Showing posts with label school. Show all posts
Showing posts with label school. Show all posts

Tuesday, October 13, 2015

Substance Use and Beliefs in Middle School Influence Risk of Driving Under the Influence: A Concerning Set of Longitudinal Survey Data

By: Lewis First, MD, MS; Editor-in-Chief     

          Risk-taking behaviors are certainly high on our anticipatory guidance radar when we see adolescents for health maintenance visits.  Even though we are concerned that a risk-taking behavior in early adolescence can portend other risk-taking behaviors in later adolescence—has it ever really been demonstrated?  Ewing et al. (doi: 10.1542/peds.2015-1143) have done just that using surveys of over 1100 teens given at ages 12 and 14 looking at alcohol and marijuana use as well as beliefs about their use and then compared these results to how often these same teens at age 16 drive under the influence (DUI) or ride with someone else who is drinking and driving (RWDD).  Even beginning at age 12, if a teen felt positively about marijuana use, let alone by age 14 was using it or drinking alcohol—there is a dramatic higher risk of DUI AND RWDD in these teens. 
Do you broach these risk-taking behaviors at age 12?  Do you wait until teens are older?  If the latter, you may be too late in offering the education these teens need to make better choices when confronted by peers with risk-taking opportunities for substance use and abuse.  How early do you begin to discuss marijuana and alcohol use with preteens and have you found talking to preteens is making a difference in a positive sense?  Share with us your thoughts on this interesting, but sad look at early adolescence through a response to this blog, an e-letter or posting a comment on our Facebook or Twitter sites.

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Friday, August 28, 2015

ADHD Diagnosis – What Risk is defined at birth?

By: Lydia Furman, MD,  Assistant Editor 
     How do prematurity and fetal growth impact risk of ADHD? Comprehensive epidemiological studies from countries such as Finland that have universal health care, national tracking registries and relatively homogeneous populations can provide unique insights into challenging questions like this one. Dr. Sucksdorff et al. (doi: 10.1542/peds.2015-1043) have conducted a careful and thoughtful study whose conclusions have both pragmatic practice implications, as well as potential to stimulate new research.
      The authors were able to use national registries to identify all 900,603 live singleton births between 1991 and 2001, and then to further select the study subpopulations of (a) all 10,321 children who were diagnosed with ADHD and (b) 38,355 matched healthy controls. Very few had missing information or exclusionary diagnoses, and the authors are able to cite prior work showing that 88% of children with an ADHD Registry diagnosis who were subsequently examined did meet the DSM-IV diagnostic criteria for ADHD. The exposures of interest were (1) gestational age by week, and (2) sex-specific fetal growth for gestational age by standard deviation category (please read the paper for relevant details); obviously the outcome of interest was the diagnosis of ADHD. The authors were able to include 9 key confounding variables in the analysis, for example maternal smoking and parental psychiatric diagnoses, with sufficient detail and documentation to provide meaningful information.
      The results of the logistic regression analyses are convincing. Readers familiar with multiple studies examining risk for ADHD will likely not be surprised by the results, but the magnitude of the association of gestational age with ADHD diagnosis is highly persuasive. Are late preterm, “early term” and even younger term infants impacted? The information is presented clearly in both the text and tables, and I hope you will enjoy the read. Previous work has suggested that small for gestational age status increases risk for ADHD, but Dr. Sucksdorff and colleagues are able to show a beautifully “fine-grained” view of the impact of being either larger or smaller for gestational age on risk for ADHD diagnosis. In both analyses (gestational age and weight for gestational age) there are interesting surprises, as well as implications for how we classify gestational maturity and appropriateness of fetal growth for gestational age. And the article may influence practicing pediatricians to think differently about risk for ADHD diagnosis in individual children.
      As the authors note, given the limited socioeconomic differences and disparities in perinatal health in Finland, it is unlikely that these results are hiding uncontrolled social factors. So although it can be difficult to generalize results from one country to another, in this case a study setting that essentially controls for the myriad of social and health disparities in the US provides a unique opportunity for researchers to think more clearly about the etiology of ADHD. These authors found a very minor impact of familial factors after adjustment for confounders. They point out that the processes underlying fetal neurodevelopment, including “synaptogenesis, brain folding and myelination,” along with factors related to the multiple possible mechanisms of preterm labor including inflammation, infection and ischemia, may play an etiologic role in susceptibility to ADHD, i.e. to the behaviors of inattention, hyperactivity and impulsiveness. And taking this one step further, since susceptibility or risk for ADHD is not ADHD diagnosis, what postnatal environmental factors might “tip the ship” and lead to or be associated with diagnosis? We will need to await another careful and thoughtful study to answer this question… 

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Wednesday, August 12, 2015

Are There Differences in School Readiness for Late Preterm Infants Compared to Term? New Study Says Yes!

By: Lewis First, MD, MS; Editor-in-Chief       

          How often do parents ask us if their child is ready to start kindergarten despite their meeting the age requirement?  This is especially common for parents of children born been born preterm—but what about late preterm infants 34 to 36 weeks gestation?
Woythaler et al. (doi: 10.1542/peds.2014-4043) opted to look at neurodevelopmental outcomes using a longitudinal cohort population of 950 late preterm babies, comparing them to more than 4900 term infants to see if their 24-month developmental assessment correlated with their “school readiness score” using a valid assessment tool once the subjects were age-appropriate for kindergarten.     
 The good news is that just because a late preterm infant has delayed neurodevelopment at 24 months does not mean he or she won’t be improved neurodevelopmentally by the time they are ready to enter kindergarten.  If a late preterm is developmentally on target at 20 months, the prognosis is good for moving into kindergarten when age-appropriate.  
 Have you noticed the same findings in your own patients? Do you note any developmental differences in your late preterm patients as they get older?  Share your thoughts and experience with us by responding to this blog, sending an e-letter or posting on our Facebook or Twitter sites.

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Tuesday, May 26, 2015

You Can Dance If You Want To: Dance Class and Continued Physically Activity

By: Lewis First, MD, MS; Editor-in-Chief       
     We publish many studies stressing the importance of physical activity as a means of maintaining general health and fitness, not to mention prevention or treatment of conditions like being overweight or obese.  Dance is certainly an option for many children—but just how good is an organized after-school dance class or program in generating the CDC recommended 30 minutes of of moderate to vigorous physical activity?  
      Cain et al (doi: 10.1542/peds.2014-2415)  collected data from 17 private dance studios and 4 community centers in San Diego involving more than 250 girls ranging from children to teens and used accelerometers and activity levels to measure the degree of physical activity demonstrated in 7 dance types—ballet, hip-hop, jazz, Latin-flamenco, Latin-salsa/Ballet Folklorico, partnered and tap.  So which dance types provided good amounts of physical activity in dance classes? Not as many as you might think—and by adolescence, not one of the dances studied is more effective than any other at increasing physical activity.  
      Perhaps you should foxtrot over to your local dance instructors and see if they agree with the findings in this article relative to their own dance programs.  That would certainly be a step in the right direction when it comes to making dance a better activity for improving the physical fitness of our pediatric patients.

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