Influence of fitness on health status among survivors of acute lymphoblastic leukemia

Introduction

We aimed to determine the prevalence of self‐reported adverse health status among childhood acute lymphoblastic leukemia (ALL) survivors and to identify associations between components of physical fitness and health status.

Methods

Participants included 365 ALL survivors (mean age at evaluation of 28.6 ± 5.9 years) and 365 age‐, sex‐, and race‐matched community controls. Self‐report of poor general health, poor mental health, functional impairments, and activity limitations were used to describe adverse health status. Fitness was evaluated by assessing flexibility, muscular strength and endurance, peak oxygen uptake, and balance. Generalized linear models were used to examine associations between fitness metrics and health status.

Results

Survivors were more likely than controls to report poor general health (20.6% vs. 10.4%, risk ratio [RR] = 2.0, 95% confidence intervals [CI] = 1.4–2.9), poor mental health (28.0% vs. 14.5%, RR = 1.9, 95% CI = 1.4–2.6), functional impairments (10.5% vs. 4.1%, RR = 2.5, 95% CI = 1.4–4.6), and activity limitations (29.0% vs. 14.4%, RR = 2.0, 95% CI = 1.5–2.7). Survivors whose balance scores were more than 1.5 standard deviations below the mean of the control population were more likely to report poor general health (RR = 1.7, 95% CI = 1.1–2.8), poor mental health (RR = 1.9, 95% CI = 1.3–2.8), and functional limitations (RR = 2.5, 95% CI = 1.2–56). Survivors with low strength were more likely to report poor general health (RR = 1.8, 95% CI = 1.1–3.1), functional impairments (RR = 4.2, 95% CI = 1.7–10.4), and activity limitations (RR = 1.8, 95% CI = 1.2–2.8).

Conclusions

ALL survivors, particularly those with poor balance and reduced muscular strength, are at increased risk for adverse health status.

     

Early intervention best practice: collaboration among an NICU,an early intervention program,and an NICU follow-up program

Maryland's PRemature Infant Developmental Enrichment (PRIDE) program is a collaborative endeavor between the University of Maryland Medical Systems (UMMS) and the Baltimore Infants and Toddlers Program (BITP). This article discusses the components of Maryland's PRIDE, the program's implications for nursing, and recommendations for replication.     

Examining the sensitivity of an injury surveillance program using population-based estimates.

This study uses population-based estimates to assess the sensitivity and representativeness of an injury surveillance system using a 1-year population-based approach. Data from the Ottawa Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) site (Children's Hospital of Eastern Ontario) were compared with those from six expansion sites. The overall sensitivity of CHIRPP was 43% of all treated injuries and 57% of injuries treated at emergency departments. CHIRPP was less likely to be representative for older children and more likely to capture children with more severe injuries. The limitations related to using CHIRPP for representing population-based injury remain fairly stable over time. A one-time population-based sample can provide useful information to add to routinely collected injury surveillance.     

Child maltreatment and substance abuse among U.S. Army soldiers

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U.S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.     

Poverty and program participation among immigrant children

Researchers have long known that poverty in childhood is linked with a range of negative adult socioeconomic outcomes, from lower educational achievement and behavioral problems to lower earnings in the labor market. But few researchers have explored whether exposure to a disadvantaged background affects immigrant children and native children differently. George Borjas uses Current Population Survey (CPS) data on two specific indicators of poverty-the poverty rate and the rate of participation in public assistance programs-to begin answering that question. He finds that immigrant children have significantly higher rates both of poverty and of program participation than do native children. Nearly half of immigrant children are being raised in households that receive some type of public assistance, compared with roughly one-third of native children. Although the shares of immigrant and native children living in poverty are lower, the rate for immigrant children is nonetheless about 15 percentage points higher than that for native children-about the same as the gap in public assistance. Poverty and program participation rates among different groups of immigrant children also vary widely, depending in part on place of birth (foreign- or U.S.-born), parents (immigrant or native), and national origin. According to the CPS data, these native-immigrant differences persist into young adulthood. In particular, the program participation and poverty status of immigrant children is strongly correlated with their program participation and poverty status when they become young adults. But it is not possible, says Borjas, to tell whether the link results from a set of permanent factors associated with specific individuals or groups that tends to lead to "good" or "bad" outcomes systematically over time or from exposure during childhood to adverse socioeconomic outcomes, such as poverty or welfare dependency. Future research must explore the causal impact of childhood poverty on immigrant adult outcomes and why it might differ between immigrant and native families. Developing successful policies to address problems caused by the intergenerational breeding of poverty and program participation in the immigrant population depends on understanding this causal mechanism.     

Impact of a quality improvement program on care and outcomes for children with asthma

OBJECTIVE: To test a quality improvement intervention, a learning collaborative based on the Institute for Healthcare Improvement's Breakthrough Series methodology, specifically intended to improve care and outcomes for patients with childhood asthma. DESIGN: Randomized trial in primary care practices. SETTING: Practices in greater Boston, Mass, and greater Detroit, Mich. PARTICIPANTS: Forty-three practices, with 13 878 pediatric patients with asthma, randomized to intervention and control groups.Intervention Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement. MAIN OUTCOME MEASURES: Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma, and in the proportion of children whose parent received a written management plan for their child's asthma, as determined by telephone interviews with parents of 631 children. RESULTS: After adjusting for state, practice size, child age, sex, and within-practice clustering, no overall effect of the intervention was found. CONCLUSIONS: This methodologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma. Potential deficiencies in program implementation, project duration, sample selection, and data sources preclude making the general inference that this type of improvement program is ineffective. Additional rigorous studies should be undertaken under more optimal settings to assess the efficacy of this method for improving care.     

妊娠合并急性胰腺炎对妊娠结局及新生儿的影响

目的 探讨妊娠合并急性胰腺炎（APIP）对妊娠结局及新生儿的影响。方法 以33例APIP患者及其31例活产新生儿为研究对象,对孕产妇及其新生儿进行回顾性分析。结果 33例APIP中发生于妊娠晚期的最多（26例,79%）。从病因分析,以高脂血症性最多（14例,45%）,胆源性13例（42%）,其他类型4例（13%）;从严重程度分析,以轻度最多（22例,67%）,中度最少（5例,15%）。33例APIP患者中病死率为0。足月分娩的20例中终止妊娠的11例,早产10例中终止妊娠的9例,2例发生胎死宫内,1例于孕中期发生流产。31例活产新生儿（其中2例为双胎）中1例（3%）死亡,12例（39%）发生新生儿高胆红素血症,8例（26%）发生新生儿低血糖症,6例（19%）发生新生儿呼吸窘迫综合征,5例（16%）发生感染性疾病,2例（6%）发生颅内出血。胆源性、高脂血症性和其他类型所致APIP 3组所娩新生儿中早产儿的比例、出生体重以及新生儿各疾病发生率的差异均无统计学意义（P > 0.05）,但终止妊娠以高脂血症性APIP组最多（P < 0.05）。轻、中、重度3组以中度组娩出的早产儿最多（P < 0.05）;所娩新生儿的出生体重以中度组最低（P < 0.05）;所娩新生儿呼吸窘迫综合征、颅内出血、感染性疾病的发生率以轻度组最低（P < 0.05）。结论 妊娠合并急性胰腺炎可导致不良妊娠结局和新生儿疾病发生,并且与胰腺炎的严重程度相关。     

Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy

AimTo evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE).MethodsA retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors.ResultsOf 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33°C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33°C to 34°C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52).ConclusionOutreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.     

Prenatal tobacco effects on neuropsychological outcomes among preadolescents.

This study evaluated the relationships between maternal smoking during pregnancy and 10-year-old children's performance on measures of learning, memory, and problem-solving. In this prospective cohort study, mothers were recruited from an urban prenatal clinic in 1982 and 1983 and observed from their fourth prenatal month until the time of the study. At the 10-year visit, 593 children and mothers were evaluated. The prevalence of tobacco use was high in this cohort: 54.3%, 53.3%, and 60% of the women smoked in the first trimester, third trimester, and 10-year assessment, respectively. After controlling statistically for other prenatal substance use, current tobacco, other substance use variables, and multiple sociodemographic covariates, prenatal tobacco exposure was significantly associated with deficits in learning and memory. Specifically, prenatal tobacco exposure was associated with deficits in verbal learning and design memory, as well as slowed responding on a test of eye-hand coordination. In addition, these children demonstrated a reduced ability for flexible problem solving and more impulsivity, as indicated by an increase in perseverative responses on a card-sorting test. Prenatally exposed children did not show attention deficits or increased activity on a continuous performance test.     

Effects of a structured exercise program on insulin resistance, inflammatory markers and physical fitness in obese Korean children

Thirty-eight obese Korean children (21 boys, 17 girls), whose ages were between 9 and 15, were divided into either the intervention group (19 obese children: BMI>95P) or the age- and sex-matched obese control group. The intervention group performed an intensive exercise program under the supervision of educated instructors for 12 weeks (90 minutes/day, two days/week) and received lifestyle modification counseling using food diaries and phone calls. The control group participated in conventional counseling at an out-patient clinic. The intervention group appeared to have more improvement of body weight, body composition, serum lipid profiles and high-sensitivity C-reactive protein (hs-CRP) levels (P < 0.05) but without changes in serum adiponectin level. HOMA-IR decreased from 2.3 to 1.3 in the intervention group. Maximal oxygen consumption (VO2 max) and other physical fitness parameters were significantly improved after the intervention program (P < 0.05).