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Humor is a central feature of close and intimate relationships in childhood. However, fundamental questions regarding the relationship between humor production, pretend play, and social understanding have been overlooked. In a selected subsample from a prospective longitudinal study of first-born children (N = 110, M age = 6.91 years, 46.4% female, 98.1% parents identified as English, Welsh, Scottish, or Irish), we conducted detailed observational coding of children's humor production during dress-up play with younger siblings. Focal children also completed a battery of social understanding tasks that measured emotion understanding and second-order belief understanding. Focal children were also observed during solo free play with Playmobil, and their spontaneous references to others' cognitions and play with objects were coded. Correlation analyses indicated that children's word play with their sibling was associated with their tendency to engage in pretense during solo play. Regression analyses showed that humorous sound play with siblings was associated with their emotion understanding and playful teasing with siblings was associated with their spontaneous references to others' cognitive states during solo free play. Our findings contribute to knowledge and theory regarding domains of development associated with humor production in childhood. [ABSTRACT FROM AUTHOR]

Children adopted from the public care system are likely to experience a cluster of inter-related risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children's internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees' internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptees' outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention. [ABSTRACT FROM AUTHOR]

Introduction: Sexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse.Methods: Adolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months.Results: Consistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse.Conclusions: Sexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse. [ABSTRACT FROM AUTHOR]

Background Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited. Methods We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at 5 academic children's hospitals on children presenting to the emergency department with acute gastroenteritis. Caregivers were interviewed on enrollment and 7–10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the clinician's discretion. During the intervention period, multiplex molecular testing was performed on all children, with results available to clinicians. The primary outcome was return visits to a healthcare provider within 10 days of enrollment. Results Potential pathogens were identified by clinician-ordered tests in 19 of 571 (3.3%) in the pre-intervention period compared with 434 of 586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15%, respectively. In the multivariate model, the intervention was associated with a 21% reduction in the odds of any return visit (odds ratio, 0.79; 95% confidence interval,.70–.90) after adjusting for potential confounders. Appropriate treatment was prescribed in 11.3% compared with 19.6% during the intervention period (P =.22). Conclusions Routine molecular multiplex testing for all children who presented to the ED with acute gastroenteritis detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing. Clinical Trials Registration. NCT02248285. [ABSTRACT FROM AUTHOR]

Background: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.Methods and Findings: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria.Conclusion: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether trial of labor after cesarean (TOLAC) is associated with increased risk of adverse outcomes for small-for-gestational-age (SGA) neonates.Methods: This secondary analysis of a multicenter prospective observational study evaluated SGA neonates born to women with a single prior cesarean delivery. Nonanomalous, singleton pregnancies delivered at 24-41 weeks were included. The primary exposure was whether women underwent planned cesarean versus attempted TOLAC. Log-linear regression models were developed to characterize the relationship between TOLAC and neonatal outcomes. The primary outcome was a composite measure of neonatal morbidity and/or mortality, including death, respiratory complications, treated hypoglycemia, sepsis, neonatal intensive care unit (NICU) admission and hospital stay >5 days.Results: Of 1009 patients identified, 258 underwent repeat cesarean; 751 attempted TOLAC. Controlling for age, race, body mass index, smoking, maternal disease, prior vaginal birth after cesarean, corticosteroids, prematurity and nonreassuring fetal status as indication for delivery, the composite adverse outcome was similarly likely in both groups (adjusted risk ratio (RR) 0.99, 95% confidence interval (95% CI) 0.88-1.12, p = 0.93).Conclusions: SGA infants born to women who TOLAC have similar neonatal outcomes to those who deliver by planned repeat cesarean. We conclude that TOLAC is an acceptable option for women with a prior cesarean and suspected SGA neonates. [ABSTRACT FROM AUTHOR]

Objectives: A cuffed tracheostomy tube facilitates prolonged mechanical ventilation and weaning but usually leads to prolonged voicelessness, which can be one of the most negative experiences of hospitalization. No randomized trials have examined the effects of targeted early communication intervention for the restoration of voice in ventilated tracheostomy patients in the ICU.Design: A prospective randomized clinical trial.Setting: The trial was conducted in the ICU of an urban tertiary level hospital.Patients: Thirty adult participants enrolled, with 15 randomly allocated to the intervention and control groups.Interventions: The early intervention group received early cuff deflation and insertion of an in-line speaking valve during mechanical ventilation. The control group received standard cuff deflation and a speaking valve during self-ventilation. A speech-language pathologist provided all treatments.Measurements and Main Results: The primary outcome measure was time from tracheostomy insertion to phonation. Early intervention significantly hastened return to phonation (median difference = 11 d; hazard ratio = 3.66; 95% CI, 1.54-8.68) with no significant effect on duration of tracheostomy cannulation (hazard ratio = 1.40; 95% CI, 0.65-3.03), duration of mechanical ventilation in days from tracheostomy insertion (hazard ratio = 1.19; 95% CI, 0.58-2.51), length of stay in ICU (hazard ratio = 1.16; 95% CI, 0.54-2.52), or time to return to oral intake (hazard ratio = 2.35; 95% CI, 0.79-6.98). Adverse events were low and equal in both groups. There was no significant change in measures of quality of life.Conclusions: Focused early intervention for communication during mechanical ventilation allows the restoration of phonation significantly sooner than standard treatment, with no increase in complications in a small patient cohort. Although these results are favorable, further research is needed to determine whether the effects on any of the secondary outcomes are statistically significant and clinically important. [ABSTRACT FROM AUTHOR]

Nosocomial pneumonia is common in critically ill patients and is associated with high mortality rates. The development of pneumonia in the intensive care unit (ICU) has been associated with bacterial colonisation within the oral cavity and translocation into the respiratory tract. Over recent years, several strategies have been employed and recommended for preventing ventilator associated pneumonia in the ICU. Chlorhexidine, a topical antiseptic, is a promising agent in preventing nosocomial pneumonia because of its wide antimicrobial spectrum of activity, ease of administration, minimal concerns of contributing to bacterial resistance and relatively benign side effect profile. To evaluate the safety and efficacy of chlorhexidine in preventing nosocomial pneumonia in critically ill patients, we conducted a literature search by using PubMed, EMBASE, CINAHL, Web of Science, and MEDLINE databases; Google Scholar, and the Cochrane Central Register of Controlled Trials (1966– February 2013) for relevant studies. Overall, seven clinical trials were identified. These studies showed mixed results and the majority failed to demonstrate a significant reduction in the incidence of nosocomial pneumonia with the use of chlorhexidine. However, the cardiothoracic surgery ICU patient population may benefit from its use. Further studies are warranted to clearly define the role of chlorhexidine in preventing nosocomial pneumonia. [ABSTRACT FROM PUBLISHER]

Objectives. We tested a theory of syndemic production among men who have sex with men (MSM) using data from a large cohort study. Methods. Participants were 1551 men from the Multicenter AIDS Cohort Study enrolled at 4 study sites: Baltimore, Maryland-Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Participants who attended semiannual visits from April 1, 2008, to March 31, 2009, completed an additional survey that captured data about events throughout their life course thought to be related to syndemic production. Results. Using multivariate analysis, we found that the majority of life-course predictor variables (e.g., victimization, internalized homophobia) were significantly associated with both the syndemic condition and the component psychosocial health outcomes (depressive symptoms, stress, stimulant use, sexual compulsivity, intimate partner violence). A nested negative binomial analysis showed that the overall life course significantly explained variability in the syndemic outcomes (χ2 = 247.94; P < .001; df = 22). Conclusions. We identified life-course events and conditions related to syndemic production that may help to inform innovative interventions that will effectively disentangle interconnecting health problems and promote health among MSM. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of in-hospital mortality and morbidity between outborn and inborn neonates treated with whole body hypothermia.Methods: The association of outborn birth status with in-hospital mortality and morbidity, prior to NICU discharge or transfer, was assessed in a large historical cohort of neonates who had therapeutic hypothermia initiated on the day of birth. The cohort was restricted to neonates born at ≥35 weeks gestational age from 2007 to 2018. Since the sample was non-random, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalance in baseline maternal and neonatal characteristics between outborn and inborn neonates. Cox proportional hazards regression was used to assess the association between outborn status and in-hospital mortality.Results: There were 4447 neonates included in the study (2463 outborn). Outborn status was not significantly associated with an increased risk of in-hospital mortality in the unadjusted cohort (HR = 1.17, 95% CI 0.97-1.42, p = 0.10) or IPW cohort (HR = 1.09, 95% CI 0.95-1.26, p = 0.22). However, in the IPW cohort, outborn neonates were significantly more likely to have seizures (28% vs 24%, p = 0.006), anticonvulsant exposure (46% vs 41%, p = 0.002), and gastrostomy tube placement (5.8% vs 3.8%, p = 0.009) during their newborn hospitalization.Conclusion: Outborn status was not significantly associated with increased in-hospital mortality among neonates treated with whole body hypothermia. However, outborn neonates were more likely to have seizures, receive anticonvulsant treatment, and undergo gastrostomy tube placement. Further study is needed to better understand the etiologies of these outcome disparities and potential implications for long-term neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.Methods: We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure.Results: We identified 1,881 women who underwent a sling procedure for primary SUI-1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein are based on the covariate-matched cohort. Women undergoing a transobturator sling procedure had an increased risk of reoperation for recurrent SUI compared with women undergoing a retropubic sling procedure (hazard ratio 2.42, 95% CI 1.37-4.29). The cumulative incidence of reoperation for recurrent SUI by 8 years was 5.2% (95% CI 3.0-7.4%) in the retropubic group and 11.2% (95% CI 6.4-15.8%) in the transobturator group. Women in the retropubic group had a significantly higher rate of intraoperative complications compared with women in the transobturator group (13.7% [78/570] vs 4.7% [15/317]; difference=9.0%, 95% CI for difference 5.3-12.6%); the majority of this difference was due to bladder perforation (7.0% [40/570] vs 0.6% [2/317]; difference=6.4%, 95% CI for difference 4.1-8.7%). The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups.Conclusion: Women with primary SUI treated with a retropubic sling procedure have significantly lower cumulative incidence of reoperation for recurrent SUI compared with women who were treated with a transobturator sling procedure. Retropubic slings were associated with a higher risk of sling revision for urinary retention. [ABSTRACT FROM AUTHOR]

Objective: To compare postpartum contraception use between Somali and non-Somali women.Methods: A retrospective cohort study was performed using the Rochester Epidemiology Project. All Somali women aged 18 and older with live singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) were included, and a group of age-matched non-Somali women (n=317) were identified. Postpartum contraception was defined as the use of any method within 12 months after the first delivery within the study period. Rates of contraception use and types of contraception used were compared between groups using χ analysis. Among Somali women, an a priori list of factors was evaluated for associations with postpartum contraception use by including these factors in a multivariable logistic regression model.Results: After the index birth, 33 Somali women did not present for follow-up, compared with 12 non-Somali women (10.4% vs 3.8%, difference 6.6%, 95% CI 2.3-10.9%). Somali women were less likely to use postpartum contraception than non-Somali women (69.4% vs 92.8%, odds ratio [OR] 0.18, 95% CI 0.11-0.29). Among those using postpartum contraception, both groups had comparable use of long-acting reversible contraception (LARC) (19.9% vs 23.7%, difference -3.8%, 95% CI -11.8% to 4.0%) and non-LARC hormonal contraception (39.3% vs 42.4%, difference -3.1%, 95% CI -12.7% to 6.0%). However, Somali women were more likely to use less reliable methods (40.3% vs 20.8%, difference 19.5%, 95% CI 11.0-28.5%). Among Somali women, contraception use was less likely with older maternal age (OR 0.12 for oldest vs youngest quartile, 95% CI 0.04-0.37) and more likely with prepregnancy contraception use (OR 15.46, 95% CI 5.18-46.18).Conclusion: Somali women were less likely to use postpartum contraception. Similar practices and beliefs may also be present in other immigrant populations. Recognition of sociocultural differences in immigrant populations and potential health care provider biases may improve patient-provider relationships and counseling practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To test the instrument, Nursing Student Perception of Civil and Uncivil Behaviors (NSPCUB) in newly licensed nurses' (NLNs') to create a credible measure of NLNs' perceptions of civil/uncivil behaviors by RNs. BACKGROUND: Uncivil behaviors in the workplace result in poor morale, absenteeism, and turnover. When targeted toward NLNs, the outcome of these behaviors can affect not only a job but a future career. METHODS: A convenience sample of NLNs from 3 cohorts completed the modified NSPCUB-NLN 12-item survey. Exploratory factor analysis and reliability statistics were conducted. Concurrent validity was evaluated. RESULTS: Exploratory factor analysis identified passive and active incivility subscales with high reliability (overall Cronbach's α = 0.917). Participants expressing positive experiences scored higher than those with negative experiences (P < 0.0001), supporting instrument validity. CONCLUSIONS: This study demonstrated that the NSPCUB-NLN is a valid and reliable instrument for use with NLNs. This will assist nurse leaders in evaluating unit cultures for incivility, guiding interventions for a healthy work environment. [ABSTRACT FROM AUTHOR]

Objective: Febrile seizures may follow vaccination. Common variants in the sodium channel gene, SCN1A, are associated with febrile seizures, and rare pathogenic variants in SCN1A cause the severe developmental and epileptic encephalopathy Dravet syndrome. Following vaccination, febrile seizures may raise the specter of poor outcome and inappropriately implicate vaccination as the cause. We aimed to determine the prevalence of SCN1A variants in children having their first febrile seizure either proximal to vaccination or unrelated to vaccination compared to controls.Methods: We performed SCN1A sequencing, blind to clinical category, in a prospective cohort of children presenting with their first febrile seizure as vaccine proximate (n = 69) or as non-vaccine proximate (n = 75), and children with no history of seizures (n = 90) recruited in Australian pediatric hospitals.Results: We detected 2 pathogenic variants in vaccine-proximate cases (p.R568X and p.W932R), both of whom developed Dravet syndrome, and 1 in a non-vaccine-proximate case (p.V947L) who had febrile seizures plus from 9 months. All had generalized tonic-clonic seizures lasting >15 minutes. We also found enrichment of a reported risk allele, rs6432860-T, in children with febrile seizures compared to controls (odds ratio = 1.91, 95% confidence interval = 1.31-2.81).Interpretation: Pathogenic SCN1A variants may be identified in infants with vaccine-proximate febrile seizures. As early diagnosis of Dravet syndrome is essential for optimal management and outcome, SCN1A sequencing in infants with prolonged febrile seizures, proximate to vaccination, should become routine. ANN NEUROL 2020;87:281-288. [ABSTRACT FROM AUTHOR]

Objective: To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy.Methods: We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires. Overall continence was defined as a negative stress test, no retreatment for stress incontinence, and no self-reported urinary incontinence (International Consultation on Incontinence Questionnaire, Short Form, score, 0). Stress-specific continence was defined as fulfillment of the first two criteria and no self-reported stress-related incontinence. Primary outcomes were assessed with intention-to-treat and within-protocol analyses. Comparisons between groups were evaluated using χ or Fisher exact test.Results: The two groups were similar in all measured baseline features. Outcome assessments at 2 years were available for 48 of 57 patients (84%) in the sling group and 45 of 56 patients (80%) in the Burch group. With intention-to-treat analysis, the sling group had significantly higher rates of overall continence than the Burch group (49% [28/57] vs 29% [16/56]; 95% CI for absolute risk difference 3.0-38.1; P=.03) at 1- but not 2-year follow-up (47% [27/57] vs 32% [18/56]; 95% CI for absolute risk difference -2.6 to 33.1; P=.10). The sling group had significantly higher rates of stress-specific continence than the Burch group at 1-year (70% [40/57] vs 46% [26/56]; 95% CI for absolute risk difference 6.1-41.4; P=.01) and 2-year (70% [40/57] vs 45% [25/56]; 95% CI for absolute risk difference 7.9-43.2; P=.006) follow-up. No difference was detected in prolapse recurrence, voiding dysfunction, antimuscarinic medication use, urgency incontinence, or patient satisfaction.Conclusion: Among women with baseline urinary incontinence undergoing sacrocolpopexy, the retropubic midurethral sling resulted in higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic ileal pouch-anal anastomosis (L-IPAA) has been increasingly adopted over the last decade due to short-term patient-related benefits. Several studies have shown L-IPAA to be equivalent to open IPAA in terms of safety and short-term outcomes. However, few L-IPAA studies have examined long-term functional outcomes. We aimed to evaluate the long-term functional outcomes of L-IPAA as compared to open IPAA.Methods: A previous case-matched cohort study at our institution compared short-term outcomes between L-IPAA and open IPAA from 1998 to 2004. For this study, we selected all patients from this case-matched cohort study with chronic ulcerative colitis (CUC) who had follow-up functional data of greater than 1 year. Functional data was obtained through prospective surveys, which were sent annually to all IPAA patients postoperatively.Results: One hundred and forty-nine patients (58 L-IPAA, 91 open IPAA) with a median 8-year duration of follow-up were identified. There were no differences in demographics and long-term surgical outcomes between groups. Stapled anastomosis was more common in the laparoscopic group (91.4 versus 54.9%, p < 0.001). Stool frequency during daytime (>6 stools, L-IPAA 32.8%, open 49.4%, p = 0.048) and nighttime (>2 stools, L-IPAA 13.8%, open 30.6%; p = 0.024) was significantly lower in the L-IPAA group. Ability to differentiate gas from stool was not different (p = 0.13). Rate of complete continence was similar in L-IPAA and open groups (L-IPAA 36.2%, open 21.8%, p = 0.060). There was no difference in use of medication to control stools, perianal skin irritation, voiding difficulty, sexual problems, and occupational change between groups. Subgroup analysis to evaluate for any group differences attributable to anastomotic technique demonstrated only that stapled anastomoses lead to more perianal skin irritation in the L-IPAA group (L-IPAA = 60.4% versus open IPAA = 38.8%; p = 0.031).Conclusion: Overall, L-IPAA has comparable functional results to the open approach with slightly lower daytime and nighttime stool frequency. This difference may be attributed to a greater number of stapled anastomoses performed in the laparoscopic cohort. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of hysterectomy on ovarian function by comparing antimüllerian hormone, a marker of ovarian reserve, before and after hysterectomy.Methods: The Prospective Research on Ovarian Function study prospectively followed 1) premenopausal women undergoing ovary-sparing hysterectomy for benign indications, and 2) a referent cohort with similar age distributions and intact reproductive organs; they reported that women undergoing hysterectomy became menopausal 1.9 years earlier than referents. In a planned secondary analysis, baseline antimüllerian hormone levels and the absolute change and percentage change in antimüllerian hormone levels between baseline and 1-year follow-up were compared between groups.Results: Baseline median antimüllerian hormone levels were similar between the hysterectomy group (n=148) and the referent group (n=172). After 1 year, patients undergoing hysterectomy had a significantly greater median percentage decrease (-40.7% compared with -20.9%; P<.001), had a higher proportion with undetectable antimüllerian hormone (12.8% compared with 4.7%; P=.02), and had on average 0.77 times the antimüllerian hormone level (P=.001) compared with referents. These differences were attenuated among white women but remained significant among black women. Comparisons of women stratified by low or high ovarian reserve at baseline or among propensity score-matched cohorts showed similar findings; however, the absolute median change in antimüllerian hormone levels was similar between groups (-0.3 compared with -0.2; P=.31).Conclusion: Women undergoing hysterectomy had similar antimüllerian hormone levels at baseline and experienced a greater percentage decrease in levels after 1 year compared with referents, suggesting that hysterectomy may lead to ovarian damage that is unrelated to baseline ovarian reserve. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical relevance of obtaining antral follicle counts (AFC) before ovarian stimulation in an IVF program. Design: Retrospective cohort study. Setting: An IVF program in a large academic teaching hospital. Patient(s): A total of 1,049 stimulated IVF cycles in 734 subjects between September 2003 and December 2007 selected from our program's database. Intervention(s): Basal antral follicles (AFCs) (3 mm-10 mm) were counted via ultrasound scan on cycle day 3 in luteal leuprolide acetate stimulations, or after at least 2 weeks of oral contraceptives in microdose leuprolide acetate stimulations. Patients were grouped according to basal AFC, and outcome parameters compared for AFC groups within each stimulation protocol. Main Outcome Measure(s): Oocytes retrieved, ovarian response, implantation rate, cancellations, pregnancy, pregnancy loss, and live births per cycle start. Result(s): Antral follicle count grouping is predictive of threefold change in ovarian response to gonadotropins and oocytes retrieved. Low AFC did predict a higher cancellation rate. Antral follicle count did not predict implantation rate, pregnancy rate, or live birth rate per cycle start. Conclusion(s): Antral follicle count may be helpful in determining stimulation protocol, as it is the most reliable determinant of oocytes retrieved per starting FSH dose. Antral follicle count predicts ovarian response, not embryo quality or pregnancy. [ABSTRACT FROM AUTHOR]

Previous studies have suggested a higher incidence of symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy, but few have investigated epilepsy in children with ADHD. The objective here was to compare the incidence and characteristics of epilepsy among population-based, research identified cohorts of children with (n = 358) and without ADHD (n = 728), based on medical record review to age 20 years. Data abstracted included characteristics of seizures, testing, and treatment. Cases were 2.7 times more likely than controls to have epilepsy (95% CI = 0.94-7.76; P = 0.066), had earlier seizure onset (median age, 5.5 vs 15 years; P = 0.020), and exhibited a trend toward more frequent seizures (more than monthly, 63% vs 17%). Among children who met the research criteria for ADHD, those with epilepsy tended to be less likely to have received a clinical diagnosis of ADHD (63% vs 89%; P = 0.052) or to be treated with stimulants (50% vs 85%; P = 0.025). The findings suggest a strong trend toward a higher incidence of epilepsy among children with ADHD than among children without ADHD. Epilepsy in children with ADHD appears to be more severe than in those without. Finally, there appears to be a reluctance to diagnose and initiate treatment for ADHD in children with epilepsy. [Copyright &y& Elsevier]

Despite emerging literature linking juvenile bipolar disorder (BPD) and substance abuse, little is known about a link between BPD and cigarette smoking. To this end, we evaluated the association between BPD and cigarette smoking in youth. Subjects were 31 bipolar adolescents derived from a cohort of boys with DSM-III-R ADHD (N = 128) and non-ADHD comparisons (N = 109) followed prospectively for 4 years into mid-adolescence. Information on cigarette smoking was obtained in a standardized manner blind to the proband's clinical status. Logistic regression models were used to determine risk for smoking at follow-up. BPD was associated with a higher risk for cigarette smoking in mid-adolescence, which was largely accounted for by conduct disorder. The developmental onset of BPD in adolescence (age 13-18 years) conferred a greater risk for cigarette smoking compared to those youths with the onset of their BPD prepubertally (< or = 12 years; odds ratio = 10.8, p < 0.01), even after controlling for conduct disorder and other confounds. The naturalistic treatment of BPD with combined counseling and pharmacotherapy appeared to reduce the risk for cigarette smoking. BPD, particularly when it onsets in adolescence, is a significant risk factor for the early initiation of cigarette smoking in these ADHD youths. These data coupled with the literature strongly suggest that juveniles with BPD need to be carefully monitored for the early initiation of cigarette smoking and substance abuse. [ABSTRACT FROM AUTHOR]