Diagnosis and treatment of pulmonary hypertension in the adolescent

This article discusses diagnostic and therapeutic options of adolescents with primary and secondary pulmonary hypertension. Pulmonary hypertension is an important determinant of morbidity and mortality in many diseases, including congenital heart disease and respiratory disease. Previously, the diagnosis of pulmonary hypertension in children carried a poor prognosis. However, advances in the diagnosis and treatment of pulmonary hypertension over the last decade have markedly improved survival of many patients. A targeted approach includes treatment of the underlying disease, and therefore requires an extensive evaluation. Many of the treatment modalities are based on advanced understanding of basic pulmonary vascular biology.     

青少年身高体重最大发育年龄的民族差异

目的分析内蒙古自治区城乡7～18岁汉族、蒙古族和日本学生身高、体重发育现状与差异,为民族体质人类学研究提供基础资料。方法内蒙古自治区汉族和蒙古族学生身高、体重数据来自《2014年内蒙古自治区学生体质与健康调查研究》,日本学生数据来源于日本文部科学省"平成26年度体育与运动调查统计情报",计算身高和体重总增长量、平均增长量及最大发育年龄,检验各项指标的民族差异。结果身高方面,汉族城市男生身高平均高出蒙古族和日本3.02和4.09 cm,汉族城市女生分别高出2.34和3.99 cm;汉族乡村男女生身高平均高出日本1.26和1.69 cm,差异均有统计学意义(P值均<0.05)。体重方面,城市汉族男生体重平均高出蒙古族和日本2.36和5.92 kg,蒙古族比日本高出3.55 kg,汉族和蒙古族城市女生平均高出日本4.12和3.99 kg;汉族和蒙古族乡村男生平均高出日本2.48和1.55 kg,汉族和蒙古族乡村女生分别比日本高出1.53和2.24 kg,差异均有统计学意义(P值均<0.05)。身高最大发育年龄为汉族城市男生10.52岁、日本城市女生9.69岁、日本乡村男生11.5...     

Influence of parental height and sociodemographic factors on adolescent height in brazil

Objective: To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample.

Methods: A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14–18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data.

Results: The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents’ stature was 10 cm (R²= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R² = 0.29). For girls, these values were 7 cm (R²= 0.35) for the parental influence and 5 cm (R² = 0.11) for the sociodemographic factors.

Conclusions: Mother’s stature had the same influence on adolescent’s stature as father’s stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.     

校正血压身高比值筛查儿童高血压准确性研究

探讨血压身高比值校正公式筛查儿童高血压的准确性,为简化儿童高血压筛查工作提供参考.方法 采用分层整群随机抽样方法,抽取秦皇岛市5所小学1 352名7~12岁汉族儿童进行问卷调查及身高、体重、血压等指标测量.计算校正收缩压身高比值(MSBPHR)和校正舒张压身高比值(MDBPHR).结果 儿童年龄与MSBPHR(r男=-0.058,r女=0.036,P值均>0.05)和MDBPHR(r男=-0.042,r女=0.019,P值均>0.05)的相关均无统计学意义.MSBPHR与SBP呈正相关(r男=0.864,r女=0.878,P值均<0.01),与DBP也呈正相关(r男=0.932,r女=0.929,P值均<0.01).MSBPHR和MDB-PHR识别儿童收缩压和舒张压升高的ROC曲线下面积均在0.9以上(0.940~0.970).以MSBPHR/MDBPHR替代收缩压/舒张压,识别儿童高血压的灵敏性分别为男生76.1%,女生83.3%;特异性分别为男生92.1%,女生96.9%.结论 校正血压身高比值是儿童高血压筛查的有效指标,可在基层单位中推广使用.     

The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use

ObjectiveIn the United States, many states have established minimum legal purchase ages for electronic nicotine delivery systems (ENDS) to ban adolescent purchases, but these policies may also affect other related substance use. We explore whether ENDS are substitutes or complements for cigarettes, cigars, smokeless tobacco, and marijuana among adolescents by using variation in state-level implementation of ENDS age purchasing restrictions.MethodsWe linked data on ENDS age purchasing restrictions to state- and year-specific rates of adolescent tobacco and marijuana use in 2007–2013 from the Youth Risk Behavior Surveillance System. This data provides a nationally representative sample of adolescents who attend public and private schools. We performed a fixed effect regression analysis exploring the influence of ENDS age purchasing restrictions on outcomes of tobacco use and marijuana use, controlling for state and year fixed characteristics, age-race cohorts, cigarette excise taxes, and cigarette indoor use restrictions.ResultsFor cigarette use, we separate our results into cigarette use frequency. We found causal evidence that ENDS age purchasing restrictions increased adolescent regular cigarette use by 0.8 percentage points. ENDS age purchasing restrictions were not associated with cigar use, smokeless tobacco use, or marijuana use.ConclusionsWe document a concerning trend of cigarette smoking among adolescents increasing when ENDS become more difficult to purchase.     

Reliability of self-reported smoking history and age at initial tobacco use

BACKGROUND: Many studies use questionnaires to determine smoking status and age of smoking onset. This study aimed to determine the reliability of self-reported smoking history and age of smoking initiation. METHOD: The proportion of inconsistent answers and correlation coefficients of reported age of initial smoking were measured by an answer-reanswer analysis of questionnaires in an ongoing, two-step, population-based survey of health behavior. Interviews were conducted on the day of recruitment to and the day of discharge from mandatory military service in Israel among a sample of 25,437 young men and women recruited between 1986 and 2000. RESULTS: Of 7276 participants reporting current or past smoking upon recruitment, 559 (7.7%) reported never having smoked upon discharge, thus demonstrating prima facie inconsistency. Variables significantly associated with reliable reporting in a multivariate logistic regression model were female gender (P = 0.04) and more than 4 years of military service (P < 0.01). 6010 subjects who reported a positive smoking history at both recruitment and discharge were available for analysis of reliability of reported age at smoking onset. Intraclass correlation coefficients for recruitment/discharge consistency in reported age at first cigarette were 0.73 (95% CI: 0.71-0.74) and 0.76 (95% CI: 0.74-0.78) for men and women, respectively. Eastern origin, lower subject education level, and lower paternal education level were also associated with lower reliability. CONCLUSIONS: Our results showed a relatively high level of answer-reanswer reliability, with some variance attributable to personal characteristics. These results suggest that self-reported age at onset of tobacco use is practical and reliable in normative, young adult populations. However, time elapsed between questionnaires and demographic and lifestyle characteristics may affect reliability rates, and thus should be carefully regarded in future studies.     

Impact of pregnancy-induced hypertension on birthweight by gestational age

Few studies to date have examined the effect of severe pre-eclampsia, pre-eclampsia, and gestational hypertension on birthweight according to gestational age. We conducted a population-based retrospective cohort study of 16,936 pregnant women in Suzhou, China. Analysis of variance and multivariable linear regression were performed to compare the mean birthweights of babies born to mothers with gestational hypertension, pre-eclampsia, and severe pre-eclampsia with birthweights of infants born to mothers with normal blood pressure at each week of gestation. The differences in mean birthweight between women with severe pre-eclampsia and women with normal blood pressure ranged between -467.7 g and 189.1 g. The birthweights were statistically significantly lower in women with severe pre-eclampsia than in women with normal blood pressure for gestational age categories < or = 35 and 36 weeks. However, after adjustment for confounding variables, the birthweights were not statistically significantly different in women with severe pre-eclampsia when compared with women with normal blood pressure even at < or = 35 and 36 weeks. The differences in mean birthweight between women with pre-eclampsia and women with normal blood pressure ranged between -132.2 g and 174.6 g. These differences were not statistically significant, before or after adjusting for confounding variables. There were no differences in mean birthweight between women with gestational hypertension and women with normal blood pressure. Further analysis suggested that pre-eclampsia and gestational hypertension were associated with increased rates of both small-for-gestational-age and large-for-gestational-age infants. The majority of the babies born to mothers with different types of pregnancy-induced hypertension were appropriate-for-gestational-age or even large-for-gestational-age. In this Chinese population, most babies born to mothers with severe pre-eclampsia or pre-eclampsia and gestational hypertension had similar fetal growth to those born to normotensive mothers.     

Differences by age and sex in adolescent suicide

Objectives : To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. Methods : Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. Results : Between 2006 and 2015, there were 273 completed suicides aged 10–19 years, with none aged 10–12 years. There were 171 (63%) suicides in the older adolescent group (17–19 years), and 102 (37%) in the younger group (13–16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self‐harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. Conclusion : Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self‐harm with possible co‐existenting mental illness appear to be key differentiating features. Implications for public health : Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex‐specific suicide prevention strategies.     

Psychosocial factors associated with the use of breast cancer screening by women age 60 years or over.

This study examined psychosocial factors related to breast cancer screening among older women. Data for the study were obtained from interviews with 719 women age 60 years or over attending rural and urban primary care clinics in North Carolina. The results indicated that 50% of the women had mammograms in the past year, 65% reported clinical breast examinations in the past year, and 31% said they practiced breast self-examinations once a month. Several psychosocial factors were significant predictors of a lower likelihood of being screened. Multivariate analysis confirmed the importance of psychosocial factors as predictors of breast cancer screening. Educational intervention to increase screening for breast cancer in this population is needed, and the results provide specific suggestions regarding the content of effective educational materials and approaches for older women.     

利用社会科学统计软件分析患者年龄和体重对高血压病的影响

目的：探讨社会科学统计（SPSS）软件分析患者的年龄和体重对高血压病的影响,研究高血压病的影响因素,从而有效避免或减少高血压病的发生。方法：应用数学基础中的双因素方差分析的原理,借助数理统计软件中的SPSS软件,研究引起高血压病的影响因素。结果：高血压病患者的体重和年龄对高血压的指标舒张压和收缩压均有显著影响,且与线性相关。结论：患者的年龄和体重是影响高血压病的主要因素。     

Factors related with the use of screening mammogram in middle age women in Puerto Rico

Mammography for low-income women is an important intervention issue as it is still under utilized in these sectors. Despite evidence in favor of breast cancer screening with mammograms, research indicates that mammogram compliance among low-income females and women over 50 years of age has been slow. This article revolves around the factors that affect compliance with screening mammograms among low-income women ages 40 to 64 in Puerto Rico once they receive a referral from a physician. Although the multivariate analysis demonstrated that only age, work outside of the home and performing breast self-exams significantly increased the probability for middle-aged, low-income women in Puerto Rico to comply with referrals and have mammograms, this research illustrated that certain factors such as knowledge about the disease and screening practices, a satisfactory perception of the patient-physician relationship, and the performance of a clinical breast exam by a physician influence mammogram compliance.     

Social influences on adolescent substance use

OBJECTIVES: To assess the overtime relationships between adolescent and peer substance use and parenting practices. METHODS: Five times from sixth to ninth grade, students (n=2453) in 7 middle schools reported smoking, drinking, and marijuana use; the number of substance-using friends; and parent practices. Relationships were assessed using latent growth curve modeling. RESULTS: Adolescent substance use predicted the growth in substance-using friends, and substance-using friends predicted adolescent use, except for smoking. The negative over-time relationship between parenting practices and adolescent substance use was mediated by the growth in the number of substance-using friends. CONCLUSIONS: The results are consistent with both selection and socialization effects and provide evidence of the protective effects of positive parenting practices.     

有人值守的标准化测量血压模式在社区高血压筛查中的应用

目的研究诊室血压标准化测量（简称“标准化测压”）模式用于社区高血压筛查的效果。方法从上海市奉贤区简单随机抽取4个社区,根据社区来源不同将筛查对象分为干预组和对照组,以社区非高血压患者作为筛查对象人群,干预前两组均采用常规测压方法,从2021年1月1日—2021年12月31日进行为期1年的干预研究。干预组采用有人值守的标准化测量血压方法作为干预措施,对照组采取常规测压方法。采用SPSS 20.0进行χ2检验分析干预组与对照组间血压末位数分布均衡性,通过正态性检验比较两组间血压值分布情况,通过倍差法分析干预措施前后血压升高率的变化。结果参与干预组标准化测量血压的社区居民共15 368人;参与对照组常规测压社区居民共19 811人。干预组干预后血压末位数值频率范围为9.55%~10.41%,收缩压（SBP）和舒张压（DBP）末位数值均显示分布均衡（P值分别为0.932和0.871）,对照组干预后末位数值频率范围为1.31%~42.58%,SBP和DBP末位数值均显示分布不均衡 （P均<0.001）。通过为期1年的标准化测量干预,干预组干预后血压升高率为26.29%,与人群抽样调查结果接近,干预组血压升高率增幅是对照组增幅的7.61倍（OR=7.55,95%CI:6.75~8.57,P<0.001）。结论诊室血压标准化测量模式适用于社区高血压筛查测压,数据质量高于常规测压模式。     

血压身高比筛查青春期儿童青少年血压偏高效果评价

分析血压身高比性别分类法、年龄分类法和年龄性别分类法筛查青春期血压偏高的效果,为预防儿童青少年高血压提供依据.方法 对参与黑龙江省佳木斯市中小学常规体检的10~17岁汉族学生26 068名进行生长发育指标测量,采用受试者工作特征曲线确定3种方法筛查血压偏高的最佳临界值,计算曲线下面积(AUC)、灵敏度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、阳性预测值(PPV)、阴性预测值(NPV)、Kappa值用于评价.结果 儿童青少年血压偏高检出率为22.7%.筛查青春期血压偏高时,性别分类法的AUC、灵敏度、特异度、+LR、-LR、PPV、NPV、Kappa值分别为0.87,95.0%,79.1%,4.56,0.06,57.2%,98.2%,0.60;年龄分类法分别为0.89,93.3%,84.5%,6.04,0.08,64.0%,97.7%,0.67;年龄性别分类法分别为0.90,94.3%,85.5%,6.52,0.07,65.7%,98.1%,0.69.3种方法灵敏度、特异度及阴性预测值较高,但阳性预测值较低.年龄性别分类法的AUC和Kappa值最高,性别分类法最低.结论 年龄性别分类法筛查效果最好,但相对复杂;年龄分类法筛查效果良好且更加简便.推荐采用2种方法筛查青春期血压偏高.     

Impact of preeclampsia and gestational hypertension on birth weight by gestational age

The predominant etiologic theory of preeclampsia is that reduced uteroplacental perfusion is the unique pathogenic process in the development of preeclampsia. Decreased uteroplacental blood flow would result in lower birth weights. To date, no study has assessed the effect of preeclampsia on birth weight by gestational age. Thus, the authors conducted a retrospective cohort study based on 97,270 pregnancies that resulted in delivery between 1991 and 1996 at 35 hospitals in northern and central Alberta, Canada. Differences in mean birth weight between women with preeclampsia and normotensive women ranged from -547.5 g to 239.5 g for gestational age categories ranging from < or = 32 weeks to > or = 2 weeks. The birth weights were statistically significantly lower among mothers with preeclampsia who delivered at < or = 37 weeks, with an average difference of -352.5 g. However, the birth weights were not lower among preeclamptic mothers who delivered after 37 weeks (average difference of 49.0 g). In Alberta, 61.2% of preeclamptic patients gave birth after 37 weeks of gestation. The authors conclude that babies born to mothers with preeclampsia at term have fetal growth similar to that of babies born to normotensive mothers. This finding does not endorse the currently held theory that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia.