Behavioral outcomes and exposure to perfluoroalkyl substances among children aged 6-13 years: The TEDDY child study.

BACKGROUND: Although some studies report that exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy and early life stages of a child could adversely impact neurodevelopment, literature shows mixed evidence. OBJECTIVES: Using an ecological framework for human development, we assessed the association of risk factors for environmental PFAS exposure and childhood PFAS concentrations with behavioral difficulties among school-age children exposed to PFAS from birth, while also controlling for the important influence of the parenting and familial environment. METHODS: The study participants included 331 school-age children (6-13 years) born in a PFAS-contaminated area in the Veneto Region (Italy). We study the associations between environmental risk factors of maternal PFAS exposure (residential time, consumption of tap water, residence in Red zone A or B), and breastfeeding duration with parent assessments of children's behavioral problems (using the Strengths and Difficulties Questionnaire [SDQ]), adjusting for socio-demographic, parenting and familial variables. The direct relationships between serum blood PFAS concentrations and SDQ scores was evaluated in a subset of children (n = 79), both with single PFAS and weighted quantile sum (WQS) regressions. RESULTS: Poisson regression models reported positive associations between high consumption of tap water and externalizing SDQ scores (Incidence Rate Ratio [IRR]: 1.18; 95% confidence interval [CI]: 1.04-1.32) and total difficulty scores (IRR: 1.14; 95% CI: 1.02-1.26). Childhood perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were associated with higher internalizing SDQ scores (4th vs. 1st quartile, PFOS IRR: 1.54, 95% CI: 1.06-2.25), externalizing scores (4th vs. 1st quartile, PFHxS IRR: 1.59, 95% CI: 1.09-2.32), and total difficulty scores (4th vs. 1st quartile, PFOS IRR: 1.37, 95% CI: 1.05-1.71; PFHxS IRR: 1.54, 95% CI: 1.09-1.90). The WQS regressions confirmed the associations reported by single-PFAS analyses. CONCLUSIONS: We observed cross-sectional associations of tap water consumption and childhood PFOS, and PFHxS concentrations with greater behavioral difficulties.

Gender, Racial, and Socioeconomic Disparities on Social and Behavioral Skills for K-8 Students With and Without Interventions: An Integrative Data Analysis of Eight Cluster Randomized Trials.

Despite decades of concern about disparities in educational outcomes for low SES students and students of color, there has been limited rigorous study of programmatic approaches for reducing these disparities in elementary or middle schools. We conducted integrative data analysis (IDA) of the combined data from eight Institute of Education Sciences funded cluster randomized trials to address the research gaps on social and behavioral outcome disparities. The final analytic sample includes 90,880 students in varying grade levels from kindergarten to grade 8 in 387 schools in 4 states (Maryland, Missouri, Virginia, and Texas). Two-level hierarchical linear modeling was used for multilevel moderation analysis. This study provided empirical evidence that there were significant gender, racial, and socioeconomic disparities on social and behavioral outcome measures for elementary and middle school students, the disparities significantly varied across schools, and the disparities could be reduced by interventions. We discussed our findings, implications for interpreting effect sizes of interventions using disparities as empirical benchmarks, and study limitations. We concluded with suggestions for future research.

Prevalence, correlates, and behavioral outcomes of alcohol gifting in China.

INTRODUCTION: Alcohol gifting is a very common practice in China. However, little is known about the potentially adverse consequences of alcohol gifting. This study aimed to investigate the prevalence of, and factors associated with, alcohol gifting, and explore whether drinking and tobacco use were associated with alcohol gifting. METHODS: Using a cross-sectional multi-stage survey, a sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi Province was collected online from 30 April to 30 July 2020 in China. Participants completed questionnaires regarding socio-demographic characteristics, social capital, drinking status, and gifting alcohol behavior. Chi-square analysis and multiple logistic regression analysis were used to identify the factors associated with alcohol gifting, and to identify its relationship with alcohol and cigarette use status. RESULTS: Multiple logistic regression analysis showed that age, gender, household annual income, province, drinking status, and social participation were prominent correlates of both offering and receiving alcohol. Participants who were married, had an education level of junior high school, or had a large social network had higher odds of receiving alcohol. When both alcohol gifting behaviors were included in the models, participants who offered alcohol had 2.15 (95% CI: 1.63-2.85) times higher odds of current drinking than those who didn't offer alcohol and participants who received alcohol had 1.87 (95% CI: 1.45-2.41) times higher odds of current drinking than those who did not receive alcohol. Those who received alcohol had significantly higher odds of current smoking (AOR = 1.64; 95% CI: 1.25-2.14), while those who offered alcohol had significantly lower odds of current smoking (AOR = 0.71;95% CI:0.53-0.95). CONCLUSIONS: Social participation is an important correlate of alcohol gifting. Alcohol receiving behaviors were significantly associated with both current alcohol and tobacco use. These associations can be used to inform alcohol gifting interventions in China.

Rules We Live by: How Religious Beliefs Relate to Compliance with Precautionary Measures Against COVID-19 in Tibetan Buddhists.

The present studies investigated how particular religious beliefs shape compliance with preventive measures in adherents of Gelug and Nyingma schools of Tibetan Buddhism. In Study 1, Gelug and Nyingma monks were asked to report their compliance with various infection prevention measures surrounding COVID-19. Results showed that the former group showed higher compliance with public health guidelines than the latter. Extending beyond self-report measures, Study 2 added a behavioral outcome measure and observed the same effect. Together, our results provide the first empirical evidence that various Tibetan Buddhist traditions are related to different degrees of compliance with precautionary measures against COVID-19.

Behavioral outcome among survivors of childhood brain tumor: a case control study.

BACKGROUND: Advances in the treatment of childhood brain tumors have significantly improved survival rates. With improved survival rates, long-term treatment-related toxicities have become important, and the resulting complications can affect patients' emotion and behavior. This study aimed to 1) evaluate behavioral outcomes among survivors of childhood brain tumors, 2) compare behavioral outcomes among survivors of childhood brain tumors with survivors of childhood leukemia and healthy children, and 3) determine any demographic, disease, and/or treatment-related factors that could affect the behavioral outcomes of survivors of childhood brain tumors. METHODS: A comparative cross-sectional study was conducted over a period of 1 year (June 1st, 2018-May 31st, 2019) in two tertiary referral centers in Kuala Lumpur, Malaysia. Thirty-eight survivors of childhood brain tumors aged 6 to 18 years old who had been off-treatment for at least 1 year and were in remission, 38 age- and gender-matched survivors of childhood leukemia who had been off-treatment for at least 1 year and were in remission, and 38 age- and gender-matched unrelated healthy children were recruited. The Child Behaviour Checklist (CBCL) parent report and Youth Self-Report (YSR) questionnaires were used to assess behavioral outcomes. RESULTS: Survivors of childhood brain tumors showed statistically significantly worse behavioral outcomes than healthy children for social problems and attention problems (p < 0.05, respectively). A significantly worse outcome was found for "social problems" (p < 0.05) in survivors of childhood brain tumors compared to survivors of childhood leukemia. Significant associations were also found between physical disability, visual impairment, education level of survivors, and father's occupation and behavioral outcomes among survivors of childhood brain tumors. CONCLUSIONS: Survivors of childhood brain tumors in our center showed poor behavioral outcomes for social problems and attention problems. Thus, effective psychosocial support interventions tailored to individual patients as soon as treatment is completed are important to prevent potentially debilitating emotional problems.

Neurodevelopmental outcome in survivors of hypoxic ischemic encephalopathy without cerebral palsy.

To access outcome following hypoxic ischemic encephalopathy (HIE), survivors without cerebral palsy were invited for formal developmental assessment. Children aged ≥ 42 months were assessed using the NEPSY-2, Movement Assessment Battery for Children 2 (Movement ABC-2), Behavior Rating Inventory of Executive Function, and the Child Behavior Checklist. Children aged < 42 months were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-3). One hundred forty-six children attended for assessments [Grade 1 (112), Grade 2 (33), and Grade 3 (1)]. BSITD-3 did not identify significant rates of impairment on cognitive, motor, or language subtests. A significant proportion of children scored < 3rd percentile on the adaptive behavior scale. In older age groups, difficulties were seen in 16/24 NEPSY-2 subtests and on timed assessments using Movement ABC-2. Difficulties arose especially in the "control" aspects of cognition and behavior. Behavioral difficulties were common with internalizing problems predominating. There was a graded effect with grade 2 cases differing significantly from grade 1 cases. CONCLUSION: Following HIE, children may experience attention, memory, and behavior difficulties which are not always evident at a young age. The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age. What is known: • Diversity of outcome across grades of HIE is reported and few studies have looked at the milder consequences of HIE at school age. What is new: • Following HIE children may experience attention, memory, and behavior difficulties which are not always evident at a young age. • The adaptive behavior questionnaire may be a useful tool to select children requiring developmental surveillance beyond 2 years of age.

Neurodevelopmental and emotional-behavioral outcomes in late-preterm infants: an observational descriptive case study.

BACKGROUND: Over the last decade, several studies investigated the outcomes in children born very preterm. Only recently there has been an increasing interest in the late preterm infants (born between 34 + 0 and 36 + 6 weeks). This population is at high risk of morbidity and mortality in the first years of life. Other studies reported that they are also at risk of long-term developmental problem. Therefore, the aim of this study is to describe the neurodevelopmental and emotional-behavioral outcome in a sample of late preterm patients. METHODS: The study included late preterm children and adolescents who had neuropsychiatric and/or neurological symptoms. They underwent a general, neurocognitive and an emotional-behavioral assessment. Exclusion criteria included: patients affected by Central Nervous System congenital abnormalities, neurodegenerative diseases, genetic disorders, epilepsy, or in pharmacological treatment, or adopted children. A descriptive statistics analysis was performed to describe the sociodemographic and clinical characteristics of patients. Risk factors related to late preterm birth, prevalence of neurodevelopmental disorders, and cognitive functioning were recorded and analyzed. RESULTS: The sample included 68 LPI (45 males and 23 females) aged from 2 to 16.3 years (mean age 7,5 years), who were affected by one or more neurodevelopmental disorder, including Language Disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder, Developmental Coordination Disorder, Intellectual Disability and Autism Spectrum Disorder. Moreover, in 30.8% of patients, internalizing problems (affective and social skills problem) were detected. CONCLUSIONS: Our results support the importance of a long-term surveillance of late preterm and the great need for more longitudinal large population studies in order to collect data on the neurodevelopmental outcomes of this population.

Interaction of ARC and Daxx: A Novel Endogenous Target to Preserve Motor Function and Cell Loss after Focal Brain Ischemia in Mice.

UNLABELLED: The aim of this study was to explore the signaling and neuroprotective effect of transactivator of transcription (TAT) protein transduction of the apoptosis repressor with CARD (ARC) in in vitro and in vivo models of cerebral ischemia in mice. In mice, transient focal cerebral ischemia reduced endogenous ARC protein in neurons in the ischemic striatum at early reperfusion time points, and in primary neuronal cultures, RNA interference resulted in greater neuronal susceptibility to oxygen glucose deprivation (OGD). TAT.ARC protein delivery led to a dose-dependent better survival after OGD. Infarct sizes 72 h after 60 min middle cerebral artery occlusion (MCAo) were on average 30 ± 8% (mean ± SD; p = 0.005; T2-weighted MRI) smaller in TAT.ARC-treated mice (1 µg intraventricularly during MCAo) compared with controls. TAT.ARC-treated mice showed better performance in the pole test compared with TAT.ß-Gal-treated controls. Importantly, post-stroke treatment (3 h after MCAo) was still effective in affording reduced lesion volume by 20 ± 7% (mean ± SD; p < 0.05) and better functional outcome compared with controls. Delayed treatment in mice subjected to 30 min MCAo led to sustained neuroprotection and functional behavior benefits for at least 28 d. Functionally, TAT.ARC treatment inhibited DAXX-ASK1-JNK signaling in the ischemic brain. ARC interacts with DAXX in a CARD-dependent manner to block DAXX trafficking and ASK1-JNK activation. Our work identifies for the first time ARC-DAXX binding to block ASK1-JNK activation as an ARC-specific endogenous mechanism that interferes with neuronal cell death and ischemic brain injury. Delayed delivery of TAT.ARC may present a promising target for stroke therapy. SIGNIFICANCE STATEMENT: Up to now, the only successful pharmacological target of human ischemic stroke is thrombolysis. Neuroprotective pharmacological strategies are needed to accompany therapies aiming to achieve reperfusion. We describe that apoptosis repressor with CARD (ARC) interacts and inhibits DAXX and proximal signals of cell death. In a murine stroke model mimicking human malignant infarction in the territory of the middle cerebral artery, TAT.ARC salvages brain tissue when given during occlusion or 3 h delayed with sustained functional benefits (28 d). This is a promising novel therapeutic approach because it appears to be effective in a model producing severe injury by interfering with an array of proximal signals and effectors of the ischemic cascade, upstream of JNK, caspases, and BIM and BAX activation.

Cognitive outcome after epilepsy surgery in children: A controlled longitudinal study.

OBJECTIVE: To analyze the determinants of cognitive outcome two years after surgery for drug-resistant epilepsy in a cohort of 31 children when compared to a control group of 14 surgical candidates who had yet to undergo surgery two years after the first neuropsychological assessment. METHODS: Controlled longitudinal study including three evaluations of IQ (Intelligence Quotient) scores or GDQ (General Developmental Quotient) for each group depending on the patient's age: prior to surgery (T0), one year (T1) and two years (T2) after surgery for the surgical group; baseline (T0) and one year (T1) and 2years (T2) after the first evaluation for the control-group. At follow-up, 25 children (80%) of the surgical group were seizure free, while seizure outcome was unsatisfactory in the remaining six (20%). To analyze language, visuomotor skills, memory, reading, visual attention, and behavior, we selected 11 school age children in the surgical group and nine controls. We reported performance prior to (T0) and one year after surgery (T1). RESULTS: There was a significant correlation between earlier age at seizure onset and lower IQ/GDQ at T0 (r=0.39; p=0.03) in the overall cohort. IQ/GDQ scores did not significantly differ between the surgical and control groups when analyzed at T0 and T2. However, they evolved differently with an improved developmental trajectory becoming identifiable only in the surgical group (F1,31=5.33 p=0.028; η2=0.15). There was also a significant increase of forward digit span (Z=2.33; p=0.02) and Rey recall scores (Z=1.97; p=0.049) in the surgical school age subgroup at T1 versus T0. SIGNIFICANCE: We identified significantly different developmental trajectories in operated versus non- operated children with improved IQ/GDQ scores in operated children only. We also observed a significant increase of digit span scores and Rey recall scores a year after surgery. Further studies including larger samples with longer follow-ups are needed to confirm these preliminary findings.

Ultrasound stimulation inhibits recurrent seizures and improves behavioral outcome in an experimental model of mesial temporal lobe epilepsy.

Current therapies for epilepsy consist mostly of pharmacological agents or invasive surgery. Recently, ultrasound (US) stimulation has been considered a promising tool for the noninvasive treatment of brain diseases, including epilepsy. However, in temporal lobe epilepsy (TLE), a common form of epilepsy, neurophysiological and functional outcomes following US stimulation are not well defined. To address this, we developed a paradigm of transcranial pulsed US stimulation to efficiently suppress seizure activity in the initial/acute period in a kainate (KA)-induced mouse model of mesial TLE. Pulsed US stimulation inhibited acute seizure activity and either delayed the onset of or suppressed status epilepticus (SE). Kainate-treated mice that had received US stimulation in the initial period exhibited fewer spontaneous recurrent seizures (SRSs) and improved performance in behavioral tasks assessing sociability and depression in the chronic period of epilepsy. Our results demonstrate that US stimulation in the acute period of epilepsy can inhibit SRSs and improve behavioral outcomes in a mouse model of mesial TLE. The present study suggests that noninvasive transcranial pulsed US stimulation may be feasible as an adjuvant therapy in patients with epilepsy. This article is part of a Special Issue entitled "Status Epilepticus".

Dissociation of attentional state and behavioral outcome using local field potentials.

Behavioral outcome (i.e., whether a target is detected or missed) depends on attentional state and potentially other factors related to decision-making, which could in turn modulate the power and phase of neuronal oscillations. Here we investigated whether attentional state (i.e., whether attention is inside or outside the receptive fields of neurons) and behavioral outcome are distinguishable using the power and phase of local field potential (LFP) recorded from electrode arrays in area V4 of two male rhesus monkeys performing an attentional task under different cuing conditions. Since attention also strongly modulates pairwise measures such as spike count correlation and phase consistency which are typically measured across trials, we developed novel methods to obtain single-trial estimates of these measures. Surprisingly, while attentional location was best discriminated using gamma and high-gamma power, behavioral outcome was best discriminated by alpha power and steady-state visually evoked potential. Power outperformed absolute phase, although single-trial gamma phase consistency provided good attentional discriminability. Our results provide a clear dissociation between the neural mechanisms that regulate attentional focus and those that govern behavioral outcome.

Model-based parcellation of diffusion MRI of injured spinal cord predicts hand use impairment and recovery in squirrel monkeys.

A mathematical model-based parcellation of magnetic resonance diffusion tensor images (DTI) has been developed to quantify progressive changes in three types of tissues - grey (GM), white matter (WM), and damaged spinal cord tissue, along with behavioral assessments over a 6 month period following targeted spinal cord injuries (SCI) in monkeys. Sigmoid Gompertz function based fittings of DTI metrics provide early indicators that correlate with, and predict, recovery of hand grasping behavior. Our three tissue pool model provided unbiased, data-driven segmentation of spinal cord images and identified DTI metrics that can serve as reliable biomarkers of severity of spinal cord injuries and predictors of behavioral outcomes.

School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial.

Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: -0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children's sleep-wake patterns and sleep problems.

Reduction of brain stem pathology and transient amelioration of early cognitive symptoms in transgenic mice treated with a monoclonal antibody against α-synuclein oligomers/protofibrils.

Immunotherapy against alpha-synuclein (α-syn) is a promising novel treatment strategy for Parkinson's disease (PD) and related α-synucleinopathies. We have previously shown that systemic treatment with the monoclonal oligomer/protofibril-selective antibody mAb47 targeting cytotoxic α-syn leads to reduced central nervous system levels of such species as well as an indication of reduced late-stage symptoms in aged (Thy-1)-h[A30P] α-syn transgenic mice. Here, we performed an early-onset long-term treatment study with this antibody to evaluate effects on brain pathology and behavioral outcomes in the same mouse model. Compared to the placebo group, the treatment strongly reduced phosphorylated α-syn (pS129 α-syn) pathology in the upper brain stem. Moreover, a preserved recognition memory and risk assessment behavior could be seen in antibody-treated mice at six months of age, even although these effects were no longer significant at eleven months of age. Importantly, no evidence of inflammatory responses or other potential toxic effects was seen with the treatment. Taken together, this study supports the strategy to target α-syn oligomers/protofibrils with monoclonal antibodies to counteract early symptoms and slow down the progression of PD and other α-synucleinopathies.

Behavioral outcome of very preterm children at 5 years of age: Prognostic utility of brain tissue volumes at term-equivalent-age, perinatal, and environmental factors.

OBJECTIVE: Prematurity is associated with a high risk of long-term behavioral problems. This study aimed to assess the prognostic utility of volumetric brain data at term-equivalent-age (TEA), clinical perinatal factors, and parental social economic risk in the prediction of the behavioral outcome at 5 years in a cohort of very preterm infants (VPT, <32 gestational weeks). METHODS: T2-weighted magnetic resonance brain images of 80 VPT children were acquired at TEA and automatically segmented into cortical gray matter, deep subcortical gray matter, white matter (WM), cerebellum (CB), and cerebrospinal fluid. The gray matter structure of the amygdala was manually segmented. Children were examined at 5 years of age with a behavioral assessment, using the strengths and difficulties questionnaire (SDQ). The utility of brain volumes at TEA, perinatal factors, and social economic risk for the prediction of behavioral outcome was investigated using support vector machine classifiers and permutation feature importance. RESULTS: The predictive modeling of the volumetric data showed that WM, amygdala, and CB volumes were the best predictors of the SDQ emotional symptoms score. Among the perinatal factors, sex, sepsis, and bronchopulmonary dysplasia were the best predictors of the hyperactivity/inattention score. When combining the social economic risk with volumetric and perinatal factors, we were able to accurately predict the emotional symptoms score. Finally, social economic risk was positively correlated with the scores of conduct problems and peer problems. CONCLUSIONS: This study provides information on the relation between brain structure at TEA and clinical perinatal factors with behavioral outcome at age 5 years in VPT children. Nevertheless, the overall predictive power of our models is relatively modest, and further research is needed to identify factors associated with subsequent behavioral problems in this population.

Effects of an educational planetary plate graphic on meat consumption in a Stanford University dining hall: a randomized controlled trial.

BACKGROUND: Assess the impact of an educational Planetary Health Plate (PHP) graphic on meat-related dietary choices of Stanford University dining hall patrons using a randomized controlled trial crossover design. All patrons entering the dining hall during study periods were enrolled as participants. Control, n = 631; PHP, n = 547. METHODS: Compare dietary behavior without signage to behavior while exposed to PHP during four equivalent dinner meals. The primary outcome was total meat-dish weight adjusted for the number of people entering the dining hall. Secondary outcomes included the number of meat-dish servings and average meat-dish serving weight. Analysis using T-tests, Poisson generalized linear model. RESULTS: Differences in total meat-dish weight, (1.54 kg; 95% Confidence Interval [CI] = -4.41,1.33; P = .19) and average meat-dish serving weight (0.03 kg; 95% CI = 0.00, 0.06; P = .07) between PHP and control patrons did not reach significance. The rate at which PHP patrons took meat was significantly lower (Incidence Rate Ratio 0.80; 95% CI = 0.71, 0.91; P < .001). CONCLUSION: Exposure to an educational plate graphic decreased the proportion of patrons taking meat but had no impact on total meat consumption or meat-dish serving weight. Statistical methods used in this study may inform future investigations on dietary change in the dining hall setting. Further research on the role of educational signage in influencing dietary behavior is warranted, with an aim to improve human health and environmental sustainability. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05565859, registered 4 October 2022.

Sleep and neurocognitive outcome in primary school children with Robin Sequence.

STUDY OBJECTIVES: To investigate neurocognitive and behavioral outcomes at primary school age in relation to obstructive sleep apnea (OSA) in children with Robin sequence (RS) treated with the Tuebingen palatal plate in infancy and to assess the impact of OSA in these patients. METHODS: Forty-two primary school-aged children (n = 21 with RS, n = 21 age- and sex-matched controls) underwent polysomnography, intelligence testing ("Wechsler Intelligence Scale for Children-Fifth Edition" [WISC-V]), and anthropometrics. Families completed a 7-day sleep diary and questionnaires on sleep and behavior (Children's Sleep Habits Questionnaire [CSHQ] and the Child Behavior Checklist [CBCL]). RESULTS: In children with RS (17 non-syndromic, four syndromic; median age 9.7 [8.5-10.8] years), the obstructive apnea-hypopnea index (OAHI) was significantly higher than in controls (1.3 [0.4-2.7]/h vs. 0.4 [0.1-0.6]/h). Two syndromic children with RS were already on nocturnal respiratory support for OSA prior to our study, and one non-syndromic child was diagnosed with severe OSA (OAHI 57/h) despite an unremarkable medical history and questionnaire. The overall intelligence quotient in children with RS was within the normal range and did not differ between children with RS and healthy peers (102 vs. 108, p = .05). However, children with RS had values in the at-risk clinical range for externalizing behavior. CONCLUSIONS: These children with RS showed an increased risk of OSA and behavioral problems, suggesting regular screening for OSA throughout childhood. Neurocognitive scores in children with RS were within the normal range after adequate treatment of OSA during infancy.

Cigarette sharing and gifting in China: Patterns, associated factors, and behavioral outcomes.

INTRODUCTION: The purpose of this study was to investigate the patterns and factors associated with cigarette sharing and gifting, and to explore whether smoking can be predicted by these social practices. METHODS: A cross-sectional survey using a multi-stage sampling design was conducted online from 30 April to 30 July 2020 in China. A sample of 982 household heads from Guangdong Province and 530 household heads from Shaanxi province were involved in the data analysis. Demographic characteristics, social participation, beliefs and behaviors related to cigarette sharing and gifting were assessed. Chi-squared analysis and multiple logistic regression analysis were used to explore the key factors associated with cigarette sharing and gifting, and to identify their relationship with smoking. RESULTS: The shared and gift cigarettes were both mainly offered to friends, and receiving gift cigarettes mostly occurred during the holidays. Gender and province were associated with cigarette sharing, and marital status and social participation were associated with cigarette gifting. Cigarette gifting beliefs and smoking status were prominent predictors for both sharing and gifting cigarettes. Cigarette gifting beliefs were significantly higher among smokers than non-smokers, and people with high cigarette gifting beliefs were 1.68 (adjusted odds ratio, AOR=19.17; 95% CI: 13.31-27.61) times more likely to be a smoker. Offering shared cigarettes has been found to significantly predict tobacco use (AOR=19.17; 95% CI: 13.31-27.61), while people who received shared and gift cigarettes were 1.50 (95% CI: 1.08-2.09) and 2.58 (95% CI: 1.66-4.00) times more likely to be a current smoker than those who did not receive cigarettes, respectively. CONCLUSIONS: Cigarette sharing and gifting were especially pervasive among male smokers and married people in Shaanxi Province. Offering shared cigarettes and receiving shared/gift cigarettes might facilitate cigarette use. This study provides evidence-based data to support the design and implementation of tobacco control programs for the denormalization of gifting and sharing cigarettes.

Program Practices Predict Intergenerational Interaction Among Children and Adults.

BACKGROUND AND OBJECTIVES: Intergenerational programs, those engaging youth and adults of nonadjacent generations in shared programming for mutual benefit, are attracting increasing attention from funders, policymakers, and practitioners for the range of goals they can support. The mechanisms by which these goals are achieved are rarely studied. To address this gap, we analyzed the associations between specific intergenerational implementation practices and younger and older participant outcomes. RESEARCH DESIGN AND METHODS: Activity leaders at 5 sites serving adults and preschoolers received training to implement 14 evidence-based practices during intergenerational activities involving 84 adults (M = 75.25 years; range = 55-98) and 105 preschool participants (M = 3.26 years; range = 2-5) over 4 years. Measures of activity leaders' implementation of these practices and participants' behavioral responses to programming were gathered. We utilized multilevel modeling to test whether variations in implementation of practices were associated with variations in participants' responses to programming on a session-by-session basis. RESULTS: For both preschool and adult participants, analyses revealed that the implementation of certain practices was associated with significantly more intergenerational interaction. When more practices were implemented reflecting factors of (a) participant pairing and (b) person-centered care, both child and adult intergenerational interactions were higher. DISCUSSION AND IMPLICATIONS: Practices used by intergenerational activity leaders during programming help to explain within-person responses of both child and adult participants. Intergenerational relationships may be a powerful means to achieve diverse goals; they depend on skillful practice by trained activity leaders.

The consequences of neonatal pain, stress and opiate administration in animal models: An extensive meta-analysis concerning neuronal cell death, motor and behavioral outcomes.

This systematic review and meta-analysis aimed to investigate the association of neonatal exposure to pain, stress, opiate administration alone, as well as opiate administration prior to a painful procedure on neuronal cell death, motor, and behavioral outcomes in rodents. In total, 36 studies investigating the effect of pain (n = 18), stress (n = 15), opiate administration (n = 13), as well as opiate administration prior to a painful event (n = 7) in rodents were included in our meta-analysis. The results showed a large effect of pain (g = 1.37, 95% CI 1.00-1.74, p < .001) on neuronal cell death. Moreover, higher number of neonatal pain events were significantly associated with increased neuronal cell death, increased anxiety (b = -1.18, SE = 0.43, p = .006), and depressant-like behavior (b = 1.74, SE = 0.51, p = .027) in rodents. Both opiates and pain had no impact on motor function (g = 0.26, 95% CI 0.18-0.70, p = .248).