Multicomponent school-initiated obesity intervention in a high-risk, Hispanic elementary school.

The aim of the study was to determine the effectiveness of a school-initiated cognitive and behavioral program to reduce childhood obesity. Height, weight, body mass index (BMI), and BMI z scores were obtained at the beginning and end of the school year at an intervention school (n = 1022) and at a control school (n = 692). The prevalence of overweight and obesity was 18.9% and 30.4% versus 19% and 30.2%, respectively, in the intervention and control schools. The incidence of overweight increased in the control school, but the incidence of obesity, weight, and BMI z scores increased significantly in the intervention school, suggesting that implementation of any school-based obesity intervention programs requires careful planning to achieve goals.

Mediational models of maternal stress in neonatal intensive care units.

BACKGROUND: Maternal stress in neonatal intensive care units (NICUs) is well acknowledged. However, there is currently no well-defined support at how to best assist mothers during their infants' hospitalization. Not only must they confront at the same time their infant's fragility, but also their own personal trials. In this exploratory study, we examined whether the Multiple-Stressor mediational modeling approach commonly used in Ecology could be used to better assist these parents. This approach calls attention to the overall impact that multiple stressors can have on an organism, i.e., not only in regard to their individual effects, but just as importantly, through their interactions with each other, be they positive or negative. It is hypothesized that the use of such mediational modeling could improve our understanding of the overall impact that multiple stressors can have on NICU mothers. METHODS: At 2 weeks postpartum, 30 mothers with infants born between 24 and 29 weeks gestation responded to the following self-reported psychological outcome measures: Affect Intensity Measure (AIM); Crowne-Marlowe Social Desirability Scale (CM); Edinburgh Postnatal Depression Scale (EDPS); Brief Symptom Inventory-Anxiety (BSI-Anx); Parental Stress Scale: NICU (PSS:NICU); Multidimensional Scale of Perceived Social Support (MSPSS); and Coping Inventory for Stressful Situations (CISS). The "Best Subsets Regression" analysis (www.minitab.com) was used to identify the four interactive maternal outcome measures that best correlated with the mediational stress models of interest, namely, Depression, Anxiety, parental NICU stress, Perceived Social Support, and Coping skills. RESULTS: The following mediational models of maternal stress outcomes during their infant's NICU hospitalization were identified: depression, anxiety, stress of the sights and sounds in the NICU, "the looks of my baby", my "inability" to be a parent, perceived social support, and coping skills. CONCLUSIONS: It is advanced that the use of the Multiple-Stressor approach, with its ability to identify factors associated with particular stressors, can offer psychosocial providers a more tangible understanding of the maternal key elements at the source of maternal stress in NICUs. It is expected that to ease the stressful experiences these mothers encounter, such approach will facilitate the development of more effective interventions to assist these parents' challenges than currently available.

Potocki-Lupski syndrome: a microduplication syndrome associated with oropharyngeal dysphagia and failure to thrive.

OBJECTIVE: Failure to thrive (FTT) is a feature of children with Potocki-Lupski syndrome (PTLS) [duplication 17p11.2]. This study was designed to describe the growth characteristics of 24 subjects with PTLS from birth through age 5 years in conjunction with relevant physical features and swallow function studies. STUDY DESIGN: We evaluated 24 individuals with PTLS who were ascertained by chromosome analysis and/or array comparative genome hybridization. Clinical assessments included review of medical records, physical examination, otolaryngological examination, and swallow function studies. Measures of height and weight were converted to Z-scores. RESULTS: The mean weight-for-age and weight-for-length Z-scores at birth were lower (P < .01) than the reference standard and did not change with age. A history of poor feeding, hypotonia, and FTT were reported in 92%, 88%, and 71%, respectively. Individuals with hypotonia had lower weight-for-age and body mass index-for-age Z-scores (P = .01). Swallow function studies demonstrated at least one abnormality in all subjects. CONCLUSIONS: FTT is common in children with PTLS. We hypothesize that oropharyngeal dysphagia and hypotonia likely contribute to FTT in patients with PTLS and recommend that once a diagnosis is established, the individual be assessed for feeding and growth issues and be availed of oromotor therapy and nutritional services.

Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants.

OBJECTIVE: We previously reported better psychomotor development at 30 months of age in infants whose mothers received a docosahexaenoic acid (DHA) (22:6n-3) supplement for the first 4 months of lactation. We now assess neuropsychological and visual function of the same children at 5 years of age. STUDY DESIGN: Breastfeeding women were assigned to receive identical capsules containing either a high-DHA algal oil (∼200 mg/d of DHA) or a vegetable oil (containing no DHA) from delivery until 4 months postpartum. Primary outcome variables at 5 years of age were measures of gross and fine motor function, perceptual/visual-motor function, attention, executive function, verbal skills, and visual function of the recipient children at 5 years of age. RESULTS: There were no differences in visual function as assessed by the Bailey-Lovie acuity chart, transient visual evoked potential or sweep visual evoked potential testing between children whose mothers received DHA versus placebo. Children whose mothers received DHA versus placebo performed significantly better on the Sustained Attention Subscale of the Leiter International Performance Scale (46.5 ± 8.9 vs 41.9 ± 9.3, P < .008) but there were no statistically significant differences between groups on other neuropsychological domains. CONCLUSIONS: Five-year-old children whose mothers received modest DHA supplementation versus placebo for the first 4 months of breastfeeding performed better on a test of sustained attention. This, along with the previously reported better performance of the children of DHA-supplemented mothers on a test of psychomotor development at 30 months of age, suggests that DHA intake during early infancy confers long-term benefits on specific aspects of neurodevelopment.

Age- and ethnic-specific elevation of ALT among obese children at risk for nonalcoholic steatohepatitis (NASH): implications for screening.

The objectives are to: (1) characterize ethnic-specific differences in alanine aminotransferase (ALT) elevation among obese children, (2) investigate the earliest ages at which significant ALT elevation occurs, and (3) determine associations between ALT and biochemical parameters. A cohort of 134 multiethnic obese children and adolescents was analyzed retrospectively. ALT levels > or =45 U/L or <45 U/L, denoting high or normal risk, were used to categorize obese children's risk for developing nonalcoholic steatohepatitis. In all, 60% of Hispanics had high-risk ALT levels compared with 12% of whites and 8% of blacks. A significantly higher proportion of boys had ALT > or = 45 U/L (49.4%, vs 37.9% for girls, P = .002); 17.5% were Hispanic boys less than 7 years old. Obese Hispanic children, particularly boys, not only have higher ALT levels but present alarmingly young with high-risk levels. This study highlights a discrete subgroup of children who may present with fatty liver at a younger age and should be screened earlier.

Comparison of the validity of direct pediatric developmental evaluation versus developmental screening by parent report.

To compare the validity of direct pediatric developmental evaluation with developmental screening by parent report, parents completed a developmental screen (the Child Development Review), a pediatrician performed a direct developmental evaluation (Capute Scales), and a psychologist administered the Bayley Scales of Infant Development to a group of 30-month-old children. The agreement between these instruments was tested. All developmental quotient scores derived from the Capute Scales were more highly correlated with concurrent Bayley Mental Development Index scores than developmental quotient scores derived from the Child Development Review. Differences between developmental quotient scores derived from the Capute Scales and corresponding Bayley Mental Development Index scores were significantly smaller than those derived from the Child Development Review. Thus, direct pediatric developmental evaluation more reliably predicted concurrent Mental Development Index scores at 30 months of age than developmental screening by parent report. Increased emphasis on training of pediatric health care providers in direct developmental evaluation should be considered.

Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants.

BACKGROUND: Normal brain and visual development is thought to require exogenous docosahexaenoic acid (DHA; 22:6n-3) intake, but the amount needed is debatable. Because the supplementation of breastfeeding mothers with DHA increases the DHA content of their infants' plasma lipids, we hypothesized that it might also improve brain or visual function in the infants. OBJECTIVE: The objective was to determine the effect of DHA supplementation of breastfeeding mothers on neurodevelopmental status and visual function in the recipient infant. DESIGN: Breastfeeding women received capsules containing either a high-DHA algal oil ( approximately 200 mg DHA/d) or a vegetable oil (no DHA) for 4 mo after delivery. Outcome variables included the fatty acid pattern of maternal plasma phospholipid and milk lipids 4 mo postpartum, the fatty acid pattern of plasma phospholipids and visual function in infants at 4 and 8 mo of age, and neurodevelopmental indexes of the infants at 12 and 30 mo of age. RESULTS: Milk lipid and infant plasma phospholipid DHA contents of the supplemented and control groups were approximately 75% and approximately 35% higher, respectively, at 4 mo postpartum. However, neither the neurodevelopmental indexes of the infants at 12 mo of age nor the visual function at 4 or 8 mo of age differed significantly between groups. In contrast, the Bayley Psychomotor Development Index, but not the Mental Development Index, of the supplemented group was higher (P < 0.01) at 30 mo of age. CONCLUSION: DHA supplementation of breastfeeding mothers results in higher infant plasma phospholipid DHA contents during supplementation and a higher Bayley Psychomotor Development Index at 30 mo of age but results in no other advantages either at or before this age.

Mitral valve morphology and morbidity/mortality in Shone's complex.

Early echocardiographic studies of 50 patients with Shone's complex were retrospectively examined to identify left-sided cardiac features associated with progressive mitral valve (MV) disease requiring intervention, as well as mortality. Thickened MV leaflets, shortened MV chordae coupled with either thickened MV leaflets or turbulence at or below the MV noted by color Doppler, left ventricular outflow tract obstruction without coarctation of the aorta, and mild or moderate aortic insufficiency were associated with a poor prognosis.

Characteristics and outcomes of fetuses with pericardial effusions.

Little is known about the characteristics and outcomes of fetuses with pericardial effusions (PEs); therefore, this study sought to identify factors associated with fetal PEs and the natural histories and outcomes of fetuses with PEs. Large PEs are associated with a greater likelihood of structural heart disease, impaired cardiac function, and chromosomal abnormalities, and PEs with hydrops or extracardiac malformations are associated with death. Most fetal PEs resolve, and fetuses with isolated PEs have a very good prognosis.

Concurrent and predictive validity of the cognitive adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) and the Mental Developmental Index of the Bayley Scales of Infant Development.

The Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was designed for use by primary pediatric health care providers to identify children with developmental delays. This study assesses the concurrent and predictive validity of CAT/CLAMS developmental quotient (DQ) scores and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development in healthy children without risk factors for developmental delay. Overall CAT/CLAMS DQ scores correlated significantly with Bayley MDI scores at both 12 (r = 0.393; p = 0.008) and 30 months (r = 0.742; p = 0.0001) of age. Overall CAT/CLAMS DQ scores at 12 months of age also correlated modestly with Bayley MDI scores at 30 months of age (r = 0.181; p = 0.036). Despite its modest predictive validity at 12 months, its satisfactory concurrent validity plus its ease and speed of administration make the CAT/CLAMS a reasonable choice for assessment of early development by primary pediatric health care providers.

Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations.

BACKGROUND: Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage. OBJECTIVE: To determine if introduction of bubble nasal CPAP (bnCPAP), early surfactant treatment, and rapid extubation (combined bnCPAP strategy) in our community-based neonatal ICU reduced bronchopulmonary dysplasia (BPD). METHODS: This was a 7-year retrospective,single-institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model. RESULTS: The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4% (P = .02), reaching a minimum in the last post-bnCPAP year of22.1% (P = .02). When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD(P = .003, odds ratio 0.43, 95% CI 0.25­ 0.75). Decreases occurred in mechanical ventilation and the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely-low-birth-weight newborns, improved respiratory outcomes in the post-bnCPAP years,as compared to outcomes in the pre-bnCPAP years, included an increase in the percentage alive and off mechanical ventilation at 1 week postnatal age (P < .001), a more rapid extubation rate(P < .03), a decrease in the median days on mechanical ventilation (P = .002), and a decrease in the percentage with BPD plus died (P = .01). Post-bnCPAP extremely-low-birth-weight babies had a statistically significant decrease in retinopathy of prematurity, an increase in low-grade intraventricular hemorrhage, and a decrease in ductal ligations. CONCLUSIONS: A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.

Clinical outcomes of a 2-y soy isoflavone supplementation in menopausal women.

BACKGROUND: Soy isoflavones are naturally occurring phytochemicals with weak estrogenic cellular effects. Despite numerous clinical trials of short-term isoflavone supplementation, there is a paucity of data regarding longer-term outcomes and safety. OBJECTIVE: Our aim was to evaluate the clinical outcomes of soy hypocotyl isoflavone supplementation in healthy menopausal women as a secondary outcome of a trial on bone health. DESIGN: A multicenter, randomized, double-blind, placebo-controlled 24-mo trial was conducted to assess the effects of daily supplementation with 80 or 120 mg aglycone equivalent soy hypocotyl isoflavones plus calcium and vitamin D on the health of 403 postmenopausal women. At baseline and after 1 and 2 y, clinical blood chemistry values were measured and a well-woman examination was conducted, which included a mammogram and a Papanicolaou test. A cohort also underwent transvaginal ultrasound measurements to assess endometrial thickness and fibroids. RESULTS: The baseline characteristics of the groups were similar. After 2 y of daily isoflavone exposure, all clinical chemistry values remained within the normal range. The only variable that changed significantly was blood urea nitrogen, which increased significantly after 2 y (P = 0.048) but not after 1 y (P = 0.343) in the supplementation groups. Isoflavone supplementation did not affect blood lymphocyte or serum free thyroxine concentrations. No significant differences in endometrial thickness or fibroids were observed between the groups. Two serious adverse events were detected (one case of breast cancer and one case of estrogen receptor-negative endometrial cancer), which was less than the expected population rate for these cancers. CONCLUSION: Daily supplementation for 2 y with 80-120 mg soy hypocotyl isoflavones has minimal risk in healthy menopausal women. This trial was registered at clinicaltrials.gov as NCT00665860.

Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children.

BACKGROUND: The association between body mass index (BMI) and gastroesophageal reflux disease (GERD) has been extensively studied among adults but few studies have examined such association in children. AIMS: 1) to determine the relationship between BMI in children and GERD, and 2) to use the National Center for Health Statistics (NCHS) values for BMI as a valid source for comparison. METHODS: We identified two cohorts of children aged between two and 17 years who were seen at Texas Children's Hospital (TCH). The first cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI) at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic findings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal reflux (GER) who received outpatient gastrointestinal (GI) consultation at TCH for any 9th revision of the International Statistical Classification of Diseases (ICD-9) code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded. MEASUREMENTS: The records for each child namely, age, gender, height, and weight were obtained on the same date as that of the diagnosis. Using the growth curves published by the NCHS, the gender/age specific weight-for-age Z-score (WAZ), and height-for-age Z-score (HAZ) were calculated. BMI was calculated as the weight in kilograms divided by height in meters squared. Children having values greater than the 95th percentile for their age/gender-specific BMI were defined as obese. RESULTS: In a one-year period (January 2006 to December 2006), a total of 627 children who attended the GI clinic at TCH were identified with GERD symptoms of whom 131 underwent endoscopic examination. The mean age was 9.7 years; 42% were females; 57% were Caucasians; 15% were African Americans, and 28% were Hispanics. Using National Health and Nutrition Examination Survey (NHANES) data obtained from the same period as the the current data as a baseline for comparison, the BMI of children diagnosed with GERD was higher than the BMI reported by NHANES data. The final analysis of test proportion showed an overall proportion of 0.207 for the current study versus NHANES data (0.174). The current study also showed that more boys than girls have BMI greater than 95th percentile (24.7% vs 16.5%, respectively, OR = 1.7, 95% CI = 1.2-2.6, p = 0.04). CONCLUSIONS: Children diagnosed with GERD or those who presented with symptoms of GERD are more likely to be obese. The findings of this study show a possible association between obesity and GERD in children. Further understanding about the co-morbidity between GERD and obesity in children may have important implications on GERD management and treatment in children.

Soy isoflavone supplementation and bone mineral density in menopausal women: a 2-y multicenter clinical trial.

BACKGROUND: Isoflavones are naturally occurring plant estrogens that are abundant in soy. Although purported to protect against bone loss, the efficacy of soy isoflavone supplementation in the prevention of osteoporosis in postmenopausal women remains controversial. OBJECTIVE: Our aim was to test the effect of soy isoflavone supplementation on bone health. DESIGN: A multicenter, randomized, double-blind, placebo-controlled 24-mo trial was conducted to assess the effects of daily supplementation with 80 or 120 mg of soy hypocotyl aglycone isoflavones plus calcium and vitamin D on bone changes in 403 postmenopausal women. Study subjects were tested annually and changes in whole-body and regional bone mineral density (BMD), bone mineral content (BMC), and T scores were assessed. Changes in serum biochemical markers of bone metabolism were also assessed. RESULTS: After study site, soy intake, and pretreatment values were controlled for, subjects receiving a daily supplement with 120 mg soy isoflavones had a statistically significant smaller reduction in whole-body BMD than did the placebo group both at 1 y (P < 0.03) and at 2 y (P < 0.05) of treatment. Smaller decreases in whole-body BMD T score were observed among this group of women at 1 y (P < 0.03) but not at 2 y of treatment. When compared with the placebo, soy isoflavone supplementation had no effect on changes in regional BMD, BMC, T scores, or biochemical markers of bone metabolism. CONCLUSION: Daily supplementation with 120 mg soy hypocotyl isoflavones reduces whole-body bone loss but does not slow bone loss at common fracture sites in healthy postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00665860.

The Test of Variables of Attention (TOVA): internal consistency (Q1 vs. Q2 and Q3 vs. Q4) in children with attention deficit/hyperactivity disorder (ADHD).

The internal consistency of the Test of Variables of Attention (TOVA) was examined in a cohort of 6- to 12-year-old children (N = 63) strictly diagnosed with ADHD. The internal consistency of errors of omission (OMM), errors of commission (COM), response time (RT), and response time variability (RTV) of different test conditions (stimulus infrequent condition [Q1 vs. Q2] and stimulus frequent condition [Q3 vs. Q4]) was assessed via correlation analyses. All TOVA index scores under investigation assessing its internal consistency exhibited statistically significant correlations. All correlations fell in the moderate-high range.

Nitric oxide in the evaluation of congenital heart disease with pulmonary hypertension: factors related to nitric oxide response.

Inhaled nitric oxide (NO) has been used in the preoperative evaluation of patients with congenital heart disease and pulmonary hypertension. The purpose of this study was to characterize responses in pulmonary vascular resistance (PVR) to oxygen and increasing doses of NO during cardiac catheterization and to determine if any related factors affect the response of the pulmonary vascular bed to NO. A prospective analysis of 42 patients (median age, 3.0 years) with congenital heart disease and pulmonary hypertension who underwent NO testing was performed. Systemic vascular resistance (SVR) and PVR were assessed in room air, 100% oxygen, and oxygen plus 20, 40, and 80 parts per million (ppm) NO. Changes in pulmonary artery pressure, PVR, and SVR were assessed. The response to NO was then correlated to individual patient's age, gender, type of heart defect, the presence of trisomy 21, and baseline PVR/SVR. There was a greater decrease in PVR and PVR/SVR with 20 ppm NO than with oxygen alone. There was no additional decrease at 40 or 80 ppm NO. There was no correlation between age, gender, type of congenital heart disease, and baseline PVR/SVR ratio with the degree of response to NO. Patients with trisomy 21 had less of a response to NO (p = 0.017) than patients without trisomy 21. There is no difference in determining PVR response with doses of NO beyond 20 ppm during cardiac catheterization. Age, gender, and baseline PVR/SVR ratio are not associated with responsiveness to NO. Patients with trisomy 21 may be less responsive to NO.

Growth characteristics of children with ectodermal dysplasia syndromes.

OBJECTIVE: Clinical observations suggested that growth abnormalities may be present in children with ectodermal dysplasia (ED) syndromes. This study characterizes the longitudinal pattern of growth in a cohort of children with the ED syndromes. We hypothesized that (1) linear and ponderal growth abnormalities are present in children with ED from infancy through adolescence, and (2) linear and ponderal growth abnormalities differ among the clinical variants of these disorders. METHODS: We studied 138 children who had ED and were registered with the National Foundation for Ectodermal Dysplasias, 74% of whom had clinical features consistent with the hypohidrotic EDs (HEDs). Height (or length) and weight measurements were obtained by standardized techniques and from review of available medical records. We converted these measurements to weight-for-height (children younger than 5 years and <103 cm in length) or BMI (children > or =2 years old). Height, weight, weight-for-height, and BMI were converted to age- and gender-specific z scores. We applied linear regression, 1-sample t tests, and analysis of variance to detect linear and ponderal growth abnormalities in children with ED compared with a reference population. RESULTS: Mean weight-for-age, weight-for-height, and BMI-for-age z scores but not height-for-age z score, were significantly lower in children with the ED syndromes than in the reference population. Mean weight-for-age and weight-for-height z scores but not BMI-for-age or height-for-age z scores increased significantly with increasing age. The mean height-for-age z score of children with the ED syndromes other than the HEDs was significantly lower than that of children with the HEDs. CONCLUSIONS: Growth abnormalities, measured as weight deficits, were present at an early age in children with the ED syndromes and persisted through adolescence. Height deficits were seen only in children with ED syndromes other than HEDs. Clinicians should evaluate carefully children with ED syndromes for growth abnormalities.

Helicobacter pylori infection in asymptomatic children: impact of epidemiologic factors on accuracy of diagnostic tests.

BACKGROUND: Childhood is a time of high risk for acquiring H. pylori infection. Accurate information on the epidemiology of the infection requires accurate diagnostic tests. OBJECTIVE: To study the epidemiologic factors that influence the accuracy of diagnostic tests among asymptomatic children. METHODS: Two rapid, noninvasive assays (FlexSure whole-blood test and OraSure saliva test) were evaluated using the 13C-urea breath test ((13)C-UBT) as the gold standard. The three diagnostic tests were conducted in children from 10 licensed day care centers from various locations in Houston, Texas. Demographic information and socioeconomic factors evaluated included age, gender, ethnicity, and crowded living conditions in each center. The three tests were conducted on each child on the same day. We examined the effect of epidemiologic factors on the sensitivity, the specificity, and the positive and negative predictive values of both tests. RESULTS: Thirty-two percent of the 243 asymptomatic children who participated in the study tested positive for H. pylori using 13C-UBT. Among all the children, the sensitivities of FlexSure and OraSure were 47% (95% confidence interval, 35-57%) and 65% (95% confidence interval, 54-73%), respectively. Both tests had greater than 95% specificity. Positive and negative predictive values for FlexSure were 86% and 80%, respectively, and 98% and 86% for OraSure. Among children attending the more crowded day care centers, the sensitivities of FlexSure and OraSure were 40% and 63%, respectively, compared with 100% sensitivity for FlexSure and 80% sensitivity for OraSure among children attending the less-crowded centers. FlexSure and OraSure tests had the highest sensitivities among the 6-to 10-year-olds. Ethnicity had no effect on the sensitivity or the specificity of either test. CONCLUSION: Epidemiologic factors influenced the accuracy of serologic tests for diagnosing H. pylori infection in children. The lowest sensitivities of both tests were among children who attended the more crowded centers and among the youngest and oldest age groups, reflecting an increased proportion of recent infections. The strategy for choosing a diagnostic test for H. pylori infection in children varies based on the epidemiologic characteristics of the studied population.

Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing.

OBJECTIVE: The purpose of this study was to determine the effect of docosahexaenoic acid supplementation on plasma phospholipid docosahexaenoic acid content and indices of depression and information processing for women who breast-feed. STUDY DESIGN: Mothers who planned to breast-feed their infants were assigned randomly in a double-masked fashion to receive either docosahexaenoic acid (approximately 200 mg/d) or placebo for the first 4 months after the delivery. Major outcome variables included plasma phospholipid fatty acid patterns and scores on a self-rating questionnaire of current depression symptoms. A structured clinical interview of depression, scores on another self-rating questionnaire of depression symptoms, and a laboratory measure of information processing were obtained in subgroups of the total population. RESULTS: Plasma phospholipid contents of docosahexaenoic acid at baseline were 3.15 +/- 0.78 and 3.31 +/- 0.70 (mg/dL of total fatty acids) in the docosahexaenoic acid and placebo groups, respectively. After 4 months, the plasma phospholipid docosahexaenoic acid content of the docosahexaenoic acid group was 8% higher (3.40 +/- 0.97 mg/dL), whereas that of the placebo group was 31% lower (2.27 +/- 0.87 mg/dL). Despite the higher plasma phospholipid docosahexaenoic acid content of the supplemented group after 4 months, there was no difference between groups in either self-rating or diagnostic measures of depression; information processing scores of the two groups also did not differ. CONCLUSION: Docosahexaenoic acid supplementation ( approximately 200 mg/d) for 4 months after the delivery prevented the usual decline in plasma phospholipid docosahexaenoic acid content of women who breastfeed but did not influence self-ratings of depression, diagnostic measures of depression, or information processing.