Emotional reactivity at 12 months in very preterm infants born at <29 weeks of gestation.

The present study evaluated the socio-emotional development of very preterm born infants at 12 months corrected age. Forty-one infants born very preterm (<29 weeks of gestation) were compared to 22 infants born full term on a standardized behavioral assessment and a parental temperament questionnaire, both measuring emotional reactivity to joy, anger and fear, as well as sustained attention. The behavioral assessment showed that very preterm infants exhibited as much joy as full term infants during a joy-eliciting episode. However, they expressed a significantly higher reactivity in anger-eliciting situations and a reduced reactivity toward fear-eliciting situations. For all three emotion-eliciting situations, the preterm infants reacted with a higher level of motor activity. The preterm infants also exhibited a distinct attention pattern with a significantly higher initial attention level which declined rapidly throughout the episode. The questionnaire did not show any group differences. The clinical relevance of these results in terms of preliminary hallmarks of later behavioral difficulties such attention deficit/hyperactivity disorder are discussed as well as the inconsistencies observed between the questionnaire and the behavioral assessment.

Access surgery for hemodialysis in the Cayman Islands: Preliminary results of a vascular access service.

OBJECTIVE: In the Cayman Islands, a vascular access service was created in 2005 to facilitate the creation of vascular access for hemodialysis by local surgeons. The present retrospective audit aims to establish the outcomes of this practice in the Cayman Islands. METHODS: Data from the operative log of the Cayman Islands Hospital was collected over a period of 36 months. The data were analyzed using SPSS version 12.0 (SPSS Inc, USA). Statistical analyses were performed using Student's t tests and Fisher's exact tests. RESULTS: A total of 19 operative procedures were performed to create vascular accesses in 12 men and seven women. Thirteen procedures (68%) created autogenous arteriovenous fistulas (AVFs) and six (32%) involved the insertion of a prosthetic arteriovenous graft (AVG). There were six incident dialysis patients, all of whom had an AVF created. The remaining 13 prevalent dialysis patients had new accesses in the form of AVFs (n=7) or AVGs (n=6). The statistical analyses were limited by sample size, but with AVFs, there were trends toward reduced incidence of secondary failure (four of 13 versus four of six), thrombosis (four of 13 versus two of six), infectious morbidity (zero versus two of six) and less demand for interventions to maintain patency (one of 13 versus two of six) with AVFs. There were also trends toward superior primary (461 days versus 227 days) and secondary (803 days versus 205 days) patency rates for AVFs. CONCLUSIONS: In this setting, the rate of AVF creation exceeds the goals set by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative and the Fistula First Breakthrough Initiative. To ensure continued delivery of modern quality care, further audits of the local practice will be required at regular intervals.

Influence of environmental temperatures during gestation and at birth on eating characteristics in adolescence: a replication and extension study.

Past research has shown a season of birth effect in clinical subjects with eating disorders. Studies also indicate a similar effect of environmental temperatures in non-clinical subjects, as well as effects of environmental temperatures during the three trimesters of gestation. These two studies aimed to replicate and extend those findings. The participants were adolescents (ages 15-19 years) who attended public schools in a mid-Atlantic US city. They completed the relevant scales of the Eating Disorder Inventory (N=578) and the Three Factor Eating Questionnaire (N=191). Correlational analyses were employed to study the relationship of environmental temperatures during pregnancy (the three trimesters of intrauterine development and at birth) with eating characteristics. The results of the previous studies were broadly replicated in Study 1, but Study 2 revealed a difference in the pattern of associations according to the measure used. This contrast indicates that the way in which one conceptualizes eating pathology is of critical importance in understanding the long-term impact upon eating patterns of environmental temperature during the intrauterine period. Possible theoretical bases for these findings are discussed.

Environmental temperature during gestation and body mass index in adolescence: new etiologic clues?

OBJECTIVE: Being born during certain parts of the year is linked to the presence of obesity in later years. Animal studies suggest that environmental temperature during fetal development may be one aspect of the link to later weight status, but this relationship has not been extensively studied in humans. The present study investigates whether environmental temperature during different stages of human gestation is associated with body mass index (BMI) during late adolescence. METHODS: Questionnaire data were collected from adolescents (n=578; ages 15-19 y) attending public schools in a mid-Atlantic US city. Pearson correlations were used to assess association of BMI with mean environmental temperature (from meteorological records) during trimesters of intrauterine development and at birth. RESULTS: BMI was significantly correlated with environmental temperatures in the second and third trimester, but only among female African Americans. Among females, those 'at risk for overweight' or overweight (BMI >85th percentile) tended to be born during periods of warmer average environmental temperatures (>13.2 degrees C). However, this effect was reliable only among African American females (relative risk=2.51, CI 1.07-5.91). A similar, non-significant tendency emerged among Caucasian females, but there was no such effect in males. CONCLUSIONS: Environmental temperatures during pregnancy and at birth are associated with the likelihood that African American females become overweight as adolescents. Possible biological and dietary mechanisms for this finding are discussed.

Environmental temperature during pregnancy and eating attitudes during teenage years: a replication and extension study.

OBJECTIVE: Among nonclinical adolescents, restrictive eating attitudes are more likely to occur among females born during warmer months. The present study aimed to replicate this finding and to extend it, considering whether such an effect is found in males and across the teenage years. In addition, the influence of temperature across the intrauterine period was considered. METHOD: The participants consisted of younger and older teenagers, all born in England. Each completed the relevant scales of the Eating Disorders Inventory and provided demographic information. Temperature across fetal development was determined using national meteorological records. RESULTS: There was a positive link between restrictive attitudes and temperature at birth among the older female group, although this replication effect did not reach significance. The same association among the older males was highly significant. The range of temperatures during fetal development also predicted later restrictive attitudes. In contrast, these effects were not replicated among the younger group, where a different pattern of effect was found (among the females only). CONCLUSION: Environmental temperature seems to have an important influence on later eating attitudes, but the pattern of influence appears to vary across development. Therefore, studies of the mechanisms behind this effect need to consider the role of gender and development, as well as the role of temperature across the period of intrauterine development.

Early environmental influences on restrictive eating pathology among nonclinical females: the role of temperature at birth.

OBJECTIVE: In eating-disordered populations, restrictive pathologies are associated with a higher rate of births in the spring and early summer. The reasons for this relationship are not understood. The present study of a nonclinical group aimed to determine whether there is a link between being born in warmer months and the level of restrictive pathology in later years. METHODS: The participants (N = 117) were all young adult females who were conceived and born in England. Each completed the relevant scales of the Eating Disorders Inventory and provided demographic information. Temperature at birth was determined using national meteorological records. RESULTS: Restrictive attitudes were stronger among women born during the warmer part of the year (May-August), and those attitudes were dimensionally associated with temperature at birth. Body dissatisfaction showed some of the same relationships. Neither period of birth nor temperature at birth was related to bulimic attitudes or body mass index. CONCLUSIONS: Being born during warmer months is significantly associated with restrictive eating attitudes among nonclinical females, although the link is relatively weak. Potential causal mechanisms are outlined, but further research is needed to explain this link in clinical and nonclinical groups.