247 results on '"Ian M. Paul"'
Search Results
2. Differing prevalence of microcephaly and macrocephaly in male and female fetuses
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Amalia M. Brawley, Eric W. Schaefer, Elizabeth Lucarelli, Serdar H. Ural, Cynthia H. Chuang, Wenke Hwang, Ian M. Paul, and Carrie Daymont
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microcephaly ,macrocephaly ,ultrasound ,biometry ,growth ,Gynecology and obstetrics ,RG1-991 ,Women. Feminism ,HQ1101-2030.7 - Abstract
ObjectiveTo compare the proportion of female and male fetuses classified as microcephalic (head circumference [HC] 97th percentile) by commonly used sex-neutral growth curves.MethodsFor fetuses evaluated at a single center, we retrospectively determined the percentile of the first fetal HC measurement between 16 and 0/7 and 21–6/7 weeks using the Hadlock, Intergrowth-21st, and NICHD growth curves. The association between sex and the likelihood of being classified as microcephalic or macrocephalic was evaluated with logistic regression.ResultsFemale fetuses (n = 3,006) were more likely than male fetuses (n = 3,186) to be classified as microcephalic using the Hadlock (0.4% male, 1.4% female; odds ratio female vs. male 3.7, 95% CI [1.9, 7.0], p
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- 2023
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3. Improving infant sleep safety via electronic health record communication: a randomized controlled trial
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Ethan A. Canty, Benjamin N. Fogel, Erich K. Batra, Eric W. Schaefer, Jessica S. Beiler, and Ian M. Paul
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SIDS ,SUID ,HER ,Electronic health record ,Patient portals ,Photograph ,Pediatrics ,RJ1-570 - Abstract
Abstract Background With increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines. Methods One hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months. Results One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface. Conclusions Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices. Trial registration Name: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048 ; Date of Registration: September 7, 2018; Data Sharing Statement: None
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- 2020
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4. Validation and human factor analysis study of an infant weight estimation device
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Susan M. Abdel-Rahman, Ian M. Paul, Paula Delmore, Jia-Yuh Chen, Mary Mills, Rachel G. Greenberg, and on behalf of the Best Pharmaceuticals for Children Act – Pediatric Trials Network
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Chest circumference ,Head circumference ,Preterm ,Full-term ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Weight is critical for the medical management of infants; however, scales can be unavailable or inaccessible in some practice settings. We recently developed and validated a robust infant weight estimation method based on chest circumference (CC) and head circumference (HC). This study was designed to determine the human factors (HF) experience with, and predictive performance of, an infant weight estimation device that implements this method. Methods Prospective, multi-center, observational, masked study of 486 preterm and term infants (0–90 days) assessed by 15 raters. Raters measured the infant using calibrated scales/measures and masked versions of the device. Raters also evaluated critical tasks associated with device use. Mean error (ME) and mean percentage error (MPE) were used to assess predictive performance. Result Among 486 infants enrolled (36.8 ± 4.0 weeks gestational age, 31.5 ± 28.6 days postnatal age), predicted weight correlated highly with actual weight (r = 0.97, ME: − 69 ± 257 g, MPE: − 1.3 ± 6.9%). Predicted weight was within 10 and 15% of actual weight in 86 and 99%, of infants. HF errors were low, 0.1–0.8% depending on task. In all cases raters were confident or very confident in their measurements. Conclusion The device was statistically equivalent to the method on which it was based and approximated weight with acceptable variance from the true weight. HF data suggest the device is easy to use. This device can be used to estimate weight in infants when calibrated scales are impractical or unavailable.
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- 2020
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5. Ecological momentary assessment of using food to soothe during infancy in the INSIGHT trial
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Elizabeth L. Adams, Michele E. Marini, Timothy R. Brick, Ian M. Paul, Leann L. Birch, and Jennifer S. Savage
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Obesity prevention ,Responsive parenting ,Infant cry ,Infant fuss ,Infant feed ,Soothing strategies ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Use of food to soothe infant distress has been linked to greater weight in observational studies. We used ecological momentary assessment to capture detailed patterns of food to soothe and evaluate if a responsive parenting intervention reduced parents’ use of food to soothe. Methods Primiparous mother-newborn dyads were randomized to a responsive parenting intervention designed for obesity prevention or a safety control group. Responsive parenting curriculum included guidance on using alternative soothing strategies (e.g., swaddling), rather than feeding, as the first response to infant fussiness. After the initial intervention visit 3 weeks after delivery, mothers (n = 157) were surveyed for two 5–8 day bursts at infant ages 3 and 8 weeks. Surveys were sent via text message every 4 h between 10:00 AM-10:00 PM, with 2 surveys sent at 8:00 AM asking about nighttime hours. Infant fusses and feeds were reported for each 4-h interval. Food to soothe was defined as “Fed First” and “Not Fed First” in response to a fussy event. Use of food to soothe was modeled using random-intercept logistic regression. Results The control group had greater odds of having Fed First, compared to the responsive parenting group at ages 3 and 8 weeks (3 weeks: OR = 1.9; 95% CI = 1.4–2.7; p
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- 2019
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6. Evaluation of the quality and value of data sources for postmarket surveillance of the safety of cough and cold medications in children
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Jody L. Green, Kate M. Reynolds, William Banner, G. Randall Bond, Ralph E. Kauffman, Robert B. Palmer, Ian M. Paul, and Richard C. Dart
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Adverse drug reaction reporting systems ,Cold and flu medications ,Data quality ,Drug safety ,Nonprescription drugs ,Postmarket drug surveillance ,Medicine (General) ,R5-920 - Abstract
Abstract Background The purpose of this report is to evaluate the quality of data sources used to study cough and cold medication (CCM) safety in children via the Pediatric Cough and Cold Safety Surveillance System. Methods The System utilized the National Poison Data System (NPDS), FDA Adverse Event Reporting System (FAERS), English-language medical literature, manufacturer postmarket safety databases, and news/media reports to identify cases from January 2008 through September 2016. Each data source was evaluated by the proportion of detected cases determined to be eligible (met case criteria) and the proportion determined to be evaluable (able to determine causal relationship between adverse event and exposure). Results A total of 7184 unique cases were identified from 27,597 detected reports. Of these, 6447 (89.7%) were evaluable. The data source with the highest volume of detected cases was news/media; however, only 0.3% of those cases were eligible for panel review and only 0.2% (24 out of 13,450 cases) were evaluable. The data source with the highest proportion of eligible and evaluable cases was NPDS with 7691 detected cases, 6113 (79.5%) eligible cases, and 5587 (72.6%) evaluable cases. Conclusions The data sources utilized to evaluate the safety profile of pediatric CCMs yielded variable detection and evaluation rates, but overall provided a comprehensive look at exposures that otherwise cannot be studied in clinical trials. While this study suggests that each source made a valuable contribution and that evaluable cases are generalizable, improvements are needed in case completeness and accuracy to enhance the quality of postmarket safety evaluations.
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- 2018
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7. Growth during the first year in infants affected by neonatal abstinence syndrome
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Tammy E. Corr, Eric W. Schaefer, and Ian M. Paul
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Neonatal abstinence syndrome ,Neonatal opioid withdrawal syndrome ,Infant growth ,Infant nutrition ,Pediatric obesity ,Behavioral feeding ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Infants with neonatal abstinence syndrome (NAS) initially experience neurologic excitability, poor feeding, and/or hyperphagia in the setting of increased metabolic demand. Because the longitudinal effects of these early symptoms and behaviors on weight trends are unknown, we sought to contrast weight gain patterns through age 1 year for infants diagnosed with NAS with matched controls. Methods Retrospective cohort of 70 singletons with a gestational age of ≥37 weeks and an ICD-9 or ICD-10 diagnosis of NAS made ≤7 days after birth with institutional follow-up matched to patients without NAS. Infants were matched on gestational age (±2 weeks), birth weight (±20 g), sex (exact), and insurance type (exact). Quantile regression methods were used to estimate 10th, 25th, 50th, 75th and 90th percentiles of weight over time. Results The mean gestational age for an infant with NAS was 38.8 weeks (standard deviation [SD], 1.3). The mean birth weight was 3.141 kg (SD, 0.510). NAS patients had a median of 24 weights recorded between birth and 400 days (inter-quartile range [IQR], 16–32 weights). Patients without NAS had a median of 12 weights recorded (IQR, 10–16). Growth curves were similar over the first 400 days of life. Patients with NAS had non-significantly higher and lower estimated weights for the 90th and 10th percentiles, respectively. Conclusion Infants with a diagnosis of NAS grew similarly to controls during their first year. Given the frequently-encountered NAS symptoms of hyperphagia and irritability, future studies may evaluate whether early differences in caregiver feeding exist and whether they have longer-term impacts on growth.
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- 2018
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8. Child Weight Gain Trajectories Linked To Oral Microbiota Composition
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Sarah J. C. Craig, Daniel Blankenberg, Alice Carla Luisa Parodi, Ian M. Paul, Leann L. Birch, Jennifer S. Savage, Michele E. Marini, Jennifer L. Stokes, Anton Nekrutenko, Matthew Reimherr, Francesca Chiaromonte, and Kateryna D. Makova
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Oral Microbiota ,Rapid Infant Weight Gain ,Linear Discriminant Analysis Effect Size (LEfSe) ,Diet-related Variables ,Microbiota Samples ,Medicine ,Science - Abstract
Abstract Gut and oral microbiota perturbations have been observed in obese adults and adolescents; less is known about their influence on weight gain in young children. Here we analyzed the gut and oral microbiota of 226 two-year-olds with 16S rRNA gene sequencing. Weight and length were measured at seven time points and used to identify children with rapid infant weight gain (a strong risk factor for childhood obesity), and to derive growth curves with innovative Functional Data Analysis (FDA) techniques. We showed that growth curves were associated negatively with diversity, and positively with the Firmicutes-to-Bacteroidetes ratio, of the oral microbiota. We also demonstrated an association between the gut microbiota and child growth, even after controlling for the effect of diet on the microbiota. Lastly, we identified several bacterial genera that were associated with child growth patterns. These results suggest that by the age of two, the oral microbiota of children with rapid infant weight gain may have already begun to establish patterns often seen in obese adults. They also suggest that the gut microbiota at age two, while strongly influenced by diet, does not harbor obesity signatures many researchers identified in later life stages.
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- 2018
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9. A patient-centered, coordinated care approach delivered by community and pediatric primary care providers to promote responsive parenting: pragmatic randomized clinical trial rationale and protocol
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Jennifer S. Savage, Samantha M. R. Kling, Adam Cook, Lindsey Hess, Shawnee Lutcher, Michele Marini, Jacob Mowery, Shannon Hayward, Sandra Hassink, Jennifer Franceschelli Hosterman, Ian M. Paul, Chris Seiler, and Lisa Bailey-Davis
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Early obesity prevention ,Responsive parenting ,Health information technology ,Coordination of care ,The special supplemental women ,Infants ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Economically disadvantaged families receive care in both clinical and community settings, but this care is rarely coordinated and can result in conflicting educational messaging. WEE Baby Care is a pragmatic randomized clinical trial evaluating a patient-centered responsive parenting (RP) intervention that uses health information technology (HIT) strategies to coordinate care between pediatric primary care providers (PCPs) and the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) community nutritionists to prevent rapid weight gain from birth to 6 months. It is hypothesized that data integration and coordination will improve consistency in RP messaging and parent self-efficacy, promoting shared decision making and infant self-regulation, to reduce infant rapid weight gain from birth to 6 months. Methods/design Two hundred and ninety mothers and their full-term newborns will be recruited and randomized to the “RP intervention” or “standard care control” groups. The RP intervention includes: 1) parenting and nutrition education developed using the American Academy of Pediatrics Healthy Active Living for Families curriculum in conjunction with portions of a previously tested RP curriculum delivered by trained pediatric PCPs and WIC nutritionists during regularly scheduled appointments; 2) parent-reported data using the Early Healthy Lifestyles (EHL) risk assessment tool; and 3) data integration into child’s electronic health records with display and documentation features to inform counseling and coordinate care between pediatric PCPs and WIC nutritionists. The primary study outcome is rapid infant weight gain from birth to 6 months derived from sex-specific World Health Organization adjusted weight-for-age z-scores. Additional outcomes include care coordination, messaging consistency, parenting behaviors (e.g., food to soothe), self-efficacy, and infant sleep health. Infant temperament and parent depression will be explored as moderators of RP effects on infant outcomes. Discussion This pragmatic patient-centered RP intervention integrates and coordinates care across clinical and community sectors, potentially offering a fundamental change in the delivery of pediatric care for prevention and health promotion. Findings from this trial can inform large scale dissemination of obesity prevention programs. Trial registration Restrospective Clinical Trial Registration: NCT03482908. Registered March 29, 2018.
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- 2018
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10. INSIGHT responsive parenting intervention and infant feeding practices: randomized clinical trial
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Jennifer S. Savage, Emily E. Hohman, Michele E. Marini, Amy Shelly, Ian M. Paul, and Leann L. Birch
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Obesity prevention ,Infancy ,Responsive parenting ,Feeding practices and styles ,Bottle-feeding and diet ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background What, when, how, how much, and how often infants are fed have been associated with childhood obesity risk. The objective of this secondary analysis was to examine the effect of a responsive parenting (RP) intervention designed for obesity prevention on parents’ infant feeding practices in the first year after birth. Methods Primiparous mother-newborn dyads were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study RP intervention or child safety control. Research nurses delivered intervention content at home at infant age 3–4, 16, 28, and 40 weeks, and at a research center at 1 year. RP feeding guidance advised feeding that was contingent (i.e., feed in response to hunger and satiety signs, alternatives to using food to soothe), and developmentally appropriate (i.e., delaying introduction of solids, age-appropriate portion sizes). Infant feeding practices (i.e., bottle use, introduction of solids, food to soothe) were assessed by phone interviews and online surveys and dietary intake was assessed using a food frequency questionnaire. Results RP mothers were more likely to use of structure-based feeding practices including limit-setting (p
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- 2018
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11. INSIGHT responsive parenting intervention reduces infant’s screen time and television exposure
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Elizabeth L. Adams, Michele E. Marini, Jennifer Stokes, Leann L. Birch, Ian M. Paul, and Jennifer S. Savage
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Obesity prevention ,Media use in children ,Infancy ,Tummy time ,Physical activity ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention. Methods The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant’s screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years. Results More RP than control parents reported their infants met the American Academy of Pediatrics’ no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p
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- 2018
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12. An anthropometric survey of US pre-term and full-term neonates
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Susan M. Abdel-Rahman, Ian M. Paul, Paula Delmore, Laura James, Laura Fearn, Andrew M. Atz, Brenda B. Poindexter, Amira Al-Uzri, Andrew Lewandowski, Barrie L. Harper, P. Brian Smith, and for the Best Pharmaceuticals for Children Act – Pediatric Trials Network
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extra-uterine growth ,infants ,limb length ,circumference ,growth reference ,anthropometry ,Biology (General) ,QH301-705.5 ,Human anatomy ,QM1-695 ,Physiology ,QP1-981 - Abstract
Background: Anthropometric data prove valuable for screening and monitoring various medical conditions. In young infants, however, only weight, length and head circumference are represented in publicly accessible databases. Aim: To characterise length and circumferential measures in pre-term and full-term infants up to 90 days post-natal. Subjects and methods: In eight US medical centres, trained raters recorded humeral, ulnar, femoral, tibial and fibular lengths along with mid-upper arm, mid-thigh, chest, abdominal and neck circumference. Data were pooled by post-menstrual age into 1-week intervals and population curves created using the lambda, mu and sigma (LMS) method. Goodness-of-fit was assessed by examining de-trended quantile-quantile plots, Q statistics and fitted centiles overlaid on empirical centiles. Results: In total, 2097 infants were enrolled in this study with a mean ± SD gestational age and post-natal age of 37.1 ± 3.3 weeks and 27.3 ± 25.3 days, respectively. A re-scale option was used to describe all curves. The resultant models reliably characterised anthropometric measures from 33–52 weeks PMA, with less certainty at the extremes (27–55 weeks). Conclusion: The population curves generated under this investigation expand existing reference data on a comprehensive set of anthropometric traits in infants through the first 90 days post-natal.
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- 2017
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13. Correction to: Improving infant sleep safety via electronic health record communication: a randomized controlled trial
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Ethan A. Canty, Benjamin N. Fogel, Erich K. Batra, Eric W. Schaefer, Jessica S. Beiler, and Ian M. Paul
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Pediatrics ,RJ1-570 - Abstract
An amendment to this paper has been published and can be accessed via the original article.
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- 2020
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14. A Weight Estimation Strategy for Preterm and Full-Term Infants
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Susan M. Abdel-Rahman PharmD, Ian M. Paul MD, Paula Delmore RN, Laura James MD, Laura Fearn RN, Andrew Atz MD, Brenda Poindexter MD, Amira Al-Uzri MD, Andrew Lewandowski PhD, Barrie Harper, and P. Brian Smith MD
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Pediatrics ,RJ1-570 - Abstract
Weight is the foremost marker of health outcomes in infants; however, the majority of community workers and health care providers in remote, resource-constrained settings have limited access to functional scales. This study develops and validates a simple weight estimation strategy for infants that addresses the limitations of current approaches. Circumferential and segmental anthropometric measures were evaluated for their relationship to infant weight and length. Data derived from 2097 US infants (n = 1681 for model development, n = 416 for validation). Statistical and practical considerations informed final measurement selection. Head circumference and chest circumference demonstrated the best correlations with weight ( r = 0.89) and length ( r = 0.94 and 0.93), and were among the most reproducible as reflected by intraclass correlation coefficients (>0.98). The head circumference and chest circumference combination offered better goodness-of-fit and smaller limits of agreement than did either measure alone. The final model predicted weight within 10% and 15% of actual for 84% and 94% of infants, respectively, with no bias for postnatal age ( P = .76), gestational age ( P = .10), and sex ( P = .25). The model requires simple summation to generate a weight estimate and can be embodied as a low-cost, paper-based device.
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- 2017
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15. Controlling for contamination in re-sequencing studies with a reproducible web-based phylogenetic approach
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Benjamin Dickins, Boris Rebolledo-Jaramillo, Marcia Shu-Wei Su, Ian M. Paul, Daniel Blankenberg, Nicholas Stoler, Kateryna D. Makova, and Anton Nekrutenko
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re-sequencing ,contamination ,next-generation sequencing ,Galaxy ,reproducibility ,Biology (General) ,QH301-705.5 - Abstract
Polymorphism discovery is a routine application of next-generation sequencing technology where multiple samples are sent to a service provider for library preparation, subsequent sequencing, and bioinformatic analyses. The decreasing cost and advances in multiplexing approaches have made it possible to analyze hundreds of samples at a reasonable cost. However, because of the manual steps involved in the initial processing of samples and handling of sequencing equipment, cross-contamination remains a significant challenge. It is especially problematic in cases where polymorphism frequencies do not adhere to diploid expectation, for example, heterogeneous tumor samples, organellar genomes, as well as during bacterial and viral sequencing. In these instances, low levels of contamination may be readily mistaken for polymorphisms, leading to false results. Here we describe practical steps designed to reliably detect contamination and uncover its origin, and also provide new, Galaxy-based, readily accessible computational tools and workflows for quality control. All results described in this report can be reproduced interactively on the web as described at http://usegalaxy.org/contamination.
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- 2014
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16. A model for academic institution support for community-engaged research
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Dennis P. Scanlon, Laura J. Wolf, Cynthia H. Chuang, Jennifer L. Kraschnewski, Eugene J. Lengerich, Susan M. McHale, Ian M. Paul, and Janice Penrod
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Medicine - Published
- 2017
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17. 2332
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Dennis P. Scanlon, Laura J. Wolf, Cynthia Chuang, Jen Kraschnewski, Eugene Lengerich, Susan McHale, Ian M. Paul, and Janice Penrod
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Medicine - Abstract
OBJECTIVES/SPECIFIC AIMS: Community engagement is a commonly used term, but is complex in both meaning and application. In order to help academic institutions and administrators develop infrastructure to promote and support community engagement and to help investigators work productively with communities, this analysis discusses the major components of community engagement in research on both the institutional and individual project levels as well as the interplay between them. METHODS/STUDY POPULATION: A literature synthesis conducted by a community engagement in research committee at 1 CTSA institution that examined the myriad factors related to effective community engagement in research identified across multiple disciplines was used to distill the major factors identified, assesses the interplay of the identified factors, and produce a conceptual model to help administrators and investigators apply best practices in engaging communities in clinical and translational research. RESULTS/ANTICIPATED RESULTS: This work takes a concept—community engagement in research—that is often stated and discussed, but is highly complex and challenging to implement—and identifies and discusses the multiple, interrelated factors germane to it. The model illustrates that while community engagement in research is implemented in the context of individual projects, a deep and continual interplay between individual projects and the goals, capacity, and policies of research institutions is needed for rigorous, ethical, and effective community engagement. DISCUSSION/SIGNIFICANCE OF IMPACT: Results are presented through a conceptual framework which displays the major components needed for rigorous, ethical, and effective community engagement in clinical and translational research. In addition, the conceptual framework presented will provide assistance to those developing approaches to measure and evaluate institutional readiness for community engagement in research as well as the effectiveness of individual community engagement efforts.
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- 2017
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18. Health knowledge among the millennial generation
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Tom Lloyd, Michele L. Shaffer, Christy Stetter, Mark D. Widome, John Repke, Michael R. Weitekamp, Paul J. Eslinger, Sandra S. Bargainnier, and Ian M. Paul
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health education, knowledge acquisition ,Public aspects of medicine ,RA1-1270 - Abstract
The Millennial Generation, also known as Generation Y, is the demographic cohort following Generation X, and is generally regarded to be composed of those individuals born between 1980 and 2000. They are the first to grow up in an environment where health-related information is widely available by internet, TV and other electronic media, yet we know very little about the scope of their health knowledge. This study was undertaken to quantify two domains of clinically relevant health knowledge: factual content and ability to solve health related questions (application) in nine clinically related medical areas. Study subjects correctly answered, on average, 75% of health application questions but only 54% of health content questions. Since students were better able to correctly answer questions dealing with applications compared to those on factual content contemporary US high school students may not use traditional hierarchical learning models in acquisition of their health knowledge.
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- 2013
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19. Effect of the INSIGHT Responsive Parenting Intervention on Parenting and Child Behavior at Ages 3 and 6 Years
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Sara Tauriello, Jennifer S. Savage, Juliana Goldsmith, Elizabeth Kubiniec, Ian M. Paul, and Stephanie Anzman-Frasca
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Pediatrics, Perinatology and Child Health - Published
- 2023
20. Clinical Decision Support for Newborn Weight Loss: A Randomized Controlled Trial
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Valerie J, Flaherman, Andrew, Robinson, Jennifer, Creasman, Charles E, McCulloch, Ian M, Paul, and Mark J, Pletcher
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Breast Feeding ,Child, Preschool ,Weight Loss ,Pediatrics, Perinatology and Child Health ,Infant, Newborn ,Humans ,Infant ,Female ,Gestational Age ,General Medicine ,Patient Acceptance of Health Care ,Decision Support Systems, Clinical ,Pediatrics - Abstract
BACKGROUND AND OBJECTIVE The Newborn Weight Tool (NEWT) can inform newborn feeding decisions and might reduce health care utilization by preventing excess weight loss. Clinical decision support (CDS) displaying NEWT might facilitate its use. Our study’s objective is to determine the effect of CDS displaying NEWT on feeding and health care utilization. METHODS At an hospital involved in NEWT development, we randomly assigned 2682 healthy infants born ≥36 weeks gestation in 2018–2019 either to CDS displaying NEWT with an electronic flag if most recent weight was ≥75th weight loss centile or to a control of usual care with NEWT accessed at clinician discretion. Our primary outcome was feeding type concordant with weight loss, defined as exclusive breastfeeding for those not flagged, exclusive breastfeeding or supplementation for those flagged once, and supplementation for those flagged more than once. Secondary outcomes included inpatient and outpatient utilization in the first 30 days. We used χ2 and Student’s t tests to compare intervention infants with control and to compare trial infants with those born in 2017. RESULTS Feeding was concordant with for 1854 (74.5%) trial infants and did not differ between randomized groups (P = .65); concordant feeding was higher for all trial infants than for infants born in 2017 (64.4%; P < .0005). Readmission occurred for 51 (3.8%) CDS infants and 45 (3.4%) control infants (P = .56). Among the 60% of trial infants with outpatient records available, there were 3.5 ± 1.7 visits with no differences between randomized groups (P = .10). CONCLUSIONS At an hospital involved in NEWT development, CDS displaying NEWT did not alter either feeding or health care utilization compared with discretionary NEWT access.
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- 2022
21. Assessment and impact of paediatric internalized weight bias: A systematic review
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Melissa Butt, Alexandra Harvey, Eiman Khesroh, Andrea Rigby, and Ian M. Paul
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Nutrition and Dietetics ,Health Policy ,Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health - Published
- 2023
22. Coordination between Primary Care and Women, Infants, and Children to Prevent Obesity for Infants from Low-Income Families: A Pragmatic Randomized Clinical Trial
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Jennifer S. Savage, Amy M. Moore, Samantha M.R. Kling, Michele Marini, Erika Hernandez, Jennifer Franceschelli Hosterman, Sandra Hassink, Ian M. Paul, and Lisa Bailey-Davis
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Nutrition and Dietetics ,Endocrinology, Diabetes and Metabolism ,Pediatrics, Perinatology and Child Health - Published
- 2022
23. Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study
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Alexis V. Hyczko, Ian M. Paul, Emily E. Hohman, Stephanie Anzman-Frasca, Leann L. Birch, Jennifer S. Savage, and Cara F. Ruggiero
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CFQ ,business.industry ,Repeated measures design ,Intervention effect ,medicine.disease ,Childhood obesity ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Intervention (counseling) ,Pediatrics, Perinatology and Child Health ,medicine ,030212 general & internal medicine ,Analysis of variance ,business ,Infant feeding ,Body mass index ,Demography - Abstract
Background Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding. Design/Methods Mothers (N = 279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using 2-way analysis of variance and repeated measures. Results Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs 2.8 ± 1.0, P = .07) and across annual measurements from age 1 to 3 years (SCPF: P = .04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs 3.0 ± 0.9, P = .002) with no control group sex difference (3.4 ± 0.8 vs 3.3 ± 0.9, P = .79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (ie, structure-based feeding, pressure). Conclusions Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.
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- 2021
24. Acetaminophen and ibuprofen in the treatment of pediatric fever: a narrative review
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Philip D. Walson and Ian M. Paul
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medicine.medical_specialty ,Antipyretics ,Fever ,Combination therapy ,Ibuprofen ,030204 cardiovascular system & hematology ,Controlled studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Acetaminophen ,business.industry ,organic chemicals ,digestive, oral, and skin physiology ,General Medicine ,Analgesics, Non-Narcotic ,3. Good health ,Antipyretic Effect ,Administration, Intravenous ,Narrative review ,business ,medicine.drug - Abstract
A narrative review of randomized, blinded, controlled studies assessing the antipyretic effect of ibuprofen versus acetaminophen or combined or alternating treatment in children was conducted.Searches of the PubMed and Embase literature databases were conducted to identify relevant articles. Selected articles were limited to studies published in English that investigated OTC oral tablet and syrup formulations of acetaminophen and ibuprofen; there were no publication date limits. Open-label studies, nonrandomized studies, and those evaluating intravenous or suppository formulations of acetaminophen or ibuprofen were excluded. Variations in designs, endpoints, methods, and patient populations precluded our ability to conduct a formal systematic review.At physician-directed dosing (acetaminophen 15 mg/kg vs ibuprofen 10 mg/kg), no significant differences in antipyretic effects from 0‒6 h and between 0‒6, ‒12, ‒24, or ‒48 h, with single or multiple-doses, respectively, were observed. Tolerability profiles at physician dosing were similar. In 14 over-the-counter dose comparisons (acetaminophen, 10-15 mg/kg; ibuprofen, 2.5-10 mg/kg), antipyresis favored ibuprofen in 6, was similar between groups in 7, and favored acetaminophen (15 mg/kg vs ibuprofen 5 mg/kg) in 1 comparison. Both medications were well tolerated. Efficacy favored combination over individual components in 3 of 4 studies; alternating use results were mixed. All combination or alternating treatments were well tolerated.Antipyretic effects of ibuprofen and acetaminophen are similar at physician-directed doses; ibuprofen may be modestly superior at over-the-counter doses.
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- 2021
25. Body composition during the first 4 months in infants affected by neonatal abstinence syndrome: a pilot study
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Eric W. Schaefer, Tammy E. Corr, and Ian M. Paul
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Male ,Change over time ,Pediatrics ,medicine.medical_specialty ,Medicine (miscellaneous) ,Gestational Age ,Pilot Projects ,Feeding difficulty ,Pharmacological treatment ,Fat mass ,03 medical and health sciences ,0302 clinical medicine ,Neonatal abstinence ,030225 pediatrics ,Humans ,Medicine ,Symptom control ,030212 general & internal medicine ,business.industry ,Infant, Newborn ,Infant ,Gestational age ,Pennsylvania ,Confidence interval ,Body Composition ,Female ,business ,Neonatal Abstinence Syndrome - Abstract
Newborns with neonatal abstinence syndrome (NAS) display symptoms related to neurologic excitability and autonomic dysfunction that result in increased metabolic demands. These infants also exhibit feeding difficulties and/or hyperphagia. Because the effects of these symptoms and behaviors on growth are unknown, we sought to measure serial body composition measurements over the first 4 months in infants with NAS requiring pharmacologic treatment using air displacement plethysmography. Fourteen infants of singleton birth with appropriate-for-gestational-age (AGA) weight and a gestational age of ≥35 weeks and N = 5) requiring multidrug therapy for symptom control had lower mean fat percent (−1.2%, CI: −5.2–2.1), fat mass (−60 g, CI: −25–13), and fat-free mass (−270 g, CI: −610–80) across time compared to infants requiring monotherapy. We are the first to report how body composition measures change over time in a small group of patients with NAS. Infants with NAS were smaller and leaner in the first several weeks compared to previously reported body composition measurements in term infants, but grew similarly to their healthy counterparts by 16 weeks. Infants with more severe NAS may be at risk for abnormalities in longer term growth.
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- 2021
26. Pilot Study of Inclined Position and Infant Gastroesophageal Reflux Indicators
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Ian M. Paul, Katherine E. Shedlock, Eric W. Schaefer, Ellen J. Stoute, and Rachel Rosen
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General Medicine - Published
- 2023
27. Associations between stool micro-transcriptome, gut microbiota, and infant growth
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Steven D. Hicks, Kateryna D. Makova, Sarah J. C. Craig, Molly C. Carney, Akanksha Rangnekar, Xiang Zhan, Ian M. Paul, and Maria Z. Chroneos
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Male ,Medicine (miscellaneous) ,Gut flora ,Microbiology ,Clostridia ,Transcriptome ,Feces ,03 medical and health sciences ,0302 clinical medicine ,microRNA ,Humans ,Microbiome ,030304 developmental biology ,0303 health sciences ,biology ,Gene Expression Profiling ,Infant ,RNA ,Pennsylvania ,biology.organism_classification ,Gastrointestinal Microbiome ,Metabolic pathway ,Burkholderia ,Female ,Growth and Development ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Rapid infant growth increases the risk for adult obesity. The gut microbiome is associated with early weight status; however, no study has examined how interactions between microbial and host ribonucleic acid (RNA) expression influence infant growth. We hypothesized that dynamics in infant stool micro-ribonucleic acids (miRNAs) would be associated with both microbial activity and infant growth via putative metabolic targets. Stool was collected twice from 30 full-term infants, at 1 month and again between 6 and 12 months. Stool RNA were measured with high-throughput sequencing and aligned to human and microbial databases. Infant growth was measured by weight-for-length z-score at birth and 12 months. Increased RNA transcriptional activity of Clostridia (R = 0.55; Adj p = 3.7E-2) and Burkholderia (R = −0.820, Adj p = 2.62E-3) were associated with infant growth. Of the 25 human RNAs associated with growth, 16 were miRNAs. The miRNAs demonstrated significant target enrichment (Adj p < 0.05) for four metabolic pathways. There were four associations between growth-related miRNAs and growth-related phyla. We have shown that longitudinal trends in gut microbiota activity and human miRNA levels are associated with infant growth and the metabolic targets of miRNAs suggest these molecules may regulate the biosynthetic landscape of the gut and influence microbial activity.
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- 2021
28. Effect of the INSIGHT Firstborn Parenting Intervention on Secondborn Sleep
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Emily E. Hohman, Jennifer S. Savage, Michele E. Marini, Stephanie Anzman-Frasca, Orfeu M. Buxton, Eric Loken, and Ian M. Paul
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Parenting ,Siblings ,Pediatrics, Perinatology and Child Health ,Humans ,Infant ,Mothers ,Female ,Birth Order ,Child ,Sleep ,Article - Abstract
BACKGROUND AND OBJECTIVES The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers improved firstborn infant sleep compared with controls. The goals of this analysis were to test intervention spillover effects on secondborn siblings and examine birth order differences in infant sleep. METHODS Secondborns (n = 117) of INSIGHT mothers were enrolled in an observational cohort, SIBSIGHT. The Brief Infant Sleep Questionnaire was collected at 3, 16, and 52 weeks. Generalized linear mixed models assessed differences among secondborns by firstborn randomization, as well as birth order differences at 16 and 52 weeks. RESULTS The RP group secondborns slept 42 minutes longer at night (95% confidence interval [95% CI]: 19–64) and 53 minutes longer total (95% CI: 17–90) than control secondborns. RP secondborns were more likely to self-soothe to sleep (odds ratio [OR] = 2.0, 95% CI: 1.1–3.7) and less likely to be fed back to sleep after waking (OR = 0.5, 95% CI: 0.3–0.9) than secondborns of control mothers. RP secondborns were more likely to have a bedtime ≤8 pm at 3 (OR = 2.9, 95% CI: 1.1–7.7) and 16 weeks (OR = 4.7, 95% CI: 2.0–11.0). Few differences in sleep parenting practices were observed when comparing siblings within families. Secondborns slept 37 minutes longer than firstborns at 16 weeks (CI: 7–67, P = .03). CONCLUSIONS The INSIGHT RP intervention for first-time mothers had a spillover effect to secondborns, positively impacting sleep duration and behaviors. Intervening with first-time mothers benefits both firstborns and subsequent children.
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- 2022
29. Differences in sibling temperament are associated with differences in maternal use of food to soothe during infancy: A sibling analysis
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Cara F. Ruggiero, Michele E. Marini, Clare H. Llewellyn, Susan M. McHale, Ian M. Paul, and Jennifer S. Savage
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Nutrition and Dietetics ,Parenting ,Siblings ,Health Policy ,Public Health, Environmental and Occupational Health ,Infant ,Mothers ,Feeding Behavior ,Overweight ,Body Mass Index ,Pediatrics, Perinatology and Child Health ,Humans ,Female ,Child ,Temperament - Abstract
Firstborn children are more likely to have obesity than secondborns, which may partially be explained by differential use of food to soothe (FTS) infant distress, which has been inked to higher weight status.To test associations between the birth order and maternal FTS and whether differences in sibling temperament and body mass index (BMI) z-scores were associated differences in maternal FTS.Random effect models assessed associations between birth order and FTS. Linear regressions examined associations between differences in maternal FTS and sibling differences in temperament at 16 weeks and BMI z-scores at 1 year.Mothers (n = 117) used contextual-based FTS more with firstborns than secondborns (2.70 vs. 2.38, p 0.0001). Sibling differences in negative affect were associated with differences in maternal contextual-based (RTo promote healthy child weight, mothers should learn to respond to each child's temperament and use alternatives to FTS infant distress.
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- 2022
30. Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children
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Richard C. Dart, William Banner, Ian M. Paul, Robert B. Palmer, Malin Rapp-Olsson, Ralph E. Kauffman, Kate M. Reynolds, G. Randall Bond, George Sam Wang, and Jody L. Green
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Pediatrics ,medicine.medical_specialty ,Psychological intervention ,Nonprescription Drugs ,law.invention ,Eating ,law ,medicine ,Humans ,Child ,Pediatric Liquid ,Adverse effect ,business.industry ,Cold medications ,Diphenhydramine ,Infant ,General Medicine ,Dextromethorphan ,Intensive care unit ,United States ,Hospitalization ,Cough ,Accidental ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,business ,medicine.drug - Abstract
Objectives Previous research has demonstrated that accidental unsupervised ingestions (AUIs) were responsible for the majority of cough and cold medication (CCM) ingestions leading to significant adverse events (AEs) in children. The objective of this analysis was to characterize the role of AUIs in the morbidity associated with CCM exposure in children. Methods This surveillance study collected data from 5 United States data sources from 2009 to 2016, in children younger than 6 years with an AE from an AUI involving at least 1 CCM over-the-counter pharmaceutical ingredient. An expert panel reviewed each case to determine causality. Results From 4756 total cases reviewed, 3134 (65.9%) had an AE from an AUI determined to be at least potentially related to a CCM ingredient. The majority (61.3%) of cases occurred in children aged 2 to younger than 4 years. Most exposures occurred in the child's own residence (94.9%), and 43.8% were admitted to a health care facility (22.0% to a critical care unit). Dextromethorphan and diphenhydramine, when packaged alone or in combination products, contributed to 96.0% of AUIs. The most common specific products involved were single-ingredient pediatric liquid diphenhydramine (30.1%) and single-ingredient pediatric liquid dextromethorphan (21.4%). There were 3 deaths from solid diphenhydramine formulations. Conclusions There continues to be opportunities for the implementation of interventions to prevent AUIs of CCM in children. Additional emphasis on engineering controls, such as flow restrictors for liquid formulations targeting diphenhydramine and dextromethorphan products, represent additional opportunities to further reduce AEs from AUIs of CCM.
- Published
- 2020
31. Biography of Leann L Birch, PhD, 25 June 1946 – 26 May 2019
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Alison K. Ventura, Stephanie Anzman-Frasca, Justin A. Lavner, Susan L. Johnson, Jennifer S. Savage, Ian M. Paul, Lori A. Francis, Jennifer O. Fisher, and Kirsten K. Davison
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Nutrition and Dietetics ,Nutritional Sciences ,MEDLINE ,Medicine (miscellaneous) ,Historical Article ,Biography ,History, 20th Century ,Nutritional science ,Psychology ,History, 21st Century ,Classics - Published
- 2020
32. Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity
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Finn Rasmussen, Hein Raat, Cristina Palacios, Barry J Taylor, Lisa Askie, Alison Hayes, Cindy-Lee Dennis, Karen Campbell, Wendy Smith, Luke Wolfenden, Sharleen O’Reilly, Eva Corpeleijn, Maria Bryant, Chris Rissel, Denise O’Connor, Paul Chadwick, Jessica Thomson, Anna Lene Seidler, Kylie E Hunter, Rachael W Taylor, Angie Barba, Kristy Robledo, Ken Ong, Carolina González Acero, Ana Pérez-Expósito, Kylie D Hesketh, Rebecca K Golley, David Espinoza, Ken K Ong, Sarah Taki, Rachael Taylor, Louise A Baur, Li Ming Wen, Seema Mihrshahi, Emily Oken, Barry Taylor, Ian Marschner, Junilla K Larsen, Kylie Hesketh, Rajalakshmi Lakshman, Amanda L Thompson, Sharleen L O'Reilly, Jonathan Williams, Charles Wood, Alison J Hayes, Kaumudi Joshipura, Hongping Xia, Lynne Daniels, Rebecca Byrne, Alison Karasz, Rebecca Golley, Kaumudi J Joshipura, Angela Webster, Nina Cecilie Øverby, Brittany J Johnson, Mason Aberoumand, Sol Libesman, Kristy P Robledo, Charles T Wood, Lukas P Staub, Michelle Sue-See, Ian C Marschner, Jessica L Thomson, Vera Verbestel, Sarah-Jeanne Salvy, Levie T Karssen, Finn E Rasmussen, Mary Jo Messito, Rachel S Gross, Ian M Paul, Heather M Wasser, Claudio Maffeis, Ata Ghaderi, Jinan C Banna, Maribel Campos Rivera, Ana B Pérez-Expósito, Jennifer S Savage, Margrethe Røed, Michael Goran, Kayla de la Haye, Stephanie Anzman-Frasca, Kylie Hunter, Brittany Johnson, Louise Baur, Lukas Staub, Shonna Yin, Lee Sanders, Amanda Thompson, Ana Maria Linares, Cathleen Odar Stough, Christine Helle, Eliana Perrin, Heather Wasser, Jinan Banna, Kayla dela Haye, Levie Karssen, Nina Øverby, Rachel Gross, Russell Rothman, Wendy A Smith, Alexander Fiks, Deborah Jacobvitz, Jennifer Savage Williams, Márcia Regina Vitolo, Elizabeth Widen, Hunter, Kylie E [0000-0002-2796-9220], Johnson, Brittany J [0000-0001-5492-9219], O'Connor, Denise A [0000-0002-6836-122X], Hesketh, Kylie D [0000-0002-2702-7110], Ong, Kenneth [0000-0003-4689-7530], Øverby, Nina Cecilie [0000-0002-1871-041X], Seidler, Anna Lene [0000-0002-0027-1623], and Apollo - University of Cambridge Repository
- Subjects
Gerontology ,obesity ,Pediatric Obesity ,MEDLINE ,Psychological intervention ,CINAHL ,PsycINFO ,preventive medicine ,Childhood obesity ,Body Mass Index ,paediatrics ,Meta-Analysis as Topic ,Behavior Therapy ,Medicine and Health Sciences ,medicine ,Humans ,Early childhood ,Prospective Studies ,Child ,Exercise ,ASSOCIATIONS ,Research ethics ,OVERWEIGHT ,business.industry ,public health ,Infant ,General Medicine ,medicine.disease ,RANDOMIZED-TRIALS ,BODY-MASS INDEX ,000 DAYS ,PHYSICAL-ACTIVITY ,Meta-analysis ,Child, Preschool ,RISK-FACTORS ,1114 Paediatrics and Reproductive Medicine ,Medicine ,WEIGHT ,HEALTH ,TRAJECTORIES ,business ,1ST 1 ,Developmental Psychopathology ,community child health ,Systematic Reviews as Topic - Abstract
IntroductionBehavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups.Methods and analysisSystematic searches of Medline, Embase, CENTRAL, CINAHL, PsycInfo, and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2020 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis (PMA) will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index (BMI) z-score at age 24 +/- 6 months using World Health Organisation Growth Standards, and effect differences will be explored among pre-specified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events.Ethics and disseminationApproved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations, and media releases.RegistrationProspectively registered on PROSPERO: CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis will be the largest individual participant data (IPD) meta-analysis evaluating behavioural interventions for the prevention of early childhood obesity to date, and will provide the most reliable and precise estimates of early intervention effects to inform future decision-making.IPD meta-analysis methodology will enable unprecedented exploration of important individual and trial-level characteristics that may be associated with childhood obesity or that may be effect modifiers.The proposed innovative methodologies are feasible and have been successfully piloted by members of our group.It may not be possible to obtain IPD from all eligible trials; in this instance, aggregate data will be used where available, and sensitivity analyses will be conducted to assess inclusion bias.Outcome measures may be collected and reported differently across included trials, potentially increasing imprecision; however, we will harmonise available data where possible, and encourage those planning or conducting ongoing trials to collect common core outcomes following prospective meta-analysis methodology.
- Published
- 2022
33. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: A systematic review and intervention coding protocol
- Author
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Finn Rasmussen, Hein Raat, Cristina Palacios, Barry J Taylor, Lisa Askie, Alison Hayes, Karen Campbell, Wendy Smith, Luke Wolfenden, Sharleen O’Reilly, Eva Corpeleijn, Maria Bryant, Chris Rissel, Denise O’Connor, Paul Chadwick, Jessica Thomson, Anna Lene Seidler, Kylie E Hunter, Ian Paul, Rachael W Taylor, Angie Barba, Kristy Robledo, Ken Ong, Carolina González Acero, Kylie D Hesketh, Rebecca K Golley, David Espinoza, Sarah Taki, Rachael Taylor, Louise A Baur, Li Ming Wen, Seema Mihrshahi, Emily Oken, Barry Taylor, Ian Marschner, Junilla K Larsen, Kylie Hesketh, Rajalakshmi Lakshman, Amanda L Thompson, Sharleen L O'Reilly, Charles Wood, Alison J Hayes, Kaumudi Joshipura, Lynne Daniels, Alison Karasz, Rebecca Golley, Kaumudi J Joshipura, Nina Cecilie Øverby, Brittany J Johnson, Mason Aberoumand, Sol Libesman, Kristy P Robledo, Charles T Wood, Lukas P Staub, Michelle Sue-See, Ian C Marschner, Jessica L Thomson, Vera Verbestel, Cathleen Odar Stough, Sarah-Jeanne Salvy, Levie T Karssen, Finn E Rasmussen, Mary Jo Messito, Rachel S Gross, Ian M Paul, Ana M Linares, Heather M Wasser, Claudio Maffeis, Ata Ghaderi, Jinan C Banna, Maribel Campos Rivera, Ana B Pérez-Expósito, Jennifer S Savage, Margrethe Røed, Michael Goran, Kayla de la Haye, Stephanie Anzman-Frasca, Kylie Hunter, Brittany Johnson, Louise Baur, Lukas Staub, Shonna Yin, Lee Sanders, Amanda Thompson, Ana Maria Linares, Ana Perez Exposito, Christine Helle, Eliana Perrin, Heather Wasser, Jennifer Savage, Jinan Banna, Junilla Larsen, Kayla dela Haye, Levie Karssen, Nina Øverby, Rachel Gross, Russell Rothman, Johnson, Brittany J [0000-0001-5492-9219], Hunter, Kylie E [0000-0002-2796-9220], O'Connor, Denise A [0000-0002-6836-122X], Hesketh, Kylie D [0000-0002-2702-7110], Øverby, Nina Cecilie [0000-0002-1871-041X], Joshipura, Kaumudi J [0000-0003-1964-7579], Seidler, Anna Lene [0000-0002-0027-1623], and Apollo - University of Cambridge Repository
- Subjects
Pediatric Obesity ,education ,Psychological intervention ,MEDLINE ,PsycINFO ,CINAHL ,preventive medicine ,Pediatrics ,Childhood obesity ,paediatrics ,Nursing ,PARENTS ,Behavior Therapy ,medicine ,Medicine and Health Sciences ,Humans ,Early childhood ,Child ,METAANALYSIS ,Research ethics ,public health ,General Medicine ,TAXONOMY ,medicine.disease ,Clinical trial ,Child, Preschool ,1114 Paediatrics and Reproductive Medicine ,Medicine ,Psychology ,Developmental Psychopathology ,community child health ,Systematic Reviews as Topic - Abstract
IntroductionLittle is known about how early (e.g., commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to 1) characterise early obesity prevention interventions in terms of target behaviours, delivery features, and behaviour change techniques (BCTs), 2) explore similarities and differences in BCTs used to target behaviours, and 3) explore effectiveness of intervention components in preventing childhood obesity.Methods and analysisAnnual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the TOPCHILD Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components.Ethics and disseminationThe study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations, and targeted communication with key stakeholders.DiscussionOur study will provide an in depth understanding of behavioural components and delivery features used in obesity prevention interventions starting antenatally or in the first 12 months after birth. Understanding common intervention approaches in a systematic way will provide much needed insight to advance the design of early obesity prevention interventions and provide the opportunity to undertake future quantitative predictive modelling.RegistrationPROSPERO registration no. CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis study provides an understanding of behaviours targeted, behaviour change techniques and delivery features used in early childhood obesity prevention trials identified in a systematic review as being eligible for inclusion in the Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration.Extends previous methods by coding behaviour change techniques in published and unpublished intervention materials and performing cross validation with trialists through the TOPCHILD Collaboration.Using standardised coding taxonomies will allow for comparisons across studies, and we will pilot test new ontologies from the Human Behaviour Change Project.Explores the complex area of targeting parent and caregivers’ behaviours to impact child outcomes across four key obesity prevention behavioural domains (relating to infant feeding practices, food provision and parent feeding practices, movement practices, sleep health practices).This study will provide preliminary results regarding the examination of intervention components’ effectiveness based on exploratory analysis. Yet, the internationally unique database this project creates will further our understanding of effective intervention components in future research.To date we already have 38 out of 65 eligible trials agreeing to share data, since not all trials may provide unpublished material we may perform sensitivity analyses comparing trials that have shared data to trials that have not shared materials.
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- 2022
34. Metabolomic profiling of stool of two-year old children from the INSIGHT study reveals links between butyrate and child weight outcomes
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Francesca Chiaromonte, Matthew Reimherr, Ian M. Paul, Jingwei Cai, Sarah J. C. Craig, Michele E. Marini, Debmalya Nandy, Kateryna D. Makova, Andrew D. Patterson, Jennifer S. Savage, Emily E. Hohman, and Yuan Tian
- Subjects
1-HNMR ,Pediatric Obesity ,Maternal smoking ,Physiology ,Mothers ,Butyrate ,Gut flora ,Childhood obesity ,Body Mass Index ,Feces ,Pregnancy ,medicine ,Humans ,Maternal health ,Child ,Preschool ,Nutrition and Dietetics ,biology ,butyrate ,childhood obesity ,metabolomics ,weight outcomes at 2-years ,Butyrates ,Child, Preschool ,Female ,Gastrointestinal Microbiome ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,medicine.disease ,biology.organism_classification ,Obesity ,Metabolomic profiling ,Pediatrics, Perinatology and Child Health ,business - Abstract
Background Metabolomic analysis is commonly used to understand the biological underpinning of diseases such as obesity. However, our knowledge of gut metabolites related to weight outcomes in young children is currently limited. Objectives To (1) explore the relationships between metabolites and child weight outcomes, (2) determine the potential effect of covariates (e.g., child's diet, maternal health/habits during pregnancy, etc.) in the relationship between metabolites and child weight outcomes, and (3) explore the relationship between selected gut metabolites and gut microbiota abundance. Methods Using 1 H-NMR, we quantified 30 metabolites from stool samples of 170 two-year-old children. To identify metabolites and covariates associated with children's weight outcomes (BMI [weight/height2 ], BMI z-score [BMI adjusted for age and sex], and growth index [weight/height]), we analysed the 1 H-NMR data, along with 20 covariates recorded on children and mothers, using LASSO and best subset selection regression techniques. Previously characterized microbiota community information from the same stool samples was used to determine associations between selected gut metabolites and gut microbiota. Results At age 2 years, stool butyrate concentration had a significant positive association with child BMI (p-value = 3.58 × 10-4 ), BMI z-score (p-value = 3.47 × 10-4 ), and growth index (p-value = 7.73 × 10-4 ). Covariates such as maternal smoking during pregnancy are important to consider. Butyrate concentration was positively associated with the abundance of the bacterial genus Faecalibacterium (p-value = 9.61 × 10-3 ). Conclusions Stool butyrate concentration is positively associated with increased child weight outcomes and should be investigated further as a factor affecting childhood obesity.
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- 2022
35. Bottleneck and selection in the germline and maternal age influence transmission of mitochondrial DNA in human pedigrees
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Peter R. Wilton, Arslan A. Zaidi, Ian M. Paul, Anton Nekrutenko, Marcia Shu-Wei Su, Barbara Arbeithuber, Kateryna D. Makova, Rasmus Nielsen, and Kate Anthony
- Subjects
bottleneck ,Male ,Mitochondrial Diseases ,Somatic cell ,Pedigree chart ,Reproductive health and childbirth ,Germline ,0302 clinical medicine ,80 and over ,mitochondrion ,heteroplasmy ,Child ,Pediatric ,Genetics ,Aged, 80 and over ,0303 health sciences ,education.field_of_study ,Multidisciplinary ,Biological Sciences ,Middle Aged ,Heteroplasmy ,Mitochondrial ,3. Good health ,Mitochondria ,Pedigree ,Child, Preschool ,Medical genetics ,Female ,Maternal Age ,Adult ,Mitochondrial DNA ,medicine.medical_specialty ,Adolescent ,Evolution ,1.1 Normal biological development and functioning ,Population ,Biology ,DNA, Mitochondrial ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,Preschool ,education ,030304 developmental biology ,Aged ,Human Genome ,Haplotype ,Human Genetics ,DNA ,Genetics, Population ,Germ Cells ,Generic health relevance ,030217 neurology & neurosurgery - Abstract
Significance Mitochondria frequently carry different DNA—a state called heteroplasmy. Heteroplasmic mutations can cause mitochondrial diseases and are involved in cancer and aging, but they are also common in healthy people. Here, we study heteroplasmy in 96 multigenerational healthy families. We show that mothers effectively transmit very few mitochondrial DNA to their offspring. Because of this bottleneck, which intensifies with increasing maternal age at childbirth, mutation frequencies can change dramatically between a mother and her child. Thus, a child might inherit a disease-causing mutation at high frequency from an asymptomatic carrier mother and might develop a disease. We also demonstrate that natural selection acts against disease-causing mutations during germline development. Our study has important implications for genetic counseling of mitochondrial diseases., Heteroplasmy—the presence of multiple mitochondrial DNA (mtDNA) haplotypes in an individual—can lead to numerous mitochondrial diseases. The presentation of such diseases depends on the frequency of the heteroplasmic variant in tissues, which, in turn, depends on the dynamics of mtDNA transmissions during germline and somatic development. Thus, understanding and predicting these dynamics between generations and within individuals is medically relevant. Here, we study patterns of heteroplasmy in 2 tissues from each of 345 humans in 96 multigenerational families, each with, at least, 2 siblings (a total of 249 mother–child transmissions). This experimental design has allowed us to estimate the timing of mtDNA mutations, drift, and selection with unprecedented precision. Our results are remarkably concordant between 2 complementary population-genetic approaches. We find evidence for a severe germline bottleneck (7–10 mtDNA segregating units) that occurs independently in different oocyte lineages from the same mother, while somatic bottlenecks are less severe. We demonstrate that divergence between mother and offspring increases with the mother’s age at childbirth, likely due to continued drift of heteroplasmy frequencies in oocytes under meiotic arrest. We show that this period is also accompanied by mutation accumulation leading to more de novo mutations in children born to older mothers. We show that heteroplasmic variants at intermediate frequencies can segregate for many generations in the human population, despite the strong germline bottleneck. We show that selection acts during germline development to keep the frequency of putatively deleterious variants from rising. Our findings have important applications for clinical genetics and genetic counseling.
- Published
- 2019
36. Preventing Home Medication Administration Errors
- Author
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Rohit Shenoi, Shannon C. Phillips, Sandra P. Spencer Cockerham, Ian M. Paul, Richard N. Shiffman, Bridgette L. Jones, Sean P. Gleeson, Kathleen A. Neville, Wayne H. Franklin, Laura Elizabeth Ferguson, Joel S. Tieder, Michael G. Leu, Matthew M. Laughon, Janice E. Sullivan, Jeffrey M. Brown, Thomas P. Green, Constance S. Houck, John R. Reigart, Elizabeth V. Saarel, Kathleen Mack Walsh, Philip A. Verhoef, Jennifer Foster, H. Shonna Yin, Michael L. Rinke, John N. van den Anker, Ricardo A. Quinonez, Francisco Alvarez, Adam C. Adler, Terry A. Adirim, David G. Bundy, Brigitta U. Mueller, Ulfat Shaikh, Corinna J. Rea, and Daniel R. Neuspiel
- Subjects
Medical home ,Parents ,medicine.medical_specialty ,Adolescent ,Drug Storage ,MEDLINE ,Pharmacy ,Nonprescription Drugs ,Drug Administration Schedule ,Medication Reconciliation ,Medicine ,Humans ,Medication Errors ,Dosing ,Medical prescription ,Child ,Language ,Dosage Forms ,business.industry ,Communication Barriers ,Medication administration ,Health Literacy ,Caregivers ,Limited English proficiency ,Family medicine ,Pediatrics, Perinatology and Child Health ,Polypharmacy ,Pamphlets ,business ,Patient education - Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy–informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
- Published
- 2021
37. Pediatric Fatalities Associated With Over-the-Counter Cough and Cold Medications
- Author
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Laurie Seidel Halmo, G. Randall Bond, Ian M. Paul, Richard C. Dart, Jody L. Green, William Banner, Robert B. Palmer, Malin Rapp-Olsson, Ralph E. Kauffman, George Sam Wang, Kate M. Reynolds, and Heather Delva-Clark
- Subjects
Male ,Chlorpheniramine ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,Nonprescription Drugs ,Dextromethorphan ,Phenylephrine ,Guaifenesin ,medicine ,Humans ,Child ,Drug Labeling ,Doxylamine ,business.industry ,Cold medications ,Diphenhydramine ,Infant ,Medication administration ,Brompheniramine ,Pseudoephedrine ,Antitussive Agents ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Female ,Over-the-counter ,Homicide ,business ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVES In 2008, over-the-counter cough and cold medications (CCMs) underwent labeling changes in response to safety concerns, including fatalities, reported in children exposed to CCMs. The objective of this study is to describe fatalities associated with exposures to CCMs in children METHODS Fatalities in children RESULTS Of the 180 eligible fatalities captured during the study period, 40 were judged by the expert panel to be either related or potentially related to the CCM. Of these, the majority (n = 24; 60.0%) occurred in children CONCLUSIONS Pediatric fatalities associated with CCMs occurred primarily in young children after deliberate medication administration with nontherapeutic intent by a caregiver.
- Published
- 2021
38. INSIGHT responsive parenting educational intervention for firstborns is associated with growth of second-born siblings
- Author
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Jennifer S. Savage, Anna K. Hochgraf, Eric Loken, Michele E. Marini, Sarah J. C. Craig, Kateryna D. Makova, Leann L. Birch, and Ian M. Paul
- Subjects
Nutrition and Dietetics ,Parenting ,Endocrinology, Diabetes and Metabolism ,Siblings ,Parturition ,Medicine (miscellaneous) ,Infant ,Mothers ,Article ,Endocrinology ,Pregnancy ,Humans ,Female ,Obesity ,Child - Abstract
The aim of this study was to test whether the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention, delivered to parents of firstborn children, is associated with the BMI of first- and second-born siblings during infancy.Participants included 117 firstborn infants enrolled in a randomized controlled trial and their second-born siblings enrolled in an observation-only ancillary study. The RP curriculum for firstborn children included guidance on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. Anthropometrics were measured in both siblings at ages 3, 16, 28, and 52 weeks. Growth curve models for BMI by child age were fit.Second-born children were delivered 2.5 (SD 0.9) years after firstborns. Firstborn and second-born children whose parents received the RP intervention with their first child had BMI that was 0.44 kg/m2 (95% CI: -0.82 to 0.06) and 0.36 kg/m2 (95% CI: -0.75 to 0.03) lower than controls, respectively. Linear and quadratic growth rates for BMI for firstborn and second-born cohorts were similar, but second-born children had a greater average BMI at 1 year of age (difference = -0.33 [95% CI: -0.52 to -0.15]).A RP educational intervention for obesity prevention delivered to parents of firstborns appears to spill over to second-born siblings.
- Published
- 2021
39. Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents’ Feeding Practices
- Author
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Cara F. Ruggiero, Jennifer S. Savage, Susan M. McHale, and Ian M. Paul
- Subjects
responsive feeding ,Resource (biology) ,family systems ,030309 nutrition & dietetics ,Health, Toxicology and Mutagenesis ,Review ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Family systems ,030212 general & internal medicine ,Obesity ,Sibling ,Parent-Child Relations ,Child ,0303 health sciences ,Parenting ,Siblings ,Perspective (graphical) ,Public Health, Environmental and Occupational Health ,Feeding Behavior ,Birth order ,Medicine ,Parental feeding ,Psychology - Abstract
Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents’ knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics—which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.
- Published
- 2021
40. Variability in the use of growth curves between preterm and term infants in NICUs and newborn nurseries
- Author
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Jeffrey R. Kaiser, Sherry Z. Thrash, Ian M. Paul, Jennifer R. Miller, and Yuanyi L. Murray
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Pediatrics, Perinatology and Child Health ,MEDLINE ,Medicine ,business ,Term (time) - Published
- 2020
41. Flow Restrictors and Reduction of Accidental Ingestions of Over-the-Counter Medications
- Author
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Ian M. Paul, Randy I. Burnham, Heather Delva-Clark, Kate M. Reynolds, and Jody L. Green
- Subjects
Male ,Over the counter medications ,Poison Control Centers ,Injury control ,Epidemiology ,Poison control ,Ibuprofen ,Nonprescription Drugs ,Humans ,Medicine ,Million Units ,Pediatric Liquid ,Drug Packaging ,Acetaminophen ,business.industry ,Age Factors ,Public Health, Environmental and Occupational Health ,Infant ,United States ,Antitussive Agents ,Diphenhydramine ,Accidents ,Child, Preschool ,Anesthesia ,Accidental ingestion ,Female ,Seasons ,Drug Overdose ,business ,medicine.drug - Abstract
Flow restrictors are child-resistant packaging innovations designed to limit the amount of liquid dispensed from a medication bottle. In 2011, flow restrictors were added to pediatric liquid single-ingredient acetaminophen formulations. The hypothesis of this study is that implementation would be associated with reduced volume and severity of pediatric acetaminophen exposures reported to the U.S. National Poison Data System.This study describes accidental unsupervised ingestions of acetaminophen in children aged6 years. Exposures were grouped into pre-implementation (pre-period; January 4, 2010-July 17, 2011); transition (July 18, 2011-July 15, 2012); and post-implementation (post-period; July 16, 2012-December 25, 2016) periods. Cumulative and annual rates of change per million units (i.e., bottles) sold were calculated for the pre- and post-periods for acetaminophen and pediatric liquid ibuprofen (comparator without flow restrictors). Pre- to post-period rate ratios were used to compare products and to estimate the potential effect on other over-the-counter medications. Analysis was conducted in 2017 and 2018.The pre- and post-period cumulative acetaminophen exposure rate was 507.2 (95% CI=481.1, 534.6) and 325.6 (95% CI=305.8, 346.7) per 1 million units sold, respectively. Declines in the pre- versus post-period rate ratios were seen for exposures with any effect (0.642, 95% CI=0.591, 0.696) and with clinically significant outcomes (0.728, 95% CI=0.581, 0.913). In the post-period, acetaminophen exposures decreased faster than ibuprofen with a rate of change ratio of 0.936 (95% CI=0.912, 0.960) for all exposures and 0.939 (95% CI=0.909, 0.970) for exposures with any effect.The addition of flow restrictors to pediatric liquid acetaminophen was associated with a reduction in the number and severity of exposures. Application of flow restrictors to other liquid medications should be considered.
- Published
- 2019
42. Role of preoperative blood markers as prognostic factors for lung cancer surgery
- Author
-
Ian M. Paul, Alastair Graham, Reza Al-Saudi, and Umar Imran Hamid
- Subjects
Male ,Lung Neoplasms ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Fibrinogen ,Gastroenterology ,Hemoglobins ,0302 clinical medicine ,Risk Factors ,Carcinoma, Non-Small-Cell Lung ,Pneumonectomy ,Aged, 80 and over ,0303 health sciences ,Lung cancer surgery ,biology ,General Medicine ,Middle Aged ,Up-Regulation ,C-Reactive Protein ,Treatment Outcome ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Wedge resection (lung) ,Blood Platelets ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Clinical Decision-Making ,Risk Assessment ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Lung cancer ,Aged ,Retrospective Studies ,030304 developmental biology ,Proportional hazards model ,business.industry ,C-reactive protein ,Cancer ,medicine.disease ,biology.protein ,Surgery ,business ,Biomarkers - Abstract
Objective This study was undertaken to assess the potential value of preoperative blood components as prognostic markers of outcome after lung cancer resection, and hence their potential to aid in the selection of patients for curative surgery. Methods This was a single-center study on 313 patients who underwent surgery for non-small-cell lung cancer from 2006 to 2008. Data were analyzed retrospectively from a prospectively maintained thoracic database. Preoperative blood results including plasma fibrinogen levels, serum C-reactive protein, hemoglobin concentration, and platelet count were included in the analysis. Results The mean age was 75 years, and 40% of the patients were females. The most common resection was lobectomy in 68% of patients, followed by pneumonectomy, wedge resection, and segmentectomy in 18%, 10%, and 1.6%, respectively. Patients with abnormal C-reactive protein, fibrinogen, and hemoglobin levels had a worse overall survival. Large tumor size and nodal metastasis on clinical staging was also associated with poor survival. However, on Cox regression analysis, plasma fibrinogen and nodal metastasis were the only independent predictors of survival after lung resection. Conclusions Among the different blood markers, elevated preoperative plasma fibrinogen was an independent marker of reduced survival in patients with resected non-small-cell lung cancer, and its value in selecting patients who may benefit from surgery needs further investigation.
- Published
- 2019
43. Breastfeeding initiation and duration and child health outcomes in the first baby study
- Author
-
Danielle Symons Downs, Jennifer L. Kraschnewski, Kristen H. Kjerulff, Krista S. Leonard, Krista L. Pattison, Erik Lehman, Elizabeth L. Adams, Ian M. Paul, and Jennifer S. Savage
- Subjects
Adult ,Pediatric Obesity ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Epidemiology ,Breastfeeding ,Mothers ,Overweight ,Logistic regression ,01 natural sciences ,Article ,Childhood obesity ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,0101 mathematics ,Child ,Preventive healthcare ,business.industry ,Body Weight ,010102 general mathematics ,Child Health ,Public Health, Environmental and Occupational Health ,Infant ,medicine.disease ,Obesity ,Breast Feeding ,Child, Preschool ,Female ,medicine.symptom ,business ,Breast feeding ,Body mass index - Abstract
Despite the known benefits of breastmilk, associations between breastfeeding and child overall health outcomes remain unclear. We aimed to understand associations between breastfeeding and health outcomes, including child weight, through age 3. Analysis included women (N = 3006) in the longitudinal, prospective First Baby Study from 2009 to 2014. For this analysis, breastfeeding initiation and duration were measured using self-reported data from the 1-, 6- and 12-month surveys; child illnesses were analyzed from the 6-, 12-, and 24-month interviews; height and weight at age 3 were used to determine overweight/obese (≥85th percentile) and obese (≥95th percentile). Adjusted logistic regressions were utilized to determine significance. Greater duration of breastfeeding was associated with fewer reported acute illnesses at 6 months (p 0.001) and fewer diarrheal illness/constipation episodes at 6, 12, and 24 months (p = 0.05) in adjusted analyses. Fewer breastfed children, compared to non-breastfed children, were overweight/obese (23.5% vs. 37.8%; p = 0.032) or obese (9.1% vs. 21.6%; p = 0.012) at age 3. Breastfeeding duration was negatively associated with overweight/obese (never breastfed: 37.8%, 0-6 months: 26.9%,6 months: 20.2%; p = 0.020) and obesity (never breastfed: 21.6%, 0-6 months: 11.0%,6 months: 7.3%; p = 0.012). Overall, our findings support the hypothesis that duration of breastfeeding is associated with fewer reported acute illnesses at 6 months of age and diarrheal illness and/or constipation episodes at 6, 12, and 24 months. Additionally, results from our study suggest a protective effect of breastfeeding from childhood overweight/obesity, as children who received breastmilk for 6 months or longer had lower odds of overweight/obesity at age 3 years.
- Published
- 2019
44. Racial and Ethnic Diversity in Studies Funded under the Best Pharmaceuticals for Children Act
- Author
-
Kanecia O. Zimmerman, Kelly C. Wade, Susan M. Abdel-Rahman, Ian M. Paul, Gaurav Sharma, Janice E. Sullivan, Chi D. Hornik, Daniel K. Benjamin, and Paula Delmore
- Subjects
Male ,Canada ,Adolescent ,Ethnic group ,MEDLINE ,Legislation ,Article ,Young Adult ,Social Justice ,Cultural diversity ,Ethnicity ,Medicine ,Humans ,Generalizability theory ,Israel ,Child ,Minority Groups ,Clinical Trials as Topic ,Singapore ,Descriptive statistics ,business.industry ,Racial Groups ,Infant ,Census ,Legislation, Drug ,United States ,England ,Pharmaceutical Preparations ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Pacific islanders ,Female ,business ,Demography - Abstract
BACKGROUND AND OBJECTIVES: The Best Pharmaceuticals for Children Act (BPCA) incentivizes the study of on-patent medicines in children and mandates that the National Institutes of Health sponsor research on off-patent drugs important to pediatric therapeutics. Failing to enroll cohorts that reflect the pediatric population at large restricts the generalizability of such studies. In this investigation, we evaluate racial and ethnic minority representation among participants enrolled in BPCA-sponsored studies. METHODS: Data were obtained for all participants enrolled in 33 federally funded studies of drugs and devices conducted from 2008 through June 2020. Observed racial and ethnic distributions were compared with expected distributions by sampling Census data at the same geographic frequency as in the studies. Racial and ethnic enrollment was examined by demography, geography, study type, study burden, and expected bias. Standard descriptive statistics, χ2, generalized linear models, and linear regression were applied. RESULTS: A total of 10 918 participants (51% male, 6.6 ± 8.2 years) were enrolled across 46 US states and 4 countries. Studies ranged from treatment outcome reviews to randomized, placebo-controlled trials. Minority enrollment was comparable to, or higher than, expected (+0.1% to +2.6%) for all groups except Asian Americans (−3.7%, P < .001). American Indian and Alaskan Native and multiracial enrollment significantly increased over the evaluation period (P < .01). There were no significant differences in racial distribution as a function of age or sex, although differences were observed on the basis of geography, study type, and study burden. CONCLUSIONS AND RELEVANCE: This study revealed no evidence of racial and ethnic bias in enrollment for pediatric studies conducted with funding from BPCA, fulfilling the legislation’s expectation to ensure adequate representation of all children.
- Published
- 2021
45. Diabetes During Pregnancy Is Associated with Concern For Developmental Delay In Offspring
- Author
-
Nicole M. Hackman, Kristin H. Kjerulff, Brittany Massare, Ian M. Paul, Kristin K. Sznajder, and Douglas M. Teti
- Subjects
Pregnancy ,Pediatrics ,medicine.medical_specialty ,Offspring ,business.industry ,First pregnancy ,medicine.disease ,Motor function ,Diabetes mellitus ,Pediatrics, Perinatology and Child Health ,Cohort ,medicine ,Observational study ,business - Abstract
Background Maternal glucose intolerance during pregnancy has been associated with developmental delays and impairments in offspring including worse motor function and a greater likelihood of inattention and/or hyperactivity. The First Baby Study recruited an observational cohort 3006 women during their first pregnancy and followed maternal-child dyads for 3 years. We sought to evaluate associations between diabetes during pregnancy and subjective concern for developmental delay among offspring at ages …
- Published
- 2021
46. Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight
- Author
-
Ian M. Paul, Kristen H. Kjerulff, Danielle Symons Downs, Krista S. Leonard, Elizabeth L. Adams, Jennifer S. Savage, Jennifer L. Kraschnewski, and Krista L. Pattison
- Subjects
Mediation (statistics) ,030309 nutrition & dietetics ,Endocrinology, Diabetes and Metabolism ,Psychological intervention ,030209 endocrinology & metabolism ,Overweight ,Body Mass Index ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,0303 health sciences ,business.industry ,Postpartum Period ,medicine.disease ,Obesity ,Gestational Weight Gain ,Gestation ,Female ,medicine.symptom ,business ,Psychosocial ,Weight gain ,Stress, Psychological ,Clinical psychology - Abstract
Women with excessive gestational weight gain (GWG) are at risk for poor psychosocial well-being and postpartum weight retention (PPWR). Scant research has examined longitudinal interrelations of GWG, psychosocial factors, and PPWR. This study examined: (a) pre-pregnancy weight status (ie, normal, overweight, obesity) differences in PPWR and its psychosocial determinants (perceived social support, perceived stress, depression) in women with excessive GWG (ie, above 2009 Institute of Medicine guidelines); and (b) whether GWG mediated associations between psychosocial determinants and PPWR. Women (N = 1352) reported third trimester perceived social support, perceived stress, and depressive symptoms, GWG, and 6- and 12-month PPWR via telephone interviews. Multivariate ANOVA analyses showed women with normal weight had higher 6-month PPWR than women with obesity; univariate ANOVA showed no group differences in psychosocial factors. Hayes mediation analyses indicated that GWG mediated the association between perceived stress and PPWR in women with overweight but not women with normal weight or obesity; perceived stress predicted GWG, and in turn, PPWR. Prenatal perceived stress may be a modifiable target of GWG and PPWR. Future research is needed to examine the utility of tailoring perinatal weight regulation interventions to reduce perceived stress in pregnant women with overweight.
- Published
- 2021
47. Constructing a polygenic risk score for childhood obesity using functional data analysis
- Author
-
Ian M. Paul, Sarah J. C. Craig, Ana Kenney, Leann L. Birch, Michele E. Marini, Jennifer S. Savage, Francesca Chiaromonte, Matthew Reimherr, Junli Lin, and Kateryna D. Makova
- Subjects
Statistics and Probability ,Economics and Econometrics ,business.industry ,Functional data analysis ,Genome-wide association study ,Single-nucleotide polymorphism ,Heritability ,medicine.disease ,Childhood obesity ,Cohort ,medicine ,SNP ,Statistics, Probability and Uncertainty ,business ,Demography ,Genetic association - Abstract
Obesity is a highly heritable condition that affects increasing numbers of adults and, concerningly, of children. However, only a small fraction of its heritability has been attributed to specific genetic variants. These variants are traditionally ascertained from genome-wide association studies (GWAS), which utilize samples with tens or hundreds of thousands of individuals for whom a single summary measurement (e.g., BMI) is collected. An alternative approach is to focus on a smaller, more deeply characterized sample in conjunction with advanced statistical models that leverage longitudinal phenotypes. Novel functional data analysis (FDA) techniques are used to capitalize on longitudinal growth information from a cohort of children between birth and three years of age. In an ultra-high dimensional setting, hundreds of thousands of single nucleotide polymorphisms (SNPs) are screened, and selected SNPs are used to construct two polygenic risk scores (PRS) for childhood obesity using a weighting approach that incorporates the dynamic and joint nature of SNP effects. These scores are significantly higher in children with (vs. without) rapid infant weight gain—a predictor of obesity later in life. Using two independent cohorts, it is shown that the genetic variants identified in very young children are also informative in older children and in adults, consistent with early childhood obesity being predictive of obesity later in life. In contrast, PRSs based on SNPs identified by adult obesity GWAS are not predictive of weight gain in the cohort of young children. This provides an example of a successful application of FDA to GWAS. This application is complemented with simulations establishing that a deeply characterized sample can be just as, if not more, effective than a comparable study with a cross-sectional response. Overall, it is demonstrated that a deep, statistically sophisticated characterization of a longitudinal phenotype can provide increased statistical power to studies with relatively small sample sizes; and shows how FDA approaches can be used as an alternative to the traditional GWAS.
- Published
- 2021
48. INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years
- Author
-
Leann L. Birch, Emily E. Hohman, Cara F. Ruggiero, Jennifer S. Savage, and Ian M. Paul
- Subjects
0301 basic medicine ,media_common.quotation_subject ,Psychological intervention ,Appetite ,Child Behavior ,Mothers ,030209 endocrinology & metabolism ,Intervention effect ,Satiation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Group differences ,Intervention (counseling) ,Surveys and Questionnaires ,Medicine ,Humans ,Child ,General Psychology ,media_common ,Obesity prevention ,Meal ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Parenting ,business.industry ,Infant, Newborn ,Feeding Behavior ,Moderation ,Child, Preschool ,Female ,business ,Clinical psychology - Abstract
Expert guidance encourages interventions promoting structure-based practices to establish predictable eating environments in order to foster children's self-regulatory skills. However, few studies have examined whether and how child characteristics may moderate effects of interventions on maternal feeding practices. This analysis aimed to examine the effect of the INSIGHT Responsive Parenting (RP) intervention delivered largely during infancy, on child appetitive traits at 2.5 years and maternal feeding practices at 3 years. Primiparous mother-newborn dyads were randomized to a RP intervention designed for obesity prevention or a safety control intervention. Mothers completed the Child Eating Behavior Questionnaire at 2.5 years and the Structure and Control in Parent Feeding Questionnaire at 3 years. T-tests assessed study group differences on child appetitive traits at 2.5 years and maternal feeding practices at age 3. ANCOVA models assessed the effect of study group on parent feeding practices and tested appetitive traits as a moderator. Two hundred thirty-two mother-child dyads completed the trial. Mothers were predominantly white, non-Hispanic, college educated, and married. RP group mothers used more consistent meal routines, and less pressure, food to soothe, and food as reward compared to controls. Child satiety responsiveness moderated the RP intervention effect on maternal use of limiting exposure to unhealthy foods such that the RP intervention was most effective for children at higher levels of satiety responsiveness. Food responsiveness moderated RP intervention effects on maternal use of pressure, such that at lower levels of food responsiveness, control group mothers used more pressure than RP mothers. The INSIGHT RP intervention demonstrated sustained effects on maternal feeding practices through age 3 years, with some intervention effects showing moderation by child appetitive traits.
- Published
- 2020
49. Maternal use of food to soothe and temperament in infancy: A sibling analysis in the INSIGHT and SIBSIGHT cohorts
- Author
-
Michele E. Marini, Ian M. Paul, Jennifer S. Savage, Cara F. Ruggiero, Susan M. McHale, and Clare H. Llewellyn
- Subjects
Nutrition and Dietetics ,media_common.quotation_subject ,Temperament ,Sibling ,Psychology ,General Psychology ,media_common ,Developmental psychology - Published
- 2022
50. Correction to: Improving infant sleep safety via electronic health record communication: a randomized controlled trial
- Author
-
Jessica S. Beiler, Benjamin N. Fogel, Ethan A. Canty, Eric W. Schaefer, Erich K. Batra, and Ian M. Paul
- Subjects
medicine.medical_specialty ,business.industry ,lcsh:RJ1-570 ,MEDLINE ,lcsh:Pediatrics ,Infant sleep ,law.invention ,Randomized controlled trial ,Electronic health record ,law ,Pediatrics, Perinatology and Child Health ,Physical therapy ,medicine ,business - Abstract
An amendment to this paper has been published and can be accessed via the original article.
- Published
- 2020
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