Prospective Studies Of Children Research Articles

Clinically significant differences in self-reported pain scores in children with headaches.

Changes in pain scores that represent clinically significant differences in children with headaches are necessary for study design and interpretation of findings reported in studies. We aimed to determine changes in pain scores associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) in this population. We performed a secondary analysis of two prospective studies of children with headaches presenting to an emergency department. Two serial assessments were performed in children aged 6-17 and 4-17 years who self-reported their pain intensity using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used receiver operating characteristic curve-based methodology to identify changes in pain scores associated with "a little less" (MCSD) and "much less" (ICSD) pain and patients declining additional analgesics because they experienced adequate analgesia after treatment (PPAA). We analyzed 105 children: 63.8% were female and the median (IQR) age was 13 (10-15) years. Ninety-eight children were analyzed for the VNRS and 101 were analyzed for the FPS-R. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 25%, 4/10 and 56%, and 3/10 and 50%, respectively, and for the FPS-R, 2/10 and 25%, 4/10 and 67%, and 4/10 and 60%, respectively. The area under the curve (AUC) associated with a MCSD for both scales ranged from 94% to 98%; the AUC associated with an ICSD or PPAA for both scales ranged from 76% to 83%. We identified changes in pain score associated with patient-centered outcomes in children with headaches suitable for designing trials and assigning clinical significance to changes in pain scores reported in studies.

Association of atopic dermatitis with attention-deficit hyperactivity disorder among US adults in the “All of Us” research program: A case-control study

Association of atopic dermatitis with attention-deficit hyperactivity disorder among US adults in the “All of Us” research program: A case-control study

Understanding Open Access Data Using Visuals: Integrating Prospective Studies of Children's Responses to Natural Disasters.

As access to open data is increasing, researchers gain the opportunity to build integrated datasets and to conduct more powerful statistical analyses. However, using open access data presents challenges for researchers in understanding the data. Visuals allow researchers to address these challenges by facilitating a greater understanding of the information available. This paper illustrates how visuals can address the challenges that researchers face when using open access data, such as: (1) becoming familiar with the data, (2) identifying patterns and trends within the data, and (3) determining how to integrate data from multiple studies. This paper uses data from an integrative data analysis study that combined data from prospective studies of children's responses to four natural disasters: Hurricane Andrew, Hurricane Charley, Hurricane Katrina, and Hurricane Ike. The integrated dataset assessed hurricane exposure, posttraumatic stress symptoms, anxiety, social support, and life events among 1707 participants (53.61% female). The children's ages ranged from 7 to 16 years (M = 9.61, SD = 1.60). Visuals serve as an effective method for understanding new and unfamiliar datasets. In response to the growth of open access data, researchers must develop the skills necessary to create informative visuals. Most research-based graduate programs do not require programming-based courses for graduation. More opportunities for training in programming languages need to be offered so that future researchers are better prepared to understand new data. This paper discusses implications of current graduate course requirements and standard journal practices on how researchers visualize data.

The Effect of Cigarette Smoking on Lung Function in Young Adults with Asthma.

Life-course persistent asthma and tobacco smoking are risk factors for irreversible airflow obstruction. It is often assumed that smoking and asthma have additive or multiplicative effects on the risk for airflow obstruction, but this has not been demonstrated in prospective studies of children with persistent asthma. To investigate the effects of smoking and asthma on the development of airflow obstruction in a population-based birth cohort followed to age 38 years. Reports of childhood asthma from ages 9, 11, and 13 and self-reports of adult asthma at ages 32 and 38 years were used to define childhood-onset persistent asthma (n = 91), late-onset asthma (n = 93), asthma in remission (n = 85), and nonasthmatic (n = 572) phenotypes. Cumulative tobacco smoking histories and spirometry were obtained at ages 18, 21, 26, 32, and 38 years. Analyses were by generalized estimating equations adjusting for childhood spirometry, body mass index, age, and sex. Smoking history and childhood-onset persistent asthma were both associated with lower FEV1/FVC ratios. Associations between smoking and FEV1/FVC ratios were different between asthma phenotypes (interaction P < 0.001). Smoking was associated with lower prebronchodilator and post-bronchodilator FEV1/FVC ratios among subjects without asthma and those with late-onset or remittent asthma, but smoking was not associated with lower FEV1/FVC ratios among those with childhood-onset persistent asthma. Childhood-onset persistent asthma is associated with airflow obstruction by mid-adult life, but this does not seem to be made worse by tobacco smoking. We found no evidence that smoking and childhood-persistent asthma have additive or multiplicative effects on airflow obstruction.

Dexamethasone Therapy for Septic Arthritis in Children.

Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P < .001), more rapid decrease in C-reactive protein level to <1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P < .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course. Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

Your earliest memory may be earlier than you think: Prospective studies of children’s dating of earliest childhood memories.

Theories of childhood amnesia and autobiographical memory development have been based on the assumption that the age estimates of earliest childhood memories are generally accurate, with an average age of 3.5 years among adults. It is also commonly believed that early memories will by default become inaccessible later on and this eventually results in childhood amnesia. These assumptions were examined in 2 prospective studies, in which children recalled and dated their earliest memories at an initial interview and did it again 1 year (Study 1) and 2 years later (Study 2). Systematic telescoping errors emerged: Children substantially postdated their memories for the same events at the follow-up interview, particularly for memories initially dated from earlier ages. These findings have critical methodological and theoretical implications for research on childhood amnesia and autobiographical memory development.

Developmental Pathways to Borderline Personality Disorder

This paper reviews recent studies of biological and environmental risk and protective factors and patterns of continuity leading to borderline personality disorder (BPD). It focuses on prospective studies of children and adolescents and studies of young people with borderline pathology, reporting findings from genetics, neurobiology, experimental psychopathology, environmental risk, and precursor signs and symptoms. Studies of individuals earlier in the course of BPD demonstrate relatively consistent environmental risk factors, but neurobiological and experimental psychopathology findings are still inconsistent. Also, temperamental and mental state abnormalities that resemble aspects of the BPD phenotype emerge in childhood and adolescence and presage the BPD syndrome in adolescence or adulthood. Further work is required to better understand the roles that all these factors play in the developmental pathways to BPD and to increase their specificity for BPD in order to facilitate prevention and early intervention.

The association between parental bonding and obsessive compulsive disorder in offspring at high familial risk

Background The aim of the current study is to estimate the association between parenting factors derived from the Parental Bonding Instrument (PBI) and a lifetime DSM-IV diagnosis of OCD. Method Data were from approximately 1200 adults from 465 families assessed as part of a large family and genetic study of OCD. The association of three parenting factors, for fathers and mothers, with offspring OCD status were examined; analyses were stratified by parental OCD status and family loading for OCD (multiplex versus sporadic). Results Three factors were derived by principal components factor analysis of the PBI (maternal and paternal care, overprotection and control). Maternal overprotection was associated with OCD in offspring with familial OCD (familial cases) but only if neither parent was affected with OCD, which suggests independent but additive environmental and genetic risk (OR = 5.9, 95% CI 1.2, 29.9, p = 0.031). Paternal care was a protective factor in those not at high genetic risk (sporadic cases) (OR = 0.2, 95% CI 0.0, 0.8, p = 0.027). Maternal overprotection was also associated with offspring OCD in sporadic families (OR = 2.9, 95% CI 1.3, 6.6, p = 0.012). The finding that parental overprotection and care were not associated with offspring OCD when at least one parent had OCD addressed directly the hypothesis of maternal or paternal OCD adversely impacting parenting. Conclusions This study provides evidence that aspects of parenting may contribute to the development of OCD among offspring. Prospective studies of children at risk for OCD are needed to explore the direction of causality.

Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review

Background There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse? Methods We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review. Findings Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel. Conclusion Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.

Suchtmittelgebrauch bei jungen erwachsenen Straftätern mit und ohne Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS)

Prospective studies of children with ADHD have shown a high level of substance use disorder comorbidity, particularly when associated with social maladaptation and antisocial behavior. Conversely, studies of drug abusing participants and delinquents revealed a high prevalence of ADHD comorbidity. In this study 129 young male prison inmates were systematically examined for ADHD and substance use disorders. 64,3 % showed harmful alcohol consumption. 67,4 % fulfilled DSM-IV criteria for any drug abuse or dependence. 28,8 % of these participants were diagnosed with ADHD, combined type, other 52,1 % showed ADHD residual type. Opioid dependence was more common in delinquents without ADHD. Addicted delinquents with ADHD showed worse social environment and a higher degree of psychopathology, including externalizing and internalizing behavior, compared to addicted delinquents without ADHD. Neuroticism and conscientiousness ratings of the addicted ADHD group, but not of those without ADHD, differed from non-addicted delinquents. The results underline the need of adequate therapeutic programs for addicted young prison inmates considering ADHD comorbidity, which is associated with additional psychopathology and social problems.

Molecular epidemiology of human astroviruses.

Human astroviruses (HAstVs) are associated with 5-9 percent of cases of gastroenteritis in young children. Seven serotypes (HAstV-1 to -7), which correlate with genotypes, have been defined by using immune typing methods. We have used partial nucleotide sequence information from the capsid protein gene for molecular typing of 29 unique human astrovirus strains obtained from prospective studies of children with gastroenteritis in Egypt and Malawi. HAstV-1 was the most commonly detected strain, consistent with previous studies, but a surprising variety of strains were identified in both collections. An eighth astrovirus type, HAstV-8, has been defined on the basis of the complete capsid protein gene sequence and was detected in both collections analysed in this study. Although HAstV-8 and HAstV-4 strains segregate into well resolved clades by analysis of sequences from the region encoding protein P2 (VP32), the pair-wise distances between these types are less than those between strains of the other serotypes. In contrast, analysis of sequences from the region encoding protein P3 unambiguously resolve HAstV-4 and HAstV-8 strains, consistent with their classification as distinct serotypes. Overall, strains representing six of the eight serotypes were detected in two collections of samples from prospective studies of gastroenteritis in young children indicating that multiple astrovirus types are frequently co-circulating within communities.

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview. The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to reported overwhelming childhood experiences (sexual and physical abuse). When sexual abuse was severe (involving penetration, several perpetrators, lasting more than 1 year), dissociative symptoms were even more prominent. Highest dissociation levels were found in patients reporting cumulative sexual trauma (intrafamilial and extrafamilial) or both sexual and physical abuse. In particular, maternal dysfunction was related to the level of dissociation. With control for gender and age, stepwise multiple regression analysis indicated that the severity of dissociative symptoms was best predicted by reported sexual abuse, physical abuse, and maternal dysfunction. These findings indicate that dissociation, although trauma-related, is neglect-related as well. This implies the importance of object relations and attachment in the diagnosis and treatment of patients with dissociative disorders.

One‐year incidence rate of major depression and other psychiatric disorders in 239 alcoholic men

The rate of depressive symptoms among alcoholics is high, but many of these syndromes appear to be alcohol-induced mood disorders and might not represent major depressive episodes independent of heavy drinking. The present study examines one aspect of the relationship between alcoholism and depression by evaluating the incidence of new episodes of major depressive disorders among alcohol-dependent men during the year following treatment. One year following discharge from an alcohol treatment program, structured face-to-face interviews were carried out with 239 primary alcoholic men, as well as additional informants. Approximately 4% of the men developed depressive episodes while drinking heavily, but only 2.1% demonstrated major depressions independent of heavy alcohol intake. There was no evidence of an increased incidence of any other major psychiatric disorder during the year of follow-up. These results are consistent with prospective studies of children of alcoholics and of longitudinal evaluations of general population samples. They do not indicate that in the present sample most primary alcohol-dependent men have elevated rates for major depressive disorders independent of alcohol-induced mood syndromes. However, it is likely that in the context of heavy drinking severe, although temporary, depressive episodes are likely to be observed.

Trends in survival for children reported with maternally transmitted acquired immunodeficiency syndrome in New York City, 1982 to 1989.

To better understand the natural history of severe pediatric human immunodeficiency virus infection, reported cases of perinatally acquired pediatric acquired immunodeficiency syndrome (AIDS) in New York City were examined for differences in survival and age at diagnosis before and after implementation of an expanded case definition in 1987. One hundred ninety-six children reported through August, 1987, and 333 children reported between September, 1987, and February, 1990, and diagnosed through 1989 were compared. Significant differences were not found in survival by either gender or race/ethnicity although Hispanics were slightly more likely to be diagnosed with Pneumocystis carinii pneumonia (PCP) and blacks with lymphocytic interstitial pneumonitis (LIP). The most striking differences were noted regardless of race between children whose earliest AIDS-specific diagnosis was PCP and those whose earliest diagnosis was LIP. In the group reported through August, 1987, median survival from birth was 10 months with PCP vs. 54 months with LIP, median age at diagnosis 5 months vs. 20 months, and median survival after diagnosis 2 months vs. 22 months, respectively. Twelve-month survival for PCP improved in the two time periods examined, but survival with LIP did not. After implementation of the 1987 case definition, bacterial infections replaced LIP as the second most common diagnosis. This study provides data on children diagnosed and reported with AIDS. Ongoing prospective studies of children who have a full spectrum of human immunodeficiency virus infection with and without reportable AIDS wil further elucidate survival in children infected with human immunodeficiency virus.

A Process Model for the Development of Schizophrenia

Less than two decades ago scientists interested in the etiology of schizophrenia were still vigorously debating the nature-nurture controversy, with many adhering to the view that the illness grew either out of a constitutional deficit or a pathological family environment. Today, virtually all researchers adopt interactional models that include both constitutional and environmental factors. Interactional models are most often expressed in diathesis-stress terms: Development of schizophrenia requires both a biological vulnerability (diathesis) and stressful life circumstances that facilitate expression of the illness. Modern debate within the field now primarily focuses on understanding the characteristics of the biological diathesis, the stressful environment, and their interaction. Scientists using diathesis-stress theories have employed several research strategies (Rosenthal 1970): (1) consanguinity studies exploring the distribution of illness among the relatives of schizophrenics, (2) twin studies comparing the concordance of schizophrenic illness in monozygotic and dizygotic twin pairs reared together or apart, (3) retrospective studies examining the premorbid behavior and development of schizophrenic parents, and (4) prospective studies of children at high risk for schizophrenia. The population most frequently followed in prospective high-risk studies has been offspring of schizophrenics. Biological offspring of schizophrenics who are reared by their parents are at extremely high risk for becoming schizophrenic themselves, approximately ten times greater risk than the general population. The present paper will make use of the Israeli High-Risk Study to test a diathesis-stress model for the transmission of schizophrenia. The goodness of fit of this model to the data will be explored using a simple decision tree data analytic approach.

Schizophrenia during adolescence and early adulthood: A developmental perspective on risk research

This paper considers schizophrenia from a developmental perspective. Recent results from prospective studies of children at risk for schizophrenia are reviewed with the goal of identifying consistent findings across studies and developmental periods. A tentative vulnerability/stress model for understanding the development of schizophrenia during adolescence and early adulthood is proposed. This model is intended as a heuristic device for (a) integrating many of the findings from risk research, and (b) organizing assessment and treatment strategies for working with adolescents or young adults showing symptoms of schizophrenic disorders.