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EnvironHealthPerspect113(7):894-899 (2005); https://doi.org/10.1289/ehp.7688 The source of the errors in this article, which were limited to the Boston cohort, was twofold. Specifically, performance IQ data were used instead of full-scale IQ [...]

BACKGROUND: Prenatal exposure to organophosphate (OP) insecticides, a widely used class of pesticides, may be associated with decreased gestational age and lower birth weight. Single nucleotide polymorphisms in paroxanase (PONI) [...]

Benefits of resistance training include improved muscle strength and sports performance and may include reduced injuries. However, few studies have examined sex differences in resistance training--related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with strength training in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, nonaccidental), and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism, and location of strength training injuries. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002 to 2005 using the CPSC code for 'Weightlifting.' Subjects between the ages of 14 and 30 years were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (men = 3,102; women = 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for men versus women. Men had significantly more sprains and strains (p = 0.004), whereas women demonstrated increased accidental injuries compared to men (p < 0.001). The trunk was the most commonly injured body part for both men (36.9%) and women (27.4%). Men had more trunk injuries than women (p < 0.001), whereas women had more foot (p < 0.001 ) and leg (p = 0.03) injuries than men (p < 0.001). The findings indicate that men may suffer more exertional-type resistance injuries during strength training (sprains and strains) compared to women, especially at the trunk. Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training. KEY WORDS strength training, resistance training, power lifting, injury incidence, injury rates

Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for 'Weightlifting.' Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as 'accidental' if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p < 0.05) with age: 8 to 13 > 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to 'dropping' and 'pinching' in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p < 0.001). The study findings indicate that children have lower risk of resistance training-related joint sprains and muscle strains than adults. The majority of youth resistance training injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines. KEY WORDS pediatric resistance training, weight room injuries, resistance training injuries, weight room safety guidelines, resistance training safety

ABSTRACT Objective: An evaluation of the histological and clinical response to varying density settings (-10%, 0, and 10% overlap) with a fractionally scanned [CO.sub.2] laser. Study design: Clinical and histological [...]

OBJECTIVE. The goal was to test the hypothesis that participation in a community-based home-visiting program is associated with a decreased risk of infant death. METHODS. A retrospective, case-control design was used to compare the risk of infant death among participants in Cincinnati&apos;s Every Child Succeeds program and control subjects matched for gestational age at birth, previous pregnancy loss, marital status, and maternal age. The likelihood of infant death, adjusted for level of prenatal care, maternal smoking, maternal education, race, and age, was determined with multivariate logistic regression. The interaction between race and program participation and the effect of home visiting on the risk of preterm birth were explored. RESULTS. Infants whose families did not receive home visiting (n = 4995) were 2.5 times more likely to die in infancy compared with infants whose families received home visiting (n = 1665). Black infants were at least as likely to benefit from home visiting as were nonblack infants. No effect of program participation on the risk of preterm birth was observed. CONCLUSION. The current study is consistent with the hypothesis that intensive home visiting reduces the risk of infant death. Key Words home visiting, infant death, THE AMERICAN ACADEMY of Pediatrics encourages pediatricians to "support referral of high-risk parents to home-visitation programs as early as possible, ideally before or at the time of the prenatal visit [...]

OBJECTIVE. Evaluation procedures that rely solely on attending physician ratings may not identify residents who display poor communication skills or unprofessional behavior. Inclusion of non-physician evaluators should capture a more complete account of resident competency. No published reports have examined the relationship between resident evaluations obtained from different sources in pediatric settings. The objective of this study was to determine whether parent and nurse ratings of specific resident behaviors significantly differ from those of attending physicians. METHODS. Thirty-six pediatric residents were evaluated by parents, nurses, and attending physicians during their first year of training. For analysis, the percentage of responses in the highest response category was calculated for each resident on each item. Differences between attending physician ratings and those of parents and nurses were compared using the signed rank test. RESULTS. Parent and attending physician ratings were similar on most items, but attending physicians indicated that they frequently were unable to observe the behaviors of interest. Nurses rated residents lower than did attending physicians on items that related to respecting staff (69 % vs 97 %), accepting suggestions (56 % vs 82%), teamwork (63% vs 88%), being sensitive and empathetic (62% vs 85%), respecting confidentiality (73% vs 97%), demonstrating integrity (75% vs 92%), and demonstrating accountability (67% vs 83%). Nurse responses were higher than attending physicians on anticipating postdischarge needs (46% vs 25%) and effectively planning care (52% vs 33%). CONCLUSIONS. Expanding resident evaluation procedures to include parents and nurses does enhance information that is gathered on resident communication skills and professionalism and may help to target specific behaviors for improvement. Additional research is needed to determine whether receiving feedback on parent and nurse evaluations will have a positive impact on resident competency. Key Words medical education resident education/ training, multisource feedback patient--doctor communication, professionalism Abbreviations ABIM--American Board of Internal Medicine PSQ--Patient Satisfaction Questionnaire, COMMUNICATION AND PROFESSIONALISM are fundamental to the patient-physician relationship. Effective communication improves patient satisfaction and health outcomes, (1,2) whereas poor communication and unprofessional behavior are linked to patient complaints and [...]

Lead is a confirmed neurotoxin, but questions remain about lead-associated intellectual deficits at blood lead levels < 10 [micro]g/dL and whether lower exposures are, for a given change in exposure, [...]

Exposure to environmental tobacco smoke (ETS) is a major cause of morbidity and mortality among U.S. children. Despite African-American children's having a lower reported exposure to tobacco compared to whites, [...]

In the United States, injury-related morbidity and mortality continues to contribute substantially to the health services burden for children. (1,2) In 1998, injuries accounted for 5,189 deaths in U.S. children […]

Problem The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown. Objective This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA). Subjects Sixty-nine patients with a mean TBSA burn of 50.6[+ or -]2.2% (range 27% to 94%) and full thickness injury of 41.3[+ or -]3.0% (range 0% to 94%) were studied. Subjects ranged in age from 0.6 to 18 years (mean, 5.8[+ or -]0.6 years). Main Outcome Measures Blood samples were obtained for serum 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), albumin, cortisol, triiodothyronine (T3), tetraiodothyronine ([T.sub.4]), thyroid stimulating hormone (TSH), and parathormone (PTH). Results Two hundred eighty morning blood samples of D25 and D1,25 demonstrated that 45% and 26.2% were low and 8.9% and 11% were very low, respectively. At least one low D25 or D1,25 level occurred in 62.3% of all subjects. Very low levels were noted in 23.2% of all patients. There was an increased incidence of hyperparathyroidism in patients with very low serum D25. Vitamin D25 and D1,25 levels were lower in subjects with larger burns or inhalation injury, as well as those treated with thyroxine or oxandrolone. Serum albumin, cortisol, [T.sub.4], and TSH were not correlated with concentration of vitamin D. Conclusions Demonstration of a high incidence of low serum vitamin D indicates vitamin D status may be significantly compromised in burned children. It is unclear why vitamin D deficiency exists in this population. The most effective way to improve vitamin D status remains elusive at this time. J Am Diet Assoc. 2004;104:931-941.

Americans were more likely to know at least one of the warning signs of a stroke in 2000 than they did in 1995, according to a survey of 2,173 residents of Cincinnati, Ohio. However, the number of Americans who know at least one of the risk factors for stroke did not change during that time period. People at high risk for stroke were especially ignorant of the risk factors and warning signs of a stroke.

Much effort is needed to educate the public about risk factors for stroke. Researchers surveyed 1,880 residents of the Greater Cincinnati area, including many who had risk factors for stroke. Sixty-eight percent knew at least one risk factor for stroke and about half knew at least one warning sign of a stroke. However, only 57% of those with hypertension knew hypertension was a risk factor, only one-third of smokers knew smoking was a risk factor and only 13% of diabetics knew diabetes was a risk factor. Elderly people were also less likely to know risk factors and warning signs., Context.--Decreasing the time from stroke onset to hospital arrival and improving control of stroke risk factors depend on public knowledge of stroke warning signs and risk factors. Objective.--To assess current public knowledge of stroke warning signs and risk factors. Design.--A population-based telephone interview survey using random digit dialing conducted in 1995. Setting.--The Greater Cincinnati, Ohio, metropolitan area, the population of which is similar to that of the United States overall in age, sex, percentage of blacks, and economic status. Participant.--Respondents with age, race, and sex that matched the population of patients with acute stroke. Main Outcome Measure.--Knowledge of risk factors for stroke and warning signs of stroke as defined by the National Institute of Neurological Disorders and Stroke. Results.--Telephone calls were made to 17634 households, which yielded 2642 demographically eligible individuals. Interviews were completed by 1880 respondents (response rate, 71.2%). A total of 1066 respondents (57%) correctly listed at least 1 of the 5 established stroke warning signs, and of all respondents, 1274 (68%) correctly listed at least 1 of the established stroke risk factors. Of the respondents, 469 (57%) of 818 respondents with a history of hypertension listed hypertension, 142 (356/6) of 402 respondents who were current smokers listed smoking, and 32 (13%) of 255 respondents with diabetes listed diabetes as a risk factor for stroke. Compared with those younger than 75 years, respondents 75 years or older were less likely to correctly list at least 1 stroke warning sign (60% vs 47%, respectively; P [is less than] .001) and were less likely to list at least 1 stroke risk factor (72% vs 56%, respectively; P [is less than] 001). Conclusion.--Considerable education is needed to increase the public&apos;s awareness of the warning signs and risk factors for stroke. Respondents with self-reported risk factors for stroke are largely unaware of their increased risk. The population at greatest risk for stroke, the very elderly, are the least knowledgeable about stroke warning signs and risk factors.

Objective Energy expenditure measurements, performed while patients are in standardized resting conditions, are often used as an indicator of care by which to evaluate the adequacy of nutrition support regimens. Little attention has been directed toward examining potential errors incurred by deriving daily energy needs based on a single 15- to 20-minute measurement. This study was designed to differentiate energy expenditure during periods of sleep (defined as time spent in any of the standard sleep stages) and wakefulness in pediatric burn patients. Design Twenty-four-hour indirect calorimetry, polysomnography, and physiologic assessments (mean arterial pressure, heart rate, body temperature, oxygen saturation, and respiratory rate) were conducted simultaneously in 14 patients, who were thermally injured and tracheally intubated, for a total of 45 24-hour intervals. Subjects Mean age of the patients was 10.8±1.2 years. Mean total body surface area of the injury was 55.7±4.7%, and mean full-thickness burn was 48.8±6.0%. Statistical analyses performed A nested general linear analysis of variance model was used to evaluate the association between sleep, wakefulness, and energy needs; adjustments were made for postburn day and multiple test runs per patient. Results On average, subjects slept 699±46 minutes/day. They experienced a large number of awakenings from sleep (mean=53±6.3 awakenings per 24 hours). Patients had mean energy expenditure of 2,529±396 kcal/day while awake and 2,360±291 kcal/day while asleep, and these mean values did not differ significantly. No differences in physiologic measurements during the awake and sleep states were found. Applications There appears to be little difference in the metabolism of seriously injured burn patients while asleep and while awake. The study deemphasizes the importance of performing indirect calorimetry at rest in critically ill pediatric burn patients, and it supports the extrapolation of daily energy expenditure from a 15- to 20-minute steady-state measurement obtained during either sleep or wakefulness., Designing effective regimens of nutrition support for patients with burns is often a difficult task because of the complex nature of their injury and the dearth of knowledge about precise [...]

Immune therapy with ragweed extract may have only marginally positive affects on adult asthma. Ragweed pollen causes summertime allergies in some people. Researchers treated 37 asthmatics whose symptoms worsened during the ragweed season with ragweed extract injections. A control group of forty people received placebo injections. Although members of the immunotherapy group reported improved asthma symptoms during both seasons compared to the control group, there was no noticeable group difference overall. Medication use decreased in both groups, but especially in the immunotherapy group during the first treatment year. After two years, medication use, subjective asthma symptoms, and peak flow measurements of lung capacity were similar in both groups. Only 53 of 77 people completed the two-year treatment period.

Nutrition management of thermally injured persons is indisputably recognized as a vital component of the overall treatment necessary to combat the deleterious effects of burn injury. Nutrition support is essential [...]

ABSTRACT Objective The potential additive effect of obesity on selected nutritional, immunologic, hormonal, and clinical outcome parameters was evaluated. Design Fifteen obese patients were randomly matched for age, percentage of [...]

Background: Early-life exposure to bisphenol A (BPA) may increase childhood obesity risk, but few prospective epidemiological studies have investigated this relationship. OBJECTIVE: We sought to determine whether early-life exposure to BPA was associated with increased body mass index (BMI) at 2-5 years of age in 297 mother-child pairs from Cincinnati, Ohio (HOME Study). METHODS: Urinary BPA concentrations were measured in samples collected from pregnant women during the second and third trimesters and their children at 1 and 2 years of age. BMI z-scores were calculated from weight/height measures conducted annually from 2 through 5 years of age. We used linear mixed models to estimate BMI differences or trajectories with increasing creatinine-normalized BPA concentrations. RESULTS: After confounder adjustment, each 10-fold increase in prenatal (β = -0.1; 95% CI: -0.5, 0.3) or early-childhood (β = -0.2; 95% CI: -0.6, 0.1) BPA concentrations was associated with a modest and nonsignificant reduction in child BMI. These inverse associations were suggestively stronger in girls than in boys [prenatal effect measure modification (EMM) p-value = 0.30, early-childhood EMM p-value = 0.05], but sex-specific associations were imprecise. Children in the highest early-childhood BPA tercile had lower BMI at 2 years (difference = -0.3; 95% CI: -0.6, 0.0) and larger increases in their BMI slope from 2 through 5 years (BMI increase per year = 0.12; 95% CI: 0.07, 0.18) than children in the lowest tercile (BMI increase per year = 0.07; 95% CI: 0.01, 0.13). All associations were attenuated without creatinine normalization. CONCLUSIONS: Prenatal and early-childhood BPA exposures were not associated with increased BMI at 2-5 years of age, but higher early-childhood BPA exposures were associated with accelerated growth during this period. Environ Health Perspect 122:1239-1245; http://dx.doi.org/10.1289/ehp.1408258, Introduction Child obesity is one of the greatest public health challenges worldwide (World Health Organization 2010). Excess food consumption and inadequate physical activity are major risk factors for obesity, but [...]

Infants born to women with insulin-dependent diabetes were studied to determine whether insulin can cross the placenta from the mother to the fetus. The insulin administered to diabetic patients may be of human or animal (pork or beef) origin. Insulin is also secreted by the pancreas of infants and therefore simply testing the presence of maternal insulin in amniotic fluid was not considered reliable for the purposes of this study. Insulin is used by the fetus as a growth factor and placental transfer of insulin may result in a complication of maternal diabetes known as fetal macrosomia, abnormally large size at birth. Previous research in this area has suggested that insulin administered to pregnant women does not cross the placenta. The umbilical cord blood of 45 infants was tested for the presence of maternal insulin. Twenty-one infants had macrosomia and 24 had normal birth weights. The concentration of human insulin was higher in the infants with macrosomia than those without, and in 28 infants in whom animal insulin was detected, 12 had macrosomia, while 12 had normal weight. Among infants in whom a combination of human and animal insulin was detected, there was a significant correlation with fetal growth. Even when maternal blood glucose was maintained at a normal level, fetal macrosomia still occurred. The cause of fetal macrosomia is believed to be directly proportional to the concentration of glucose and other nutrients in the mother and fetus and an excess of these substances leads to fetal hyperinsulinism and macrosomia. (Consumer Summary produced by Reliance Medical Information, Inc.)

ABSTRACT Objective To determine whether higher dietary fiber intake (water soluble and insoluble) is associated with lower insulin requirements and better glycemic control in pregnant women with type 1 diabetes [...]

Effects of chronic reduction in uterine blood flow on fetal and placental growth in the sheep. Am J Physiol Regulatory Integrative Comp Physiol 279: R53-R59, 2000.--Pregnancy is associated with a significant increase in uteroplacental blood flow (UBF), which is responsible for delivering adequate nutrients and oxygen for fetal and placental growth. The present study was designed to determine the effects of vascular insufficiency on fetal and placental growth. Thirty-nine late-term pregnant ewes were instrumented to investigate the effects of chronic UBF reduction. Animals were split into three groups based on uterine blood flow, and all animals were killed on gestational day 138. UBF, which began at 851 [+ or -] 74 ml/min (n = 39), increased in controls (C) to 1,409 [+ or -] 98 ml/min (day 138 of gestation) and in the moderately restricted ([R.sub.M]) group to 986 [+ or -] 69 ml/min. In the severely restricted ([R.sub.S]) group, UBF was only 779 [+ or -] 79 ml/min on gestational day 138. This reduction in UBF significantly affected fetal body weight with [R.sub.M] fetuses weighing 3,685 [+ or -] 178 g and [R.sub.S] fetuses weighing 2,920 [+ or -] 164 g compared with C fetal weights of 4,318 [+ or -] 208 g. Fetal brain weight was not affected, whereas ponderal index was significantly reduced in [R.sub.M] (2.94 [+ or -] 0.09) and [R.sub.S] fetuses (2.49 [+ or -] 0.08) compared with the value of the C fetuses (3.31 [+ or -] 0.08). Placental weight was also significantly reduced in the [R.sub.M] group, being 302 [+ or -] 24 g, whereas the [R.sub.S] group placenta weighed 274 [+ or -] 61 g compared with the C values of 414 [+ or -] 57 g. Fetal heart, liver, lung, and thymus were all significantly smaller in the [R.sub.S] group. Thus the present study shows a clear relationship between the level of UBF and both fetal and placental size. Furthermore, the observation that fetal brain weight was not affected, whereas fetal body weight was significantly reduced suggests that this experimental preparation may provide a useful model in which to study asymmetric fetal growth restriction. placenta; fetus; fetal growth restriction; intrauterine growth restriction

As described in our original article (Lanphear et al. 2005), we decided apriori to focus our analyses on the blood lead (BPh) variable that had the strongest association with IQ [...]