Prenatal predictors of objectively measured appetite regulation in low-income toddlers and preschool-age children

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152019/1/ijpo12554_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152019/2/ijpo12554.pd

Child cortisol moderates the association between family routines and emotion regulation in lowâ income children

Biological and social influences both shape emotion regulation. In 380 lowâ income children, we tested whether biological stress profile (cortisol) moderated the association among positive and negative home environment factors (routines; chaos) and emotion regulation (negative lability; positive regulation). Children (M ageâ =â 50.6, SDâ =â 6.4 months) provided saliva samples to assess diurnal cortisol parameters across 3 days. Parents reported on home environment and child emotion regulation. Structural equation modeling was used to test whether cortisol parameters moderated associations between home environment and child emotion regulation. Results showed that home chaos was negatively associated with emotion regulation outcomes; cortisol did not moderate the association. Child cortisol level moderated the routinesâ emotion regulation association such that lack of routine was most strongly associated with poor emotion regulation among children with lower cortisol output. Findings suggest that underlying child stress biology may shape response to environmental influences.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135499/1/dev21471_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135499/2/dev21471.pd

Patient characteristics associated with response to NSAID monotherapy in children with systemic juvenile idiopathic arthritis

Abstract Background Systemic juvenile idiopathic arthritis (sJIA) is an auto-inflammatory disease characterized by fever, arthritis, and ≥1 of rash, generalized lymphadenopathy, hepato/splenomegaly, and serositis. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the initial treatments of sJIA, but there is currently no evidence indicating which children should undergo a trial of NSAID monotherapy and which should not. Our objective is to identify presentation characteristics which are associated with response and lack of response to a trial of NSAID monotherapy. Methods This is a retrospective single-center cohort study of children diagnosed with sJIA from 2000 to 2014. Patient demographics and disease characteristics were investigated to identify predictors of response to NSAID monotherapy. Results Eighty-seven children were newly diagnosed with sJIA 2000-2014. Thirteen of the 51 children who received NSAID monotherapy achieved clinically inactive disease (CID) without other medications. Age at presentation (≤8 years old), initial joint count (≤5), and C-reactive protein (CRP) (≤13 mg/dL) at diagnosis were associated with achievement of CID on NSAIDs alone. Physicians were less likely to trial NSAID monotherapy if the patient had either serositis or macrophage activation syndrome (MAS) at diagnosis. Ultimate achievement of CID and time to CID were not significantly affected by whether the patient received a trial of NSAID monotherapy. Conclusions While a subset of children with sJIA can achieve CID with NSAID monotherapy, we recommend against a trial in patients who are >8 years old, with >5 joints involved, or with CRP > 13 mg/dL. Patients who undergo a trial of NSAID monotherapy should follow up within 2-4 weeks to evaluate for possible need for drug escalation. Clinical trials are necessary to confirm these findings.https://deepblue.lib.umich.edu/bitstream/2027.42/140717/1/12969_2017_Article_219.pd

Patient preferences for prenatal testing and termination of pregnancy for congenital anomalies and genetic diseases in Ethiopia

ObjectiveAs prenatal diagnostic services expand throughout low‐income countries, an important consideration is the appropriateness of these services for patients. In these countries, services now include prenatal ultrasound and occasionally genetic testing. To assess patient interest, we surveyed pregnant patients at a hospital in Addis Ababa, Ethiopia, on their preferences for prenatal testing and termination of affected pregnancies for congenital anomalies and genetic diseases.MethodOne hundred one pregnant patients were surveyed on their preferences for prenatal testing and termination of affected pregnancies using a survey covering various congenital anomalies and genetic diseases.ResultsEighty‐nine percent of patients reported interest in testing for all conditions. Three percent of patients were not interested in any testing. Over 60% of patients reported interest in termination for anencephaly, early infant death, severe intellectual disability, hemoglobinopathy, and amelia. Patients were more likely to express interest in prenatal testing and termination for conditions associated with a shortened lifespan.ConclusionEthiopian patients were interested in prenatal testing and termination of pregnancy for many conditions. Advancing prenatal diagnostic capacities is a potential strategy for addressing the incidence of congenital anomalies and genetic disease in Ethiopia. Importantly, there exist many factors and technological limitations to consider before implementation.What’s already known about this topic?Prenatal genetic services are expanding throughout many low‐ and middle‐income countries.In low‐ and middle‐income countries, little is known on patient preferences for prenatal testing for congenital anomalies and genetic diseases and patient interest in termination of affected pregnancies.What does this study add?Patients at St. Paul’s Hospital in Addis Ababa, Ethiopia, were interested in prenatal testing and termination of pregnancy for many congenital anomalies and genetic diseases.Studying patient preferences for genetic services in a low‐income country is possible and should be considered prior to the introduction of a new service and/or technology.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150617/1/pd5472_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150617/2/pd5472.pd

A Comprehensive Pediatric Asthma Management Program Reduces Emergency Department Visits and Hospitalizations

We evaluated the impact of a comprehensive pediatric asthma management program (the Children's Asthma Wellness Program, CAWP) on the frequency of emergency department (ED) visits and hospital admissions. The CAWP generally consisted of 4 clinic sessions over a 1-year period, but some patients attended fewer clinic sessions, and some required additional clinic sessions due to incomplete asthma control. Patients were evaluated and treated by pediatric pulmonologists, nurse asthma care coordinator/educator, and social worker. We retrospectively reviewed program results over an 8-year period (2005?2013). We compared ED visits and hospital admissions before and after participation in the CAWP. There were 254 children referred to the CAWP; 172 children were enrolled. Fifty-four children (31%) received >6 sessions due to incomplete asthma control. On average, children requiring additional clinic sessions were older and more likely to be African American, hold Medicaid insurance, and have severe asthma. We obtained a minimum of 1-year preprogram and 1-year postprogram administrative data for 86 children (50%). Using each participating child as his/her own control, we found that taking part in the program decreased the risk of ED visits to 0.26 times the preprogram rate (P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140178/1/ped.2015.0561.pd

Family conflict, chaos, and negative life events predict cortisol activity in low‐income children

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic‐pituitary‐adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low‐income 7–10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow‐up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST‐C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144279/1/dev21602_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144279/2/dev21602.pd

Adolescent eating disorder treatment outcomes of an in-person partial hospital program versus a virtual intensive outpatient program

ObjectiveThough virtual outpatient psychotherapy for eating disorders is likely effective, less is known about virtual higher levels of care. The current study examined the clinical outcomes of a family-based virtual intensive outpatient program (vIOP) for youth with eating disorders which was developed in response to the COVID-19 pandemic, compared to the same institution’s in-person partial hospital program (PHP).MethodsTreatment outcomes were assessed via chart review in 102 patients between the ages of 9–23 (M = 15.2, SD = 2.5) who were predominantly cisgender female (84.3%) and primarily diagnosed with anorexia nervosa (64.7%) or atypical anorexia (23.5%). Participants were either treated in the in-person PHP before the pandemic (n = 49) or the vIOP during the pandemic (n = 53). Percent expected body weight (%EBW) was examined at baseline, end of treatment, 3-months post-treatment, and 6-months post-treatment, as well as the frequency of medical, psychiatric, and residential admissions before, during, and after vIOP or PHP participation.ResultsLinear mixed models demonstrated no effect of treatment modality (in-person versus virtual) on %EBW over time. The duration of the vIOP was, on average, 12 calendar days longer, though the amount billed for the vIOP was lower. Survival analyses and Cox regression models did not suggest differences in the frequency of hospital and residential treatment admissions during treatment (vIOP: 9.4%, PHP: 10.0%) or post-treatment (vIOP: 15.0%, PHP: 10.2%).DiscussionFindings support virtual family-based programs as suitable alternatives to in-person treatment and underscore the potential cost-effectiveness of a family-based IOP versus PHP.Public SignificanceThis study demonstrates that a virtual, family-based, intensive outpatient program for youth with eating disorders had similar treatment outcomes to an in-person partial hospitalization program. Specifically, the virtual and in-person programs had similar weight restoration outcomes and rates of medical, psychiatric, or residential treatment admissions during or after treatment initiation. Findings support the use of virtual treatment, even for youth requiring a high level of intervention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175735/1/eat23866.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175735/2/eat23866_am.pd

Extended-Interval Aminoglycoside Use in Cystic Fibrosis Exacerbation in Children and Young Adults

This is a prospective quality improvement project for patients with cystic fibrosis who are 5 years of age and older who were admitted for intravenous antibiotic administration as part of treatment of cystic fibrosis exacerbation. The goal of this project was to compare the pharmacokinetics of once-daily versus thrice-daily aminoglycoside use when treating cystic fibrosis exacerbation in different age groups. Of the total of 119 patient encounters, 82.4% were started on once-daily dosing, and the remainder were started on thrice-daily dosing. Patients with pharmacokinetics allowing the continuation of once-daily dosing differed from patients who required a switch to thrice-daily dosing in terms of baseline forced expiratory volume in 1 second, forced expiratory flow from 25% to 75% of vital capacity, age, and body mass index (BMI) but were similar in BMI percentiles. The once-daily dosing group had higher mean 18-hour level, higher mean half-life, higher mean area under the curve, and lower mean elimination constant. This study showed that aminoglycoside clearance is higher in younger children