Greater Proportion Of Children Research Articles

How high can you count? Probing the limits of children's counting.

While much research has focused on understanding the process by which young children learn to count, little work has explored the effects of direct instruction on this process. In the current study, we explored the impacts of training children in an explicit counting procedure on two distinct cardinality tasks. Two- to 5-year-old children first participated in a Give-N task in which counting proficiency was assessed, and then participated in a short instruction session where explicit counting was modeled and encouraged. Following training, children were significantly better at identifying which of two cards contained a set size outside of their range of counting mastery (Huang, Spelke, & Snedeker, 2010) and were more likely to improve on a secondary numerical production task (Give-N; Wynn, 1990, 1992) compared with children in the control group. Not surprisingly, a greater proportion of children in the count training condition overtly counted during the cardinality task, a strategy that was found to be the strongest indicator of performance. Together, results reveal that even 5 min of counting instruction greatly increases the likelihood that a child will engage in counting behavior and results in improvements in cardinality judgments in two distinct numerical tasks. (PsycINFO Database Record

Pre-school nutrition-related behaviours at home and early childhood education services: findings from the Growing Up in New Zealand longitudinal study.

Pre-school nutrition-related behaviours influence diet and development of lifelong eating habits. We examined the prevalence and congruence of recommended nutrition-related behaviours (RNB) in home and early childhood education (ECE) services, exploring differences by child and ECE characteristics. Telephone interviews with mothers. Online survey of ECE managers/head teachers. New Zealand. Children (n 1181) aged 45 months in the Growing Up in New Zealand longitudinal study. A mean 5·3 of 8 RNB were followed at home, with statistical differences by gender and ethnic group, but not socio-economic position. ECE services followed a mean 4·8 of 8 RNB, with differences by type of service and health-promotion programme participation. No congruence between adherence at home and in ECE services was found; half of children with high adherence at home attended a service with low adherence. A greater proportion of children in deprived communities attended a service with high adherence, compared with children living in the least deprived communities (20 and 12 %, respectively). Children, across all socio-economic positions, may not experience RNB at home. ECE settings provide an opportunity to improve or support behaviours learned at home. Targeting of health-promotion programmes in high-deprivation areas has resulted in higher adherence to RNB at these ECE services. The lack of congruence between home and ECE behaviours suggests health-promotion messages may not be effectively communicated to parents/family. Greater support is required across the ECE sector to adhere to RNB and promote wider change that can reach into homes.

Determining Responsiveness to Tier 2 Intervention in Response to Intervention: Level of Performance, Growth, or Both

This response to intervention study examined agreement between classification methods of preschool children’s responsiveness to Tier 2 intervention using level of performance (25th percentile), growth (equivalent to small and medium effect sizes), and both level of performance and growth in a dual-discrepancy approach. Overall, 181 children identified as making inadequate progress within high-quality Tier 1 instruction in 1 or more early literacy domains (language, print knowledge, phonological awareness) were randomly assigned to either an intervention group or a business-as-usual control group. All children were classified as responsive or not, and although greater proportions of children were classified as responsive after intervention compared with the control groups, agreement between methods of classifying responsiveness varied across the 3 early literacy domains and the single measures within each domain. These results indicated that depending on which of these methods was used, different children were classified as responsive.

Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity

Elucidation of optimal dosing and treatment content is critical for health care providers, payers, and policy makers, as well as mechanisms of change to inform intervention delivery and training initiatives for childhood obesity. To evaluate effects, following a 4-month family-based behavioral weight loss treatment (FBT), of 2 doses (HIGH or LOW) of a weight-control intervention (enhanced social facilitation maintenance [SFM+]) vs a weight-control education condition (CONTROL; matched for dose with LOW), on child anthropometrics, and to explore putative mediators of weight loss outcomes. For this parallel-group randomized clinical trial conducted at 2 US academic medical centers from December 2009 to March 2013, 172 parent-child dyads completed FBT and were then randomized to 8 months of SFM+ (HIGH, n = 59; LOW, n = 56) or CONTROL (n = 57). Children (aged 7-11 years) with overweight and obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥85th percentile) with at least 1 parent with overweight and obesity (BMI ≥25) were recruited. HIGH SFM+ vs LOW SFM+ (CONTROL matched the dose of LOW). Intention-to-treat analysis using mixed-effects models estimated change in child percentage overweight (percentage above the median BMI for a child's age and sex) for the FBT period (0-4 months) and the SFM+ period (4-12 months), and proportion of children achieving a clinically significant change in percentage overweight (≥9-unit decrease; months 0-12). Theory-based outcome mediators were also evaluated. This study recruited 172 parent-child dyads (mean [SD] age: parents 42.3 [6.4] years; children, 9.4 [1.3] years). The omnibus treatment × time interaction for child percentage overweight was significant (F8, 618.9 = 2.89; P = .004). Planned pairwise comparisons revealed that from months 4 to 12, LOW had better outcomes than CONTROL (difference, -3.34; 95% CI, -6.21 to -0.47; d = -0.40; P = .02). HIGH had better outcomes than LOW (difference, -3.37; 95% CI, -6.15 to -0.59; d = -0.38; P = .02) and CONTROL (difference, -6.71; 95% CI, -9.57 to -3.84; d = -0.77; P < .001). A greater proportion of children in HIGH (45 [82%]) vs LOW (34 [64%]) (difference, 18.00; 95% CI, 1.00-34.00; P = .03; number needed to treat = 5.56) and CONTROL (25 [48%]) (difference, 34.00; 95% CI, 16.00-51.00; P < .001; number needed to treat = 2.94) had clinically significant percentage overweight reductions. Food and activity monitoring and goal setting mediated the effect of LOW vs CONTROL (50%). Monitoring and goal setting, family and home environment, and healthy behaviors with peers mediated the effect of HIGH vs CONTROL (25%-42%). Following FBT, specialized intervention content (SFM+) enhanced children's weight outcomes and outperformed a credible control condition, with high dose delivery yielding the best outcomes. Sustained monitoring and goal setting, support from the family and home environment, and healthy peer interactions explained outcome differences, highlighting key treatment targets. clinicaltrials.gov Identifier: NCT00759746.

Racial and ethnic differences among children with new-onset autoimmune Type 1 diabetes.

To compare demographic and clinical characteristics among children from ethnic minorities and non-Hispanic white children with new-onset autoimmune Type 1 diabetes. We analysed a single-centre series of 712 children with new-onset autoimmune Type 1 diabetes between January 2008 and March 2011. The median (range) age was 9.7 (0.3-18.1) years, the mean (sd) BMI percentile was 69.7 (25.4) and 48.3% of the cohort were girls. The cohort comprised 57.3% non-Hispanic white, 20.5% Hispanic and 14.8% African-American children, and 7.4% were of other, mixed or unknown race. The Hispanic subgroup, compared with non-Hispanic white subgroup, had a higher mean (sd) C-peptide level [0.82 (1.62) vs 0.55 (0.47) ng/ml; P=0.004), and a greater proportion of children with elevated BMI (overweight or obesity; 49.6% vs 32.5%; P<0.001) and diabetic ketoacidosis (51.8% vs 38.2%; P=0.006). The African-American group had a higher mean (sd) glucose level [24.4 (12.8) vs 21.4 (10.7) mmol/l; P=0.017], a greater proportion of children with ketoacidosis (56.7% vs 38.2%; P=0.001), a greater proportion with elevated BMI (52.9% vs 32.5%; P<0.001), and a lower proportion of children at pre-pubertal stage (49.0% vs 61.6%; P=0.01), and tended to have higher C-peptide levels [0.65 (0.59) vs 0.55 [0.47] ng/ml; P=0.079) compared with the non-Hispanic white children. The differences in C-peptide levels compared with non-Hispanic white children persisted for Hispanic (P=0.01) but not African-American children (P=0.29) after adjustment for age, sex, BMI, ketoacidosis, glucose, Tanner stage and autoantibody number. At the onset of paediatric autoimmune Type 1 diabetes, Hispanic, but not African-American children had higher C-peptide levels, after adjustment for potential confounders, compared with non-Hispanic white children. These findings suggest that ethnicity may contribute to the heterogeneity of Type 1 diabetes pathogenesis, with possible implications for intervention.

Early preschool environments and gender: Effects of gender pedagogy in Sweden

To test how early social environments affect children’s consideration of gender, 3- to 6-year-old children (N=80) enrolled in gender-neutral or typical preschool programs in the central district of a large Swedish city completed measures designed to assess their gender-based social preferences, stereotypes, and automatic encoding. Compared with children in typical preschools, a greater proportion of children in the gender-neutral school were interested in playing with unfamiliar other-gender children. In addition, children attending the gender-neutral preschool scored lower on a gender stereotyping measure than children attending typical preschools. Children at the gender-neutral school, however, were not less likely to automatically encode others’ gender. The findings suggest that gender-neutral pedagogy has moderate effects on how children think and feel about people of different genders but might not affect children’s tendency to spontaneously notice gender.

Therapeutic Benefit of Addition of Cetirizine to Ambroxol in Fixed Dose Combination in the Treatment of Productive Cough in Children: A Prospective, Multi-center Study

Productive cough is a common problem in children and is accompanied by disruption of sleep and routine daily activities leading to a deterioration in quality of life. We evaluated the efficacy, safety and tolerability of cetirizine and ambroxol fixed dose combination (FDC) as compared with ambroxol in these patients. We conducted open-label, prospective, multicenter study attending outpatient department with cough ≥12 hours; were screened to receive either cetirizine and ambroxol FDC (AC group) or ambroxol alone (AX group). Primary efficacy variables were evaluation of total symptom score (TSS) for cough and secondary efficacy variables included evaluation of total nasal symptom score (TNSS); assessment of cough frequency; number of awakenings due to cough; and time to complete relief. Out of 250 children included, 246 completed the study with a statistically significant improvement in TSS from baseline to day 3 (<i>p</i>=0.029) and day 7 (<i>p</i>=0.048) in the AC group as compared with AX group. Improvement in TNSS was better in the AC group from baseline to day 3 (<i>p</i><0.0001) and day 7 (<i>p</i>=0.016) as compared with the AX group. Greater proportion of children in the AC group recovered completely from cough by day 7 (97.67%) as compared with the AX group (78.63%). As side effects, only two children of the AC group experienced mild AEs (drowsiness). We thus conclude that FDC demonstrated improved efficacy and safety and was well tolerated as compared with ambroxol alone in children with productive cough.

Why are children sedentary: an examination using the International Study of Childhood Obesity, Lifestyle and the Environment.

Physical inactivity and sedentary behaviour have been independently associated with a wide range of negative health indicators including obesity, poor cardio-metabolic health, and poor psychosocial health. The overarching objective of this research was to gain a better understanding as to why children are sedentary and where we need to focus public health messages and interventions to reduce sedentary behaviour. Specifically, I aimed to provide insight on current awareness of sedentary behaviour guidelines, determine important correlates of total sedentary time (SED) and screen time (ST) in Canadian children, and understand correlates of SED and ST in a global context. The primary dataset used for this project was the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Background work was completed to review current literature on knowledge and awareness of Canadian physical activity and sedentary behaviour guidelines (in all age groups) and to understand the representativeness of the ISCOLE dataset. In addition to the 2 background papers, this dissertation includes 3 manuscripts, all prepared for submission in scientific, peer-reviewed journals: Canadian physical activity and screen time guidelines: do children know?, Correlates of objectively measured sedentary time and self-reported screen time in Canadian children, and Correlates of total sedentary time and screen time in 9-11 year-old children around the world: The International Study of Childhood Obesity, Lifestyle and the Environment. Overall, this work showed the majority of children around the world are accumulating large amounts of sedentary time, and exceeded current screen time guidelines. We found that the large majority of Canadian children are not aware of screen time guidelines; however, a greater proportion of children could identify physical activity guidelines. We also identified a number of correlates of SED and ST in Canadian children and in children around the world. The most common correlates included weight status and access to electronics in the house. Taken together, this work suggests that public health messaging should focus on increasing awareness of screen time guidelines. While increasing awareness of the guidelines, messaging can be tailored to promoting healthy weight status and reducing (or removing) children's access to electronic devices in hopes of reducing overall time spent sedentary.

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions.

To compare the mental health care US children receive from primary care providers (PCPs) and other mental health care providers. Using nationally representative data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2011, we determined whether children and youth aged 2 to 21 years with outpatient visits for mental health problems in the past year saw PCPs, psychiatrists, and/or psychologists/social workers for these conditions. We compared the proportion of children prescribed psychotropic medications by provider type. Using logistic regression, we examined associations of provider type seen and medication prescribing with race/ethnicity, household income, insurance status, geographical area, and language at home. One-third (34.8%) of children receiving outpatient care for mental health conditions saw PCPs only, 26.2% saw psychiatrists only, and 15.2% saw psychologists/social workers only. Nearly a quarter (23.8%) of children saw multiple providers. A greater proportion of children with attention-deficit/hyperactivity disorder (ADHD) versus children with anxiety/mood disorders saw a PCP only (41.8% vs 17.2%). PCPs prescribed medications to a higher percentage of children than did psychiatrists. Children seeing a PCP for ADHD were more likely to receive stimulants or α-agonists than children with ADHD seeing psychiatrists (73.7% vs 61.4%). We found only limited associations of sociodemographic characteristics with provider type or medication use. PCPs appear to be sole physician managers for care of 4 in 10 US children with ADHD, and one-third with mental health conditions overall. Efforts supporting mental health in primary care will reach a substantial portion of children receiving mental health services.

Management of hearing loss and the normal ear in cases of unilateral Microtia with aural atresia.

To identify the rate of hearing loss related to middle ear disease and the frequency of tympanostomy tube (TT) insertion in the contralateral ear of patients with unilateral microtia/aural atresia. Retrospective case series of patients less than 3 years of age with unilateral microtia/aural atresia treated at an urban, tertiary care children's hospital from 2008 to 2013. Clinical and audiologic data were reviewed. Statistical analysis was performed to determine the relative risk of TT insertion in the normal ear. A total of 72 patients were included for analysis. The average age of patients at their initial otolaryngology visit was 3.3 months (range 0.08-1.67 years); 38 (52.8%) patients were males. Aural atresia involved the right ear in 43 (59.7%) cases. Five (6.9%) patients were syndromic. Abnormal audiometric testing of the normal ear was noted in 12 (16.7%), and 14 (19.4%) underwent TT during the first 3 years of life. Twelve children (85.7%) who had a TT placed were nonsyndromic. When compared to published norms for TT placement in the general population (6.8% of children < 3 year of age), a greater proportion of children with unilateral microtia/aural atresia had TT placement in the normal ear (z = 4.26, P < 0.0001). Patients with unilateral microtia/aural atresia have increased rates of hearing loss and middle ear effusion leading to TT in their normal ear at a higher rate versus the general population. This information can help guide more vigilant care and audiologic follow-up in affected children. 4. Laryngoscope, 126:1470-1474, 2016.

Vestibular and Balance Impairment Contributes to Cochlear Implant Failure in Children.

To determine the role of vestibular and balance dysfunction in children with cochlear implant (CI) failure. Retrospective case review. Tertiary referral center. Thirty-five children with CI failure were compared to 165 children who did not experience CI failure. Vestibular function was compared between groups by horizontal canal function (measured by caloric, rotational, video Head Impulse Testing [vHIT]), saccular function (vestibular evoked myogenic potentials [VEMP]), and balance (measured by Bruininks-Oseretsky Test [BOT-2]). Twenty-one patients completed vestibular and balance testing. Patients with CI failure demonstrated significantly more abnormal horizontal canal function than those who did not experience CI failure (caloric: 81 vs. 47%, p = 0.004; rotational/vHIT: 71 vs. 35%, p = 0.001). Absence of bilateral horizontal canal function increased the odds of CI failure 7.6 times. A greater proportion of children with CI failure had abnormal saccular function compared to those without CI failure (81 vs. 46%, p = 0.003). Children with CI failure had significantly worse balance (BOT-2 score: 7.8) than children who did not experience CI failure (BOT-2 score: 12.2) (p < 0.0001). Vestibular end-organ dysfunction and its resulting balance impairment have been identified as important risk factors for CI failure in children. Early identification and treatment of such impairments may avoid or delay implant failures and prevent children from experiencing periods of sound deprivation that could impact speech and language acquisition.

Dietary Diversity in Children 6 to 11 Age with Food Insecurity from Food Assistance Programs in San Luis Potosi, Mexico

ObjectiveTo Evaluate the dietary diversity in school age children with food insecurity (FI) at their households.Methods: Were analyzed 404 children's information who received food assistance programs in San Luis Potosi, Mexico. Households were classified with FI by the Latin American and Caribbean household food Security measurement scale (ELCSA). Dietetic data were obtained through food frequency questionnaire (FFQ). Children's dietary diversity was classified through a rate and terciles. Dietary diversity adjusted proportions were calculated according to FI in households using multinomial regression models. Results: FI was found in 81.2% of the children. 47.1% of those with severe FI have low dietary diversity. A greater proportion of children with severe FI consume legumes. In contrast a grater proportion of children with food security consume meat and sugar‐sweetened drinks.ConclusionDietary diversity and food consumption with better nutrimental quality are determined by FI condition at household. It is necessary to create strategies that improve disponibility and access to nutritive and low price food.Supported by FOMIX, SLP‐COPOCYT. Project: FMSLP‐213‐CO2‐208475

Investigating active travel to primary school in Ireland

Purpose– Active travel to school, by walking or cycling, can positively influence children's health and increase physical activity. The purpose of this paper is to investigate the context and promoters and barriers of active travel, and the required actions and actors that need to be involved to address each of these.Design/methodology/approach– Both quantitative and participative research methodologies were employed. The sample consisted of 73 children aged between 11 and 13 years from four primary schools in the West of Ireland. A self-completion questionnaire was followed by a participative protocol conducted with the class groups.Findings– Overall 30.1 per cent of children reported that they actively travelled to school. A greater proportion of children from urban and disadvantaged schools actively travelled. Proximity to the school was the most frequently reported promoter and barrier. The children identified many actors that need to be involved to eliminate the barriers and enact the promoters of active travel to school. They also highlighted the need for a multi-sectorial approach to improve active travel rates in Ireland.Originality/value– This study holds potential value in addressing the continued decline in active travel to school in Ireland as it shares a new perspective on the issue; that of the children. Adopting a participative approach allowed the children to participate in groups and develop the data themselves. The children confirmed that they have a relevant and valuable understanding of the process necessary to address active travel to school as a public health issue in Ireland.

Sources and Correlates of Sodium Consumption in the First 2 Years of Life

BackgroundHigh sodium intake during infancy and early childhood can change salt preference and blood pressure trajectories across life, representing a modifiable cardiovascular risk factor. Describing young children's sodium intake is important for informing effective targets for sodium reduction. ObjectiveThis study aimed to describe food sources and demographic and behavioral correlates of sodium intake in 295 young Australian children using three unscheduled 24-hour recalls (when children were 9 and then 18 months of age) with mothers participating within an existing randomized controlled trial, the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. MethodsDifferences in individual-level and family-level demographic and behavioral variables were assessed across tertiles of sodium density (mg/1,000 kcal). Descriptive statistics were used to describe food-group contributions to total energy and sodium intakes at both ages. ResultsMean sodium intake was 486 mg (standard deviation=232 mg) at 9 months and had more than doubled to 1,069 mg (standard deviation=331 mg) at 18 months of age. Fifty-four percent of children at 18 months exceeded the Recommended Daily Upper Level for sodium intake, with bread, cheese, breakfast cereal, soup, and mixed dishes all important sources of sodium at both ages. Yeast extracts, processed meats, and bread products became important additional sources at 18 months. A greater proportion of children in the highest sodium-density tertile had ceased breastfeeding and had commenced solids at an earlier age. ConclusionsThe key food sources of sodium for children younger than 2 years are those that contribute to the whole population's high salt burden and highlight the essential role governments and food industry must play to reduce salt in commonly consumed foods.

Characterizing severe obesity in children and youth referred for weight management.

BackgroundSevere obesity (SO) in pediatrics has become increasing prevalent in recent decades.The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers.MethodsA retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99th percentile) and OW/OB (BMI ≥85th and <99th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved.ResultsOf the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05).ConclusionChildren and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.

Early Goal-Directed Therapy in Pediatric Septic Shock

To evaluate the effect of intermittent central venous oxygen saturation monitoring (ScvO(2)) on critical outcomes in children with septic shock, as continuous monitoring may not be feasible in most resource-restricted settings. Prospective cohort study. PICU of a tertiary care teaching hospital. Consecutive children younger than 17 years with fluid refractory septic shock admitted to our ICU from November 2010 to October 2012 were included. Enrolled children were subjected to subclavian/internal jugular catheter insertion. Those in whom it was successful formed the "exposed" group (ScvO(2) group), whereas the rest constituted the control group (no ScvO(2) group). In the former group, intermittent ScvO(2) monitoring at 1, 3, and 6 hours was used to guide resuscitation, whereas in the latter, only clinical variables were used. The major outcomes were in-hospital mortality and achievement of therapeutic goals within first 6 hours. One hundred twenty children were enrolled in the study-63 in the ScvO(2) group and 57 in the no ScvO(2) group. Baseline characteristics including the organ dysfunction and mortality risk scores were comparable between the groups. Children in the ScvO(2) group had significantly lower in-hospital mortality (33.3% vs 54%; relative risk, 0.61; 95% CI, 0.4, 0.93; number needed to treat, 5; 95% CI, 3, 27). A greater proportion of children in exposed group achieved therapeutic endpoints in first 6 hours (43% vs 23%, p = 0.02) and during entire ICU stay (71% vs 51%, p = 0.02). The mean number of dysfunctional organs was also significantly lesser in ScvO(2) group in comparison with no ScvO(2) group (2 vs 3, p < 0.001). Early goal-directed therapy using intermittent ScvO(2) monitoring seemed to reduce the mortality rates and improved organ dysfunction in children with septic shock as compared with those without such monitoring.

Intensively managed young children with type 1 diabetes consume high-fat, low-fiber diets similar to age-matched controls

Despite significant emphasis on nutrition, older children with diabetes demonstrate poor dietary quality. We tested the hypothesis that dietary quality in young children with type 1 diabetes (T1D) would be better than age-matched children in the US population. Dietary data from children with T1D (n = 67) aged 2 to 12 years attending a pediatric diabetes clinic were compared with a nationally representative, age-matched sample from the National Health and Nutrition Examination Survey (NHANES; n = 1691). Multiple 24-hour dietary recalls were used. Recommended intakes were based on national guidelines, and dietary quality was assessed using the Healthy Eating Index-2005. More children with T1D were overweight or obese compared with children participating in NHANES (42% vs 30%, P = .04). Greater proportions of children with T1D met daily recommendations for vegetables (22% vs 13%, P = .03), whole grains (12% vs 5%, P = .005), and dairy (55% vs 36%, P = .001) compared with NHANES children, whereas similar proportions met daily fruit recommendations (40% vs 33%, P = .2). Less than one-third of all children limited total fat to recommended levels; children with T1D consumed more saturated fat than did NHANES children (14% vs 12% total energy intake, P = .0009). Fiber intakes were very low in both groups. Compared with NHANES children, children with T1D had higher Healthy Eating Index-2005 scores (59.6 vs 49.7, P = .0006) primarily because of lower intakes of added sugars. The nutritional intake of young children with T1D remains suboptimal in the contemporary era of diabetes management. Despite focused nutrition management, young children with T1D consume high-fat, low-fiber diets comparable with youth in the general population.

Economic burden of childhood autism spectrum disorders.

To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non-ASD-related illnesses. Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P < .05). A greater proportion of children in the ASD group used special educational services (76% vs. 7% in the control group, P < .05). After adjusting for child demographic characteristics and non-ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017-$4259) higher health care costs and $14,061 (95% CI: $4390-$24,302) higher aggregate non-health care costs, including $8610 (95% CI: $6595-$10,421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents. The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

Anti-MDA5 autoantibodies in juvenile dermatomyositis identify a distinct clinical phenotype: a prospective cohort study.

IntroductionThe aim of this study was to define the frequency and associated clinical phenotype of anti-MDA5 autoantibodies in a large UK based, predominantly Caucasian, cohort of patients with juvenile dermatomyositis (JDM).MethodsSerum samples and clinical data were obtained from 285 patients with JDM recruited to the UK Juvenile Dermatomyositis Cohort and Biomarker Study. The presence of anti-MDA5 antibodies was determined by immunoprecipitation and confirmed by ELISA using recombinant MDA5 protein. Results were compared with matched clinical data, muscle biopsies (scored by an experienced paediatric neuropathologist) and chest imaging (reviewed by an experienced paediatric radiologist).ResultsAnti-MDA5 antibodies were identified in 7.4% of JDM patients and were associated with a distinct clinical phenotype including skin ulceration (P = 0.03) oral ulceration (P = 0.01), arthritis (P <0.01) and milder muscle disease both clinically (as determined by Childhood Myositis Assessment Score (P = 0.03)) and histologically (as determined by a lower JDM muscle biopsy score (P <0.01)) than patients who did not have anti-MDA5 antibodies. A greater proportion of children with anti-MDA5 autoantibodies achieved disease inactivity at two years post-diagnosis according to PRINTO criteria (P = 0.02). A total of 4 out of 21 children with anti-MDA5 had interstitial lung disease; none had rapidly progressive interstitial lung disease.ConclusionsAnti-MDA5 antibodies can be identified in a small but significant proportion of patients with JDM and identify a distinctive clinical sub-group. Screening for anti-MDA5 autoantibodies at diagnosis would be useful to guide further investigation for lung disease, inform on prognosis and potentially confirm the diagnosis, as subtle biopsy changes could otherwise be missed.

Effects of Surgical Side and Site on Mood and Behavior Outcome in Children with Pharmacoresistant Epilepsy

Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6–16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.