Adolescent caffeine use and problematic school behavior: A longitudinal analysis of student survey data and teacher observations.

INTRODUCTION: Caffeine is a psychostimulant possessing arousal, motor activation, and reinforcing properties, which is consumed daily by most adolescents aged 12-19 years. Although current understanding of the implications of adolescent caffeine consumption for school behaviors remains incomplete, studies have shown that in addition to acute effects of the drug, in common with other habit-forming psychoactive substances, regular use leads to physical dependence, evidenced by recurring negative withdrawal symptoms. METHODS: Employing two waves of longitudinal data, we tested the prospective association between daily caffeine use and homeroom teacher-observed self-control and problem behavior in a sample of middle-school students in 20 schools in West Virginia in the United States. Caffeine was operationalized with two dichotomized variables, daily consumption of <100 mg, and daily consumption of >100 mg, versus no daily use. Gender, mother's education, family financial status, social support by primary caregiver and adults in school, and school climate, were applied as covariates in linear mixed models. RESULTS: Daily caffeine use of >100 mg was robustly and inversely associated with self-control and positively associated with problem behavior. CONCLUSIONS: Caffeine consumption and associated withdrawal symptoms may be an important factor in problematic school behavior among adolescents. Recent advent of highly concentrated caffeine products (e.g., caffeine "shots") commonly marketed directly at youth, should give rise to concerns including consideration about limiting caffeine consumption among children and youth.

Identifying Gender-Related Differences in Graduate Medical Education with the Use of a Web-Based Professionalism Monitoring Tool.

OBJECTIVES: Medical education is required to ensure a healthy training and learning environment for resident physicians. Trainees are expected to demonstrate professionalism with patients, faculty, and staff. West Virginia University Graduate Medical Education (GME) initiated a Web-based professionalism and mistreatment form ("button") on our Web site for reporting professionalism breaches, mistreatment, and exemplary behavior events. The purpose of this study was to identify characteristics in resident trainees who had a "button push" activation about their behavior to better understand ways to improve professionalism in GME. METHODS: This West Virginia University institutional review board-approved quality improvement study is a descriptive analysis of GME button push activations from July 2013 through June 2021. We compared characteristics of all of those trainees who had specific button activation(s) about their behavior. Data are reported as frequency and percentage. Nominal data and interval data were analyzed using the χ2 and the t test, respectively. P < 0.05 was significant. Logistic regression was used to analyze those differences that were significant. RESULTS: In the 8-year study period, there were 598 button activations, and 54% (n = 324) of the activations were anonymous. Nearly all of the button reports (n = 586, 98%) were constructively resolved within 14 days. Of the 598 button activations, 95% (n = 569) were identified as involving one sex, with 66.3% (n = 377) identified as men and 33.7% (n = 192) as women. Of the 598 activations, 83.7% (n = 500) involved residents and 16.3% (n = 98) involved attendings. One-time offenders comprised 90% (n = 538), and 10% (n = 60) involved individuals who had previous button pushes about their behavior. CONCLUSIONS: Implementation of a professionalism-monitoring tool, such as our Web-based button push, identified gender differences in the reporting of professionalism breaches, because twice as many men as women were identified as the instigator of a professionalism breech. The tool also facilitated timely interventions and exemplary behavior recognition.

"It is more isolating to patients if you aren't familiar with the resources": a pilot test of a clinician sensitivity training on eating disorders in pregnancy.

It is more isolating to patients if you aren't familiar with the resources: A pilot test of a clinician sensitivity training on eating disorders in pregnancy.(IRB Number: 1909705198).Background Pregnant women with a history of eating disorders (EDs) or active EDs have greater maternal and child health complications. They are also unlikely to disclose their history with an ED to their clinician, few of which are confident in their knowledge to provide appropriate care for patients who present with EDs. This study's goal was to evaluate changes to knowledge, behavior, and attitudes for health professionals who were part of a sensitivity training (to provide information of and awareness, address potential clinician biases, and offer strategies for more patient-centered care with de-stigmatizing language) about eating disorders and pregnancy compared with those who received a reference document.Methods Our pilot study compared responses of health professionals before and after this sensitivity training (N = 54) with a group who were provided a clinician reference document about the same topic (N = 61).Results Mann-Whitney Wilcoxon tests showed significant differences between the sensitivity training and reference document groups, with the sensitivity training resulting in increases to participants' perception of ED's relevance to overall treatment (p = 0.018), comfort in providing resources (p < 0.0001), frequency of ability to introduce strategies (p = 0.001), and interest in additional strategies/recommendations in treating patients with eating disorders (p = 0.009). Thematic analysis of the open-ended responses indicated four major themes: Resources and support, Treatment, Additional training, and Clinician Strategies. Discussion Results indicated that the sensitivity training improved training outcomes compared to the reference document group. Qualitative responses from both groups indicated four themes that can help inform ED-centered care. This study provides context for future directions for continuing education courses as well as clinical training recommendations for treating pregnant patients with EDs.

Accuracy of Digital Impressions at Varying Implant Depths: An In Vitro Study.

PURPOSE: Implants placed at variable depths may vary the amount of visible scannable surface of a scan body. Intraoral scanner technology uses advanced optical principles to record the surface of the scan body to accurately capture the implant position. The purpose of this study is to investigate the effect implant placement depth has on the accuracy of digital implant impressions using an intraoral scanner. MATERIALS AND METHODS: A partially edentulous gypsum master model was fabricated to allow the positioning of a single implant analog at different depths. Four groups were created based on the planned implant depths of 7, 6, 3, and 0 mm and corresponding visibility of the scan body at 2, 3, 6, and 9 mm. The model was digitized with a laboratory scanner for the reference scan and with an intraoral scanner to generate 15 test scans per group, with a total of 60 scans. The test scans were superimposed onto the reference scan using the best fit algorithm to analyze and measure the positional (dXYZ) and angular deviation (d⍬) of the scan body using three-dimensional metrology software. Statistical analysis was performed using a one-way ANOVA and pairwise comparison was done with a Tukey-Kramer HSD test (α = 0.05). RESULTS: The one-way ANOVA of the groups for the dXYZ and dθ parameters was statistically significant (F3,56 = 11.45, p < 0.001, F3,56 = 24.04, p < 0.001). Group D (9 mm) showed the least positional deviation at 38.41 µm (95% CI 30.26; 46.56) and the least angular deviation of 0.17° (95% CI 0.12; 0.21). Group A (2 mm) showed the greatest positional deviation of 77.17 µm (95% CI 65.23; 89.11) and greatest angular deviation of 0.84° (95% CI 0.65; 1.03). The positional and angular deviation increased with increased implant depth. CONCLUSIONS: The accuracy of digital impressions is influenced by the implant depth and the amount of visibility of the scan body. The trueness and precision are highest when the implant is placed at 0 mm depth with complete visibility of the scan body and decreases with subgingival implant placement.

Caffeine consumption and onset of alcohol use among early adolescents.

Preventing or delaying the onset of alcohol use among children and youth is an important public health goal. One possible factor in alcohol use onset among early adolescents is caffeine. The aim of this study was to assess the possible contribution of caffeine to the onset of alcohol use during early adolescence. We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020, and again approximately 6 months later in spring of 2021. We limited our analyses to students reporting never having used any form of alcohol at baseline. Logistic regression was employed in multivariable analyses and both Odds Ratios and Relative Risks reported. At follow-up, almost 14% of participants reported having consumed alcohol at least once and 57% used caffeine of 100 mg + daily. In multivariable analyses we controlled for social and behavioral variables known to impact tobacco use. Caffeine use was operationalized as a three-level factor: no use, <100 mg per day, and 100 + mg per day, with the latter being the approximate equivalent of the minimum of a typical cup of coffee or can of energy drink. Caffeine use of 100 mg + per day was significantly related to alcohol use at 6-months follow-up (OR: 1.79, RR: 1.56, p = .037). We conclude that caffeine consumption among 11-12-year-old adolescents may be a factor in early onset of alcohol use.

Monitoring one heart to help two: heart rate variability and resting heart rate using wearable technology in active women across the perinatal period.

BACKGROUND: Characterizing normal heart rate variability (HRV) and resting heart rate (RHR) in healthy women over the course of a pregnancy allows for further investigation into disease states, as pregnancy is the ideal time period for these explorations due to known decreases in cardiovascular health. To our knowledge, this is the first study to continuously monitor HRV and RHR using wearable technology in healthy pregnant women. METHODS: A total of 18 healthy women participated in a prospective cohort study of HRV and RHR while wearing a WHOOP® strap prior to conception, throughout pregnancy, and into postpartum. The study lasted from March 2019 to July 2021; data were analyzed using linear mixed models with splines for non-linear trends. RESULTS: Eighteen women were followed for an average of 405.8 days (SD = 153). Minutes of logged daily activity decreased from 28 minutes pre-pregnancy to 14 minutes by third trimester. A steady decrease in daily HRV and increase in daily RHR were generally seen during pregnancy (HRV Est. = - 0.10, P < 0.0001; RHR Est. = 0.05, P < 0.0001). The effect was moderated by activity minutes for both HRV and RHR. However, at 49 days prior to birth there was a reversal of these indices with a steady increase in daily HRV (Est. = 0.38, P < 0.0001) and decrease in daily RHR (Est. = - 0.23, P < 0.0001), regardless of activity level, that continued into the postpartum period. CONCLUSIONS: In healthy women, there were significant changes to HRV and RHR throughout pregnancy, including a rapid improvement in cardiovascular health prior to birth that was not otherwise known. Physical activity minutes of any type moderated the known negative consequences of pregnancy on cardiovascular health. By establishing normal changes using daily data, future research can now evaluate disease states as well as physical activity interventions during pregnancy and their impact on cardiovascular fitness.

Development and validation across trimester of the Prenatal Eating Behaviors Screening tool.

Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique medical needs of pregnant women with eating disorders (EDs). There is a need for a rapid, sensitive, and specific screening tool that can be used to identify a potential ED in pregnancy. We started with a set of 25 questions, developed from our qualitative work along with other ED screening tools, and tested on a development (n = 190) and validation sample (n = 167). Statistical analysis included factor analysis and logistic regressions with ROC curves. Development and validation samples were combined for trimester analysis (n = 357). Refining the tool to 12 items demonstrated strong internal reliability (development alpha = 0.95, validation alpha = 0.91). With correlated errors, questions demonstrated acceptable CFA fit (development: GFI: 0.91, RMSEA: 0.10, NNFI: 0.95; validation: GFI: 0.85, RMSEA: 0.14, NNFI: 0.86). Similar fits were seen by trimester: first trimester n = 127, GFI: 0.89, RMSEA: 0.12, NNFI: 0.94; second trimester n = 150, GFI: 0.83, RMSEA: 0.14, NNFI: 0.88; third trimester n = 80, GFI: 0.99, NNFI: 0.99. Validation against current ED diagnosis demonstrated acceptable sensitivity and specificity using a cutoff of 39 (development sensitivity = 80.7%, specificity = 79.7%, OR = 16.42, 95% CI: 7.51, 35.88; validation sensitivity = 69.2%, specificity = 86.5%, OR: 17.43, 95% CI: 6.46, 47.01). Findings suggest the PEBS tool can reliably and sensitively detect EDs across pregnancy trimesters with 12 questions. A further implication of this work is to reduce health and mental health treatment disparities through this standard and rapid screening measure to ensure early identification and treatment.

Testing risk and protective factor assumptions in the Icelandic model of adolescent substance use prevention.

Iceland has witnessed a dramatic decline in adolescent substance use that may be partly the result of efforts related to the Icelandic prevention model (IPM). We sought to test risk and protective factor assumptions of the IPM using a prospective cohort study with 12 months separating baseline from follow-up. Participants were students in grades 8 and 9 in the national Icelandic school system enrolled in the spring of 2018 and 2019 (N=2165). Participants self-reported their experiences of cigarette smoking, alcohol consumption, and cannabis use and seven risk and protective factors. Analyses were conducted with generalized linear modeling with extension to general estimating equations with correlated outcomes data. Both individual main-effects models and collective models including all main-effects were tested. Out of 28 individual main-effects models, 23 produced findings consistent with study premises (P<0.05). Multiple main-effects models largely sustained the findings of the individual main-effects models. Findings support the assumption that the risk and protective factors commonly emphasized in the IPM are associated with the four different substance use outcomes in the hypothesized direction. Communities that plan to implement the IPM among adolescents might consider these factors in their work.

Factors Associated with Acceptance of Repeat MCAT Test Takers into a West Virginian Allopathic Medical School.

OBJECTIVES: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data. METHODS: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data. RESULTS: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data. CONCLUSIONS: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas.

Longitudinal association between social media use and psychological distress among adolescents.

This study aimed to examine in a longitudinal cohort design whether social media use among adolescents is related to symptoms of social anxiety, depressed mood, and physical symptoms of anxiety over time. As part of the LIFECOURSE study of risk and protective factors for healthy adolescent development, three waves of school-based surveys of adolescents born in Iceland in 2004 were analyzed. Of the 3914 eligible adolescents, 2378 gave informed consent. Complete responses for this study were collected from 2211 students at the first wave, with 2052 responding roughly 12 months later, and 2097 responding in year 3. Linear mixed-effects models were used to analyze time spent on social media in relation to psychological distress over time. More time spent on social media was weakly but significantly associated with increased symptoms of depressed mood, social anxiety and symptoms of physical anxiety over time. However, the effect size of these relationships suggest they may not be of clinical relevance. The relationship between time spent on social media and symptoms of depressed mood and physical symptoms of anxiety grew stronger over time, although it is not known if this relationship is causal. The relationship between time spent on social media and all outcomes of psychological distress were stronger for girls than boys and increased social media use had a positive relationship with symptoms of depressed mood over time. The relationships found in this study were relatively small and future studies need to focus on the clinical and public health significance of these effects.

Predicting Student Success on the National Board for Certification in Occupational Therapy® Examination.

IMPORTANCE: A predictive tool to support academic and practice outcomes for occupational therapy students is needed for use in advising students. OBJECTIVE: To determine whether characteristics of academic and professional behavior across cohorts could indicate the likelihood of student success in passing the National Board for Certification in Occupational Therapy® examination. DESIGN: Causal-comparative research. PARTICIPANTS: Master of occupational therapy students (N = 315; eight cohorts). MEASURES: Demographics, college entrance exams, grade point average, program benchmarks (i.e., specific course grades, fieldwork grades, Occupational Therapy Knowledge Exam scores), licensure exam. RESULTS: Baseline and in-program characteristics were used to determine success; for each unit increase in the success score, the odds of passing the exam were 4.11 (95% confidence interval [2.23, 7.60]). CONCLUSIONS AND RELEVANCE: Case studies that have used this success score suggest that additional resources and targeted interventions could be allocated to help students at highest risk of not passing the licensure exam. WHAT THIS ARTICLE ADDS: Using a predictive tool to support student success can enable more effective academic advising throughout an occupational therapy program and result in positive outcomes on the licensure exam.

An exploratory study on the intergenerational transmission of dieting proneness within an eating disorder population.

An Exploratory Study on the Intergenerational Transmission of Dieting Proneness within an Eating Disorder Population (IRB Protocol Number: 160928271). PURPOSE: Parents and families are not the sole factor in eating disorder (ED) development and their involvement in recovery is crucial. However, parents provide a social and environmental context for a child's eating and weight that cannot be completely discounted. The purpose of this study was to explore the intergenerational transmission of dieting behavior within an ED sample. METHODS: Participants (N = 65) were recruited for this cross-sectional study through four distinct ED treatment sites. Participants completed a questionnaire that was developed previously to examine parental feedback as predictor variables, as well as completing the Eating Pathology Severity Index (EPSI) as an outcome variable. A total of 60 completed the questionnaire items of interest to be included in the analyses. SAS JMP® 13.0 was used for descriptive analyses, correlations, and multivariable linear regressions. RESULTS: Results of the multivariable linear regression showed that the amount of variance explained by the final model for eating pathology severity (via the EPSI) doubled when parental feedback was included (Model 1: R2= 0.09, Model 2: R2= 0.20). Additionally, there was a significant relationship between the "Negative Direct Parental Feedback Subscale" and EPSI total scores (ß = 14.1; SD = 7.0; p = 0.05). CONCLUSION: These findings of increased eating pathology associated with direct parental feedback in a clinical population of ED participants even when controlling for parental ED history suggests greater attention is needed within the ED literature on social and environmental factors and their potential associations with eating pathology. LEVEL OF EVIDENCE: Level V, descriptive study.

Pediatric metabolic outcome comparisons based on a spectrum of obesity and asthmatic symptoms.

RATIONALE: Asthma and obesity are 2 of the most prevalent public health issues for children in the U.S. Trajectories of both have roughly paralleled one another over the past several decades causing many to explore their connection to one another and to other associated health issues such as diabetes and dyslipidemia. Earlier models have commonly designated obesity as the central hub of these associations; however, more recent models have argued connections between pediatric asthma and other obesity-related metabolic conditions regardless of children's obesity risk. OBJECTIVES: To examine the relationships between asthma, obesity, and abnormal metabolic indices. METHODS: We conducted a cross-sectional study of 179 children ages 7 to 12 years recruited from a rural, Appalachian region. Our model controlled for children's smoke exposure, body mass index percentile, and gender to examine the association between children's asthma (based on pulmonary function tests, medical history, medications, and parent report of severity), lipids (fasting lipid profile), and measures of altered glucose metabolism (glycosylated hemoglobin and homeostatic model assessment 2-insulin resistance). RESULTS: Our findings revealed a statistically significant model for low density lipids, high density lipids, log triglyceride, and homeostatic model assessment 2-insulin resistance; however, Asthma had a significant effect for the mean triglycerides. We also found an asthma-obesity interaction effect on children's glycosylated hemoglobin with asthmatic obese children revealing significantly higher glycosylated hemoglobin values than non-asthmatic obese children. CONCLUSIONS: Our findings support a connection between asthma and children's glycosylated hemoglobin values; however, this association remains entwined with obesity factors.

Association of county perinatal resources and gestational weight gain in West Virginia, United States.

BACKGROUND: Inappropriate (inadequate or excessive) gestational weight gain (GWG) is of great concern to maternal, fetal and infant health. Different maternal and fetal risk factors are associated with GWG, but little is known about a more distal risk factor: inadequate county-level perinatal resources. Therefore, the study aim was to investigate GWG in women living in counties with below average perinatal resources in comparison with their counterparts living in counties with above average perinatal resources. METHODS: Retrospective study of 406,792,010-2011 West Virginia births in 55 counties. The outcome was GWG and the main predictor was county perinatal resources. Hierarchical linear mixed model was used to investigate the association of county perinatal resources and GWG. RESULTS: County perinatal resources was associated with GWG (p = 0.009), controlling for important covariates. Below average county perinatal resources was not significantly associated with a decrease in mean GWG (M: - 5.29 lbs., 95% CI: - 13.94, 3.35, p = 0.2086), in comparison with counties with above average county perinatal resources. There was significant difference between average, and above average county perinatal resources (M: - 17.20 lbs., 95% CI: - 22.94, - 11.47, p < 0.0001), controlling for smoking during pregnancy and other covariates. CONCLUSIONS: Average county perinatal resources was associated with reduced mean GWG relative to above average county perinatal resources, but not below average county perinatal resources. However, this could be due to the small number of counties with above average resources as the effect was in the hypothesized direction. This highlights one of the challenges in county perinatal resource studies.

An exploratory study on the intergenerational transmission of obesity and dieting proneness.

PURPOSE: There is a paucity of research exploring individuals' memories of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This exploratory study utilized a community sample to further characterize the retrospective report of parenting dieting behavior. METHODS: A total of 507 participants (78.1% females; 20.7% males; and 1.2% transgender) were recruited to participate in an online, self-administered survey. RESULTS: Forty percent (216) of participants reported maternal dieting in their family of origin and 34% (182) reported maternal fat talk, 24% (120) reported paternal dieting, and 11% recalled paternal 'fat talk' (58). Subgroup analyses suggest that both male and female participants had greater odds of remembering maternal rather than paternal weight or shape criticism and encouragement to diet (OR = 58.1; and OR = 3.12; p < 0.0001 for male and female participants, respectively). Retrospective report of indirect parental behaviors (e.g. parental dieting) also appears to be associated with direct parental behaviors (e.g. encouraging children to diet). Additionally, participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (ß = 1.31, SE = 0.32, p < 0.0001). CONCLUSION: Results provide preliminary evidence that a sizeable percentage of both adult male and female participants recalled that their parents engaged in fat talk and dieting. In addition, participants recalled parental criticism of their own weight or eating behaviors, which was associated with recall of parental dieting and fat talk. LEVEL OF EVIDENCE: Level V, Descriptive Study.

Maternal smoking during pregnancy and academic achievement of offspring over time: A registry data-based cohort study.

Few studies have assessed the cumulative impact of maternal smoking during pregnancy (MSDP) on scholastic outcomes over time. We examined the relations between MSDP and academic achievement in the 4th, 7th and 10th grades using registry data collected at birth, during the neonatal period, and at each grade level from the 2000, LIFECOURSE study birth cohort in Reykjavik, Iceland (N = 1151, girls = 49.3%). Latent growth modeling showed that MSDP influenced Icelandic achievement scores, standardized to a range from 0 to 60, at baseline (ß = -0.04), and over time (ß = -0.05). Likewise, MSDP was negatively associated with standardized mathematics scores at baseline (ß = -0.09) and continued to exert a negative impact on mathematics scores over time (ß = -0.08) after controlling for gender, income, cohabitation, and baseline mathematics and Icelandic achievement scores. Results provide evidence of the persistent negative impact of MSDP on academic achievement in offspring. Findings support the proposition that children whose mothers smoke during the first trimester of pregnancy are, on average, at greater risk for poor scholastic outcomes over time than children whose mothers do not smoke during their first trimester. To our knowledge, this is the first study using a longitudinal cohort design to assess whether the impacts of maternal smoking during pregnancy may persist over time. This study contributes to the current state of knowledge by providing an assessment that focuses on the impact of smoking during pregnancy on academic achievement from childhood into early adolescence.

Waking up every day in a body that is not yours: a qualitative research inquiry into the intersection between eating disorders and pregnancy.

BACKGROUND: Women with eating disorders are more likely to negatively react to finding out they are pregnant, although this difference in attitudes between women with eating disorders and controls disappears at 18-weeks' gestation. Those with anorexia also are twice as likely to have an unplanned pregnancy and those with bulimia have a 30-fold increased chance compared with healthy controls. Therefore, due to these considerations, pregnancy and the transition to motherhood can be an extremely challenging time for these women both psychologically and physically. The purpose of this qualitative descriptive study was to understand the intersection between eating disorders and pregnancy from the lived experience of women who have been pregnant or want to or do not want to become pregnant. METHODS: A total of 15 women with a current or past history of an eating disorder were recruited, including nine women who have had previous pregnancies as well as six nonparous women. Interviews were the primary unit of data collection, in addition to document analysis of diaries or blogs. Data analysis was based on verbatim transcripts from audio recordings. NVIVO 11© was used to manage the data from these interviews and thematic analysis was then conducted for emergence of major and sub themes. RESULTS: A total of six themes emerged from the iterative process of coding and categorizing. They were: Control, Disclosure to Others, Battle between Mothering & Eating Disorder, Fear of Intergenerational Transmission, Weight and Body Image Concerns, and Coping Strategies. One theme, Battle between Mothering & Eating Disorder also had three sub-themes: Decision to Have Child, Emotions Towards Pregnancy, and Focus on Child/Greater Good. CONCLUSIONS: It is hoped that quotes and themes derived from this study will help inform both prenatal and postnatal care and interventions, as well as addressing intergenerational transmission concerns among mothers with eating disorders.

LDL cholesterol level in fifth-grade schoolchildren associates with stature.

Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors. Data collected at school screenings over 18 years in WV schools were analyzed for 63,152 fifth-graders to determine relationship of LDL to stature with consideration of age, gender, and BMI. The first (shortest) quartile showed an LDL level of 93.6 mg/dl compared with an LDL level of 89.7 mg/dl for the fourth (tallest) quartile. Each incremental increase of 1 SD of height lowered LDL by 0.049 mg/dl (P < 0.0001). Multivariate analysis showed LDL to vary inversely as a function of the first (lowest) quartile of height after controlling for gender, median age, BMI percentile for age and gender, and year of screening. The odds ratio for LDL ≥ 130 mg/dl for shortest versus tallest quartile is 1.266 (95% CL 1.162-1.380). The odds ratio for LDL ≥ 160 mg/dl is 1.456 (95% CL 1.163-1.822). The relationship between short stature and LDL, noted in adults, is confirmed in childhood.

Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis.

BACKGROUND: Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. METHODS: Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child's adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher's r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. RESULTS: Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = -0.06; 95% CI: -0.10, -0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. CONCLUSIONS: The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. SYSTEMATIC REVIEW AND META-ANALYSIS: PROSPERO 2015: CRD42015019763 .