Associations between prenatal exposure to power plants and birth outcomes across the United States.

OBJECTIVES: Although there is growing evidence that in utero exposure to power plants increases the risk of adverse birth outcomes, studies have focused on coal-fired plants and single US locations, limiting generalizability. We used birth certificate data from 50 states and DC to examine the associations between prenatal exposure to power plants and birth outcomes overall and by race/ethnicity. METHODS: We linked 2009-2018 county-level microdata natality files on 34,674,911 singleton births from 50 states and DC with 9-month county-level averages of power plant fuel consumption based on month/year of birth. We estimated linear regression models for birth weight and gestational age and probit models for the dichotomous outcomes of low birth weight, small for gestational age (SGA), and preterm birth. We subsequently examined interactions between plant fuel consumption and race/ethnicity. RESULTS: Overall, 69.1% of counties had any power plant fuel consumption. Although we found no overall effects of prenatal exposure to power plants on birth weight or SGA, a significant interaction (both P < 0.01) revealed that a 10% increase in fuel consumption was associated with infants born to White women having slightly lower birth weights (1.76 g; 95% confidence interval = -2.87, -0.65) and higher risk of being born SGA (0.0002; 95% confidence interval = 0.0002, 0.0002). CONCLUSION: Power plants have negative effects on infant health, which exist independent of locality.

Social determinants of inadequate sleep in US children and adolescents.

BACKGROUND AND OBJECTIVES: Despite recognised disparities in child health outcomes associated with sleep, the majority of research has been based on small, homogeneous samples. Using a nationally-representative sample of US children and adolescents, we examined trends and social determinants of inadequate sleep across age groups. STUDY DESIGN: Comparison of cross-sectional studies. METHODS: Our study used the 2003 (n = 68,418), 2007 (n = 63,442), and 2011/2012 (n = 65,130) waves of the National Survey of Children's Health, a nationally-representative survey of 6-17-year-olds. Parents reported whether the child had inadequate sleep (0-6 days of not getting enough sleep vs 7 days). RESULTS: From 2003 through 2011/12, inadequate sleep increased from 23 to 36% among 6-9-year-olds, 30 to 41% among 10-13-year-olds, and 41 to 49% among 14-17-year-olds. Among 10-17-year-olds, those from households with more than a high school degree were more likely to have inadequate sleep (adjusted ORs 1.2). Although for 10-13-year-olds there was a gradient in inadequate sleep across income (aORs 1.2-1.3), for 14-17-year-olds, only those from the two highest income levels were more likely to have inadequate sleep (aORs 1.3-1.4). Parents' reports that neighbours did not watch out for other's children was associated with an increased risk for inadequate sleep across all ages (aORs 1.1-1.3). CONCLUSIONS: Inadequate sleep occurred as young as age six years and increased with age, became more prevalent, and was socially patterned. In order to prevent inadequate sleep across the life course, surveillance and monitoring are needed across all age groups to identify critical periods for intervention.

Identifying infants at high-risk for second-hand smoke exposure.

BACKGROUND: To examine the social determinants of infant smoke exposure and whether these associations vary by mothers' smoking status and number of children in the household. METHODS: There were 135 278 mothers from 28 states who participated in the Pregnancy Risk Assessment Monitoring System from 2000 to 2003. RESULTS: Overall 9.9% of mothers reported that her infant was in the same room as someone smoking for 1 or more hours per day. Among smoking households, infants with 1 or 2+ siblings were 25% and 59% more likely to be exposed to 1+ hours of second-hand smoke daily, respectively, than infants with no siblings. CONCLUSION: Infants only a few months old are being exposed to second-hand smoke, particularly infants whose mother smokes and infants with siblings, indicating the importance of surveillance even for this young age group.

Population-level effects of Hurricane Sandy on adolescent health.

BACKGROUND: Disasters are increasing in frequency and intensity due to climate change. Youth are the largest and most vulnerable group exposed to disasters. More evidence is needed regarding how youth mental health and health behaviors vary based on disaster exposure, how mental health influences health behaviors, and how diverse groups of youth may be differentially affected. METHODS: Using data from the Youth Risk Behavior Survey and Federal Emergency Management Agency, we examined the impact of Hurricane Sandy (2012) on mental health (sadness, suicidality) and health behaviors (substance use, physical activity, screen time, sexual behaviors) of 240,365 youth. Difference-in-differences regression analyses evaluated pre-disaster (2005-2011) and post-disaster (2013-2019) changes. RESULTS: There were 83,442 (34.7 %) adolescents (51.2 % female, 18.1 % non-Hispanic White) located in 6 districts exposed to Hurricane Sandy and 156,923 (65.3 %) adolescents located in 13 non-exposed districts. Exposure was associated with differences in substance use, physical (in)activity, and risky sexual behaviors, but not mental health outcomes. Mental health did not moderate the association between disaster exposure and health behaviors. Hispanic adolescents and those identifying as Other races/ethnicities were most vulnerable to post-disaster negative health outcomes. LIMITATIONS: Study limitations include questionnaire design, cross-sectional data, sampling, and possible response biases. CONCLUSIONS: Findings provide critical information about youth mental health and health behaviors following disasters, as well as how youth may differ in their responses. Findings provide guidance for early identification and resource allocation for youth at higher risk for post-disaster health issues.

Risk factors for rapid weight gain in preschool children: findings from a UK-wide prospective study.

OBJECTIVE: To examine risk factors for rapid weight gain between 3 and 5 years of age. DESIGN: Nationally representative prospective cohort study. PARTICIPANTS: A total of 11 653 preschool children participating in the UK Millennium Cohort Study, with anthropometry at 3 and 5 years. MEASUREMENTS: Weight gain z-scores were calculated from 3 to 5 years. Children in the top quarter of this distribution were classified as gaining weight rapidly. A total of 26 biological and early life, social, psychological, behavioural and environmental risk factors were examined. RESULTS: Among the participants, 13% of normal weight, 63% of overweight and 88% of obese 5-year olds had experienced rapid weight gain since 3 years of age. Six biological and early life factors and two social factors were found to be significantly associated with this growth pattern. In a mutually adjusted model, children were more likely to gain weight rapidly if they had a higher body mass index at age 3 (adjusted odds ratio: 1.27, 95% confidence interval: 1.23-1.32), if they were of Bangladeshi (adjusted odds ratio: 1.88, 95% confidence interval: 1.27-2.79) or black (adjusted odds ratio: 1.47, 95% confidence interval: 1.07-2.02) ethnicity, if their mother was overweight (adjusted odds ratio: 1.32, 95% confidence interval: 1.15-1.51) or had been overweight before pregnancy (adjusted odds ratio: 1.56, 95% confidence interval: 1.36-1.79), if their father was overweight (adjusted odds ratio: 1.56, 95% confidence interval: 1.34-1.81) or if their mother smoked during pregnancy (adjusted odds ratio:1.23, 95% confidence interval: 1.09-1.38). Children were also more likely to gain weight rapidly if others smoked in the same room (adjusted odds ratio: 1.31, 95% confidence interval: 1.16-1.49) or if they were a lone child in the household (adjusted odds ratio: 1.14, 95% confidence interval: 1.01-1.30). CONCLUSIONS: Factors operating during pregnancy and early life increase the risk of rapid weight gain in young children; thus, signalling the importance of obesity prevention programmes before and during pregnancy and for children at an early age. In particular, these programmes should address parental weight status and smoking habits, both modifiable risk factors.

Maternal employment and early childhood overweight: findings from the UK Millennium Cohort Study.

BACKGROUND: In most developed countries, maternal employment has increased rapidly. Changing patterns of family life have been suggested to be contributing to the rising prevalence of childhood obesity. OBJECTIVES: Our primary objective was to examine the relationship between maternal and partner employment and overweight in children aged 3 years. Our secondary objective was to investigate factors related to early childhood overweight only among mothers in employment. DESIGN: Cohort study. SUBJECTS: A total of 13 113 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002 in the United Kingdom, who had complete height/weight data and parental employment histories. MEASUREMENTS: Parents were interviewed when the child was aged 9 months and 3 years, and the child's height and weight were measured at 3 years. Overweight (including obesity) was defined by the International Obesity Task Force cut-offs. RESULTS: A total of 23% (3085) of children were overweight at 3 years. Any maternal employment after the child's birth was associated with early childhood overweight (odds ratio (OR) [95% confidence interval (CI)]; 1.14 [1.00, 1.29]), after adjustment for potential confounding and mediating factors. Children were more likely to be overweight for every 10 h a mother worked per week (OR [95% CI]; 1.10 [1.04, 1.17]), after adjustment. An interaction with household income revealed that this relationship was only significant for children from households with an annual income of pound33 000 ($57 750) or higher. There was no evidence for an association between early childhood overweight and whether or for how many hours the partner worked, or with mothers' or partners' duration of employment. These relationships were also evident among mothers in employment. Independent risk factors for early childhood overweight were consistent with the published literature. CONCLUSIONS: Long hours of maternal employment, rather than lack of money may impede young children's access to healthy foods and physical activity. Policies supporting work-life balance may help parents reduce potential barriers.

Ceforanide kinetics in renal insufficiency.

Ceforanide (500 mg) was infused intravenously over 30 min into six normal subjects, 10 nondialysis patients with renal insufficiency, and six hemodialysis patients. Dialysis patients received two ceforanide infusions, one immediately before dialysis and another during an interdialysis period. Sequential plasma samples over 24 to 72 hr were assayed for ceforanide. Peak ceforanide levels (mean = 69 +/- 12 micrograms/ml) and volumes of distribution did not vary with creatinine clearance (Clcr, ml/min/1.73 m2) and both plasma clearance and renal clearance decreased linearly as Clcr decreased. Mean nonrenal clearance (4.6 +/- 1.8 ml/min/1.73 m2) did not vary with Clcr. Mean half-life was 3 hr in the normal subjects, increasing to approximately 25 hr in patients with severe renal insufficiency. Hemodialysis resulted in a removal of approximately 21% of the dose of ceforanide. Dosing recommendations for patients with renal insufficiency are provided.

An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study.

OBJECTIVE: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children. METHODS: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index. RESULTS: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods <4 months (1.12, 1.02 to 1.23), lone motherhood (1.32, 1.15 to 1.51), smoking during pregnancy (1-9 cigarettes daily: 1.34, 1.17 to 1.54; 10-19: 1.49, 1.26 to 1.75; 20+: 1.34, 1.05 to 1.70), parental overweight (both: 1.89, 1.63 to 2.19; father only: 1.45, 1.28 to 1.63; mother only: 1.37, 1.18 to 1.58), prepregnancy overweight (1.28, 1.14 to 1.45) and maternal employment > or =21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeeding > or =4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England. CONCLUSIONS: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children.

Regional differences in overweight: an effect of people or place?

OBJECTIVE: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. DESIGN: Nationally representative prospective study. SETTING: England, Wales, Scotland and Northern Ireland. PARTICIPANTS: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. MAIN OUTCOME MEASURE: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. RESULTS: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. CONCLUSIONS: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children.

Patterns of research activity related to government policy: a UK web based survey.

AIMS: To describe the patterns of child and family health and wellbeing research activity in the fiscal year (FY) 2002/2003 in relation to UK government policies. METHODS: Projects investigating the health and wellbeing of children and families were located through a web based survey of major research funders, including UK government departments and non-departmental public bodies, research councils, and medical charities. A budget was estimated for each project for the FY 2002/2003, and each project coded according to a framework which reflected government priorities and research methodologies. RESULTS: There was a substantial amount of project information posted on the websites of the funding organisations, but the level of detail varied. For the FY 2002/2003, 31 organisations were identified that commissioned 567 projects investigating the health and wellbeing of children and families. Based on information from organisations' websites, this represented approximately 3% of their research budgets. Within this funding area, low proportions of research activity related to health inequalities (9% of total expenditure on child and family health research), health economic analysis (8%), primary and secondary prevention (12%), and children and adolescents at high risk of ill health (14%). CONCLUSIONS: A limited amount of research activity on children and families health funded in the FY 2002/2003 is addressing UK government policy priorities. This suggests the need to commission further research to fill gaps in the evidence.

Corynebacterium equi peritonitis in a patient receiving peritoneal dialysis.

Our patient represents the first reported case of peritonitis due to C equi. He had no known exposure to farm or domestic animals, and no evidence of underlying systemic immunodeficiency. After relapse, the patient was successfully treated with vancomycin, and catheter removal was not necessary. We suggest that C equi be added to the growing list of organisms not typically thought to be human pathogens that can cause peritonitis in patients receiving CAPD and recommend intraperitoneal vancomycin as primary therapy. Catheter removal may be necessary to clear the infection. Identification of the organism is important, as it may not respond to treatment with antibiotics such as cephalosporins or penicillins, which are commonly used to treat peritonitis.

Progressive disseminated histoplasmosis; favorable response to ketoconazole.

Four patients with disseminated histoplasmosis, two of whom had late relapses after previous therapy with amphotericin B, were treated with ketoconazole 200 to 400 mg daily for 1 year. All patients improved markedly during therapy, with resolution of symptoms decreasing liver and spleen size, and weight gain; resolution of oral ulcers occurred in the two patients in whom they were present. Decrease in serum alkaline phosphatase levels correlated well with clinical improvement. One patient who was much improved while receiving ketoconazole continued to harbor Histoplasma capsulatum in an abdominal aortic aneurysm, which became symptomatic 4 months after cessation of the drug. He underwent aneurysmectomy, and H. capsulatum isolated from the resected aneurysm was susceptible in vitro to ketoconazole. No significant adverse reactions to the drug were noted despite prolonged therapy. Our results indicate that ketoconazole may have a role in the therapy of disseminated histoplasmosis in adults.

Stochastic dynamics of the nerve growth cone and its microtubules during neurite outgrowth.

The controlled extension of neurites is essential not only for nervous system development, but also for effective nerve regeneration after injury. This process is critically dependent on microtubule assembly since axons fail to elongate in the presence of drugs which disrupt normal assembly dynamics. For this reason, neurite outgrowth is potentially controllable by manipulation of the assembly state of the intracellular array of microtubules. Therefore, understanding how microtubule assembly dynamics and neurite outgrowth are coupled, in the absence of drugs, can lend valuable insight into the control and guidance of the outgrowth process. In the present study we characterized the stochastic dynamics of neurite outgrowth and its corresponding microtubule array, which advances concomitantly with the advance of the nerve growth cone, the highly motile structure at the terminus of the growing neurite, using reported fluorescent microscopic image sequences (Tanaka and Kirschner, 1991, J. Cell Biol. 115:345-363). Although previously modeled as an uncorrelated random walk, the stochastic advance of the growth cone was found to be anticorrelated over a time scale of approximately 4 min, meaning that growth cone advances tended to be followed by growth cone retractions approximately 4 min later. The observed anticorrelation most likely reflects the periodic stops and starts of neurite outgrowth that have been reported anecdotally. A strikingly similar pattern of anticorrelation was also identified in the advance of the growth cone's microtubule array. Cross-correlation analysis showed that growth cone dynamics tended to precede microtubule dynamics on a time scale of approximately 0-2 min, while microtubules tended to precede growth cone dynamics on a approximately 0-20-s time scale, indicating a close temporal coupling between microtubule and growth cone dynamics. Finally, the scaling of the mean-squared displacements with time for both the growth cone and microtubules suggested a fractional Brownian motion model which accounts for the observed anticorrelation of growth cone and microtubule advance. (c) 1996 John Wiley & Sons, Inc.

Penetration of aztreonam into human bronchial secretions.

Nine intubated patients were given a single, 2-g intravenous dose of aztreonam over 5 min. Samples of serum and bronchial secretion were obtained 2, 4, and 8 h after administration and assayed for aztreonam content. The mean concentrations in bronchial secretion ranged from 1.9 to 5.2 micrograms/ml and tended to be highest at 4 h. The concentrations in bronchial secretion varied from patient to patient, but each patient had one or more bronchial secretion samples that contained at least 2.7 micrograms of drug per ml.

Conditions associated with relapse of amphotericin B-treated disseminated histoplasmosis.

Progressive disseminated histoplasmosis (PDH) is a rare consequence of infection with Histoplasmia capsulatum. Usually fatal if untreated, PDH generally is cured by appropriate amphotericin B treatment. Of 31 persons with uncomplicated PDH treated with amphotericin B, we found that relapse occurred in five (16%) after an interval of up to nine years after initial therapy. Review of these five cases and 31 additional relapsing cases from the literature indicates that fungal endocarditis or endarteritis without surgical treatment, underlying lymphoreticular neoplasm, and amphotericin B dosage of less than 2 g appear to be associated with relapse of PDH.

Histoplasma infection of abdominal aortic aneurysms.

Fungal endarteritis resulting from progressive disseminated histoplasmosis may cause arterial aneurysms, or lead to infection of pre-existing aneurysms. Three patients with Histoplasma capsulatum infections of abdominal aortic aneurysms are reported. All had previous disseminated histoplasmosis and atherosclerotic peripheral vascular disease. All were considered cured of systemic infection when their aneurysms were discovered. Atherosclerotic vascular lesions may become infected during the course of systemic fungal disease and may serve as a haven for viable organisms in patients whose dissemination recurs despite seemingly adequate antifungal therapy. In treating these patients, resection of all infected arterial tissue, revascularization through uninfected tissues, and long-term antimicrobial therapy are recommended.

Prototypes of facial attributes developed through image averaging techniques.

Image capture and quantification has proven useful in a variety of scientific applications, for example, biology, medicine, geology, meteorology and forensics. The objective of this research was to utilize this technology to quantify clinical- and consumer-perceivable changes in facial attributes. A panel of expert assessors was trained, and, in a large consumer study, consumer facial attributes were identified and grading scales for each attribute were established. These experts then rated over 240 subjects on a total of 19 different facial attributes. Based on methodology developed by Perrett et al., facial averages or prototypes were computed from panelists rated high or low for each attribute. Prototypes were developed in a 3 step process: 1) selection of 224 predefined feature points; 2) calculation of average face shape; and 3) 'morphing' individual faces into that shape and blending the images together. Naive assessors could readily appreciate the differences in facial appearance of the prototypes. In addition, expert graders were able to identify the general class of attribute affected. This method provides a powerful tool for assessing the effects of skin care technologies.