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Childhood obesity efforts have been characterized by low levels of caregiver involvement. This qualitative study explores caregiver perceptions about childhood obesity prevention. We conducted 12 in-depth interviews with caregivers of African American children aged 8-11 years. We used thematic analysis to identify consistent patterns of preventing childhood obesity and encouraging healthy behaviors. Four themes emerged including rural culture and the built environment, physical and social health effects of childhood obesity, measuring childhood obesity, and preventive strategies. Caregivers are cognizant of childhood obesity risk factors and discussed challenges in their rural environment when attempting to practice and maintain health behaviors for their children. They also stated that caregivers were vital in preventing childhood obesity. Our findings highlight the value of involving caregivers in the design and implementation of childhood obesity initiatives. Additionally, future childhood obesity efforts should equip caregivers and children with behavioral skills and resources to assist in developing healthy habits. Keywords Child health * African American youth * Qualitative research * Obesity * Caregivers * Rural health, Introduction The prevalence of childhood obesity in the United States (US) is well documented. Current data indicate that childhood obesity rates are stabilizing; however, obesity continues to be a public [...]

Importance Changes in kidney function are typically followed by the sequential estimation of glomerular filtration rate (eGFR). Formulae for eGFR work well on a population basis, but there are well-known conditions where they do not work. Objective The purpose of this review is to summarize the existing literature on special populations in the pediatric age range and provide recommendations on how to estimate GFR in these populations. Findings The reliability of creatinine depends on muscle mass, while cystatin C (not widely available) is limited by inflammation and changes in protein catabolism. Various dietary factors can alter eGFR. Renal function in neonates changes drastically every day, and there are currently no satisfactory reference intervals for routine pediatric use. Gender effects and conditions such as wasting disease and obesity require alternative ways to obtain eGFR. In oncology patients, chemotherapy may negatively affect renal function, and nuclear GFR measurements may be necessary. For body builders, high muscle mass may lead to underestimation of eGFR using creatinine. Conclusions and relevance Clinicians should be aware of special populations that may yield misleading eGFRs with conventional creatinine-based formulae, and that the alternative methods may be more appropriate for some populations., Author(s): Guido Filler [sup.1] [sup.2] [sup.3] [sup.4] , Misan Lee [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8884, grid.39381.30, Department of Pediatrics, Schulich School of Medicine & Dentistry, University of [...]

This review (Prospero Registration Number: CRD42017057915) aimed to systematically identify and summarize existing research on the relationship between additional emotional and behavioral problems (EBP) in children with autism, and parenting stress (PS) and mental health problems (MHP) in their parents. Sixty-seven studies met criteria for inclusion in the review, 61 of which were included in the meta-analysis. Pooled correlation coefficients were in the low to moderate range ( [Formula omitted]). Some evidence for moderation by measurement characteristics was found. Narrative review of concurrent adjusted associations showed some evidence for shared relationships with other factors, most notably ASD severity and parent perception of own parenting. Longitudinal studies showed mixed evidence for bidirectional predictive relationships between child EBP and parent psychological distress variables., Author(s): Isabel Yorke [sup.1] , Pippa White [sup.1] , Amelia Weston [sup.2] , Monica Rafla [sup.1] , Tony Charman [sup.1] , Emily Simonoff [sup.1] Author Affiliations: (Aff1) 0000 0001 2322 [...]

Existing research on childhood adversity and health risk across the lifespan lacks specificity regarding which types of exposures to assess and when. The purpose of this study was to contribute to an empirically-supported framework to guide practitioners interested in identifying youth who may be at greatest risk for a lifelong trajectory of health disparities. We also sought to identify the point in childhood at which screening for adversity exposure would capture the largest group of at risk individuals for triage to prevention and intervention services. Participants (n = 4036) collected as part of the Midlife in the United States study reported their medical status and history including physical (cardiovascular disease, hypertension, obesity, diabetes, cancer) and mental health (depression, substance use problems, sleep problems). Participants indicated whether they were exposed to 7 adversities at any point in childhood and their age of exposure to 19 additional lifetime adversities before the age of 18. Parent drug abuse, dropping out or failing out of school, being fired from a job, and sexual assault during childhood exhibited the largest effect sizes on health in adulthood, which were comparable to the effects of childhood maltreatment. Childhood adversity screening in early adolescence may identify the largest proportion of youth at risk for negative health trajectories. The results of this descriptive analysis provide an empirical framework to guide screening for childhood adversity in pediatric populations. We discuss the implications of these observations in the context of prevention science and practice., Author(s): Kate Ryan Kuhlman [sup.1] [sup.2] , Theodore F. Robles [sup.3] , Julienne E. Bower [sup.2] [sup.3] , Judith E. Carroll [sup.2] Author Affiliations: (Aff1) 0000 0001 0668 7243, grid.266093.8, [...]

Exergames may be one way to increase child physical activity, but long term adherence has seen little research attention. The primary objective of this study was to evaluate the usage of an exergame bike in comparison to a stationary bike in front of a TV across 3-months within a family home environment among children aged 10-14 years old. Seventy-three inactive children were recruited through advertisements and randomized to either the exergame condition (n = 39) or the standard bike condition (n = 34). Weekly bike use was recorded in a log-book. Both groups declined in bike use over time (t = 3.921, p < .01). Although the exergame group reported higher use (t = 2.0045, p < .05), this was most prominent during the first week. Overall, these results do not support exergames as a standalone physical activity intervention, and suggest that short duration examinations of exergames may be misleading., Author(s): Ryan E. Rhodes [sup.1] , Chris M. Blanchard [sup.2] , Shannon S. D. Bredin [sup.3] , Mark R. Beauchamp [sup.3] , Ralph Maddison [sup.4] , Darren E. R. Warburton [...]

Objectives Our research provides evidence on the intergenerational fetal programming effect by examining associations in the low birth weight (LBW, birth weight, Author(s): Mengcen Qian [sup.1] [sup.5] , Shin-Yi Chou [sup.2] , Lea Gimenez [sup.3] , Jin-Tan Liu [sup.4] Author Affiliations: (1) Department of Health Economics, Fudan University School of Public Health, [...]

Objectives U.S.-born Hispanic infants have a well-documented health advantage relative to other minority groups. However, little published research has examined racial heterogeneity within the Hispanic population, in relation to health outcomes. The current study aims to explore possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. Methods Data were drawn from 2007 to 2008 NCHS Cohort Linked Live Birth-Infant Death Files, restricted to deliveries of Hispanic black, Hispanic white, non-Hispanic black (NHB) and non-Hispanic white mothers (NHW) (n = 7,901,858). Adjusted odds ratios for first week mortality, neonatal, postneonatal, and overall infant mortality were calculated for each group, using NHW as the reference group. Results: A distinct health gradient was observed in which NHB infants (n = 1,250,222) had the highest risk of first week (aOR 2.29, CI 2.21-2.37), neonatal (aOR 2.23, CI 2.17-2.30), postneonatal (aOR 1.74, CI 1.68-1.81), and infant mortality (aOR 2.05, CI 2.00-2.10) compared to NHW infants (n = 4,578,150). Hispanic black infants (n = 84,377) also experienced higher risk of first-week (aOR 1.28 (1.12-1.47), neonatal (aOR .27, CI 1.13-1.44), postneonatal (aOR 1.34, CI 1.15-1.56), and infant mortality (aOR 1.30, CI 1.18-1.43) compared to both NHW and Hispanic white infants (n = 1,989,109). Conclusions for Practice: Risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes. Our findings suggest implications of racial heterogeneity on infant health outcomes, and provide insight into the role of race as a social construct., Author(s): Whitney S. Rice [sup.1] , Samantha S. Goldfarb [sup.2] , Anne E. Brisendine [sup.3] , Stevie Burrows [sup.4] , Martha S. Wingate [sup.5] Author Affiliations: (1) Department of Psychology, [...]

Several studies have reported declines in adaptive behavior amongst children with fragile X syndrome (FXS) starting in middle childhood. We examined the effects of maternal responsivity on adaptive behavior in 55 children with FXS visited 5-6 times in their homes from early through middle childhood. Our analyses indicated that sustained maternal responsivity had a significant positive impact on the trajectories of communication and to a lesser extent other adaptive behavior domains through middle childhood with many effects remaining significant after controlling for autism symptoms and developmental level. For children who showed declines in adaptive behavior during middle childhood, sustained high levels of maternal responsivity minimized the amount of decline observed in the communication, socialization, and daily living domains., Author(s): Steven F. Warren [sup.1] , Nancy Brady [sup.2] , Kandace K. Fleming [sup.3] , Laura J. Hahn [sup.3] [sup.4] Author Affiliations: (1) 0000 0001 2106 0692grid.266515.3Dole Human Development Center, [...]

This study evaluated the effectiveness of a family-centered feeding intervention, Easing Anxiety Together with Understanding and Perseverance (EAT-UP[TM]), for promoting food acceptance of children with autism spectrum disorder at home. A concurrent multiple-baseline design was used with systematic replication across three families. Baseline was followed by an 'Intervention-Coaching' phase and then an 'Intervention-Independent' phase. Using direct observation and pre- and post-intervention questionnaires, data on acceptance of less preferred foods and challenging mealtime behaviors were collected. Procedural fidelity was monitored throughout all study phases. Data were analyzed using visual analysis and measures of effect size. All children demonstrated increases in food acceptance (effect size >0.90) and dietary diversity and decreased challenging behaviors. Implications for practice and research are discussed., Author(s): Joanna Cosbey [sup.1] , Deirdre Muldoon [sup.2] [sup.3] Author Affiliations: (1) 0000 0001 2188 8502grid.266832.bDivision of Occupational Therapy, Department of Pediatrics, University of New Mexico, HSSB Room 140, MSC09 [...]

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well., Author(s): Arden Handler[sup.1] , Kay Johnson[sup.2] Author Affiliations: (1) Community Health Sciences, University of Illinois School of Public Health, 1603 W. Taylor, 60612, Chicago, ILUSA (2) Johnson Group Consulting, Inc., [...]

Objectives In order to reduce infant mortality in Indonesia, community case management (CCM) was introduced. CCM is a community-based service delivery model to improve children's wellness and longevity, involving the delivery of lifesaving, curative interventions to address common childhood illnesses, particularly where there are limited facility-based services. This paper reports the findings of a qualitative study that investigated the implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the perspective of mothers who received care. Methods Seven mothers and health workers were observed during a consultation and these mothers were interviewed in their home weeks after delivery. Field notes and the interview transcriptions were analysed thematically. Findings Mothers reported that their access to care had improved, along with an increase in their knowledge of infant danger signs and when to seek care. Family compliance with care plans was also found to have improved. Mothers expressed satisfaction with the care provided under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in each village, preferably someone from that village. However two mothers did not wish their children to receive health interventions as they did not believe these to be culturally appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of care in terms of increasing access to health care and the uptake of lifesaving interventions for sick children. However there is a need to modify the program to demonstrate cultural sensitivity and meet cultural needs of the target population. While CCM is a potentially effective model of care, further integrative strategies are required to embed this model into maternal and child health service delivery., Author(s): Agus Setiawan[sup.1] , Denise Dignam[sup.2] , Cheryl Waters[sup.2] , Angela Dawson[sup.2] Author Affiliations: (1) Faculty of Nursing, Universitas Indonesia, JakartaIndonesia (2) Faculty of Health, University of Technology, SydneyAustralia Significance [...]

Background Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. Methods and findings The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning Conclusions This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group., Author(s): Kirsten Ann Donald 1,2,*, Catherine J. Wedderburn 1,2,3, Whitney Barnett 1,4, Raymond T. Nhapi 1, Andrea M. Rehman 5, Jacob A. M. Stadler 1, Nadia Hoffman 6, Nastassja Koen [...]

BACKGROUND/OBJECTIVES: Studies in adults indicate that dietary polyunsaturated fatty acid (PUFA) composition may play a role in development of adiposity. Because adipocyte quantity is established between late childhood and early adolescence, understanding the impact of PUFAs on weight gain during the school-age years is crucial to developing effective interventions. SUBJECTS/METHODS: We quantified N-3 and N-6 PUFAs in serum samples of 668 Colombian schoolchildren aged 5-12 years at the time of recruitment into a cohort study, using gas-liquid chromatography. Serum concentrations of N-3 (alpha- linolenic acid (ALA), eicosapentaenoic acid, docosahexaenoic acid) and N-6 PUFAs (linoleic acid, gamma-linolenic acid, dihomo-gamma-linolenic acid, arachidonic acid) were determined as percentage total fatty acids. Children's anthropometry was measured annually for a median of 30 months. We used mixed-effects models with restricted cubic splines to construct population body mass index-for-age z-score (BAZ) growth curves for age- and sex-specific quartiles of each PUFA. RESULTS: N-3 ALA was inversely related to BAZ gain after adjustment for sex, baseline age and weight status, as well as household socioeconomic level. Estimated BAZ change between 6 and 14 years among children in the highest quartile of ALA compared with those in the lowest quartile was 0.45 (95% confidence interval: 0.07, 0.83) lower (P-trend = 0.006). CONCLUSIONS: N-3 ALA may be protective against weight gain in school-age children. Whether improvement in PUFA status reduces adiposity in pediatric populations deserves evaluation in randomized trials. European Journal of Clinical Nutrition (2015) 69, 167-172; doi:10.1038/ejcn.2014.210; published online 1 October 2014, INTRODUCTION Childhood obesity poses one of the most serious public health challenges. Many countries, including those in Latin America, (1) have experienced a marked rise in pediatric overweight and obesity [...]

BACKGROUND/OBJECTIVE: The aim of this study was to assess the validity of body fatness estimations based on skinfolds and bioelectrical ilmpedance analyses (BIA) measurements compared to a three-component model (3C model) in prepubertal Chilean children, considering potential differences by sex and nutritional status. SUBJECTS/METHODS: Four hundred and twenty four Chilean children (198 females and 226 males) were assessed for body composition. Body fat percentage (BF%) was evaluated by Skinfold equations (Slaughter, Ramirez and Huang) and Bioelectrical impedance (BIA: Tanita BC-418MA) using both the equipment and the Ramirez equation. Measurements based on a 3C model constructed from total body water estimates by isotope dilution and from body volume estimates by air displacement plethysmography were used as gold standard. RESULTS: Coefficient of determination (R2) values were higher in overweight and in the whole group of both gender. All slopes were differed significantly from 1, and most intercepts were significantly different from 0. Skinfold Equations: an underestimation of BF% was found for all equations, being higher with the Slaughter equation. BIA: Tanita underestimated BF% in all groups, whereas Ramirez equation shows an overestimation. CONCLUSIONS: Skinfolds and bio-impedance equations serve well to rank children according to their BF%. However, these methods are not accurate for describing body composition in prepubertal Chilean children. European Journal of Clinical Nutrition (2015) 69, 269-273;doi: 10.1038/ejcn.2014.144;published online 6 August 2014, INTRODUCTION Body mass index (BMI) has been a valuable tool in monitoring trends in obesity as it is simple to measure; however, it does not distinguish between increments of fat [...]

OBJECTIVES: Body checking is a significant risk factor for injury, including concussion, in youth ice hockey. Recent evidence regarding injury rates in youth leagues prompted USA Hockey to institute a national policy change in 2011 that increased the age of body checking introduction from 11-12 years old (Pee Wee) to 13-14 years old (Bantam). Body checking policy was more controversial in Canada, and research evidence alone was insufficient to drive change. The purpose of this paper is to provide an example of one of the knowledge exchange processes that occurred between researchers and community stakeholders, leading up to a national policy change in 2013. PARTICIPANTS: There were 28 stakeholder attendees, representing the research community, youth hockey organizations, and child health advocacy groups. SETTING: A one-day meeting held in Whistler, British Columbia, in April 2013. INTERVENTION: Researchers and stakeholders presented current perspectives on evidence and policy change, and discussion focused on an a priori set of questions designed to elicit facilitators and barriers to policy change. OUTCOMES: Three major factors that can drive policy change in the sport safety context were identified: the need for decision-making leadership, the importance of knowledge translation, and the role of sport culture as a barrier to change. CONCLUSION: There is a critical need for researcher and stakeholder partnership in facilitating ongoing policy discussion and informing evidence-based policy change in sport and recreation injury prevention. KEY WORDS: Policy; injury; ice hockey; knowledge translation OBJECTIFS: Les mises en echec sont un important facteur de risque de traumatismes, y compris de commotions, chez les jeunes joueurs de hockey sur glace. Des donnees recentes sur les taux de traumatismes dans les ligues pour les jeunes ont pousse USA Hockey a instituer en 2011 un changement de politique national qui a releve l'age d'introduction des mises en echec de la categorie des 11-12 ans (peewee) a celle des 13-14 ans (bantam). La politique sur les mises en echec prete davantage a la controverse au Canada, oU les donnees de recherche n'ont pas suffi a elles seules a faire changer les choses. Dans cet article, nous presentons l'exemple d'un processus d'echange de connaissances entre des chercheurs et des acteurs communautaires qui a mene a un changement de politique national en 2013. PARTICIPANTS: Les 28 participants representaient le monde de la recherche, les organismes de hockey pour les jeunes et les groupes de defense de la sante des enfants. LIEU: La reunion d'une journee s'est tenue a Whistler (ColombieBritannique) en avril 2013. INTERVENTION: Des chercheurs et des acteurs du milieu ont presente les perspectives actuelles sur les donnees probantes et les changements de politique; la discussion a porte sur un ensemble de questions preparatoires concues pour deceler les elements qui facilitent ou qui entravent les changements de politique. EFFETS: On a cerne trois grands facteurs pouvant amener des changements dans les politiques de securite dans les sports : le besoin de leadership dans la prise de decisions, l'importance de l'application des connaissances et le role de la culture sportive en tant qu'obstacle au changement. CONCLUSION: Il y a un besoin pressant d'un partenariat entre les chercheurs et les acteurs du milieu pour faciliter un debat de fond et eclairer les changements de politique fondes sur les preuves afin de prevenir les traumatismes dans les sports et les loisirs. MOTS CLES: politique; traumatisme; hockey sur glace; application des connaissances, Body checking is the most consistent risk factor for injury, severe injury, and concussion in youth hockey. (1-3) Hockey Canada defines body checking as a tactic used to gain an [...]

Background The World Health Organization's integrated community case management (iCCM) guidelines recommend that all children presenting with uncomplicated fever and no danger signs return for follow-up on day 3 following the initial consultation on day 1. Such fevers often resolve rapidly, however, and previous studies suggest that expectant home care for uncomplicated fever can be safely recommended. We aimed to determine if a conditional follow-up visit was non-inferior to a universal follow-up visit for these children. Methods and findings We conducted a cluster-randomized, community-based non-inferiority trial among children 2-59 months old presenting to community health workers (CHWs) with non-severe unclassified fever in Tanganyika Province, Democratic Republic of the Congo. Clusters (n = 28) of CHWs were randomized to advise caregivers to either (1) return for a follow-up visit on day 3 following the initial consultation on day 1, regardless of illness resolution (as per current WHO guidelines; universal follow-up group) or (2) return for a follow-up visit on day 3 only if illness continued (conditional follow-up group). Children in both arms were assessed again at day 8, and classified as a clinical failure if fever (caregiver-reported), malaria, diarrhea, pneumonia, or decline of health status (development of danger signs, hospitalization, or death) was noted (failure definition 1). Alternative failure definitions were examined, whereby caregiver-reported fever was first restricted to caregiver-reported fever of at least 3 days (failure definition 2) and then replaced with fever measured via axillary temperature (failure definition 3). Study participants, providers, and investigators were not masked. Among 4,434 enrolled children, 4,141 (93.4%) met the per-protocol definition of receipt of the arm-specific advice from the CHW and a timely day 8 assessment (universal follow-up group: 2,210; conditional follow-up group: 1,931). Failure was similar (difference: -0.7%) in the conditional follow-up group (n = 188, 9.7%) compared to the universal follow-up group (n = 230, 10.4%); however, the upper bound of a 1-sided 95% confidence interval around this difference (-[infinity], 5.1%) exceeded the prespecified non-inferiority margin of 4.0% (non-inferiority p = 0.089). When caregiver-reported fever was restricted to fevers lasting [greater than or equal to]3 days, failure in the conditional follow-up group (n = 159, 8.2%) was similar to that in the universal follow-up group (n = 200, 9.1%) (difference: -0.8%; 95% CI: -[infinity], 4.1%; p = 0.053). If caregiver-reported fever was replaced by axillary temperature measurement in the definition of failure, failure in the conditional follow-up group (n = 113, 5.9%) was non-inferior to that in the universal follow-up group (n = 160, 7.2%) (difference: -1.4%; 95% CI: -[infinity], 2.5%; p = 0.012). In post hoc analysis, when the definition of failure was limited to malaria, diarrhea, pneumonia, development of danger signs, hospitalization, or death, failure in the conditional follow-up group (n = 108, 5.6%) was similar to that in the universal follow-up group (n = 147, 6.7%), and within the non-inferiority margin (95% CI: -[infinity], 2.9%; p = 0.017). Limitations include initial underestimation of the proportion of clinical failures as well as substantial variance in cluster-specific failure rates, reducing the precision of our estimates. In addition, heightened security concerns slowed recruitment in the final months of the study. Conclusions We found that advising caregivers to return only if children worsened or remained ill on day 3 resulted in similar rates of caregiver-reported fever and other clinical outcomes on day 8, compared to advising all caregivers to return on day 3. Policy-makers could consider revising guidelines for management of uncomplicated fever within the iCCM framework. Trial registration ClinicalTrials.gov NCT02595827, Author(s): Luke C. Mullany 1,*, Elburg W. van Boetzelaer 2, Julie R. Gutman 3, Laura C. Steinhardt 3, Pascal Ngoy 2, Yolanda Barbera Lainez 4, Alison Wittcoff 2, Steven A. [...]

Byline: Ajoy. Shetty, Siddharth. Aiyer Pediatric thoracolumbar spine fractures are rare injuries and there is a dearth of literature pertaining to pediatric thoracolumbar injuries (T10-L2) in the Indian scenario. Spine [...]

BACKGROUND: Arsenic (As) exposure from drinking water is associated with modest intellectual deficits in childhood. It is not known whether reducing exposure is associated with improved intelligence. OBJECTIVE: We aimed to determine whether reducing As exposure is associated with improved child intellectual outcomes. METHODS: Three hundred three 10-year-old children drinking from household wells with a wide range of As concentrations were enrolled at baseline. In the subsequent year, deep community wells, low in As, were installed in villages of children whose original wells had high water As ([greater than or equal to] 50 [micro]g/L). For 296 children, intelligence was assessed by WISC-IV (Wechsler Intelligence Scale for Children, 4th ed.), with a version modified for the study population, at baseline and approximately 2 years later; analyses considered standardized scores for both Full Scale IQ and Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed Indices. Creatinine-adjusted urinary arsenic (UAs/Cr), blood As (BAs), and blood manganese (BMn) were assessed at both times. RESULTS: UAs/Cr concentrations declined significantly by follow-up for both the high ([greater than or equal to] 50 [micro]g/L) and low (< 50 [micro]g/L) WAs subgroups. At baseline, adjusting for maternal age and intelligence, plasma ferritin, head circumference, home environment quality, school grade, and BMn, UAs/Cr was significantly negatively associated with Full Scale IQ, and with all Index scores (except Processing Speed). After adjustment for baseline Working Memory scores and school grade, each 100-[micro]g/g reduction in UAs/Cr from baseline to follow-up was associated with a 0.91 point increase in Working Memory (95% CI: 0.14, 1.67). The change in UAs/Cr across follow-up was not significantly associated with changes in Full Scale IQ or Index scores. CONCLUSIONS: Installation of deep, low-As community wells lowered UAs, BAs, and BMn. A greater decrease in UAs/Cr was associated with greater improvements in Working Memory scores, but not with a greater improvement in Full Scale IQ. http://dx.doi.org/10.1289/ehp.1509974, Introduction Exposure to naturally occurring arsenic (As) in drinking water is a global environmental health problem. The World Health Organization (WHO) estimates that > 200 million people worldwide are chronically [...]

Background Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly. Methods and Findings We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and to assumptions about contact patterns between age groups. Conclusions Vaccinating school-aged children with LAIV is likely to be cost-effective in Thailand in the short term, though the long-term consequences of such a policy cannot be reliably predicted given current knowledge of influenza epidemiology and immunology. Our work provides a coherent framework that can be used for similar analyses in other low- and middle-income countries., Introduction Vaccination against influenza has the potential to substantially reduce mortality and morbidity both through direct protection (reduced risk of infection in those receiving the vaccine) and through indirect protection [...]