Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for youth with Type 2 diabetes: reliability and validity.

AIM: To test the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module originally developed in Type 1 diabetes in youth with Type 2 diabetes. METHODS: The PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were administered in a field test study to 100 young people aged 9-25 years with Type 2 diabetes. Factor analysis was conducted to determine the factor structure of the items. RESULTS: The 15-item Diabetes Symptoms Summary Score and 12-item Type 2-specific Diabetes Management Summary Score were empirically derived through factor analysis. The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores showed acceptable to excellent reliability across the age groups tested (α = 0.85-0.94). The Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores evidenced construct validity through large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.67 and 0.57, respectively). HbA1c was correlated with the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores (r = -0.13 and -0.22). Minimal clinically important difference (MCID) scores were 5.91 and 7.39 for the Diabetes Symptoms and Type 2-specific Diabetes Management Summary Scores. CONCLUSIONS: The PedsQL 3.2 Diabetes Module Diabetes Symptoms Summary Score and Type 2-specific Diabetes Management Summary Score exhibited satisfactory measurement properties for use as youth self-reported diabetes symptoms and diabetes management outcomes for clinical research and clinical practice for young people with Type 2 diabetes.

Establishment and characterization of a canine soft tissue sarcoma patient-derived xenograft model.

Spontaneously occurring soft tissue sarcoma (STS) is relatively common in canine cancer patients. Because of the similarities to human disease, canine STSs are a valuable and readily available resource for the study of new therapeutics. In this study, a canine patient-derived xenograft (PDX) model, CDX-STS2, was established. The CDX-STS2 model was engrafted and expanded for systemic administration studies with chemotherapeutic agents commonly used to treat STS, including doxorubicin, docetaxel and gemcitabine. Immunohistochemistry for drug-specific biomarkers and tumour growth measurement revealed tumour sensitivity to doxorubicin and docetaxel, whereas gemcitabine had no effect on tumour growth. Although many human PDX tumour models have been established, relatively few canine PDX models have been reported to date. CDX-STS2 represents a new STS PDX research model of canine origin that will be useful in bridging preclinical research with clinical studies of STS in pet dogs.

Longitudinal quality of life improvement in underserved rural youth with obesity.

OBJECTIVE: ACT! (Actively Changing Together) is a family- and community-based intervention targeting youth with obesity. The objective of this study was to establish the longitudinal impact on Health-Related Quality of Life (HRQoL) as well as the relationship with anthropometric and demographic factors. METHODS: Youth (n = 75) aged 8-14 years meeting criteria for overweight or obesity were referred to the programme. Twelve, 90-min classes in English and Spanish were held at the YMCA. Demographics and anthropometrics were assessed, as well as HRQoL that was measured with the child-reported Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scale. Data was collected at three follow-up points after completion of the intervention: initial follow-up (n = 65), 6 (n = 41) and 12 months (n = 25). Analysis included paired dependent t-tests between baseline and follow-up, and Pearson's correlations on HRQoL, anthropometric and demographic data. RESULTS: PedsQL scores significantly improved from baseline to all follow-up timepoints (initial follow-up immediately following the intervention, and 6 and 12 months post intervention). Over time, body mass index Z-Score and per cent body fat displayed various points of significance and strengthening correlations. CONCLUSIONS: Longitudinal improvements in HRQoL were sustained up to 12 months following a family- and community-based intervention in this underserved population. Anthropometric measures continuously correlated with and contributed to HRQoL outcomes.

Parental barriers to weaning infants from the bottle.

BACKGROUND: Optimal bottle weaning should occur between 12 and 15 months of age. We hypothesized that high-risk populations have different parental attitudes, learned behaviors, and knowledge of weaning practices. OBJECTIVE: To determine whether high-risk populations are less likely to wean their children by 15 months of age than low-risk populations. METHODS: A cross-sectional survey using a convenience sample of parents was conducted at 3 community-based pediatric clinics. Spanish- and English-speaking parents with weaned and unweaned children 12 to 36 months of age were included in the study. A self-administered questionnaire was completed at a clinic visit. The questionnaire addressed aspects of parents' sociodemographic characteristics and included feeding history; weaning practices; sources of information about weaning; and parental behaviors, attitudes, and knowledge of age at which the child should be weaned. RESULTS: One hundred eighty questionnaires were completed. Marital status was related to weaning behavior. Seventy-six percent of single mothers had weaned their children in a timely manner, whereas 48% of married mothers had done so (chi2 = 7.70; P = .008). Parental education, race, and income were not significantly related to the timeliness of weaning. When respondents rated the helpfulness of multiple sources, only the health clinic was found to be significantly more important for the timely weaning group (t = -2.13; P = .04). Parents with timely weaned children stated that the mean +/- SD optimal age for weaning is 13.6 +/- 3.2 months. Parents with unweaned and late-weaned children stated that the mean +/- SD optimal age is 19.9 +/- 6.6 months. Bedtime bottle feedings were reported in more than 87% of the unweaned group. Sixty-nine percent reported poor dental development associated with delayed weaning. CONCLUSIONS: Married parents are at risk of late weaning. Parents continue to allow their children to sleep with milk bottles in their mouths in bed at night. Parents are not aware of the medical problems associated with late weaning. Late-weaning parents are not knowledgeable about current weaning recommendations. Current approaches are not effective in altering set patterns of inappropriate weaning habits. Additional interventions and innovative parental education methods are needed to improve age-appropriate weaning practices.

The effect of route of delivery on neonatal natural killer cytotoxicity and antibody-dependent cellular cytotoxicity to herpes simplex virus-infected cells.

The ability of human neonatal and adult Ficoll-hypaque purified mononuclear cells to mediate natural killer cytotoxicity (NKC) and antibody-dependent cellular-cytotoxicity (ADCC) against 51Cr labeled herpes simplex virus-infected (HSV-infected) and uninfected cells was evaluated in healthy term infants delivered vaginally or by Cesarean (C)-section without labor, and in healthy adult controls. Cord blood NKC to HSV-infected cells (12.5 +/- 7.0) was lower (P less than 0.01) than adult controls NKC (29.5 +/- 7.0). NKC to HSV-infected cells of babies delivered vaginally (16.6 +/- 3.4) was lower (P less than 0.05) than adult controls (28.4 +/- 4.2). NKC to HSV-infected cells of neonates delivered by C-section without labor (7.6 +/- 2.8) was also lower (P less than 0.001) than adult controls (30.7 +/- 4.0) and lower (P less than 0.05) than that of neonates delivered vaginally. Cord blood ADCC (43.1 +/- 9.0) was lower (P less than 0.05) than ADCC of adult controls (58 +/- 10). ADCC of neonates delivered vaginally (50 +/- 5.9) was similar to ADCC of adult controls (57.4 +/- 6.9). ADCC of neonates delivered by C-section without labor (30.4 +/- 7.2) was lower than ADCC of adult (58.5 +/- 7.4) and was lower (P less than 0.05) than ADCC of neonates delivered vaginally. These findings demonstrate that the method of delivery influences subsequent neonatal leukocyte NKC and ADCC. Further experiments will delineate the cause of these variations, which probably include labor or stress related hormonal changes in the mother or neonate.

Leukocyte function in healthy neonates following vaginal and cesarean section deliveries.

Oxidative metabolic activities of polymorphonuclear leukocytes from cord blood of 15 full-term infants delivered by cesarean section without labor, five infants delivered by cesarean section with labor, and 15 infants delivered vaginally, as well as 35 healthy adult control subjects, were evaluated. The absolute polymorphonuclear leukocyte counts of cord blood from infants delivered vaginally and by cesarean section with labor were significantly higher when compared to cord blood APCs from infants delivered by cesarean section without labor and healthy adult control APCs. Zymosan-stimulated oxygen consumption, hexose monophosphate shunt activity, and quantitative nitroblue tetrazolium dye reduction were significantly lower in cord blood PMNLs from infants delivered vaginally and by cesarean section with labor than in cord blood PMNLs from infants delivered by cesarean section without labor or control PMNLs. Metabolic activity of PMNLs from healthy adults and infants born by cesarean section without labor did not differ significantly. This study indicates that the function of PMNLs isolated from cord blood varies with the method of delivery. These observations may explain previous discrepancies in the literature as well as the propensity of certain neonates to infection.

Antimicrobial therapy of febrile children with malignancies and possible sepsis.

A prospective study of 100 pediatric patients (2 months to 17 years of age) who had malignancies and fever was conducted. Gentamicin or netilmicin and a beta-lactam antibiotic were administered as initial empiric treatment. Before therapy profound granulocytopenia (fewer than 500 polymorphonuclear leukocytes/microliter) was present in 66% of children and persisted to the end of therapy in 42% of children. Of the 40 children with microbiologically documented infections, 38 (95%) responded to therapy. The aminoglycoside dosing regimen of 2 mg/kg/dose intravenously over 60 minutes every 6 hours produced antibiotic concentrations in serum of 5.8 +/- 0.3 microgram/ml at the end of the infusion in the netilmicin group and 1.5 +/- 0.1 microgram/ml 6 hours after the infusion and of 6.2 +/- 0.2 and 0.9 +/- 0.1 microgram/ml for the two time periods in the gentamicin group. The serum half-lives, volumes of distribution and the total body clearance rates were comparable for netilmicin and gentamicin. No accumulation of netilmicin or gentamicin was noted. Seven patients had renal compromise, five before institution of antibiotic therapy and two while on therapy. Four episodes of ototoxicity were not related to antibiotic therapy. Superinfection occurred in five children. The combination of either gentamicin or netilmicin with a beta-lactam antibiotic produced excellent results for episodes of fever in neutropenic children with cancer. In children with severe underlying disease and/or granulocytopenia, antibiotic combinations have achieved an optimal efficacy. Future emphasis should be placed on prevention, immunoregulation and nonbacterial pathogens.