Scurvy, abnormal MRI, and gelatinous bone marrow in an adolescent with avoidant restrictive food intake disorder

BACKGROUND

Although medical literature describes pediatric scurvy as "rare", a growing number of case reports suggests otherwise. Patients often undergo costly and unnecessary workup due to unfamiliarity with the presentation of scurvy. This case report further supports the small yet growing literature documenting scurvy and its manifestations in patients with eating disorders.

CASE PRESENTATION

A 15-year-old female presented to the emergency department with bilateral knee and ankle swelling and pain in the setting of chronic lower limb rash and BMI of 16.3. For years, she had restricted her diet to carbohydrates. Exam showed perifollicular petechial hemorrhagic rash with corkscrew hairs, knee edema, ankle edema with restricted range of motion, and antalgic gait. She was admitted for severe malnutrition from avoidant restrictive food intake disorder. Her hospital course was complicated by recurrent normocytic anemia and fever. Hematology workup revealed anemia from iron deficiency, vitamin K deficiency, and anemia of chronic disease. Rheumatology workup was negative. MRI findings showed dark T1 and bright T2 signals and were read as consistent with leukemia/lymphoma, chronic multifocal osteomyelitis, or Langerhans cell histiocytosis. However, bone marrow biopsy showed gelatinous transformation secondary to malnutrition. She was treated with vitamin C and a nutrition plan and her symptoms improved.

CONCLUSIONS

Although this patient had common manifestations of scurvy, including perifollicular petechial hemorrhagic rash, joint effusions, anemia, and recurrent fevers, she still underwent an extensive workup. Clinicians should be aware that scurvy can present with multiple symptoms that mimic infectious, rheumatic, oncologic and hematological disease. Clinicians should have a high index of suspicion for scurvy in patients with malnutrition and eating disorders.

Trichomonas Vaginalis Infections Among Youth in Detention in the Southeastern United States

Most juvenile detention facilities do not screen for Trichomonas Vaginalis (TV) despite being the most common parasitic STI. We aimed to assess TV prevalence and risk factors among young women in a large urban juvenile detention center. We evaluated a retrospective cohort from April to December 2016. Youth submitted an intake urine sample for gonorrhea and chlamydia testing; we tested remnant urine for TV. Outcomes included prevalence of TV and risk factors for infection. A total of 1009 samples were collected, 374 from young women ages 13 - 17 years old. Among females, 8% tested positive for TV with co-infection of either gonorrhea, chlamydia or both occurring in 12/29 (41%) patients. Compared to youth without TV females with TV were more likely to be African American (76%) and report symptoms (41%) (p<0.05). In our study population, prevalence of TV was 8%. As nearly half of those with TV were asymptomatic, we recommend routine screening among this population.

Dental trauma characteristics in the primary dentition in Greifswald, Germany: a comparison before and after German unification

BACKGROUND

The data on the distribution and pattern of dental trauma in the primary dentition are very rare.

AIM

To investigate primary dental trauma patterns in relation to gender, age, time and cause for a recent paediatric cohort and to compare this with a historic one before German unification.

METHODS

This retrospective study compared the patterns of dental trauma injuries at the trauma centre at Greifswald University/Germany for a recent paediatric cohort (2014-16, 103 children) with a historic one (1974-1989, n = 120). The data contained details on etiology, injury types and treatment delivered for 450 injured teeth (247 historic, 203 recent).

RESULTS

In both cohorts, the occurrence was more common in males than females (63%/55%, resp.) with an age peak from 2 to 6 years. Maxillary incisors were most affected (89.6%/88.6%, resp.) and periodontal ligament injuries dominated (77.8%/90.3%, resp.). Almost half of the injuries occurred at home (46.6%), mostly due to falling (48.5%) or during playing (37.8%) in the recent paediatric cohort which provided better forensic data due to insurance issues and potential concern about child abuse. Advice and follow up was the most common approach in the recent paediatric cohort (76%).

CONCLUSION

Even after 30 years and a change in the health care system due to German unification, the patterns of dental traumatic injuries in the primary dentition were similar.

Serum zinc and copper levels in a sample of Egyptian epileptic children

Background

Epilepsy is among the most common disabling neurological disorders among children. Altered serum levels of zinc and copper may facilitate seizure occurrence and repetition, and antiepileptic drugs may disturb their serum levels affecting disease control and outcome.

Objective

To investigate the association between serum levels of zinc and copper and epilepsy and antiepileptic treatment in a group of Egyptian epileptic children.

Methods

Case-control study on 100 epileptic patients, aged from 2 to 16 years, from neurology outpatient clinic and 50 apparently healthy children with matched age and sex. Venous samples were withdrawn from patients and controls then serum levels of zinc and copper were measured with graphite furnace atomic absorption spectrometer-A Analyst 800.

Results

Serum zinc level of patients’ group was significantly lower than that of controls with a mean of 59.1 μ/dL ± 22.7 and 85 μ/dL ± 22.2, respectively (P < 0.01). Serum zinc level of patients with history of febrile seizures was significantly decreased compared to patients without history of febrile seizures with a mean of 41.5 μ/dL ± 20.1 and 67.9 μ/dL ± 19.3, respectively (P < 0.01). Patient on carbamazepine intake showed significantly lower zinc serum level than patients without carbamazepine intake, with a mean of 49.0 μ/dL ± 17 and 61.8 μ/dL ± 23.4, respectively (P < 0.01). A significant negative correlation was noted between the duration of illness of epilepsy and the mean copper serum level (P < 0.05).

Conclusion

Zinc and copper altered homeostasis have mounting evidence about their role in the pathogenesis of epilepsy. Designing treatment plans that selectively restore zinc and copper normal levels may be a beneficial strategy in the future.

Comparison of Children's Menu Items at Full- and Quick-Service Restaurants

OBJECTIVES

The proportion of food consumed by children from restaurants tripled during the last 4 decades and that coincided with the increased rate of obesity. Despite the presence of data linking quick-service (QS) food consumption to poor diet quality, studies comparing the nutrition content of the children's menu items at QS restaurants (QSRs) with those at full-service restaurants (FSRs) are limited. The objectives of this study were to examine the nutrition content of common children's menu items at both QSRs and FSRs and compare these data with recommendations reported by the Dietary Guidelines for Americans 2015-2020, Eighth Edition.

METHODS

Using the 2014 data of the MenuStat project, 10 food items that are on both QSR and FSR children's menus were selected. Data from each restaurant category were aggregated and the overall average of the nutritional content of each individual food item was calculated and compared between the two restaurant categories.

RESULTS

The average of calories, fat, carbohydrates, and added sugar of most items on the children's menu of QSRs are lower than those of FSRs. Also, most food items on children's menus of FSRs, and to a lesser extent those of QSRs, exceeded the national recommended calories and fat content per meal.

CONCLUSIONS

Although some children's menu items of QSRs have less fat and fewer calories compared with those of FSRs, most menu items in both FSRs and QSRs do not meet national dietary recommendations. Healthcare professionals may expand discussions with patients to include both restaurant categories when counseling them and their families on obesity prevention. Also, educating children and families about reading the nutritional content information of children's menu items when eating out to make an informed choice can be a tool in fighting childhood obesity.

A Contraception Quality Improvement Initiative with Detained Young Women: Counseling, Initiation, and Utilization

STUDY OBJECTIVE

To assess the effect of providing standardized counseling to improve the rates of contraception initiation and utilization among detained young women. This was a quality improvement (QI) project conducted at a large urban juvenile short-term detention center. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The intervention included educating all staff and care providers, counseling detained young women on various contraceptive options, and offering contraception initiation with oral contraceptive pills or depot medroxyprogesterone acetate injection. Retrospective chart review before February 2012 established baseline contraception initiation and utilization rates. The QI intervention began in February 2012 and continued for 6 months followed by chart review. Outcomes measured included number of patients counseled about contraception, started contraception, and overall contraception utilization.

RESULTS

We reviewed 120 and 186 charts before and after intervention, respectively. Compared with baseline data, the intervention group had statistically significant (P < .05) higher proportions of patients counseled (10% [10/120] baseline vs 84% [156/186] intervention) and who started contraception (7% [8/120] baseline vs 52% [97/186] intervention).

CONCLUSION

This contraception QI intervention showed significant improvement in the rates of contraception counseling, contraception initiation, and utilization among detained young women. Most of youths' guardians were supportive and approved contraception initiation. This project showed it is feasible for health care providers to include contraception services for all intake assessments at juvenile detention facilities.

Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation's Children

Ensuring optimal health for children requires a population-based approach and collaboration between pediatrics and public health. The prevention of major threats to children's health (such as behavioral health issues) and the control and management of chronic diseases, obesity, injury, communicable diseases, and other problems cannot be managed solely in the pediatric office. The integration of clinical practice with public health actions is necessary for multiple levels of disease prevention that involve the child, family, and community. Although pediatricians and public health professionals interact frequently to the benefit of children and their families, increased integration of the 2 disciplines is critical to improving child health at the individual and population levels. Effective collaboration is necessary to ensure that population health activities include children and that the child health priorities of the American Academy of Pediatrics (AAP), such as poverty and child health, early brain and child development, obesity, and mental health, can engage federal, state, and local public health initiatives. In this policy statement, we build on the 2013 AAP Policy Statement on community pediatrics by identifying specific opportunities for collaboration between pediatricians and public health professionals that are likely to improve the health of children in communities. In the statement, we provide recommendations for pediatricians, public health professionals, and the AAP and its chapters.

Prevalence of Pancreatic Steatosis at a Pediatric Tertiary Care Center

OBJECTIVES

Pancreatic steatosis in adults has been proposed to be associated with obesity; however, data on pancreatic steatosis in children are lacking. Our study aimed to measure the prevalence of pancreatic steatosis in children and to examine its association with obesity and nonalcoholic fatty liver disease.

METHODS

This is a retrospective chart review study of 232 patients 2 to 18 years old who underwent abdominal computed tomographic imaging in the emergency department or inpatient ward within a 1-year time span and from whom demographics, anthropometrics, and medical history were obtained. Our radiologist determined mean Hounsfield unit (HU) measurements for the pancreas, liver, and spleen. A difference of -20 between the pancreas and spleen (psHU) and between the liver and spleen was used to determine fatty infiltration.

RESULTS

Of the 232 patients, 11.5% had a psHU less than -20. The prevalence of pancreatic steatosis was more than double among obese children (19%) than that in nonobese groups (8%). There is a significant correlation between the psHU and liver-spleen HU (r = 0.50, P < 0.001).

CONCLUSIONS

Pancreatic steatosis was identified in 10% of the study population and is associated with obesity. Also, pancreatic steatosis is significantly associated with nonalcoholic fatty liver disease. This is the first study assessing the prevalence of pancreatic steatosis in children.

Changes in Fasting Lipids during Puberty

OBJECTIVE

To describe longitudinal changes in plasma lipid levels and pubertal stage in youths from age 8-18 years, in Project HeartBeat!

STUDY DESIGN

Fasting blood samples and pubertal stage, using physical assessment of secondary sex characteristics, were obtained every 4 months for up to 4 years in a mixed longitudinal study of 633 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years. Total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides (TG), and nonhigh density lipoprotein-cholesterol measurements were obtained. Data were collected from 1991-1995.

RESULTS

Pubertal stage correlations with age varied among all race-sex groups (range, r = 0.61-0.70), and a given pubertal stage could represent a range of 5 years or more of chronological age. Throughout puberty, levels of total cholesterol, low density lipoprotein-cholesterol, and nonhigh density lipoprotein-cholesterol decreased, TG in males increased, and high density lipoprotein-cholesterol and TG in females showed no changes. Within a given pubertal stage, plasma lipid levels tended to differ by race, sex, or both.

CONCLUSIONS

Lipid levels change markedly by pubertal stage, and patterns differ by sex and race. Chronological age ranges widely within a given pubertal stage and is an insensitive indicator of pubertal stage and the related changes in lipid levels. Pubertal development should be considered when determining screening criteria to identify youths with adverse blood lipid levels.

Sleep duration and its association with ambulatory blood pressure in a school-based, diverse sample of adolescents

BACKGROUND

Evidence is accumulating that sleep duration is related to blood pressure (BP) and hypertensive status, but the strength of the association varies by age, and findings are inconsistent for adolescents. This cross-sectional study tested the hypothesis that sleep duration, both during the night and during naps, would be negatively associated with ambulatory systolic BP (SBP) and diastolic BP (DBP) measured over 24 hours in adolescents.

METHODS

In this ethnically diverse (37% non-Hispanic black, 31% Hispanic, 29% non-Hispanic white, 3% other), school-based sample of 366 adolescents aged 11-16 years, ambulatory BP was measured every 30 minutes for 24 hours on a school day; actigraphy was used to measure sleep duration. Covariables included demographic factors, anthropometric indices, physical activity, and position and location at the time of each BP measurement. Mixed models were used to test day and night sleep duration as predictors of 24-hour SBP and DBP, controlling for covariables.

RESULTS

The mean sleep duration was 6.83 (SD = 1.36) hours at night, and 7.23 (SD = 1.67) hours over 24 hours. Controlling for duration of sleep during the day and covariables, each additional hour of nighttime sleep was associated with lower SBP (-0.57; P < 0.0001); controlling for nighttime sleep duration and covariables, each additional hour of daytime sleep was associated with lower SBP (-0.73; P < 0.001) and lower DBP (-0.50; P < 0.001).

CONCLUSIONS

Longer sleep duration was significantly associated with lower ambulatory SBP and DBP in adolescents. The findings have potential implications for cardiovascular health in this age group.

Nutrition Mission

The prevalence rate of childhood obesity in Houston exceeds the national figures. Nutrition Mission, a 14-week health promotion and education intervention, was conducted to determine its feasibility and whether it would increase the nutrition and exercise (NE) knowledge of students in an elementary school. This novel student-initiated program used 44 medical students as volunteer instructors in 3 fifth-grade classrooms in a Houston, Texas, elementary school, in which most of the 35 students were socioeconomically disadvantaged and members of ethnic minorities. Research subjects completed pretests and posttests containing demographic, lifestyle, and knowledge-based multiple-choice questions regarding NE content. The Nutrition Mission intervention consisted of weekly programs between September 2007 and December 2007. Outcomes were measured by responses to NE lifestyle and knowledge questions. We found a significant increase in NE knowledge as a result of the intervention (68.1% compared with 78.1%, P<0.001). Subjects' gender and ethnicity affected responses to 2 lifestyle and 3 knowledge questions. The Nutrition Mission showed that a 14-week health promotion and education intervention conceptualized and implemented by medical students is feasible and can improve elementary school students' knowledge of NE. Future studies will include student volunteers from other health care professions and assess whether improved knowledge contributes to improved measurable health outcomes.

Female adolescent athletes' awareness of the connection between menstrual status and bone health

STUDY OBJECTIVE

The aims of this study are to determine among female high school track athletes: (1) knowledge of the association between menstrual irregularity and bone health; (2) attitudes toward amenorrhea, specifically if amenorrhea is seen as a sign of athletic success; (3) the association between knowledge and attitudes based on athlete menstrual status.

DESIGN

Cross-sectional survey.

SETTING

Five public high schools in Texas.

PARTICIPANTS

103 female high school track athletes ages 14-18 years.

INTERVENTION

Participants completed a questionnaire that addressed menstrual history, details of track participation, knowledge of bone mineral density (BMD)/ menstrual status connection, and attitudes about the desirability of oligo/amenorrhea.

OUTCOME MEASURES

Frequencies of attitude and knowledge replies, summative knowledge score, and correlations between attitudes, knowledge, and menstrual status.

RESULTS

Sixteen subjects (16.7%) met criteria for amenorrhea, 16 for oligomenorrhea (16.7%). Median summative knowledge score was one of six. Menstrual irregularity was associated with lower knowledge (P = 0.035). Incorrect answers about consequences of bone loss and the link to menstrual irregularity were given by ≥90% of respondents. Lower knowledge was associated with a greater number of "don't know" replies to attitude questions (P = 0.002). Among more knowledgeable participants endorsing opinions, menstrual irregularity was not seen as a sign of athletic success.

CONCLUSIONS

The prevalence of irregular menses is high among adolescent track athletes and a larger-scale inquiry to clarify adolescent athletes' knowledge of and attitudes about the link between menstrual patterns and BMD is indicated. Education may provide one key to improved health behavior among this at-risk population.

Associations of BMI and its fat-free and fat components with blood lipids in children: Project HeartBeat!

AIM: This study aimed to distinguish between the roles of the two components of BMI, the fat mass (FM) index and the fat-free mass (FFM) index, in BMI's association with blood lipids in children and adolescents. METHODS: A total of 678 children (49.1% female, 79.9% non-black), initially aged 8, 11 and 14 years, were followed at 4-month intervals for up to 4 years (1991-1995). Total cholesterol (TC), LDL-C, HDL-C and triglycerides were determined in fasting blood samples. FFM index and FM index were calculated as FFM (kg)/height (m)(2) and FM (kg)/height (m)(2), respectively. Using a multilevel linear model, repeated measurements of blood lipids were regressed on concurrent measures of BMI or its components, adjusting for age, sex and race and, in a subsample, also for physical activity, energy intake and sexual maturity. RESULTS: Estimated regression coefficients for the relations of TC with BMI, FFM index and FM index were 1.539, -0.606 (p > 0.05) and 3.649, respectively. When FFM index and FM index were entered into the TC model simultaneously, regression coefficients were -0.855 and 3.743, respectively. An increase in BMI was related to an increase in TC; however, an equivalent increase in FM index was related to a greater increase in TC and, when FFM index was tested alone or with FM index, an increase in FFM index was related to a decrease in TC. Similar results were observed for LDL-C. FFM index and FM index were both inversely related to HDL-C and directly to triglycerides. Compared with FFM index, the equivalent increase in FM index showed a greater decrease in HDL-C. CONCLUSION: Greater BMI was related to adverse levels of blood lipids in children and adolescents, which was mainly attributable to BMI's fat component. It is important to identify weight management strategies to halt the childhood obesity epidemic and subsequently prevent heart disease in adulthood.

Utilization of a low cost agro-residue for production of coagulant aids and their applications

Different samples of rice husk ash (RHA) and sodium silicate were prepared and characterized using FTIR, NFTIR and XRD. The selected sample of RHA was obtained by calcination of untreated rice husk (RH) in a semi-closed system at 650°C. Four novel polyinorganic coagulants were also prepared, namely, poly aluminum chloride silicate, poly hydroxy aluminum sulphate silicate, poly ferric chloride silicate and poly ferric aluminum chloride silicate. Applications were carried out for the removal of some pollutants from ground, sewage and industrial waste waters. It was found that the maximum percentages removal of Fe(2+) and Mn(2+) ions in ground water reached 99 and 97%, respectively, the maximum percentage removal of, Pb(2+) ion in industrial waste water reached 97%. In addition, the maximum percentages removal of COD, BOD and TSS in sewage waste water reached 90, 92, and 93%, respectively.

Management of major blunt pediatric renal trauma: single-center experience

OBJECTIVE

To review the impact of major pediatric renal trauma and its management on long-term function and morphology of the injured kidney.

METHODS

Thirty-six blunt trauma patients (20 males, 16 females) presented in 2004-2007 (age range 2 days to 14 years; mean 6.2 years). Thirty-seven renal units were included: 13 grade III, 14 grade IV, and 10 grade V injuries. Follow up was for 3-38 (mean 14) months. Patients were managed non-operatively unless vitally unstable. The most common causes of trauma were motor vehicle accidents and falls. Fourteen patients had associated non-renal injuries. Four patients had pre-existing renal problems.

RESULTS

The surgical intervention group (13 patients, 36%) included 9/10 grade V and 4/14 grade IV renal injuries. Surgical repair of lacerations was performed in seven cases, partial nephrectomy in four cases and nephrectomy in two cases. Follow up showed no significant change in renal function, and none developed hypertension. The non-operative group (24 patients, 63.2%) included all grade III injuries, 10 grade IV injuries, and one grade V injury. There was an excellent outcome for 18/24 patients (75%) with kidney preservation, no complications from urinary extravasation and hematoma resolution. The remaining patients had lower polar infarction (1), renal atrophy (1), persistent subcapsular collection (2), recurrent hematuria requiring angioembolization (1), and there was one death related to central nervous system injury.

CONCLUSION

The outcome of our management of pediatric major renal trauma was favorable overall. Longer follow up is needed with regard to renal function and development of hypertension.

Overweight and central adiposity in school-age children and links with hypertension

The purpose of this study of school-age children was to estimate prevalence and interrelationships of overweight, central adiposity, and hypertension. It included 1,070 children in kindergarten through sixth grade (67% Hispanic, 26% African American, mean age = 8.9 years). Measures included body mass index (BMI), waist circumference (WC), systolic and/or diastolic hypertension identified by measurements on three separate occasions. Percentage overweight (BMI >or=95th percentile) was 28.7%, 17.9% were at risk of overweight, 28.8% had WC >or=90th percentile, and 9.4% had elevated (>or=90th percentile) systolic and/or diastolic blood pressure (BP). If we had screened only for BMI and examined those with BMI >or=85th percentile or underweight for hypertension, we would have missed 26% of the children with persistently elevated BP. WC explained variance in elevated BP not explained by BMI (p < .001). Measurement of WC is easily incorporated in a school-based screening protocol.

Removal of some heavy metals ions from wastewater by copolymer of iron and aluminum impregnated with active silica derived from rice husk ash

Recently because of increasing of the environmental awareness and demands, several attempts were carried out for the conversion of by-products of natural materials, especially agricultural wastes, to highly sorption capacity materials. In recent years, attention has been focused on the utilization of unmodified or modified agro-residues as sorbents for removal of pollutants. Various modifications have been reported to enhance sorption capacities for heavy metals. The present study deals with the adsorption equilibrium of iron, manganese, lead and arsenic ions from aqueous solutions on copolymer of Al(+3), Si(+4) and Fe(+3) using batch techniques. The influence of various parameters, such as agitation time, sorbent mass and pH of sorbate solution were investigated. Under this study the maximum adsorption capacity of iron and aluminum copolymer impregnated with silica (PAlFeClSi) for lead, iron, manganese and arsenic are found to be 416, 222, 158, 146 mg/g, respectively.

Evaluation of AAP guidelines for cholesterol screening in youth: Project HeartBeat!

BACKGROUND

The American Academy of Pediatrics (AAP) criterion for screening for hypercholesterolemia in children is family history of hypercholesterolemia or cardiovascular disease or BMI > or =85th percentile. This paper aims to determine the sensitivity, specificity, and positive predictive value (PPV) of dyslipidemia screening using AAP criteria along with either family history or BMI.

METHODS

Height, weight, plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and family history were obtained for 678 children aged 8, 11, and 14 years, enrolled from 1991 to 1993 in Project HeartBeat!. Sensitivity, specificity, and PPV screening of each lipid component using family history alone, BMI > or =85th percentile alone, or family history and/or BMI > or =85th percentile, were calculated using 2008 AAP criteria (total cholesterol, LDL-C, and triglycerides > or =90th percentile; HDL-C <10th percentile).

RESULTS

Sensitivity of detecting abnormal total cholesterol, LDL-C, HDL-C, and triglycerides using family history alone ranged from 38% to 43% and significantly increased to 54%-66% using family history and/or BMI. Specificity significantly decreased from approximately 65% to 52%, and there were no notable changes in PPV. In black children, cholesterol screening using the BMI > or =85th percentile criterion had higher sensitivity than when using the family history criterion. In nonblacks, family history and/or BMI > or =85th percentile had greater sensitivity than family history alone.

CONCLUSIONS

When the BMI screening criterion was used along with the family history criterion, sensitivity increased, specificity decreased, and PPV changed trivially for detection of dyslipidemia. Despite increased screening sensitivity by adding the BMI criterion, a clinically significant number of children still may be misclassified.

Systolic and fourth- and fifth-phase diastolic blood pressure from ages 8 to 18 years: Project HeartBeat!

BACKGROUND

Systolic and fourth-phase and fifth-phase diastolic blood pressure (SBP, DBP4, DBP5) have appeared to differ in their patterns of age-related change, and SBP and DBP5 differ in their respective associations with anthropometric variables. Project HeartBeat! investigated trajectories of change in SBP, DBP4, and SBP5 with age and their relationships with indices of adiposity, controlling for energy intake, physical activity, and sexual maturation.

METHODS

Project HeartBeat! was a mixed longitudinal study in 678 black and white girls and boys aged 8, 11, or 14 years at first examination, followed at 4-month intervals for up to 4 years (1991-1995). A statistical model was estimated for the trajectory of change in each blood pressure measure from ages 8 to 18 years.

RESULTS

For SBP, DBP4, and DBP5, the trajectories were sigmoid, parabolic, and linear in form, respectively. SBP and DBP4 differed significantly by gender; DBP4 and DBP5 were significantly related to race. Adjusted for age, gender, and race, all relationships of adiposity-related variables (percent body fat, abdominal circumference, skinfold thickness, and BMI and its fat and fat-free components) with SBP were positive and significant. Corresponding relationships for DBP4 were notably weaker but significant, and for DBP5, weak or not significant. After adjusting for diet, physical inactivity, and maturation, no DBP5 relationship with adiposity indices remained significant.

CONCLUSIONS

SBP, DBP4, and DBP5 are distinct in patterns of change with age, relationships to gender and race, and patterns of association with multiple anthropometric indices related to adiposity.

Trajectories of fat mass index, fat free-mass index, and waist circumference in children: Project HeartBeat!

BACKGROUND

Body composition and fat distribution change dramatically during adolescence. Data based on longitudinal studies to describe these changes are limited. The aim of this study was to describe age-related changes in fat free-mass index (FFMI) and fat mass index (FMI), which are components of BMI, and waist circumference (WC) in participants of Project HeartBeat!, a longitudinal study of children.

METHODS

Anthropometric measurements and body composition data were obtained in a mixed longitudinal study of 678 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years, every 4 months for 4 years (1991-1995). Trajectories of change from ages 8 to 18 years were measured for FFMI, FMI, and WC. Because of the small number of observations for black participants, trajectories for this group were limited to ages 8.5-15 years.

RESULTS

Body mass index, FFMI, and WC increased steadily with age for all race-gender cohorts. However, in nonblack girls, FFMI remained constant after about age 16 years. For black boys and girls, FFMI was similar at age 8.5 years but increased more steeply for black boys by age 15 years. In girls, FMI showed an upward trend until shortly after age 14 years, when it remained constant. In boys, FMI increased between age 8 years and age 10 years, and then decreased.

CONCLUSIONS

The extent to which each component of BMI contributes to the changes in BMI depends on the gender, race, and age of the individual. Healthcare providers need to be aware that children who show upward deviation of BMI or BMI percentiles may have increases in their lean body mass rather than in adiposity.

The cost of screening adolescents for overweight and hypertension using a community partnership model

OBJECTIVES

(1) Determine the prevalence of overweight and high blood pressure (BP) among middle and high school students over a 2-year period and, (2) measure the cost and initial outcomes of screening.

DESIGN

Cost and outcome description using a cross-sectional design sample. The target population was 12- to 19-year-old healthy students attending grades 7 through 12 at 3 proximal schools located in a large urban school district in Texas.

RESULTS

Of 2,338 students screened, 925 (39.6%) had a body mass index (BMI)>or=85th percentile and 504 (21.6%) had BMIs>or=95th percentile for age and gender. There were 346 students (14.8%) with BMIs>or=85th percentile and systolic blood pressure (SBP)>or=95th percentile for age, gender, and height. The cost of the 2-year screening program was $66,442, and the cost per student was $28. The cost to identify a student with increased BMI or high SBP was $72 and $107, respectively.

CONCLUSIONS

This study offered an objective framework to examine the cost and outcomes of screening children for overweight and increased BP. The study has implications for discussion and informed decision making about school-based screening for these conditions.

Body art among minority high school athletes: prevalence, interest and satisfaction; parental knowledge and consent

Of 997 minority high school students, 8.6% had tattoos and 8% piercings (excluding earlobes); 21% with tattoos and 59% with piercings would not repeat the experience. Fifty-eight percent with tattoos and 43% with piercings reported parental knowledge before the procedure; 75% and 80%, respectively, were asked for proof of parental consent.

The epidemiology of sexually transmitted infections in adolescents

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Student Nurses Participate in Public Health Research and Practice Through a School-Based Screening Program

Obesity has reached epidemic proportions among children in minority populations, placing them at risk for diabetes and hypertension. The importance of educating a generation of nurses who have the knowledge, skills, and passion to address this public health need is crucial to the profession and to America's health. This article describes the use of a Community Partnership Model to frame baccalaureate nursing students' (B.S.N.) service learning within the context of a research study to screen middle- and high-school students for health risks. The missions of education, research, and practice are linked together in the model by three processes: evidence-based practice, service learning, and scholarly teaching. The aim of the project was early identification of obesity, hypertension, and type 2 diabetes and their predictors in a high-risk student population, between 12 and 19 years of age. Early evidence indicates that the model is feasible and effective for directing student learning and addressing public health problems in the community.

Self-assessment of circumcision status by adolescents

In epidemiologic studies of the relation between circumcision and sexually transmitted infections, it is necessary to rely on self-report of circumcision status. The purpose of this 2002 study in Houston, Texas, was to determine whether adolescent males could make correct self-reports. During physical examinations, adolescents were asked whether they were circumcised. The authors then examined the adolescents' genitalia. Circumcision status was recorded as complete (glans penis fully exposed), partial (glans partly covered), or uncircumcised (glans completely covered). The mean age of the 1,508 subjects was 15.0 (standard deviation, 1.63) years; 64% were Black, 29% Hispanic, and 7% White. Forty-nine percent had full, 1% partial, and 50% no circumcision. Of the 738 fully circumcised subjects, 512 (69%) considered themselves circumcised, 54 (7%) considered themselves uncircumcised, and 172 (23%) did not know. Of the 751 uncircumcised youth, 491 (65%) described themselves as uncircumcised, 27 (4%) reported being circumcised, and 233 (31%) did not know. The sensitivity of self-report among those who thought they knew their status was 90.5%, and the specificity was 94.8%; 27% did not know their status. In this population, self-report of circumcision status did not result in accurate information mainly because many adolescents were unsure of their status.

Screening for eligibility in the study of antihypertensive medication in children: experience from the Ziac Pediatric Hypertension Study

BACKGROUND

The FDA Modernization Act has resulted in an increase in pediatric trials of antihypertensive medications. As experience is limited in children to guide the planning of these studies, we reviewed data from the Ziac Pediatric Hypertension Study to determine patterns of early study termination to help future studies.

METHODS

For inclusion, subjects aged 6 to 17 years were required to have an average systolic blood pressure (SBP) or diastolic blood pressure (DBP) above the 95th percentile at the last of three visits during 2 weeks of single-blind placebo screening. Early study termination was defined as early termination for any reason. Screening termination was defined as normalization of blood pressure (BP) during the placebo screening phase.

RESULTS

Early study termination rate was 27% (38 of 140 subjects). The most common reason was screening termination due to normalization of BP, accounting for 63% of all early study terminations. Among screening termination subjects who completed three screening visits, SBP was higher (P < .001) at visit 1 (129+/-8 mm Hg) than at visit 2 (123+/-7 mm Hg) or visit 3 (121+/-8 mm Hg), but did not differ between visits 2 and 3. Screening termination occurred in 15% with isolated SBP hypertension, and 21% with isolated DBP hypertension. At randomization, 83% had SBP hypertension and 53% had DBP hypertension.

CONCLUSIONS

These data suggest that SBP hypertension should be part of inclusion criteria to increase enrollment and reduce the rate of screening termination, and that 1-week placebo screening is necessary and sufficient to minimize inclusion of transiently hypertensive subjects.

Comparison of the actigraph versus patients' diary information in defining circadian time periods for analyzing ambulatory blood pressure monitoring data

BACKGROUND

Assessment of 24-h changes in blood pressure is one of the unique features that ambulatory blood pressure monitoring (ABPM) can provide. Most studies agree that sleep/wake periods should be based on patients' actual sleep and wake times. Actual wake and sleep time determinations are often based on patients' diary information. Several publications indicate that actigraphy is, at least, as accurate as activity diary in determining sleep/wake periods.

OBJECTIVES

To compare subjects' compliance with actigraphy and diary keeping and to compare actigraphy and diary data in determination of sleep and wake times, mean blood pressures, classification of hypertension, and assessment of nocturnal dipping status.

METHODS

We evaluated ABPM studies of 62 subjects. Blood pressure data were obtained using Spacelabs monitors for 24h. Sleep and wake times were determined by both the actigraph and patients' activity diary.

RESULTS

In the 62 studies, 56 subjects had successful actigraphy (90%), 44 had activity diary completion (71%), and 38 subjects had both (61%). There was no statistically significant difference between the mean wake and sleep onset using the two methods, but up to 3 hours' difference in wake or sleep onset was noted in some studies. Although the two methods did not significantly affect the calculated systolic blood pressure (SBP) or diastolic blood pressure (DBP) loads in either awake or sleep periods, approximately 55% of the subjects' dipping status was changed when diary information on sleep time was used compared to actigraph.

CONCLUSIONS

Our data indicate that in children and young adults, compliance with the actigraph was superior to diary completion and use of the actigraphy method rather than diary information changed the interpretation of some ABPM data. Our study suggested that actigraphy is superior to diary keeping in providing the information needed for appropriate interpretation of some ABPM data.

Comparison of arbitrary definitions of circadian time periods with those determined by wrist actigraphy in analysis of ABPM data

Determining blood pressure (BP) values at different daily time periods is a well recognised measure to assess the risk of end-organ damage. However, the use of various definitions of these periods, eg, day vs night, sleep vs wake or arbitrary definitions, makes clinical decisions based on available data difficult. In the present study, we compared BP loads in actual sleep-wake periods to default day-night definition provided by the ambulatory BP monitoring (ABPM) software (day 06.00 to 22.00; night 22.00 to 06.00) as well as to an arbitrary definition of sleep-wake periods in children published in Soergel et al (J Pediatr 1997; 130: 178-184)1 (awake 08.00 to 20.00 and sleep 00.00 to 06.00. We used an actigraphy, an accelerometer, to define the actual sleep-wake periods in 46 patients with essential hypertension who are on various treatment regimens. BP data was obtained by using Spacelabs 90207 monitors for a full 24 h. There were significant differences between actual sleep-wake and default definition for BP load. No similar finding was noted when arbitrary definition was used. The proportion of hypertensives was not significantly different when default and arbitrary definitions were used. Classification of dippers and non-dippers is greatly affected by the definition of sleep interval using the default method. Although some of the misclassifications were not statistically significant, their clinical importance must be considered. Determination of sleep and wake periods for analysis of ABPM data should be based on careful determination of actual periods. Using other definitions may not provide complete information or accommodate for individual variation.

Comparison of arbitrary definitions of circadian time periods with those determined by wrist actigraphy in analysis of ABPM data

Determining blood pressure (BP) values at different daily time periods is a well recognised measure to assess the risk of end-organ damage. However, the use of various definitions of these periods, eg, day vs night, sleep vs wake or arbitrary definitions, makes clinical decisions based on available data difficult. In the present study, we compared BP loads in actual sleep-wake periods to default day-night definition provided by the ambulatory BP monitoring (ABPM) software (day 06.00-22.00; night 22.00-06.00) as well as to an arbitrary definition of sleep-wake periods in children published in Journal of Pediatrics (Soergel et al, 1997) (awake 08.00-20:00 and sleep 00.00-06.00). We used an actigraph, an accelerometer, to define the actual sleep-wake periods in 46 patients with essential hypertension who are on various treatment regimens. BP data were obtained by using Spacelabs 90207 monitors for a full 24 hours. There were significant differences between actual sleep-wake and default definition for BP load. No similar findings were noted when arbitrary definition was used. The proportion of hypertensives was not significantly different when default and arbitrary definitions were used. Classification of dippers and non-dippers is greatly affected by the definition of sleep interval using the default method. Although some of the misclassifications were not statistically significant, their clinical importance must be considered. Determination of sleep and wake periods for analysis of ABPM data should be based on careful determination of actual periods. Using other definitions may not provide complete information or accommodate for individual variation.

Psychological and obstetrical responses of mothers following antenatal fetal sex identification

This work was designed to study the impact of prenatal knowledge of fetal sex both on the psychological and obstetrical aspects of the expectant mothers during pregnancy and labour. One hundred pregnant women attending the outpatient antenatal clinic of Assiut University Hospital were recruited. All were in the third trimester, parous, with normal pregnancy and having no past or present psychiatric disorders. The desired sex of the expected child was registered. Symptom checklist 90 (SCL-90) was applied before, and 2 weeks after sonographic fetal sex determination. Women who desired male sex scored significantly higher depressive symptoms than those who desired female sex. Women who were proven sonographically to have the undesired fetal sex showed significantly higher scores of depression, somatization, anxiety, hostility and phobia scales of SCL-90 than women whose desired fetal sex was confirmed. The second part of the study to evaluate the effect of knowing the fetal sex on the progress of labour was designed as a case control study including 57 women previously informed about their fetal sex and 40 women ignorant of their fetal sex as controls. Women delivering a baby with undesired sex showed more obstetric difficulties. In the first stage of labour, they had significant reduction in frequency of uterine contractions and rate of cervical dilatation. They also needed much more sedation, analgesia and oxytocin augmentation.