Clinical Rounds

Diabetes Care

OBJECTIVE Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes (GDM) is unclear. RESEARCH DESIGN AND METHODS We included 15,146 parous women with type 2 diabetes from the Nurses’ Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD: myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models. RESULTS We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during …

Metabolism

BackgroundMetabolic Syndrome (MetS) is a progressive pathophysiological state defined by a cluster of cardiometabolic traits. However, little is known about metabolites that may be predictors of MetS incidence or reversion. Our objective was to identify plasma metabolites associated with MetS incidence or MetS reversion.MethodsThe study included 1468 participants without cardiovascular disease (CVD) but at high CVD risk at enrollment from two case-cohort studies nested within the PREvención con DIeta MEDiterránea (PREDIMED) study with baseline metabolomics data. MetS was defined in accordance with the harmonized International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute criteria, which include meeting 3 or more thresholds for waist circumference, triglyceride, HDL cholesterol, blood pressure, and fasting blood glucose. MetS incidence was …

Journal of Allergy and Clinical Immunology

BackgroundThere are increasing numbers of metabolomic studies in food allergy (FA) and asthma, which, however, are predominantly limited by cross-sectional designs, small sample size, and being conducted in European populations.ObjectiveWe sought to identify metabolites unique to and shared by children with FA and/or asthma in a racially diverse prospective birth cohort, the Boston Birth Cohort.MethodsMass spectrometry–based untargeted metabolomic profiling was performed using venous plasma collected in early childhood (n = 811). FA was diagnosed according to clinical symptoms consistent with an acute hypersensitivity reaction at food ingestion and food specific-IgE > 0.35 kU/L. Asthma was defined on the basis of physician diagnosis. Generalized estimating equations were applied to analyze metabolomic associations with FA and asthma, adjusting for potential confounders.ResultsDuring a …

EClinicalMedicine

BackgroundUltra-processed foods (UPFs) are emerging as a risk factor for colorectal cancer (CRC), yet how post-diagnostic UPF intake may impact CRC prognosis remains unexplored.MethodsData collected from food frequency questionnaires were used to estimate intakes of total UPFs and UPF subgroups (serving/d) at least 6 months but less than 4 years post-diagnosis among 2498 patients diagnosed with stages I–III CRC within the Nurses' Health Study and Health Professionals Follow-up Study during 1980–2016. Hazard ratios (HR) and 95% confidence intervals (CIs) of all-cause, CRC- and cardiovascular disease (CVD)-specific mortality in association with UPF consumption were estimated using an inverse probability weighted multivariable Cox proportional hazards regression model, adjusted for confounders.FindingsThe mean (SD) age of patients at diagnosis was 68.5 (9.4) years. A total of 1661 deaths …

Cardiovascular diabetology

BackgroundLegume consumption has been linked to a reduced risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), while the potential association between plasma metabolites associated with legume consumption and the risk of cardiometabolic diseases has never been explored. Therefore, we aimed to identify a metabolite signature of legume consumption, and subsequently investigate its potential association with the incidence of T2D and CVD.MethodsThe current cross-sectional and longitudinal analysis was conducted in 1833 PREDIMED study participants (mean age 67 years, 57.6% women) with available baseline metabolomic data. A subset of these participants with 1-year follow-up metabolomics data (n = 1522) was used for internal validation. Plasma metabolites were assessed through liquid chromatography-tandem mass spectrometry. Cross-sectional associations between 382 …

MethodsWe included 911 participants from the San Juan Overweight Adult Longitudinal Study, a 3-year prospective cohort of overweight Puerto Ricans. At baseline, using LC-MS, we quantified metabolites from saliva (n= 635) and plasma (n= 1,051). We used elastic net regression with 10-fold cross-validation to identify features from saliva, plasma, and saliva and plasma (multi-fluid) that were predictive of BMI and WC. We used Cox-proportional hazard models to evaluate associations between metabolomic profiles and diabetes progression, adjusting for age, sex, socioeconomic factors, lifestyle, and medication use.ResultsFor BMI metabolomic profiles, we identified 207 metabolites in plasma, 118 metabolites in saliva, and 225 in the multi-fluid profile. For WC, we identified 157, 89, and 210 metabolites for saliva, plasma, and multi-fluid profiles, respectively. Highly positively weighted metabolites across all BMI and WC metabolomic profiles included those in pathways of alanine and aspartate metabolism, purine metabolism, and sphingomyelins. Each SD increase in saliva, but not plasma or multi-fluid, metabolic profile of BMI was significantly associated with all stages of diabetes progression. Saliva, but not plasma or multi-fluid, metabolomic profile of WC was significantly associated with progression from pre-diabetes to T2D. All associations became stronger after further adjustment for anthropometric measures of BMI and WC.ConclusionSaliva is an underexplored and easily accessible biofluid to measure metabolites that are reflective of adiposity measures. Validation in future studies will confirm our findings that saliva, plasma, and multi-fluid …

Diabetes/Metabolism Research and Reviews

Background Several metabolites are individually related to incident type 2 diabetes (T2D) risk. We prospectively evaluated a novel T2D‐metabolite pattern with a risk of progression to T2D among high‐risk women with a history of gestational diabetes mellitus (GDM). Methods The longitudinal Nurses' Health Study II cohort enroled 116,429 women in 1989 and collected blood samples from 1996 to 1999. We profiled plasma metabolites in 175 incident T2D cases and 175 age‐matched controls, all with a history of GDM before the blood draw. We derived a metabolomics score from 21 metabolites previously associated with incident T2D in the published literature by scoring according to the participants' quintile (1–5 points) of each metabolite. We modelled the T2D metabolomics score categorically in quartiles and continuously per 1 standard deviation (SD) with the risk of incident T2D using conditional logistic …

Nature medicine

Multiple dietary patterns have been associated with different diseases; however, their comparability to improve overall health has yet to be determined. Here, in 205,852 healthcare professionals from three US cohorts followed for up to 32 years, we prospectively assessed two mechanism-based diets and six diets based on dietary recommendations in relation to major chronic disease, defined as a composite outcome of incident major cardiovascular disease (CVD), type 2 diabetes and cancer. We demonstrated that adherence to a healthy diet was generally associated with a lower risk of major chronic disease (hazard ratio (HR) comparing the 90th with the 10th percentile of dietary pattern scores = 0.58–0.80). Participants with low insulinemic (HR = 0.58, 95% confidence interval (CI) = 0.57, 0.60), low inflammatory (HR = 0.61, 95% CI = 0.60, 0.63) or diabetes risk-reducing (HR = 0.70, 95% CI = 0.69 …

Nutrients

We aimed to investigate the associations between maternal intake of folate, vitamin B12, B6, B2, methionine, choline, phosphatidylcholine and betaine during the period surrounding pregnancy and offspring weight outcomes from birth to early adulthood. These associations were examined among 2454 mother–child pairs from the Nurses’ Health Study II and Growing Up Today Study. Maternal energy-adjusted nutrient intakes were derived from food frequency questionnaires. Birth weight, body size at age 5 and repeated BMI measurements were considered. Overweight/obesity was defined according to the International Obesity Task Force (<18 years) and World Health Organization guidelines (18+ years). Among other estimands, we report relative risks (RRs) for offspring ever being overweight with corresponding 95% confidence intervals across quintiles of dietary factors, with the lowest quintile as the reference. In multivariate-adjusted models, higher maternal intakes of phosphatidylcholine were associated with a higher risk of offspring ever being overweight (RRQ5vsQ1 = 1.16 [1.01–1.33] p-trend: 0.003). The association was stronger among offspring born to mothers with high red meat intake (high red meat RRQ5vsQ1 = 1.50 [1.14–1.98], p-trend: 0.001; low red meat RRQ5vsQ1 = 1.05 [0.87–1.27], p-trend: 0.46; p-interaction = 0.13). Future studies confirming the association between a higher maternal phosphatidylcholine intake during pregnancy and offspring risk of being overweight or obese are needed.

Food and Nutrition Bulletin

Previous multiple-choice food-based food frequency questionnaires (FFQs) were not validated against weighed dietary records (WDRs) in Iran. This study investigated the validity and reproducibility of a multiple-choice semi-quantitative food frequency questionnaire (SQ-FFQ) in adults living in central Iran. Patients with diabetes and their spouses were asked to complete 3 SQ-FFQs by interview, and nine 3-day WDRs, over 9 months. They provided 2 blood samples to assess serum calcium, magnesium, zinc, and vitamin C levels. The Pearson and intraclass correlation coefficients were calculated to assess reproducibility and validity. The degree of misclassification was explored using a contingency table of quartiles which compare the information between third FFQ and WDRs. The method of triads was incorporated to assess validity coefficients between estimated intakes using third FFQ, WDRs, and biochemical …

All changes before and after the correction are presented in Table 1. The section of the content of the updated manuscript are also included. The original Table 1, Figure 4, Supplementary Figure S2, S6, S8, S11–S12 are updated, and the original and corrected table and figures are presented below.

ImportanceConcerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed findings from both observational studies and clinical trials.ObjectiveTo synthesize the available evidence on 100% fruit juice consumption and body weight in children and adults.Data SourcesMEDLINE, Embase, and Cochrane databases were searched through May 18, 2023.Study SelectionProspective cohort studies of at least 6 months and randomized clinical trials (RCTs) of at least 2 weeks assessing the association of 100% fruit juice with body weight change in children and adults were included. In the trials, fruit juices were compared with noncaloric controls.Data Extraction and SynthesisData were pooled using random-effects models and presented as β coefficients with 95% CIs for cohort studies and mean differences (MDs) with 95 …

Med

BackgroundA healthy lifestyle is associated with a lower premature mortality risk and with longer life expectancy. However, the metabolic pathways of a healthy lifestyle and how they relate to mortality and longevity are unclear. We aimed to identify and replicate a healthy lifestyle metabolomic signature and examine how it is related to total and cause-specific mortality risk and longevity.MethodsIn four large cohorts with 13,056 individuals and 28-year follow-up, we assessed five healthy lifestyle factors, used liquid chromatography mass spectrometry to profile plasma metabolites, and ascertained deaths with death certificates. The unique healthy lifestyle metabolomic signature was identified using an elastic regression. Multivariable Cox regressions were used to assess associations of the signature with mortality and longevity.FindingsThe identified healthy lifestyle metabolomic signature was reflective of lipid …

Nature Medicine

In the initially published version of this article, we inadvertently used incident fatal cancer rather than incident total cancer for women due to a programming error. We have conducted a re-analysis using the complete cancer cases. The study population now includes 205,776 healthcare professionals (not 205,852 as stated previously) including 162,591 women (not 162,667) and 43,185 men (unchanged). The “Population characteristics” section of the Results now reports 58,309 events of major chronic disease (previously stated as 44,975), 12,958 major cardiovascular diseases (previously 12,962), 18,606 cases of diabetes (previously 18,615), and 33,530 total cancers (previously 17,909). The numbers in the abstract and the “Population characteristics” section of the Results have been amended. As in the published analysis, the inverse associations between the dietary patterns and major chronic disease (the …

European Heart Journal

We appreciate the description by Mente et al. 1 of a dietary score comprised of fruits, vegetables, nuts, legumes, fish, and dairy foods that are inversely associated with adverse health outcomes. These findings align with other studies, including that associations are strongest in diets dominated by starchy staples typical of many low-income populations. In this context, modest amounts of animal-sourced foods can provide important nutritional value. However, the omission of harmful components in the dietary score, such as trans fat, high sodium, and sugary beverages, is a critical concern. Also, their implication that high intakes of red meat and dairy foods would be without adverse health consequences, especially if compared with plant protein sources, is inconsistent with considerable evidence. 2, 3 The diversity of the PURE populations is a strength, but in many of these populations, high intake of red meat is recent …

Journal of Institutional Economics

Institutions matter for postdisaster recovery. Conversely, natural disasters can also alter a society's institutions. Using the synthetic control method, this study examines the effects that Hurricane Katrina (2005) had on the formal and informal institutions in Louisiana. As measures of formal institutions, we employ two economic freedom scores corresponding to government employment (GE) (as a share of total employment at the state-level) and property tax (PT). These measures serve as proxies for the level of governmental interference into the economy and the protection of private property rights respectively. To assess the impact on informal institutions, we use state-level social capital data. We find that Hurricane Katrina had lasting impacts on Louisiana's formal institutions. In the post-Katrina period, we find that actual Louisiana had persistently higher economic freedom scores for both GE and PT than the synthetic …

Stroke

BACKGROUND The effect of marine omega-3 PUFAs on risk of stroke remains unclear. METHODS We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome. RESULTS Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke …

The American Journal of Clinical Nutrition

BackgroundWhether physical activity could mitigate the adverse impacts of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) on incident cardiovascular disease (CVD) remains uncertain.ObjectivesThis study aimed to examine the independent and joint associations between SSB or ASB consumption and physical activity and risk of CVD, defined as fatal and nonfatal coronary artery disease and stroke, in adults from 2 United States-based prospective cohort studies.MethodsCox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs between SSB or ASB intake and physical activity with incident CVD among 65,730 females in the Nurses’ Health Study (1980–2016) and 39,418 males in the Health Professional’s Follow-up Study (1986–2016), who were free from chronic diseases at baseline. SSBs and ASBs were assessed every 4-y and physical activity …

Clinical Pediatrics

Dr. Lester F. Soyka: E. M., a 13-year-old girl, was referred to the Massachusetts General Hospital because of uncontrolled hyper-tension. She was in apparent good health until four years ago when she had an episode of dysuria and pyuria diagnosed as cystitis and treated with Furadantin. She had two subsequent attacks three years ago and one year ago similarly treated. She seemed well until six weeks prior to admission when gross hematuria developed with no associated symptoms and no previous history of recent upper respiratory infection. Penicillin was started. In the next few days she developed headache, abdominal cramps, and anorexia. On admission to another hospital it was found that her blood pressure was 270/190, there was marked arteriolar spasm on funduscopy, and her urine was loaded with red and white blood cells with no casts. Intravenous and retrograde pyelography showed a shrunken …

Clinical pediatrics

The purpose of this study is to evaluate the association between anxiety and depressive symptoms and obesity among adolescent females using objective measures of adiposity and evaluate for moderating effects of race and age. This is a cross-sectional analysis of 198 females aged 11, 13, 15, and 17 years (mean = 14.6, standard deviation = 2.2). Adiposity measures include BMI, BMI Z score, percentage body fat from dual energy X-ray absorptiometry (DXA), and fat distribution (fat mass upper vs lower body regions from DXA). Symptoms of anxiety are measured with the State-Trait Anxiety Inventory and depressive symptoms with the Children’s Depression Inventory. Trait anxiety and depressive symptoms are positively associated with BMI and percentage body fat. No interaction of anxiety/ depressive symptoms with race or age on measures of adiposity was detected. Symptoms of anxiety and depression are …

Clinical Pediatrics

The available literature is scarce on the initial symptoms of arterial hypertension in children. Our study aimed to analyze the initial clinical profile of patients referred to the hospital with suspected hypertension and those diagnosed with hypertension for the first time during a hospitalization for other reasons. This study was a retrospective analysis of medical records in 471 patients. More than half of the patients showed no symptoms. The most common symptom reported was a headache—28% (132) of patients. The diagnosis of elevated blood pressure or hypertension was more frequent in asymptomatic patients (P = 0.001). Headaches were seen more often in healthy patients than in patients with hypertension. Newly diagnosed hypertension is mainly diagnosed in asymptomatic children. Moreover, the symptoms previously described in the literature as the most common did not prove to be predictive of hypertension …

Clinical pediatrics

The purpose of this study is to evaluate the association between anxiety and depressive symptoms and obesity among adolescent females using objective measures of adiposity and evaluate for moderating effects of race and age. This is a cross-sectional analysis of 198 females aged 11, 13, 15, and 17 years (mean = 14.6, standard deviation = 2.2). Adiposity measures include BMI, BMI Z score, percentage body fat from dual energy X-ray absorptiometry (DXA), and fat distribution (fat mass upper vs lower body regions from DXA). Symptoms of anxiety are measured with the State-Trait Anxiety Inventory and depressive symptoms with the Children’s Depression Inventory. Trait anxiety and depressive symptoms are positively associated with BMI and percentage body fat. No interaction of anxiety/ depressive symptoms with race or age on measures of adiposity was detected. Symptoms of anxiety and depression are …

Clinical Pediatrics

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. 1-3 The genitourinary tract is the primary site of 20% to 25% of RMS cases, and RMS arising from the genitourinary tract affects an estimated 60 to 70 children annually in the United States, with 75% of these cases arising in boys. 3, 4 The most common symptoms on presentation include dysuria, hematuria, abdominal distension, constipation, and urinary retention. 4 There are two major histologic classifications of RMS arising from the prostate: alveolar and embryonal. 1, 4 Embryonal RMS is the most common subtype, accounting for approximately 90% of cases arising in the urogenital tract and carries a better prognosis than alveolar RMS. 1, 3, 4 Risk factors for RMS include Li-Fraumeni syndrome, neurofibromatosis, overexpression of the gene encoding for IGF2, parental use of marijuana before conception and maternal history of …

Clinical Pediatrics

To determine the percentage of female adolescent patients (13-26 years old) who had HIV testing ordered within 90 days of incident sexually transmitted infection (STI) diagnosis during an outpatient clinic visit. This was a retrospective chart review study evaluating 830 visits among 589 female patients 13 to 26 years who had an incident STI diagnosed in outpatient Adolescent Medicine or Pediatric Practices in an urban, nonprofit, academic, free-standing children’s hospital at the main campus and a community site in the Northeast United States. Odds of HIV screening was greater at the community-based adolescent medicine practice (odds ratio [OR] = 3.17; 95% confidence interval [CI]: [1.92, 5.24]) and when seen by an adolescent medicine provider (OR = 1.44; 95% CI: [1.02, 2.03]). Only 33.5% (n = 283) of 844 clinical encounters had HIV screening obtained within 90 days of incident STI diagnosis. Overall, HIV …

Clinical Pediatrics

Dr. Lester F. Soyka: E. M., a 13-year-old girl, was referred to the Massachusetts General Hospital because of uncontrolled hyper-tension. She was in apparent good health until four years ago when she had an episode of dysuria and pyuria diagnosed as cystitis and treated with Furadantin. She had two subsequent attacks three years ago and one year ago similarly treated. She seemed well until six weeks prior to admission when gross hematuria developed with no associated symptoms and no previous history of recent upper respiratory infection. Penicillin was started. In the next few days she developed headache, abdominal cramps, and anorexia. On admission to another hospital it was found that her blood pressure was 270/190, there was marked arteriolar spasm on funduscopy, and her urine was loaded with red and white blood cells with no casts. Intravenous and retrograde pyelography showed a shrunken …

Clinical Pediatrics

In this single-site, retrospective, descriptive chart review and survey, we investigated changes in pediatric behavioral health needs during the COVID-19 pandemic and the relationship between virtual schooling and hospitalized children’s mental health. Subjects included patients aged 6 and 18 years during the 2015 to 2019 and 2020 to 2021 school years who received inpatient mental health care. Parents of patients admitted in 2020 to 2021 were surveyed regarding their child’s schooling. We additionally described and compared subjects using descriptive data, including proxies for illness severity, and assessed how these outcomes changed during the pandemic and correlated with school modality. During the pandemic, the distribution of diagnoses changed, and some markers of severity increased. Patients in exclusively virtual school had higher rates of mood and anxiety disorders and tic disorders, and lower …

Clinical Pediatrics

The available literature is scarce on the initial symptoms of arterial hypertension in children. Our study aimed to analyze the initial clinical profile of patients referred to the hospital with suspected hypertension and those diagnosed with hypertension for the first time during a hospitalization for other reasons. This study was a retrospective analysis of medical records in 471 patients. More than half of the patients showed no symptoms. The most common symptom reported was a headache—28% (132) of patients. The diagnosis of elevated blood pressure or hypertension was more frequent in asymptomatic patients (P = 0.001). Headaches were seen more often in healthy patients than in patients with hypertension. Newly diagnosed hypertension is mainly diagnosed in asymptomatic children. Moreover, the symptoms previously described in the literature as the most common did not prove to be predictive of hypertension …

Clinical Pediatrics

BackgroundCongenital chloride diarrhea (CCD, OMIM 214700) is a rare autosomal recessive disorder caused by loss-of-function mutations in the SLC26A3 gene (SLC26A3; OMIM* 126650), which encodes a protein that exchanges chloride and bicarbonate on enterocyte apical surface. 1, 2 Patients usually have a history of antenatal polyhydramnios and may experience dilated intestinal loops, watery stool, dehydration, hypochloremic hypokalemic metabolic alkalosis, and high fecal chloride excretion. 3 The presence of abdominal distention, absence of meconium, and enlarged intestinal loops may lead to misdiagnosis of meconium ileus or Hirschsprung’s disease, resulting in unnecessary surgical procedures. 4 However, patients with CCD may also be misdiagnosed as Bartter and Pseudo Bartter syndrome due to the similar laboratory findings.

Clinical Pediatrics

• Unintentional THC ingestions range in symptoms and can present in groups, such as a family, and should be included in the differential diagnosis for the acutely altered patient.• Unintentional THC ingestions in children are preventable and it is the responsibility of medical providers to treat such incidents as sentinel events, and educate our communities to create safe environments for the children that we care for.

Clinical Pediatrics

In this single-site, retrospective, descriptive chart review and survey, we investigated changes in pediatric behavioral health needs during the COVID-19 pandemic and the relationship between virtual schooling and hospitalized children’s mental health. Subjects included patients aged 6 and 18 years during the 2015 to 2019 and 2020 to 2021 school years who received inpatient mental health care. Parents of patients admitted in 2020 to 2021 were surveyed regarding their child’s schooling. We additionally described and compared subjects using descriptive data, including proxies for illness severity, and assessed how these outcomes changed during the pandemic and correlated with school modality. During the pandemic, the distribution of diagnoses changed, and some markers of severity increased. Patients in exclusively virtual school had higher rates of mood and anxiety disorders and tic disorders, and lower …

Clinical Pediatrics

DiscussionProbiotics are commonly used supplements for viral gastroenteritis and antibiotic-associated diarrhea in children. 1 The World Health Organization (WHO) defined probiotics as preparations including live bacteria (Bacillus, Lactobacillus, Enterococcus) and fungal (Saccharomyces) microorganisms that, when administered in appropriate amounts, provide health benefits to the host. 2 B. clausii is a Gram-positive, rod-shaped bacterium that forms endospores resistant to environmental conditions. 3 B. clausii was registered as a probiotic in 1958, and it is commonly used for this purpose nowadays. It was found to be safe and effective in the treatment of acute childhood diarrhea by randomized controlled trials. 4 A systematic review including 6 trials showed that B. clausii decreased hospitalization by 1 day for acute diarrhea. 5 Although many benefits of probiotics are clearly known, the conditions to be careful …

Clinical Pediatrics

The aim of the study is to evaluate shared reading of families of children with chronic diseases. The mothers of children aged 2 to 6 years with chronic health problems who applied to the pediatric outpatient clinic between January and May 2022 were the study group, and the mothers of children with an acute health problem were the control group. The sociodemographic information form and “Child-Parent Shared Reading Activities Scale” were applied. At the end of the interview, 3 questions about shared reading were asked. A total of 187 children were enrolled in the study: 92 and 95 in the chronic disease group and control group, respectively. 57.6% of mothers of chronically ill children reported that the parents almost never did shared reading with their child. It was found that all mothers knew the importance of reading, but they could not support especially in the risky chronic disease group.

Clinical Pediatrics

DiscussionExtrapulmonary manifestations of severe RSV infection requiring intensive care unit admission were first described in 1993. 6 Recent literature suggests that 1% to 7% of all children hospitalized with RSV infection experience neurological problems, including acute encephalitis/encephalopathy, complex seizures, and status epilepticus. 7 Saravanos et al 8 defined the characteristics of patients in this group by a young age, severe respiratory symptoms, and high frequency of prematurity. Our patient fits this definition as being a 32-day-old late preterm infant with recurrent apnea and hyponatremia.

Clinical Pediatrics

DiscussionExtrapulmonary manifestations of severe RSV infection requiring intensive care unit admission were first described in 1993. 6 Recent literature suggests that 1% to 7% of all children hospitalized with RSV infection experience neurological problems, including acute encephalitis/encephalopathy, complex seizures, and status epilepticus. 7 Saravanos et al 8 defined the characteristics of patients in this group by a young age, severe respiratory symptoms, and high frequency of prematurity. Our patient fits this definition as being a 32-day-old late preterm infant with recurrent apnea and hyponatremia.

Clinical Pediatrics

For hypocalcemia with a persistently prolonged QTc on electrocardiogram, he received multiple intravenous calcium gluconate boluses (100-200 mg/kg/dose). He was also started on oral calcium supplementation with calcium carbonate (130 mg/kg/day divided Q6H [52 mg/kg/day elemental calcium]) and calcitriol (0.04 mcg/kg/day once daily), which eventually stabilized his calcium levels. Endocrinology was consulted shortly after admission and recommended additional laboratory evaluation, including parathyroid hormone (PTH) and vitamin D levels. Vitamin D was 24 ng/mL (reference range, 25-100 ng/mL). Parathyroid hormone was 29 pg/mL (reference range, 18-88 pg/mL), which is inappropriately normal in the setting of hypocalcemia, suggesting hypoparathyroidism. Of note, maternal calcium level obtained the day prior to the patient’s birth was normal at 8.5 mg/dL (reference range, 8.4-10.2 mg/dL). Given …

Clinical Pediatrics

Anxiety is one of the most prevalent psychological conditions in the pediatric population, and its associated impairments often persist into adulthood. Pediatricians are in a unique position to screen, briefly intervene, and facilitate treatment to prevent long-term impacts. However, they often do not have adequate training to do so. The current study addressed this gap by providing a brief online educational workshop aimed to promote: (1) screening for anxiety and (2) follow-up with appropriate evidence-based interventions. Fifty-three providers participated, and 38 completed surveys pre- and post-training. Findings indicate acceptability of the training to providers, improved knowledge related to anxiety, and increased readiness to manage anxiety during a medical visit. This study supports the utility of a brief, online training on screening and provision of evidence-based treatment for anxiety in pediatric primary care.

Clinical Pediatrics

Pulmonary disease, lower respiratory tract infection, and pneumonia are the largest causes of morbidity and mortality in individuals with Down syndrome (DS), but whether pulmonary diagnoses in children with DS are common and occur independently of cardiac disease and pulmonary hypertension (PH) is unknown. Cardiopulmonary phenotypes were examined in a cohort of 1248 children with DS. Aptamer-based proteomic analysis of blood was performed in a subset (n = 120) of these children. By the age of 10 years, half of the patients in this cohort (n = 634, 50.8%) had co-occurring pulmonary diagnoses. That proteins and related pathways were distinct between children with pulmonary diagnoses and those with cardiac disease and/or PH may indicate that pulmonary diagnoses appear to occur independently of cardiac disease and PH. Heparin sulfate-glycosaminoglycandegradation, nicotinate metabolism …

Clinical Pediatrics

The American Academy of Pediatrics recommends utilizing hospitalizations as an opportunity to provide sexual health screenings for adolescents. This study aimed to describe the current practice of sexual history documentation (SHxD) and sexually transmitted infection (STI) testing among adolescents admitted to a pediatric hospital medicine service. Retrospective cross-sectional study of adolescents (14-19 years old) admitted to the PHM service from 2017-2019 was performed at an academic children’s health system. Patient (demographics, history of complex chronic condition, and insurance), hospitalization (length of stay, diagnosis, STI tests ordered/results), and physician (level of training and gender) characteristics were extracted for each encounter. A natural language processing algorithm identified the presence of SHxD. Univariate analysis and multivariable analysis were performed to detect factors …