Bayesian sensitivity analysis of incomplete data: bridging pattern‐mixture and selection models

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109600/1/sim6302.pd

Blood Pressure Measurement Device, Number and Timing of Visits, and Intra‐Individual Visit‐to‐Visit Variability of Blood Pressure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94447/1/jch.12005.pd

A Bayesian model for longitudinal count data with non-ignorable dropout

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73907/1/j.1467-9876.2008.00628.x.pd

Is Acute High-Dose Secondhand Smoke Exposure Always Harmful to Microvascular Function in Healthy Adults?

Prev Cardiol.Long-term exposure to secondhand smoke (SHS) is associated with impaired vascular function. The authors investigated the vascular and blood pressure (BP) reactions to acute SHS exposure. Twenty-five healthy nonsmoking adults underwent a 1-hour exposure to SHS (mean fine particulate matter <2.5 μm level=315±116 μg/m 3 ). Microvascular endothelial-dependent vasodilatation (EDV) (EndoPAT, Itamar Medical, Caesarea, Israel) and aortic hemodynamics/compliance (SphygmoCor, AtCor Medical, West Ryde, Australia) were measured before and after the SHS exposure with BP measured every 15 minutes during and for a 24-hour period before and after the exposure. SHS exposure did not change EDV, aortic hemodynamics, arterial compliance, or 24-hour BP. However, diastolic BP significantly increased during the SHS exposure period by 3.4±5.6 mm Hg. Our brief SHS exposure did not impair microvascular endothelial function or arterial compliance in healthy nonsmoking adults, but brachial diastolic BP increased.Prev Cardiol. 2010;13:175–179. © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79199/1/j.1751-7141.2010.00074.x.pd

Progression of Symptoms and Functioning Among Female Cardiac Patients With and Without Diabetes

Objective: To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone. Methods: Data from older women with heart disease (>=60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes. Results: Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p<=-0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p<=-0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p-<-0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p-<-0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later. Conclusions: Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90452/1/jwh-2E2010-2E2123.pd

Using chlorhexidine varnish to prevent early childhood caries in American Indian children

Objectives: To test the efficacy of 10% chlorhexidine (CHX) dental varnish applied to the mothers' dentition in preventing caries in American Indian children. Methods: This was a placebo‐controlled, double‐blind, randomized clinical trial. Mother–child pairs were enrolled when the child was 4.5‐6.0 months. Mothers received 4 weekly applications of the study treatment (CHX or placebo) followed by single applications when her child was age 12 and 18 months. Children received caries examinations at enrollment, 12, 18 and 24 months. Analyses were limited to the intent‐to‐treat (ITT) group: children whose mothers received the first study treatment and who received at least one post‐baseline exam. The outcome variable was the number of new carious surfaces (NNCS) at the child's last visit. Wilcoxon nonparametric and Fisher's exact tests were used to test differences between the active and placebo groups. Results: We randomized 414 mother–child pairs, with 367 (88.6%) included in the ITT group (active = 188, placebo = 179). The proportion of children caries‐free at their final exam was 51.1% and 50.8% for the active and placebo groups ( P  > 0.99). The mean NNCS for the active and placebo groups was 3.82 (standard deviation [SD] = 8.18) and 3.80 (SD = 6.08), respectively ( P  = 0.54). The proportion with NNCS > 6 was 18.1% for active children versus 27.9% for placebo (relative risk [RR] = 0.65, P  = 0.03). The number needed to treat to shift one child from NNCS > 6 to a lower severity was 10.2. Conclusions: In this population CHX varnish did not reduce the mean NNCS or proportion of children with caries, but did reduce the proportion with severe caries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96744/1/jphd348.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

The impact of culture on physiological processes of emotion regulation: a comparison of US and Chinese preschoolers

Cognitive determinants of emotion regulation, such as effortful control, have been hypothesized to modulate young children's physiological response to emotional stress. It is unknown, however, whether this model of emotion regulation generalizes across Western and non‐Western cultures. The current study examined the relation between both behavioral and questionnaire measures of effortful control and densely sampled, stress‐induced cortisol trajectories in U.S. and Chinese preschoolers. Participants were 3‐ to 5‐ year‐old children recruited from the United States (N = 57) and Beijing, China (N = 60). Consistent with our hypothesis, U.S. children showed a significant negative relation between maternal‐rated inhibitory control and both cortisol reactivity and recovery. However, this was not replicated in the Chinese sample. Children in China showed a significant positive relation between maternal‐rated attentional focusing and cortisol reactivity that was not seen in the U.S. Results suggest that children who reside in Western and non‐Western cultures have different predictors of their emotion‐related stress response.We compared associations between specific effortful control subcomponents and stress‐induced cortisol trajectories in preschool children residing in the U.S. and China. U.S. preschoolers showed an expected negative association between maternal‐rated inhibitory control with cortisol reactivity and recovery. In contrast, Chinese preschoolers showed a positive association between maternal‐rated attentional focusing and cortisol reactivity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111122/1/desc12227.pd

Adolescent obesity and maternal and paternal sensitivity and monitoring

Objective . To determine if adolescent obesity is associated with parenting characterized by lower sensitivity and lower monitoring of adolescent activities. Methods . We used data from 744 adolescents in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Height and weight were measured at age 15½ years and obesity defined as body mass index ≥ 95th percentile for age and sex. Maternal and paternal sensitivity were assessed by direct observation of a parent‐adolescent interaction task. Maternal and paternal monitoring were assessed by parent report. Lower sensitivity and lower monitoring were each defined as the lowest quartiles. Two separate multivariate logistic regression models were created to evaluate, individually for mothers and fathers, associations of sensitivity and monitoring with adolescent obesity, controlling for adolescent sex and race, family income‐to‐needs ratio, and parental obesity. Results . Fourteen percent of the adolescents were obese. Lower sensitivity was associated with adolescent obesity in the maternal parenting model (adjusted odds ratio [AOR] 2.36, 95% confidence interval [CI] 1.44–3.86, n = 709), but not paternal parenting model (AOR = 0.79, 95% CI 0.38–1.63, n = 460). Neither maternal nor paternal monitoring was associated with adolescent obesity (AOR = 1.03, 95% CI 0.63–1.68; AOR = 1.07, 95% CI 0.52–2.22, respectively). Conclusion . Lower maternal sensitivity, measured by direct observation of parent‐adolescent interactions, was associated with adolescent obesity. Efforts to prevent and treat childhood obesity, both at the practitioner level and the community level, may be enhanced by educating parents that their reactions to their children's behaviors may have consequences related to obesity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93554/1/ijpo_345_sm_Appendix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/93554/2/17477166.2010.549490.pd

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

Background: Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices. Methods: In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight. Results: Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions. Conclusions: Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies