Search

Background: Children with heightened airway responsiveness have a greater tendency to develop asthma symptoms. Many existing studies describing this relationship have relied on self-reported symptoms that may be prone to [...]

Objective: The authors' goal was to construct a short screening scale for DSM-IV posttraumatic stress disorder (PTSD). Method: They used data from the Detroit Area Survey of Trauma, which is a representative population sample of 2,181 subjects 18-45 years of age. Random digit dialing was used to select the sample, and a computer-assisted telephone interview was used to collect data on traumatic experiences and PTSD. Presence or absence of PTSD was assessed with a telephone-administered structured interview that closely followed the National Institute of Mental Health Diagnostic Interview Schedule for DSM-IV and the World Health Organization Composite International Diagnostic Interview, version 2.1. Best-subset regression analysis and receiver operating characteristic analysis were used to select a subset of items from the structured interview that most efficiently predicted PTSD as diagnosed in the full-length interview. Results: A seven-symptom screening scale for PTSD was selected; five of the symptoms were from the avoidance and numbing group, and two were from the hyperarousal group. A score of 4 or greater on this scale defined positive cases of PTSD with a sensitivity of 80%, specificity of 97%, positive predictive value of 71%, and negative predictive value of 98%. Conclusions: The short screening scale is an efficient method to screen for PTSD in epidemiologic and clinical studies, given limitations on resources and burden on respondents.

Objective: To test for a suspected adverse effect of low birth weight ([less than or equal to] 2500 g) on IQ at age 6 years in two socioeconomically disparate populations. Design: Nonconcurrent prospective study. Setting: An urban, predominantly disadvantaged population and a suburban middle-class population in southeastern Michigan. Participants: Low-birth-weight (N=473) and normal-birth-weight (N=350) subjects, randomly selected from the 1983 through the 1985 newborn lists of two major hospitals, one serving an urban and the other a suburban population. Main Outcome Measure: The Wechsler Intelligence Scale for Children-Revised to measure IQ. Results: The mean full-scale IQ of low-birth-weight children was 4.9 points lower than that of normal-birth-weight children, controlling for population site, maternal IQ, maternal education, and race (95% confidence interval [CI] 3.0 to 6.8). There was no evidence of low-birth-weight interaction with population site, and the same IQ difference was detected in both populations. In the urban population, low birth weight was associated with an increased risk for IQ below 85 (odds ratio, 2.2; 95% CI, 1.3 to 3.7). In the suburban population, low birth weight was associated with an increased risk for IQ below 100 (odds ratio, 2.0; 95% CI, 1.2 to 3.4). A gradient relationship with full-scale IQ was observed, with the largest deficit in those born weighing 1500 g or less, an intermediate deficit in those born weighing 1501 through 2000 g, and the least pronounced deficit in those born weighing 2001 through 2500 g. Conclusions: The overall effect of low birth weight represents an increase of approximately 10% of low-birth-weight children with an IQ of more than 1 SD below the population's mean. Children born weighing 2000 g or less bore the major burden of the IQ deficits. (Arch Pediatr Adolesc Med. 1994;148:377-383), Low birth weight (LBW) appears to reduce the IQ in a pattern related to how low the birth weight is. IQ was measured at age six in 473 children with birth weights less than or equal to 2500 g who were free of neurologic impairment. One group was born at a hospital serving suburban middle-class Detroit children and the other was born at a hospital serving Detroit inner-city children. To minimize the effect of confounding social variables, outcomes for each group were compared with that of 350 normal-birth-weight (over 2500 g) children born at the same hospitals. The average IQ was reduced by 4.9 points after controlling for site, maternal IQ, maternal education and race. The deficit was the same at both sites. This meant that 10% more LBW children had IQs below the threshold that defines clinical concern. When the group was stratified by birth weight, the largest deficit was among children weighing less than 1500 g, the next largest among children weighing 1501 through 2000 g, and the smallest among children weighing over 2000 g.

The objective of this study was to assess the utility of bioelectrical impedance analysis (BIA) in determining nutritional status in critically ill patients in the intensive care unit (ICU). Data were collected prospectively in 33 mechanically ventilated medical and surgical ICU patients requiring nutrition as part of their care. BIA, with subsequent calculation of body-composition indexes, was performed every other day for the duration of ICU stay. Body cell mass (BCM) changes correlated with energy and protein intakes ([r.sup.2] = 0.87, P < 0.001 and [r.sup.2] = 0.67, P < 0.001, respectively). Maintenance of BCM was achieved by a daily provision of 125.5 kJ . [kg.sup.-1] [.d.sup.-1] (30 kcal . [kg.sup.-1] [.d.sup.-1]) and 1.5 g protein/kg whereas greater intakes allowed restoration of BCM. The mean ratios of exchangeable sodium to potassium ([Na.sub.e]:[K.sub.e]) improved only in patients achieving positive nitrogen balance (P = 0.013). Body-composition changes determined by BIA represent a feasible adjunctive method for evaluating and monitoring nutritional status in ICU patients.

Objective: To learn whether cigarette smoking by persons other than parents significantly contributes to the passive environmental tobacco smoke (ETS) exposure of infants. Study Design: A cohort of infants prospectively followed up from birth to age 2 years with monthly questionnaires concerning smoking by different categories of adults coming into contact with the infants. Setting: Health maintenance organization members residing in several suburban communities of Detroit, Mich, defined by contiguous ZIP codes. Subjects: Ninety-seven (83%) of 117 healthy, full-term infants, thought to be at high risk of allergic disease based on cord blood IgE, who were born to eligible mothers and who completed 24 months of follow-up. Main Outcome Measures: Average of bimonthly urinary cotinine-creatinine ratios (CCRs) during the 2 years of the study. Results: There were significant correlations (r [is less than or equal to] 0.28, P [is less than or equal to] .005) between the frequency of smoking by all 7 categories of adults considered and the average CCRs of the infants. Multivariable analysis demonstrated that average urinary CCRs were significantly associated not only with smoking by the infant's parents, but also with smoking by workers at day care away from the home, persons visited away from the home, and persons other than parents residing in the home (overall [R.sup.2]=0.72, P=.001). Conclusions: Smoking by multiple individuals, other than the parents, significantly contributes to the ETS exposure of infants. These findings suggest that, at least for infants, efforts to reduce the adverse health effects of ETS exposure should extend beyond curtailing parental smoking. Arch Pediatr Adolesc Med. 2000;154:1237-1241

Background: Asthma morbidity and mortality are higher in the United States for African-American (AA) children when compared to European-American (EA) children. Study objectives: To explore racial differences in physiologic factors [...]

To the Editor: We read with interest the article in CHEST by Celed6n et al (January 2004) (1) on ethnicity and skin test reactivity to aeroallergens. The authors found that [...]