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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2008.07.037 Byline: Erik M. Angles (a), Thomas N. Robinson (a), Walter L. Biffl (a)(b), Jeff Johnson (a)(b), Marc Moss (c), Zung V. Tran (d), Ernest E. Moore (a)(b) Keywords: Delirium; Trauma; Postinjury; Geriatric Abstract: This study aimed to describe the natural history of delirium after major injury, to identify risk factors that predict the development of postinjury delirium, and to compare outcome measures in subjects with and without delirium. Author Affiliation: (a) Department of Surgery, University of Colorado at Denver, Health Sciences Center, 12631 East 17th Ave., Mail Stop C313, PO Box 6511, Aurora, CO, USA (b) Department of Surgery, Denver Health Medical Center, Denver, CO, USA (c) Department of Medicine, University of Colorado at Denver, Health Sciences Center, Aurora, CO, USA (d) Department of Biometrics, University of Colorado at Denver, Health Sciences Center, Aurora, CO, USA Article History: Received 2 May 2008; Revised 8 July 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2008.07.007 Byline: Thomas N. Robinson (a)(c), Christopher D. Raeburn (a)(c), Erik M. Angles (a)(c), Marc Moss (b) Keywords: Tryptophan; Delirium; Surgery; Postoperative; Geriatric Abstract: Postoperative delirium is a common complication in geriatric patients. Tryptophan is an amino acid precursor to the mood-stabilizing neurotransmitters serotonin and melatonin. We hypothesized that tryptophan levels are lower in elderly subjects who develop postoperative delirium. Author Affiliation: (a) Department of Surgery, University of Colorado at Denver, Health Sciences Center, 12631 East 17th Ave., Mail Stop C313, PO Box 6511, Aurora, CO 80045, USA (b) Department of Medicine, University of Colorado at Denver, Health Sciences Center, Aurora, CO, USA (c) Department of Surgery Denver Veterans Affairs Medical Center, Denver, CO, USA Article History: Received 18 May 2008; Revised 10 July 2008

Accreditation This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of [...]

Background: Television viewing is associated with childhood obesity. Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children's weight. Objectives: Our objectives were to describe the amounts and types of foods that children consume while watching television, compare those types with the types consumed at other times of the day, and examine the associations between children's body mass index (BMI) and the amounts and types of foods consumed during television viewing. Design: Data were collected from 2 samples. The first sample consisted of ethnically diverse third-grade children, and the second consisted predominantly of Latino fifth-grade children. Three nonconsecutive 24-h dietary recalls were collected from each child. For each eating episode reported, children were asked whether they had been watching television. Height and weight were measured by using standard methods and were used to calculate BMI. Results: On weekdays and weekend days, 17-18% and [approximately to]26% of total daily energy, respectively, were consumed during television viewing in the 2 samples. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off, less soda, fast food, fruit, and vegetables were consumed with the television on. The amount of food consumed during television viewing was not associated with children's BMI, but in the third-grade sample, the fat content of foods consumed during television viewing was associated with BMI. Conclusions: A significant proportion of children's daily energy intake is consumed during television viewing, and the consumption of high-fat foods on weekends may be associated with BMI in younger children. KEY WORDS Childhood obesity, dietary intake, television viewing, dietary recalls, multiethnic population, children

Objectives: To assess nicotine dependence among adolescents to determine whether quitting smoking is associated with the emergence of nicotine withdrawal symptoms and craving, and to identify the factors associated with these symptoms. Design: Cross-sectional survey. Participants: We studied 2197 10th-grade students in 6 San Jose, Calif, high schools. Main Outcome Measures: Smoking status; history of quitting smoking; Modified Fagerstrom Tolerance Questionnaire (mFTQ) scores; subjective nicotine withdrawal symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Center for Epidemiologic Studies Depression Scale (CES-D); and saliva cotinine levels. Results: Of the 485 participants who reported having smoked during the past 30 days, 249 reported previous attempts to quit smoking. Among the participants who had attempted to quit, the self-reported frequencies of subjective withdrawal symptoms were a strong need to smoke (45.4%), nervous and tense (31.8%), restless (29.4%), irritable (28.7%), hungry (25.3%), unable to concentrate (21.7%), miserable and sad (15.3%), and trouble sleeping (12.8%). The total number of withdrawal symptoms was correlated with the mFTQ score (Spearman r= 0.51; P [is less than] .001). In a stepwise linear regression analysis, the mFTQ score and the CES-D score accounted for approximately 35% of the variance in total number of withdrawal symptoms ([R.sup.2]=0.35; P [is less than] .001). Males smoked significantly more and had significantly higher mFTQ scores than did females, while female smokers had significantly higher CES-D scores than did their male counterparts. Conclusions: Considerable levels of nicotine dependence were present among adolescent smokers. Use of mFTQ scores; withdrawal symptoms including nicotine craving; CES-D scores; and saliva cotinine levels may be helpful in designing cessation programs targeted to nicotine-dependent adolescents. Arch Pediatr Adolesc Med. 1998;152:151-156, Nicotine withdrawal symptoms may prevent many teenage smokers from successfully quitting. Researchers surveyed 249 tenth-grade smokers who had previously attempted to quit smoking, and found that strong cigarette cravings, nervousness, irritability, difficulty concentrating, and other withdrawal symptoms were common. The scores obtained from the Modified Fagerstrom Tolerance Questionnaire (mFTQ), which measures the level of nicotine dependence, were closely associated with the number of symptoms the smokers experienced.

Objective: To examine the association between adolescents, knowledge of cigarette warning labels and actual smoking behavior. Design: Cohort analytic study. Setting: Four public high schools in northern California. Subjects: Seventeen hundred forty@seven ninth graders (mean age, 14.9 years). Students from 2, of the schools (n=803) were observed for approximately 3 months. Main Outcome Measures: Self-reported knowledge of warning labels was assessed at baseline. Self-reports of smoking behavior were completed at baseline and at follow-up. Results: Greater knowledge of cigarette package warning labels was significantly associated with higher levels of smoking. Knowledge of warning labels on magazine and billboard advertisements did not differ significantly by level of smoking. In the longitudinal sample, greater knowledge of cigarette package warning labels was significantly associated with a subsequent increase in smoking, controlling for the baseline level of smoking, sex, ethnicity, and knowledge of warning labels on cigarette advertisements Codds ratio (OR, 1.06; 95% confidence interval [CI], 1.02-1.46). Knowledge of warning labels on cigarette advertisements was not associated with a significant change in smoking behavior (OR, 1.06; 95% CI, 0.82-1.35). Conclusions: Sizable proportions of adolescent smokers are not seeing, reading, or remembering cigarette warning labels. In addition, knowledge of warning labels on cigarette packages and advertisements is not associated with reduced smoking. The current warning labels are ineffective among adolescents. Arch Pediatr Adolesc Med. 1997;151:267-272, Cigarette warning labels may not reduce smoking among teenagers. A group of 1,750 ninth graders responded to a questionnaire about smoking habits and knowledge of cigarette warning labels, and 803 were retested three months later. Smoking was associated with greater knowledge of warning labels, but 15% of regular smokers reported never having read a warning label. Knowledge of warning labels was not associated with less smoking. In the group retested after three months increased knowledge was associated with an increase in smoking.

Objective: To evaluate the effects of health supervision structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care. Design: Randomized, controlled trial. Setting: Pediatric house staff continuity clinic in a university-based children's hospital. Participants: 53 pediatric house officers and 153 parents. Interventions: House staff were randomized to use structured encounter forms focused on developmental milestones (group 1) or anticipatory guidance/preventive care (group 2) during health supervision visits. Outcome Measures: Changes in house staff knowledge were assessed with pretests and posttests. Parent satisfaction was assessed with surveys. Quality of care, defined as compliance with recommended guidelines for age-specific health supervision, was assessed by audiotaping visits. Results: Group 1 demonstrated greater but not significantly different improvement in knowledge of developmental milestones than group 2, while group 2 improved more than group 1 in knowledge of anticipatory guidance/ preventive care. Parent satisfaction with developmental screening was significantly greater for group 1 visits than for group 2 visits (P, Structured encounter forms may enhance pediatric resident learning, improve quality of care, and increase parent satisfaction. Researchers randomly assigned 53 pediatric residents working in an outpatient clinic to use either a form regarding developmental milestones or one regarding anticipatory guidance/preventative care during well-child visits. Posttests, surveys of parent satisfaction, and audiotapes of encounters revealed that, compared with the other group, the group using the developmental milestones encounter form demonstrated greater knowledge of developmental milestones and adhered more closely to standards for developmental screening and parents rated their satisfaction higher.

Objective: To test the hypothesis that the patterns of pubertal progression, early vs late puberty and fast vs slow, are associated with the age at which girls start to drink alcohol and smoke cigarettes. Design: The study included 1463 female students, 10. 7 to 18.2 years of age, who were assessed five times during the 2.7-year study. Data regarding pubertal stage, alcohol use, and cigarette use were obtained at each assessment. These data were used to calculate two indexes of pubertal development, the age at which the midpoint of puberty was achieved and the rate of progression through puberty, and the ages when each subject first drank, first drank moderate amounts of alcohol, and first smoked. Results: Girls with earlier puberty (midpoint, Drinking alcohol and smoking cigarettes at an early age may be linked to early puberty. A group of 1463 girls aged 10.7 to 18.2 were followed for 2.7 years. They were periodically asked to self-evaluate alcohol intake and cigarette smoking and to match their state of pubic hair and breast development to a set of drawings. Girls with an earlier puberty midpoint reported first drinking alcohol 0.7 years younger than girls with later puberty. Girls with earlier puberty reported moderate alcohol intake at an age 0.9 years younger than girls with later puberty. Similarly, cigarette smoking was reported 0.6 years younger in girls with early puberty. Girls who drank moderate amounts of alcohol at a younger age progressed faster through puberty. Possibly, more mature girls tend to associate with older adolescents, adapting their behavior, or early puberty may increase psychological stress and lead to unhealthy behaviors.

Your child may feel self-conscious about his or her appearance. She may be teased by classmates, which can lower the youngster's self-esteem. Being overweight can also have serious physical consequences. [...]

Encourage your child to be physically active * Allow your child to spend no more than 2 hours a day watching TV, playing video games, or surfing the Internet. * [...]

Background: We hypothesized that children's perceptions of more neighborhood hazards would be associated with less physical activity, less aerobic fitness, and a higher body mass index. Objective: To examine the association between a hazardous neighborhood context and physical activity in children. Methods: Fourth-grade students (n = 796) of diverse ethnic and economic backgrounds completed measures of neighborhood hazards, self-reported physical activity, physical fitness, height, and weight. Parents (n = 518) completed telephone interviews and provided data on their education level and occupation. Results: As expected, children from families of lower socioeconomic status perceived significantly more neighborhood hazards. Contrary to our hypothesis, the perception of more hazards was significantly associated with more reported physical activity. This finding was not explained by school heterogeneity, alteration of the hazards measure, or differences in socioeconomic status. Conclusion: To further examine the relationship between neighborhood hazards and physical activity, we suggest that future studies include assessments of sedentary behavior, parental fear of violence, parental regulation of children's leisure activities, and cost and quality of available play areas and organized sports. Arch Pediatr Adolesc Med. 2001;155:1143-1148

Context: The relationship between exposure to aggression in the media and children's aggressive behavior is well documented. However, few potential solutions have been evaluated. Objective: To assess the effects of reducing television, videotape, and video game use on aggressive behavior and perceptions of a mean and scary world. Design: Randomized, controlled, school-based trial. Setting: Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif. Participants: Third- and fourth-grade students (mean age, 8.9 years) and their parents or guardians. Intervention: Children in one elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. Main Outcome Measures: In September (preintervention) and April (postintervention) of a single school year, children rated their peers' aggressive behavior and reported their perceptions of the world as a mean and scary place. A 60% random sample of children were observed for physical and verbal aggression on the playground. Parents were interviewed by telephone and reported aggressive and delinquent behaviors on the child behavior checklist. The primary outcome measure was peer ratings of aggressive behavior. Results: Compared with controls, children in the intervention group had statistically significant decreases in peer ratings of aggression (adjusted mean difference, -2.4%; 95% confidence interval [CI], -4.6 to -0.2; P = .03) and observed verbal aggression (adjusted mean difference, -0.10 act per minute per child; 95% CI, -0.18 to -0.03; P = .01). Differences in observed physical aggression, parent reports of aggressive behavior, and perceptions of a mean and scary world were not statistically significant but favored the intervention group. Conclusions: An intervention to reduce television, videotape, and video game use decreases aggressive behavior in elementary schoolchildren. These findings support the causal influences of these media on aggression and the potential benefits of reducing children's media use. Arch Pediatr Adolesc Med. 2001;155:17-23

Perspectives and approaches for primary care Most people do not need statistics to notice the fattening of our population, especially our children. In the United States across all ethnic groups [...]

Background: It is commonly believed that overweight children are unhappy with their weight. However, population-based data addressing this association are lacking. Objectives: To evaluate the association between obesity and depressive symptoms in a diverse, school-based sample of preadolescent children, and to examine whether overweight concerns play a role in this association. Design, Setting, and Participants: Third-grade students (N = 868, mean age, 8.4 years) attending 13 public elementary schools in Northern California were measured for weight and height, and were asked to complete self-report assessments of depressive symptoms and overweight concerns. Results: A modest association between depressive symptoms and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) was found for girls (r =0.14, P [is less than] .01), but not for boys (r=0.01, P [is less than] . 78). Among girls, depressive symptoms were strongly associated with overweight concerns (r= 0.32, P [is less than] .001). After controlling for level of overweight concerns, BMI was no longer significantly associated with depressive symptoms among girls. In contrast, after controlling for BMI, overweight concerns remained significantly associated with depressive symptoms. Conclusions: This study provides cross-sectional evidence for a relationship between depressive symptoms and BMI in preadolescent girls, but not in preadolescent boys. This relationship seems to be explained by an excess of overweight concerns. Assessing overweight concerns may be a useful method to identify those overweight girls who are at highest risk for associated depressive symptoms. Arch Pediatr Adolesc Med. 2000;154:931-935