Diuretic exposure in premature infants from 1997 to 2011.

OBJECTIVE: Diuretics are often prescribed off-label to premature infants, particularly to prevent or treat bronchopulmonary dysplasia. We examined their use and safety in this group. STUDY DESIGN: Retrospective cohort study of infants < 32 weeks gestation and < 1,500 g birth weight exposed to diuretics in 333 neonatal intensive care units from 1997 to 2011. We examined use of acetazolamide, amiloride, bumetanide, chlorothiazide, diazoxide, ethacrynic acid, furosemide, hydrochlorothiazide, mannitol, metolazone, or spironolactone combination. Respiratory support and fraction of inspired oxygen on the first day of each course of diuretic use were identified. RESULTS: About 37% (39,357/107,542) infants were exposed to at least one diuretic; furosemide was the most commonly used (93% with ≥ 1 recorded dose), followed by spironolactone, chlorothiazide, hydrochlorothiazide, bumetanide, and acetazolamide. About 74% patients were exposed to one diuretic at a time, 19% to two diuretics simultaneously, and 6% to three diuretics simultaneously. The most common combination was furosemide/spironolactone, followed by furosemide/chlorothiazide and chlorothiazide/spironolactone. Many infants were not receiving mechanical ventilation on the first day of each new course of furosemide (47%), spironolactone (69%), chlorothiazide (61%), and hydrochlorothiazide (68%). Any adverse event occurred on 42 per 1,000 infant-days for any diuretic and 35 per 1,000 infant-days for furosemide. Any serious adverse event occurred in 3.8 for any diuretic and 3.2 per 1,000 infant-days for furosemide. The most common laboratory abnormality associated with diuretic exposure was thrombocytopenia. CONCLUSION: Despite no Food and Drug Administration (FDA) indication and little safety data, over one-third of premature infants in our population were exposed to a diuretic, many with minimal respiratory support.

Connecting and linking neurocognitive, digital phenotyping, physiologic, psychophysical, neuroimaging, genomic, & sensor data with survey data.

Combining survey data with alternative data sources (e.g., wearable technology, apps, physiological, ecological monitoring, genomic, neurocognitive assessments, brain imaging, and psychophysical data) to paint a complete biobehavioral picture of trauma patients comes with many complex system challenges and solutions. Starting in emergency departments and incorporating these diverse, broad, and separate data streams presents technical, operational, and logistical challenges but allows for a greater scientific understanding of the long-term effects of trauma. Our manuscript describes incorporating and prospectively linking these multi-dimensional big data elements into a clinical, observational study at US emergency departments with the goal to understand, prevent, and predict adverse posttraumatic neuropsychiatric sequelae (APNS) that affects over 40 million Americans annually. We outline key data-driven system challenges and solutions and investigate eligibility considerations, compliance, and response rate outcomes incorporating these diverse "big data" measures using integrated data-driven cross-discipline system architecture.

Longitudinal trends in race/ethnic disparities in leading health indicators from adolescence to young adulthood.

OBJECTIVE: To use ethnically diverse, national data to examine longitudinal trends in race/ethnic disparities in 20 leading health indicators from Healthy People 2010 across multiple domains from adolescence to young adulthood. Much of what is known about health disparities is based on cross-sectional measures collected at a single time point. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data for more than 14 000 adolescents enrolled in wave I (1994-1995) or wave II (1996) of the National Longitudinal Study of Adolescent Health (Add Health) and followed up into adulthood (wave III; 2001-2002). We fit longitudinal regression models to assess and contrast the trend in health indicators among racial/ethnic groups of adolescents as they transition into adulthood. MAIN OUTCOME MEASURES: Diet, inactivity, obesity, tobacco use, substance use, binge drinking, violence, sexually transmitted diseases, mental health, and health care access. RESULTS: Diet, inactivity, obesity, health care access, substance use, and reproductive health worsened with age. Perceived health, mental health, and exposure to violence improved with age. On most health indicators, white and Asian subjects were at lowest and Native American subjects at highest risk. Although white subjects had more favorable health in adolescence, they experienced greatest declines by young adulthood. No single race/ethnic group consistently leads or falters in health across all indicators. CONCLUSIONS: Longitudinal data indicate that, for 15 of 20 indicators, health risk increased and access to health care decreased from the teen and adult years for most US race/ethnic groups. Relative rankings on a diverse range of health indicators (and patterns of change over time) vary by sex and race/ethnicity, causing disparities to fluctuate over time.

Reactions of young adults to September 11, 2001.

BACKGROUND: Wave III of the National Longitudinal Study of Adolescent Health provides opportunities to describe the reactions of young adults to September 11, 2001, and to increase understanding of the reactions among those who do not directly witness disasters. OBJECTIVES: To compare the feelings, perceptions, and behaviors of respondents interviewed before with those of respondents interviewed within 9 weeks after September 11; and to test the influence of time and distance from terrorist sites on pre-post comparisons. DESIGN: Cross-sectional study, with comparison groups before and after September 11. SETTING: In-home interviews. PARTICIPANTS: Seven thousand ninety-five respondents aged 18 to 26 years. MAIN OUTCOME MEASURES: Sadness, psychological distress, closeness to parents, importance of religion and spirituality, trust in government, and substance use. RESULTS: Male (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.08-1.65) and female (aOR, 1.44; 95% CI, 1.22-1.71) respondents interviewed after September 11 were more likely to report sadness and increased trust in government (aOR range, 2.11-3.30) than those interviewed before September 11. Proportions reporting sadness returned to baseline in 4 to 6 weeks; increased political trust persisted for the 9-week study period. Male respondents interviewed the second week afterwards were more likely to report religious faith (aOR, 2.06; 95% CI, 1.40-3.00) and spiritual life (aOR, 1.75; 95% CI, 1.18-2.60) as important than were those interviewed before the event. Female respondents interviewed afterwards were more likely to report higher levels of psychological distress (aOR, 1.40; 95% CI, 1.08-1.83) and closeness to fathers (aOR, 1.36; 95% CI, 1.08-1.72). There were no pre-post differences in substance use. Respondents closest to terrorist sites were most affected. CONCLUSION: Young adults who did not directly witness the events of September 11 experienced reactions that were multifaceted and transient--except for persisting trust in government.

Risk assessment of adolescents with same-sex relationships.

PURPOSE: To compare the risk status on health and behavior for those with same-sex partners and those without. METHODS: Add Health data provide a sample of 20,745 adolescents in grades 7 through 12 interviewed at home. The risk statuses of respondents with no partners, same-sex-only partners, and partners of both sexes were compared to respondents with opposite-sex partners only. Respondents were evaluated on selected personal and social attributes (verbal IQ, family structure, masculinity, popularity), and risk status (substance use, depression, suicidal thoughts, anal sex, general delinquency, being physically attacked, perceived risk of being killed or getting AIDS). Data were analyzed by logistic and linear regression using STATA to adjust for clustering and sampling weights. RESULTS: Compared to boys with opposite-sex-only partners, boys with same-sex-only partners were at high risk for emotional problems, but not delinquency or substance use. Boys with partners of both sexes were at high risk for delinquency and substance use, but not for emotional problems. Neither group of boys with same-sex partners is at high risk of being attacked compared to those with opposite-sex partners only. Girls with only same-sex partners are never a high-risk group, while girls with partners of both sexes are the high-risk category in every case. CONCLUSIONS: Adolescents with same-sex-only partners do not resemble those with partners of both sexes in risk status. Combining the two categories obscures the unique risk profile of those with both-sex partners, and obscures the low risk on most variables but the high emotional risk of boys with only same-sex partners.

Masculinity-femininity guides sexual union formation in adolescents.

The authors test the idea that patterns of masculinity-femininity (MF) help sort adolescents into romantic couples. Using a nationally representative sample of adolescents in Grades 7 to 12 from a probability sample of secondary schools in the United States, an MF measure was constructed by selecting a set of questionnaire items demonstrating sex differences. For each respondent, the probability of being a boy was predicted. Respondents identified opposite-sex romantic partners within their school. When the partner identified also was interviewed, the authors were able to create MF for both members of the couple. Trichotomizing MF scores for each sex, it was determined that couples with a very masculine boy and very feminine girl are most likely to have sex, and to have sex the soonest. The couples for which both members are in the average MF range for their sex are the quickest to break up. The pattern of MF is a strong influence on the behavior of adolescent romantic couples.

Improving human papillomavirus vaccine delivery: a national study of parents and their adolescent sons.

PURPOSE: We examined parents' and adolescents' preferences regarding potential strategies to increase human papillomavirus (HPV) vaccination rates, including offering the vaccine in alternative settings, concomitant administration of vaccines, and optimizing the structure of vaccination medical visits. METHODS: A national sample of U.S. parents of adolescent boys aged 11-17 years (n = 506) and their sons (n = 391) completed online surveys in August and September 2010. We used analysis of variance for mixed designs to examine preferences for vaccination settings. RESULTS: Parents and sons were most comfortable with sons receiving HPV vaccine in a doctor's office. Parents of sons who had not visited their regular health care providers in the past year were more comfortable with sons receiving HPV vaccine at a public clinic (p < .001) or school (p < .05) compared with parents whose sons had recent visits. Results from the son survey showed a similar pattern. Parents and sons reported moderate levels of acceptability of concomitant administration. They most preferred to have the three HPV vaccine shots administered during brief nurse visits. CONCLUSIONS: Offering HPV vaccine in alternative settings and administering it with other recommended adolescent vaccines may increase uptake among adolescent boys. Parents and sons may prefer HPV vaccines be administered during brief nurse visits.

The association between maternal glucose concentration and child BMI at age 3 years.

OBJECTIVE: The objective of the study was to determine the association between child BMI at age 3 years and maternal glucose concentration among women without pre-existing diabetes or a gestational diabetes mellitus (GDM) diagnosis. RESEARCH DESIGN AND METHODS: Data are from the Pregnancy Infection and Nutrition and Postpartum studies and include 263 mother-child pairs. Measured weights and heights at 3 years were used to calculate age- and sex-specific BMI z scores and percentiles. Multivariable linear regression models were used to examine associations of continuous BMI z scores with maternal glucose concentration. Modified Poisson regression estimated risk ratios of child overweight/obesity (BMI ≥ 85th percentile). RESULTS: The mean (SD) maternal glucose concentration and prepregnancy BMI were 103.8 (23.7) mg/dL and 24.3 (5.9) kg/m(2), respectively. At 3 years, the mean (SD) child BMI z score was 0.29 (0.99), 20.9% were overweight/obese and 5.3% were obese. In the adjusted model, when compared with glucose concentration <100 mg/dL, a concentration ≥ 130 mg/dL was associated with significantly higher child BMI z score at 3 years (estimated z score difference of 0.39 [95% CI: 0.03-0.75]). With the use of the same reference category, a concentration ≥ 130 mg/dL was associated with an approximate twofold greater risk of child overweight/obesity (adjusted risk ratio 2.34 [95% CI: 1.25-4.38]). CONCLUSIONS: Fetal exposure to high maternal glucose concentration in the absence of pre-existing diabetes or GDM may contribute to the development of overweight/obesity in the offspring, independent of maternal prepregnancy BMI.

Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life.

PURPOSE: The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n=551) and Caribbean Black men (n=1,217). METHODS: We used the 2001-2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. RESULTS: Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. CONCLUSIONS: Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

Does framing human papillomavirus vaccine as preventing cancer in men increase vaccine acceptability?

BACKGROUND: Human papillomavirus (HPV) vaccine is now approved for use in males in the United States to prevent genital warts. We conducted an experiment to see whether framing HPV vaccination as also preventing cancer in men would increase men's vaccination willingness. METHODS: We conducted an online survey in January 2009 with a national sample of men ages 18 to 59 years who self-identified as gay/bisexual (n = 312) or heterosexual (n = 296). In the within-subjects experiment, men read four randomly ordered vignettes that described hypothetical vaccines that prevented either genital warts alone, or genital warts and either anal cancer, oral cancer, or penile cancer. We analyzed data using repeated measures ANOVA and tested whether perceived severity or perceived likelihood mediated the effect of disease outcome framing on men's HPV vaccination willingness. RESULTS: Although only 42% of men were willing to receive HPV vaccine when it was framed as preventing genital warts alone, 60% were willing to get it when it was framed as preventing cancer in addition to genital warts (P < 0.001). The effect of outcome framing was the same for heterosexual and gay/bisexual men and for the three cancer types examined. Perceived severity of disease partially mediated the association between disease outcome and HPV vaccination willingness. CONCLUSIONS: Men may be more accepting of HPV vaccine when it is framed as preventing cancer, regardless which of the three most common HPV-related cancers in men is described. IMPACT: Study findings may be useful in developing health communication messages that maximize HPV vaccine acceptability among young men.

Masculinity-femininity predicts sexual orientation in men but not in women.

Using the nationally representative sample of about 15,000 Add Health respondents in Wave III, the hypothesis is tested that masculinity-femininity in adolescence is correlated with sexual orientation 5 years later and 6 years later: that is, that for adolescent males in 1995 and again in 1996, more feminine males have a higher probability of self-identifying as homosexuals in 2001-02. It is predicted that for adolescent females in 1995 and 1996, more masculine females have a higher probability of self-identifying as homosexuals in 2001-02. Masculinity-femininity is measured by the classical method used by Terman & Miles. For both time periods, the hypothesis was strongly confirmed for males: the more feminine males had several times the probability of being attracted to same-sex partners, several times the probability of having same-sex partners, and several times the probability of self-identifying as homosexuals, compared with more masculine males. For females, no relationship was found at either time period between masculinity and sex of preference. The biological mechanism underlying homosexuality may be different for males and females.

Risk factors differ according to same-sex and opposite-sex interest.

Are risk behaviours in adolescence differentiated according to same-sex vs opposite-sex interest? For all respondents a five-point scale of interest in each sex used information from both of the first two in-home waves of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regression predicted the probability of experiencing each risk behaviour from the same-sex and opposite-sex interest scores. Same-sex interests have more effect on emotional risk, and opposite-sex interests have more effect on substance use. Nevertheless, all risk variables except boys' depression are responsive to both same-sex and opposite-sex interest. The same-sex interest component of risk is attributed to the emotional strain of living with an anomalous sex interest in a heterosexual society.

Predictors of pregnancy and postpartum haemoglobin concentrations in low-income women.

OBJECTIVE: Pregnancy and postpartum iron status is of great public health importance, yet few studies have examined predictors of haemoglobin (Hb) concentration during this time. We identified predictors of Hb from 24 weeks' gestation until delivery and from 4 to 25 weeks postpartum. DESIGN: Blood was drawn as many as four times during care: at the initial visit, at 24-29 weeks' gestation, at delivery and postpartum. A longitudinal, multivariable linear regression model was used to predict Hb concentration. SETTING: A public health clinic in Raleigh, North Carolina. SUBJECTS: n=520 women who participated in the Iron Supplementation Study. RESULTS: Hb concentration at the previous blood draw, short stature, non-Hispanic white ethnicity/race, >12 years of education and smoking were positive predictors of pregnancy and postpartum Hb concentrations. Iron supplement use was a positive predictor, while inadequate weight gain and severe nausea/vomiting were negative predictors of gestational Hb. A high infant birth weight and postpartum haemorrhage were negative predictors of postpartum Hb. Pre-pregnancy body mass index had a slight positive relationship with gestational Hb, but had a strong negative relationship with postpartum Hb. The longitudinal model also confirmed the typical pattern of gestational Hb concentration. As the number of weeks between the initial visit and the 24- to 29-week visit increased, Hb at 24-29 weeks' gestation decreased. As gestational age increased from 24 weeks until delivery, Hb concentration increased as well. CONCLUSIONS: The predictors identified here could be used in clinical settings to target high-risk women for intervention.

Calcium intake during pregnancy among white and African-American pregnant women in the United States.

OBJECTIVE: To characterize the calcium intake in a racially mixed cohort of pregnant women, including the contribution of supplementation and antacids. METHODS: A cohort of women was interviewed twice during their pregnancies. The interviews included a food frequency questionnaire and questions on calcium supplementation and antacid intake. Pregnant women seeking prenatal care at a Pittsburgh hospital in the first trimester were enrolled. 454 women were enrolled and did not miscarry; 385 completed two interviews and were of white or African-American race. RESULTS: Mean and median intakes of calcium were 1671 mg/day and 1482 mg/day. 36% of the women were under the former RDA level (1200 mg/day) for calcium, while 26% were under the current AI (1000 mg/day). Six percent were taking in less than 600 mg/day, and 15% over 2500 mg/day, the tolerable upper limit. Young women were particularly likely to have low intakes (12% of those less than 21 years of age had less than 600 mg/day). Black women were slightly overrepresented among those with low intake (8% vs. 5% of whites), but, overall, their intake was quite similar to whites. Milk and cheese provided more calcium than other food items. Many women took antacids, especially during the second half of pregnancy, and these were a major source of calcium for some members of the cohort. CONCLUSIONS: Although mean and median calcium intake in the cohort were above the AI, many women had calcium intakes that were too high or low. Dairy products provided the most calcium for most pregnant women, and antacids were an important source for many.