Pediatric metabolic syndrome definitions impact prevalence and socioeconomic gradients

The choice of pediatric metabolic syndrome (MetS) definition influences prevalence estimates, but further implications, especially on the association with socioeconomic status (SES), are not well-known. This hampers a synthesis of the evidence to help guide the relevant stakeholders. For this reason, we aim to assess the impact of alternative definitions on the prevalence of MetS, the children that are identified, and the association between SES and MetS.Data were used from the Lifelines Cohort Study, a prospective multigenerational cohort in the Netherlands. At baseline 9,754 children participated, of which 5,085 (52.1\ were included in the longitudinal analyses. We computed the prevalence of MetS according to five published definitions and measured the observed positive agreement between pairs of definitions, indicating the proportion of agreement across the average number of MetS cases. Logistic regression was used to assess the association between SES and MetS. All models were adjusted for age and sex; the longitudinal models were also adjusted for baseline MetS status.The prevalence rates of MetS varied between definitions (0.7-3.0\, but positive agreement between MetS definitions was generally fair to good ranging from 0.34 (95\CI) 0.28; 0.41) to 0.66 (95\.58; 0.75) at baseline. At both assessments, we found an inverse association between baseline SES and MetS, which ranged from 0.81 (95\.70; 0.93) to 0.92 (95\.86; 0.98) per definition in the longitudinal analyses with a mean follow-up (SD) of 3.0 (0.75) years.Alternative definitions of MetS lead to differing prevalence estimates, and they agreed on 50\ regardless of which definition was used we concluded low SES was a risk factor for developing MetS.Evidence regarding different definitions of metabolic syndrome in children can be combined because the agreement among definitions is generally fair to good.As low socioeconomic status is a consistent risk factor for developing metabolic syndrome, preventive interventions should preferentially target children from low socioeconomic backgrounds

Adolescents' mental health problems increase after parental divorce, not before, and persist until adulthood:a longitudinal TRAILS study

Parental divorce is one of the most stressful life events for youth and is often associated with (long-lasting) emotional and behavioral problems (EBP). However, not much is known about the timing of the emergence of these EBP in adolescents relative to the moment of parental divorce, and its longitudinal effects. We therefore assessed this timing of EBP in adolescents of divorce and its longitudinal effects. We used the first four waves of the TRacking Adolescent's Individual Lives Survey (TRAILS) cohort, which included 2230 10-12 years olds at baseline. EBP were measured through the Youth Self-Report (YSR), as internalizing and externalizing problems. We applied multilevel analysis to assess the effect of divorce on EBP. The levels of both internalizing and externalizing problems were significantly higher in the period after parental divorce (beta = 0.03, and 0.03, respectively; p <0.05), but not in the period before divorce, with a persistent and increasing effect over the follow-up periods compared to adolescents not experiencing divorce. Adolescents tend to develop more EBP in the period after parental divorce, not before. These effects are long-lasting and underline the need for better care for children with divorcing parents

Connecting Obstetric, Maternity, Pediatric and Preventive Child Health Care:A Comparative Prospective Study Protocol

Collaboration between birth care and Preventive Child Health Care (PCHC) in the Netherlands is so far insufficient. The aim of the Connecting Obstetric; Maternity; Pediatric and PCHC (COMPLETE) study is to: (1) better understand the collaboration between birth care and PCHC and its underlying mechanisms (including barriers and facilitators); (2) investigate whether a new multidisciplinary strategy that is developed as part of the project will result in improved collaboration. To realize the first aim, a mixed-method study composed of a (focus group) interview study, a multiple case study and a survey study will be conducted. To realize the second aim, the new strategy will be piloted in two regions in an iterative process to evaluate and refine it, following the Participatory Action Research (PAR) approach. A prospective study will be conducted to compare outcomes related to child health, patient reported outcomes and experiences and quality of care between three different cohorts (i.e., those that were recruited before, during and after the implementation of the strategy). With our study we wish to contribute to a better understanding of collaboration in care and develop knowledge on how the integration of birth care and PCHC is envisioned by stakeholders, as well as how it can be translated into practice

The Terneuzen Birth Cohort: BMI Changes between 2 and 6 Years Correlate Strongest with Adult Overweight

Background: Complications of overweight amplify with age, and irreversible damage already exists in young persons. Identifying the most sensitive age interval(s) for adult overweight is relevant for primary prevention. The aim of the study was to assess the relative contribution of body mass index (BMI) changes between 0 and 18 years to adult overweight, and to identify the earliest critical growth period. Methods and Findings: Data from 762 subjects in the Terneuzen Birth Cohort with an average of 21 growth measurements per subject from birth until 18 years were used. The main outcome measure was the BMI standard deviation score (SDS) at young adulthood. For each subject BMI SDS was fitted by a piecewise linear model at eight different ages and correlated to adult BMI SDS. The age intervals in between are considered critical according to three criteria, tested by respectively Students' t-tests, multiple linear regression analyses and Pearson's correlation tests. In the age intervals 4 months(m) -1 year(y), 2-6 y, 6-10 y and 10-18 y the BMI SDS change differs between adults with and without overweight (P≤0.001). The age intervals 2-6 y and 10-18 y also meet the second criterion, implying that the BMI change during this period has a predictive value for adult BMI SDS in addition to BMI SDS at the end of the period. The largest rise in correlation between estimated BMI SDS and measured adult BMI SDS occurs during the period 2-6 y (from 0.36 to 0.63), which results in a high sensitivity (0.6) and specificity (0.8) by the age of 6 y. Conclusions/Significance: The age interval from 2 y to 6 y is the earliest and most critical growth period for adult overweight. Therefore, primary prevention of adult overweight seems most likely to be successful if targeted at this specific age interval. By identifying those with an upwards centile crossing between 2 and 6 years, the development towards adult overweight might be reversed. © 2010 De Kroon et al

Correction:Reducing growth and developmental problems in children: Development of an innovative postnatal risk assessment

[This corrects the article DOI: 10.1371/journal.pone.0217261.]

Differences in renal hemodynamics and renin secretion between patients with unifocal and multifocal fibromuscular dysplasia

Objective: Fibromuscular dysplasia (FMD) can be classified in a multifocal and a unifocal subtype. As unifocal FMD generally leads to more severe hypertension at younger age, we hypothesized that renal hemodynamics are more disturbed in unifocal renal artery FMD as compared with multifocal FMD, leading to increased renin secretion. Methods: We measured renal blood flow ((133)Xenon washout method), renin secretion, and glomerular filtration rate per kidney in 101 patients with FMD (26 unifocal and 75 multifocal), all off medication and prior to balloon angioplasty. Results: We found that renal blood flow and glomerular filtration were substantially lower in kidneys with unifocal FMD as compared with multifocal FMD. In the affected kidney from patients with unilateral FMD for example, mean renal blood flow was 173 +/- 77 in unifocal vs. 244 +/- 79 ml/100 g kidney/min in multifocal FMD (P=0.013). Moreover, lateralization in renin secretion was only observed in a subset of patients with unifocal FMD, but not in any of the patients with multifocal FMD. Conclusion: These findings suggest that the impact of unifocal FMD lesions on the kidney is more severe, resulting in a classical pattern of renovascular hypertension. In multifocal FMD, however, renal blood flow is more preserved, local renin secretion is not increased, and the association between renin levels and blood pressure is inverse. These differences may explain the often more severe clinical presentation and higher success rate of revascularization in unifocal FMD, but also suggest that the pathophysiological mechanisms leading to hypertension may differ between these two disease entities

Associations between Socio-Economic Status and Unfavorable Social Indicators of Child Wellbeing; a Neighbourhood Level Data Design

Background: Living in deprivation is related to ill health. Differences in health outcomes between neighbourhoods may be attributed to neighbourhood socio-economic status (SES). Additional to differences in health, neighbourhood differences in child wellbeing could also be attributed to neighbourhood SES. Therefore, we aimed to investigate the association between neighbourhood deprivation, and social indicators of child wellbeing. Methods: Aggregated data from 3565 neighbourhoods in 390 municipalities in the Netherlands were eligible for analysis. Neighbourhood SES scores and neighbourhood data on social indicators of child wellbeing were used to perform repeated measurements, with one year measurement intervals, over a period of 11 years. Linear mixed models were used to estimate the associations between SES score and the proportion of unfavorable social indicators of child wellbeing. Results: After adjustment for year, population size, and clustering within neighbourhoods and within a municipality, neighbourhood SES was inversely associated with the proportion of ‘children living in families on welfare’ (estimates with two cubic splines: −3.59 [CI: −3.99; −3.19], and −3.00 [CI: −3.33; −2.67]), ‘delinquent youth’ (estimate −0.26 [CI: −0.30; −0.23]) and ‘unemployed youth’ (estimates with four cubic splines: −0.41 [CI: −0.57; −0.25], −0.58 [CI: −0.73; −0.43], −1.35 [−1.70; −1.01], and −0.96 [1.24; −0.70]). Conclusions: In this study using repeated measurements, a lower neighbourhood SES was significantly associated with a higher prevalence of unfavorable social indicators of child wellbeing. This contributes to the body of evidence that neighbourhood SES is strongly related to child health and a child’s ability to reach its full potential in later life. Future studies should consist of larger longitudinal datasets, potentially across countries, and should attempt to take the interpersonal variation into account with more individual-level data on SES and outcomes

Intermittency in aging

The fluctuation-dissipation relation (FDR) is measured on the dielectric properties of a gel (Laponite) and of a polymer glass (polycarbonate). For the gel it is found that during the transition from a fluid-like to a solid-like state the fluctuation dissipation theorem is strongly violated. The amplitude and the persistence time of this violation are decreasing functions of frequency. Around $1Hz$ it may persist for several hours. A very similar behavior is observed in polycarbonate after a quench below the glass transition temperature. In both cases the origin of this violation is a highly intermittent dynamics characterized by large fluctuations. The relevance of these results for recent models of aging are discussed.Comment: Proceedings of "III workshop on non equilibrium phenomena" (Pisa 2002

Criterion Validity and Applicability of Motor Screening Instruments in Children Aged 5-6 Years:A Systematic Review

The detection of motor developmental problems, especially developmental coordination disorder, at age 5–6 contributes to early interventions. Here, we summarize evidence on (1) criterion validity of screening instruments for motor developmental problems at age 5–6, and (2) their applicability. We systematically searched seven databases for studies assessing criterion validity of these screening instruments using the M-ABC as reference standard. We applied COSMIN criteria for systematic reviews of screening instruments to describe the correlation between the tests and the M-ABC. We extracted information on correlation coefficients or area under the receiver operating curve, sensitivity and specificity, and applicability in practice. We included eleven studies, assessing eight instruments: three performance-based tests (MAND, MOT 4–6, BFMT) and five questionnaires (DCD-Q, PQ, ASQ-3, MOQ-T-FI, M-ABC-2-C). The quality of seven studies was fair, one was good, and three were excellent. Seven studies reported low correlation coefficients or AUC (<0.70), four did not report these. Sensitivities ranged from 21–87% and specificities from 50–96%, with the MOT4–6 having the highest sensitivity and specificity. The DCD-Q, PQ, ASQ-3, MOQ-T-FI, and M-ABC-2-C scored highest on applicability. In conclusion, none of the instruments were sufficiently valid for motor screening at age 5–6. More research is needed on screening instruments of motor delay at age 5–6