairment and Alzheimer's disease. Increased efforts should be made to decrease pediatric PM2.5 exposures, to deliver health interventions prior to the development of obesity and to identify and mitigate environmental factors influencing obesity and Alzheimer disease.

Decreases in Short Term Memory, IQ, and Altered Brain Metabolic Ratios in Urban Apolipoprotein ε4 Children Exposed to Air Pollution.

Children's urban air pollution exposures result in systemic and brain inflammation and the early hallmarks of Alzheimer's disease (AD). The apolipoprotein E (APOE) ε4 allele is the most prevalent genetic risk for AD. We assessed whether APOE in healthy children modulates cognition, olfaction, and metabolic brain indices. The Wechsler Intelligence Scale for Children (WISC-R) and the University of Pennsylvania Smell Identification Test were administered to 50 Mexico City Metropolitan Area children (13.4 ± 4.8 years, 28 APOE ε3 and 22 APOE ε4). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (mI)/Cr, and NAA/mI were calculated using proton magnetic resonance spectroscopy in the white matter of the frontal and parietal lobes, hippocampus, and pons. APOE ε4 versus ε3 children had a reduced NAA/Cr ratio in the right frontal white matter and decrements on attention, short-term memory, and below-average scores in Verbal and Full Scale IQ (>10 points). APOE modulated the group effects between WISC-R and left frontal and parietal white matter, and hippocampus metabolites. Soap was the predominantly failed odor in urban children and, in APOE ε4 versus ε3 carriers, strongly correlated with left hippocampus mI/Cr ratio. APOE modulates responses to air pollution in the developing brain. APOE ε4 carriers could have a higher risk of developing early AD if they reside in a polluted environment. APOE, cognition, and olfaction testing and targeted magnetic resonance spectroscopy may contribute to the assessment of urban children and their results could provide new paths toward the unprecedented opportunity for early neuroprotection and AD prevention.

Factors related to childhood suicides: analysis of the Queensland Child Death Register.

Suicide among children under the age of 15 years is a leading cause of death. The aim of the current study is to identify demographic, psychosocial, and psychiatric factors associated with child suicides. Using external causes of deaths recorded in the Queensland Child Death Register, a case-control study design was applied. Cases were suicides of children (10-14 years) and adolescents (15-17 years); controls were other external causes of death in the same age band. Between 2004 and 2012, 149 suicides were recorded: 34 of children aged 10-14 years and 115 of adolescents aged 15-17 years. The gender asymmetry was less evident in child suicides and suicides were significantly more prevalent in indigenous children. Children residing in remote areas were significantly more likely to die by suicide than other external causes compared with children in metropolitan areas. Types of precipitating events differed between children and adolescents, with children more likely to experience family problems. Disorders usually diagnosed during infancy, childhood, and adolescence (e.g., ADHD) were significantly more common among children compared with adolescents who died by suicide. Psychosocial and environmental aspects of children, in addition to mental health and behavioral difficulties, are important in the understanding of suicide in this age group and in the development of targeted suicide prevention.

Up-regulation of mRNA ventricular PRNP prion protein gene expression in air pollution highly exposed young urbanites: endoplasmic reticulum stress, glucose regulated protein 78, and nanosized particles.

Mexico City Metropolitan Area children and young adults exposed to high concentrations of air pollutants including fine and ultrafine particulate matter (PM) vs. clean air controls, exhibit myocardial inflammation and inflammasome activation with a differential right and left ventricular expression of key inflammatory genes and inflammasomes. We investigated the mRNA expression levels of the prion protein gene PRNP, which plays an important role in the protection against oxidative stress and metal toxicity, and the glucose regulated protein 78, a key protein in endoplasmic reticulum (ER) stress signaling, in ventricular autopsy samples from 30 children and young adults age 19.97 ± 6.8 years with a lifetime of low (n:4) vs. high (n:26) air pollution exposures. Light microscopy and transmission electron microscopy studies were carried out in human ventricles, and electron microscopy studies were also done in 5 young, highly exposed Mexico City dogs. There was significant left ventricular PRNP and bi-ventricular GRP78 mRNA up-regulation in Mexico City young urbanites vs. controls. PRNP up-regulation in the left ventricle was significantly different from the right, p < 0.0001, and there was a strong left ventricular PRNP and GRP78 correlation (p = 0.0005). Marked abnormalities in capillary endothelial cells, numerous nanosized particles in myocardial ER and in abnormal mitochondria characterized the highly exposed ventricles. Early and sustained cardiac ER stress could result in detrimental irreversible consequences in urban children, and while highly complex systems maintain myocardial homeostasis, failure to compensate for chronic myocardial inflammation, oxidative and ER stress, and particles damaging myocardial organelles may prime the development of pathophysiological cardiovascular states in young urbanites. Nanosized PM could play a key cardiac myocyte toxicity role.

Early Alzheimer's and Parkinson's disease pathology in urban children: Friend versus Foe responses--it is time to face the evidence.

Chronic exposure to particulate matter air pollution is known to cause inflammation leading to respiratory- and cardiovascular-related sickness and death. Mexico City Metropolitan Area children exhibit an early brain imbalance in genes involved in oxidative stress, inflammation, and innate and adaptive immune responses. Early dysregulated neuroinflammation, brain microvascular damage, production of potent vasoconstrictors, and perturbations in the integrity of the neurovascular unit likely contribute to progressive neurodegenerative processes. The accumulation of misfolded proteins coincides with the anatomical distribution observed in the early stages of both Alzheimer's and Parkinson's diseases. We contend misfolding of hyperphosphorylated tau (HPπ), alpha-synuclein, and beta-amyloid could represent a compensatory early protective response to the sustained systemic and brain inflammation. However, we favor the view that the chronic systemic and brain dysregulated inflammation and the diffuse vascular damage contribute to the establishment of neurodegenerative processes with childhood clinical manifestations. Friend turns Foe early; therefore, implementation of neuroprotective measures to ameliorate or stop the inflammatory and neurodegenerative processes is warranted in exposed children. Epidemiological, cognitive, structural, and functional neuroimaging and mechanistic studies into the association between air pollution exposures and the development of neuroinflammation and neurodegeneration in children are of pressing importance for public health.

Brain immune interactions and air pollution: macrophage inhibitory factor (MIF), prion cellular protein (PrPC), Interleukin-6 (IL-6), interleukin 1 receptor antagonist (IL-1Ra), and interleukin-2 (IL-2) in cerebrospinal fluid and MIF in serum differentiate urban children exposed to severe vs. low air pollution

Mexico City Metropolitan Area children chronically exposed to high concentrations of air pollutants exhibit an early brain imbalance in genes involved in oxidative stress, inflammation, innate and adaptive immune responses along with accumulation of misfolded proteins observed in the early stages of Alzheimer and Parkinson's diseases. A complex modulation of serum cytokines and chemokines influences children's brain structural and gray/white matter volumetric responses to air pollution. The search for biomarkers associating systemic and CNS inflammation to brain growth and cognitive deficits in the short term and neurodegeneration in the long-term is our principal aim. We explored and compared a profile of cytokines, chemokines (Multiplexing LASER Bead Technology) and Cellular prion protein (PrPC) in normal cerebro-spinal-fluid (CSF) of urban children with high vs. low air pollution exposures. PrPC and macrophage inhibitory factor (MIF) were also measured in serum. Samples from 139 children ages 11.91 ± 4.2 years were measured. Highly exposed children exhibited significant increases in CSF MIF (p = 0.002), IL6 (p = 0.006), IL1ra (p = 0.014), IL-2 (p = 0.04), and PrPC (p = 0.039) vs. controls. MIF serum concentrations were higher in exposed children (p = 0.009). Our results suggest CSF as a MIF, IL6, IL1Ra, IL-2, and PrPC compartment that can possibly differentiate air pollution exposures in children. MIF, a key neuro-immune mediator, is a potential biomarker bridge to identify children with CNS inflammation. Fine tuning of immune-to-brain communication is crucial to neural networks appropriate functioning, thus the short and long term effects of systemic inflammation and dysregulated neural immune responses are of deep concern for millions of exposed children. Defining the linkage and the health consequences of the brain / immune system interactions in the developing brain chronically exposed to air pollutants ought to be of pressing importance for public health.

The association between childhood asthma prevalence and monitored air pollutants in metropolitan areas, United States, 2001–2004

Air pollution exposure has been linked to adverse respiratory health outcomes among children, primarily in studies of acute exposures that are often in limited geographic areas. We sought to assess the association between chronic outdoor air pollution exposure, as measured by 12-month averages by county, and asthma among children in metropolitan areas across the nation. Eligible children included those aged 3-17 years residing in US metropolitan areas who were sampled in the 2001-2004 National Health Interview Survey (N=34,073). 12-month average air pollutant levels for sulfur dioxide, nitrogen dioxide, ozone and particulate matter were compiled by county for 2000-2004. Eligible children were linked to pollutant levels for the previous 12 months for their county of residence. Adjusted odds ratios of having current asthma or an asthma attack in the past 12 months were estimated in single pollutant logistic regression models. Children in counties with ozone and, to a less consistent degree, particulate matter levels in the highest quartile were more likely to have current asthma and/or a recent asthma attack than children residing in counties with the lowest pollution levels; the adjusted odds for current asthma for the highest quartile of estimated ozone exposure was 1.56 (95% confidence interval [CI]: 1.15, 2.10) and for recent asthma attack 1.38 (95% CI: 0.99, 1.91). No associations were found with sulfur dioxide or nitrogen dioxide levels. Although the current US standard for ozone is based on short-term exposure, this cross-sectional study suggests that chronic (12-month) exposure to ozone and particles is related to asthma outcomes among children in metropolitan areas throughout the US.

Invited Commentary: Residential Segregation and Health--The Complexity of Modeling Separate Social Contexts

When researching racial disparities in health, residential segregation cannot be ignored. Because of segregation, contextual differences by race are so pronounced that ignoring them may lead to mis-estimating the effect of individual-level factors. However, given the stark racial separation of social contexts, researching how residential segregation and neighborhood inequality contribute to racial health disparities remains methodologically challenging. Estimating the contribution of neighborhood effects to health disparities would require overlap in the racial distributions of neighborhood environment, for example, in the distributions of neighborhood poverty. Because of segregation, though, the extent of such overlap is extremely restricted. Previous analyses of the 2000 US Census found, on average, only a 24% overlap between the distribution of neighborhood poverty for black children and that for white children in metropolitan areas. Propensity score methods may be 1 useful tool for addressing limited overlap or exchangeability. However, as shown by their application to the segregation and health relation, their use should be informed by a sound conceptualization of the scale of the social exposure of interest, the hypothesized pathways between the exposure and the health outcome, and possible unmeasured confounders.

Sensor Queries: Algebraic Optimization for Time and Energy

Sensor networks naturally apply to a broad range of applications that involve system monitoring and information tracking (e.g., airport security infrastructure, monitoring of children in metropolitan areas, product transition in warehouse networks, fine-grained weather/environmental measurements, etc.). Meanwhile, there are considerable performance deficiencies in applying existing sensornets in the applications that have stringent requirements for efficient mechanisms for querying sensor data and delivering the query result. The amount of data collected from all relevant sensors may be quite large and will require high data transmission rates to satisfy time constraints. It implies that excessive packet collisions can lead to packet losses and retransmissions resulting in significant energy costs and latency. In this paper we provide a formal consideration of a Data Transmission Algebra (DTA) that supports application-driven data interrogation patterns and optimization across multiple network layers. We use a logical framework to specify DTA semantics and to prove its soundness and completeness. Further, we prove that DTA query execution schedules have the key property of being collision-free. Finally, we describe and evaluate an algebraic query optimizer performing collision-aware query scheduling that both improve the response time and reduce the energy consumption.

Patterns of Change over Time in Beliefs Legitimizing Aggression in Adolescents and Young Adults: Risk Trajectories and Their Relationship with Serious Aggression

Using an ecological developmental conceptual framework for understanding and preventing serious aggression, the authors examined the relationship over time between beliefs legitimizing aggression (BLA) and use of aggression. Data from seven waves of the National Youth Survey were used to fit a semiparametric group-based model that identified four distinct trajectories of BLA risk over time: low/stable, moderate/stable, moderate/decreasing, and high/decreasing. Results indicated that BLA risk was associated with the onset of serious aggression by early adolescence. BLA risk status was significantly related to aggression at all seven waves, but the magnitude of the relationships was smaller at later waves. Comparison of the moderate/stable and moderate/decreasing risk groups indicated that decreases in BLA risk level during late adolescence and young adulthood were not related to decreases in levels of aggression. Results suggest that reducing beliefs about aggression is a promising strategy for primary prevention aimed at children and young adolescents but that secondary prevention and treatment should target factors other than BLA risk to bring about reduced levels of aggression. KEY WORDS: adolescents; aggression; beliefs; young adults; trajectories ********** Increases in the level and severity of aggression in youth during the 1980s and 1990s prompted a wealth of research by scholars in social work and other fields aimed at building knowledge of its nature and etiology (Dodge & Pettit, 2003). This research has produced an extensive body of conceptual and empirical literature on the onset and course of serious aggression and related problems in childhood and adolescence and on prevention policies and programs (for example, Crick & Dodge, 1994; Dodge, Dishion, & Lansford, 2006; Fraser & Galinsky, 2004; Hawkins et al., 2003; Metropolitan Area Child Study [MACS] Research Group; 2002). An ecological developmental framework for understanding and preventing aggression and related problems has emerged from this research (Dodge & Pettit).According to the framework, which synthesizes research results from multiple disciplines, serious and chronic aggression is a result of the complex interaction over time of individual and environmental risk factors. Individual-level social--cognitive mechanisms are posited as key risk factors that mediate relationships among more distal factors and the occurrence of aggression. These social--cognitive risk factors often serve as a focus of intervention efforts aimed at preventing and treating serious aggression (U.S. Department of Health and Human Services [HHS], 2001, 2005).The current study examines a particular social--cognitive risk factor, beliefs legitimizing aggression (BLA), and its relationship with serious aggression, There is a focus on examining whether changes over time in beliefs about aggression are related to changes in levels of serious aggression. UNDERSTANDING AND PREVENTING SERIOUS AGGRESSION Multiple Levels of Risk An ecological developmental framework identifies biopsychosocial risk factors that have been empirically linked to serious aggression and related problems (Dodge & Pettit, 2003; see Fraser & Galinsky, 2004, for a more general but similar framework for risk and resilience in childhood). The framework draws on social learning, information-processing, social disorganization, and other theories to postulate processes through which risk factors are thought to influence the onset and course of problems. According to the framework, certain biological and environmental factors predispose some infants to an increased likelihood of early aggressive behavior. Across childhood and adolescence, individual, family, school, peer, neighborhood, and sociocultural risk factors interact, resulting in risk processes that launch some children onto a developmental trajectory characterized by increased and, ultimately, chronic use of aggressive behavior. …

Association Between Outdoor Air Pollution and Childhood Asthma Symptoms in Metropolitan Areas, United States

P-079 Introduction: Poor asthma outcomes have been linked to air pollution exposure in many studies focusing on local areas and/or short exposure duration. To assess the association between chronic outdoor air pollution exposure and asthma symptoms among children in metropolitan areas in the United States, air monitoring data from the U.S. Environmental Protection Agency (EPA) were merged with data from the National Health Interview Survey (NHIS). Methods: Annual average air pollutant levels for five criteria pollutants (particulate matter, ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide) were compiled by county for 2000–2003. The sample children in the study were ages 3–17 years residing in U.S. metropolitan areas for whom health conditions were reported in the 2001–2004 NHIS. Data for sample children were matched with exposure data for the previous 12 months when available for the county where they resided at the time of the NHIS interview. County-level pollutant values were ranked into quartiles. Logistic regression using survey sample weights was used to assess association between asthma outcomes (current asthma, recent asthma attack, and recent emergency room visit for asthma) and monitored air pollutant levels. Results: After adjusting for race/ethnicity, sex, parental education, poverty status, central city residence, and single parent household, the authors found that children living in the counties in the highest quartiles for all pollutants except carbon monoxide were generally more likely to have current asthma, a reported asthma attack in the previous 12 months, and a reported asthma emergency room visit in the previous 12 months than those residing in counties with pollution values ranked in the lower quartiles. For example, for children living in the highest quartile of pollution levels for particulate matter (aerodynamic diameter less than or equal to 2.5 micrometers), the adjusted odds ratio for current asthma was 1.53 (95% confidence interval [CI]: 1.06–2.23), for recent asthma attack 1.38 (95% CI: 0.95–2.01), and for asthma emergency room visit 1.73 (95% CI: 1.01–2.97). Conclusion: This analysis suggests that chronic exposure to air pollution in metropolitan areas throughout the U.S. may be associated with increased current asthma rates and ongoing asthma symptoms among children.

Paediatric trauma

Trauma remains the most common cause of death in childhood after the first year of life. It accounts for considerable morbidity that may extend into adult life at great cost to the community. Despite the scale of the disease, paediatric trauma and injury prevention research attract little funding. International data indicate that children in Australia and New Zealand would benefit from improved injury prevention strategies and the introduction of a more formalized paediatric trauma system. Such a system would need to take account of Australasian geographical and population distribution characteristics, which mandate local provision of expert and immediate care in rural areas. There would appear to be economic and clinical arguments for the introduction of an ambulance trauma bypass system for stable but severely injured children in metropolitan areas with a paediatric trauma centre.