Evidence on the cardiometabolic consequences of sedentary behavior in youth is inconsistent and mostly relies on cross-sectional studies. Studies with objective measures of sedentary time have found limited evidence of cross-sectional associations with adiposity markers but no other outcomes.

Objectively assessed daily sedentary time was not prospectively associated with cardiometabolic outcomes. Moderate to vigorous physical activity was beneficially associated with body fat mass, insulin, high-density lipoprotein cholesterol, and clustered cardiometabolic score. (Read the full article)

Physical activity (PA) of preschoolers has been found to be highly correlated with their child care environment. Preschool-aged children are sedentary for most of their time at child care and most are not meeting PA recommendations.

Preschoolers were presented with significantly fewer than recommended PA opportunities at child care. More active play opportunities are needed to increase PA, including more outdoor time, more teacher-led and child-initiated active play, and flexibility in naptime for preschoolers. (Read the full article)

Youth drinking is associated with adult drinking. Alcohol policies can influence youth and adult drinking. However, it is unknown whether alcohol policies influence youth drinking patterns directly or through their effect on adult drinking.

Alcohol policies, including population-oriented policies, are protective for youth drinking. The effect of population-oriented policies may be mediated though effects on adults. These findings suggest that efforts to reduce youth drinking should rely on policies that address all age groups. (Read the full article)

Most prospective cohort studies of acquired demyelinating syndromes in children have focused on the genetic, environmental, and neuroimaging predictors of multiple sclerosis. Less is known regarding the severity of the incident demyelinating event and predictors of residual attack–related physical disability.

In a national, prospective longitudinal study, incident acquired demyelinating syndromes in children were characterized in terms of physical deficits and acuity at onset, and recovery over the first 12 months. Follow-up evaluations up to 10 years’ postonset were analyzed. (Read the full article)

Clinical pain assessment methods in youth are vulnerable to underestimation bias and underrecognition. Facial expressions are sensitive, specific biomarkers of the presence and severity of pain. Computer vision–based pattern recognition enables measurement of pain-related facial expressions from video.

This study demonstrates initial validity for developing computer vision algorithms for automated pain assessment in children. The system developed and tested in this study could provide standardized, continuous, and valid patient monitoring that is potentially scalable. (Read the full article)

Studies on the consequences of abnormal prenatal hemoglobin (Hb) concentration have focused on maternal morbidities and adverse birth outcomes. To date, very little is known about the association between prenatal Hb concentration and infant cognitive and motor functions.

There is an inverted U-shaped relationship between maternal Hb concentration and infant gross motor function. Hb concentration between 90 and 110 g/L appears to be optimal for early gross motor function of children. (Read the full article)

Permanent neuronal deletion and neurocognitive impairment after anesthetic exposure in animals raised substantial concern that similar effects occur in children. Human studies were equivocal but have not combined structural and intelligence tests in otherwise healthy children after childhood anesthesia.

Anesthetic exposure for surgery did not lead to measurable neuronal elimination in brain regions previously identified in animals. However, language comprehension and performance IQ were decreased in exposed children and associated with decreased gray matter, primarily in posterior brain regions. (Read the full article)

Firearms are among the 10 leading causes of injury-related death for youth and continues throughout the life span. Annually youth homicides and assault-related injuries result in an estimated $16 million in combined medical and work loss costs.

Findings add to the field’s broadening conceptualization of youth victimization highlighting the potentially highly consequential risk factor of firearm and other weapon exposure as a component of victimization experiences on the mental health of youth. (Read the full article)

Simulation-based education is increasing but its use in pediatric emergency medicine (PEM) fellowships has not been recently documented. Previous studies identified barriers including equipment and space, but growth of simulation centers and equipment has been widespread.

Simulation is widely used in PEM fellowships, and current barriers include faculty and learner time, implementation of best practices in simulation; equipment is less significant. Future work should focus on curriculum and evaluation development, aligning with the milestones. (Read the full article)

Associations have been reported between celiac disease (CD) and numerous autoimmune conditions in adults and children. However, current screening guidelines do not consider patients with rheumatic diseases to be at high risk for CD.

The prevalence of CD in children presenting for rheumatology evaluation was found to be 2% by routine serologic screening. The majority of screening-detected CD cases had no CD-associated symptoms. Gluten restriction was found to relieve some musculoskeletal complaints. (Read the full article)

Treatment of idiopathic steroid-resistant nephrotic syndrome is challenging, and therapeutic options are limited. In spite of good initial response with rituximab, responders always remain prone to further relapse, necessitating either repeat course of rituximab or addition of another steroid-sparing immunosuppressant.

Mycophenolate mofetil may be an effective maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory steroid-resistant nephrotic syndrome. (Read the full article)

Previous research has described important variability in the medical evaluation of suspected child physical abuse. This variability may contribute to bias and reduce reliability in the medical diagnosis of abuse.

A panel of child abuse pediatricians participated in a Delphi Process, defining critical elements for the medical evaluation of suspected physical abuse in children. Results can be used to reduce practice variability that may contribute to potential bias in evaluation. (Read the full article)

The 2011 national guidelines for the management of pediatric community-acquired pneumonia recommended narrow-spectrum antibiotic therapy (eg, ampicillin) for most children hospitalized with pneumonia. Before the release of the guidelines, the use of broader-spectrum antibiotics (eg, third-generation cephalosporins) was much more common.

After release of the guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with pneumonia. Changes were most apparent among institutions that proactively disseminated the guidelines, underscoring the importance of local efforts for timely guideline implementation. (Read the full article)

Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.

Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children. (Read the full article)

The etiology of juvenile idiopathic arthritis (JIA) is poorly understood. A recent study suggested a link between antibiotics and JIA but did not examine the potential for confounding from infections or the role of antibiotic timing.

Antibiotics were associated with newly diagnosed JIA in a dose- and time-dependent manner after adjusting for infection and other confounders. Antibiotics may play a role in the pathogenesis of JIA. (Read the full article)

Prior studies have found a positive relationship between macro-level indicators of home foreclosure and child maltreatment rates. The extent to which home foreclosure may be associated with child protective services involvement at the micro level is largely unknown.

Foreclosure filings are positively associated with child protective services involvement. However, this is true of the periods before and after a filing, which are characterized by economic and other stress, which may drive this association more than the filing itself. (Read the full article)

Street youth demonstrate elevated mortality compared with the general adolescent and young adult population. Suicide is a leading cause of death among street youth. Many street youth have experienced childhood maltreatment, including abuse and neglect.

In this prospective cohort of street youth, self-reported attempted suicide and history of childhood maltreatment were common. Individuals who experienced childhood physical abuse, emotional abuse, or emotional neglect were at highest risk of attempting suicide. (Read the full article)

The American Academy of Pediatrics recommends parent-child reading from infancy through at least kindergarten, the span of maximal brain growth. Home literacy environment, including reading behaviors and access to books, has been shown to promote oral language and print concepts.

Home reading environment is positively associated with activation of brain areas supporting narrative comprehension and mental imagery in preschool children. This offers novel insight into the neurobiological foundations of emergent literacy and potential effect of shared reading during early childhood. (Read the full article)

The value of ultrasound imaging for the diagnosis, prognosis, and surgical planning of cryptorchidism is limited at best.

Ultrasound remains grossly overused by referring physicians throughout Ontario, Canada, which resulted in a 3-month delay to definitive surgery and unnecessary expenditures. (Read the full article)

A previous national study conducted over 2 seasons by this group of authors demonstrated the effectiveness of mandated protective eyewear in reducing eye/orbital, concussive, and head/facial injuries in high school girls' field hockey.

Data collected from regional/national high school sports injury surveillance databases by certified athletic trainers over 4 seasons has shown that nationally mandated protective eyewear results in a greater than 3-fold reduced risk of eye/orbital injuries in girls playing high school field hockey. (Read the full article)

Childhood inflammatory mediators are associated with adult obesity, but the stimuli that initiate and perpetuate chronic inflammation start in early life are largely unknown.

Childhood infection-related hospitalization was independently associated with adverse adult metabolic variables, which suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases. (Read the full article)

Embryonal tumors occur almost exclusively in children. The group is heterogeneous and includes relatively common pediatric tumors as well as rare tumors. The incidence rate for hepatoblastoma has been increasing in some countries.

This population-based study is the first comprehensive study on embryonal tumors in German children. Incidence rates, trends, and survival for 1991 through 2012 are presented. A statistically significant increasing trend for hepatoblastoma was detected for the first time in Europe. (Read the full article)

Concern of the risk of malignancy from ionizing radiation has prompted many to advocate for judicious use of computed tomography (CT) and as low as necessary radiation doses administered per scan. Recent analysis has shown a decline in CT utilization.

We identified decreases in CT utilization between 2004 and 2012 for the 10 most common diagnostic groups receiving CT. Decreases were typically associated with increases in alternate imaging modalities. We provide a possible reason for the decrease in CT utilization. (Read the full article)

Electronic cigarette use among youth is rising exponentially. Among other concerns, modified electronic cigarettes can be used to vaporize cannabis. However, no scientific data have been published on the rates of using electronic cigarettes to vaporize cannabis among youth.

This study presents rates of vaporizing cannabis among a sample of high school students (N = 3847). Rates of vaporizing cannabis were high among lifetime e-cigarette users (18.0%), lifetime cannabis users (18.4%), and lifetime dual cannabis and e-cigarette users (26.5%). (Read the full article)

Congenital cytomegalovirus infection is the leading infectious cause of neurologic disabilities and sensorineural hearing loss in children. Little is known concerning the frequency and impact of vestibular disorders induced by cytomegalovirus infection.

This study reports on the largest cohort of vestibular assessment of children congenitally infected with cytomegalovirus, demonstrating vestibular damages, and analyzes the correlations between vestibular dysfunction and hearing impairment or severity of infection. Cytomegalovirus infection affects postural development in children. (Read the full article)

Choosing career paths can be a difficult decision for residents contemplating fellowship training. Limited resources are available to residents to help guide their choices.

This article provides additional descriptions and insight into actual lifestyle and workplace environments for pediatric residents who choose fellowship training compared with those who do not. (Read the full article)

Two prospective studies of children with septic arthritis have shown that the addition of dexamethasone to antibiotic therapy contributes to clinical and laboratory improvement. Nevertheless, the mainstay of treatment remains antibiotics alone.

This study, which was conducted outside a randomized controlled trial, demonstrates that children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone. (Read the full article)

Infants with neonatal abstinence syndrome are hospitalized for longer after birth and are more likely to be from highly vulnerable families. Determining long-term outcomes is difficult because this is a large and chaotic population.

(Read the full article)

Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect with high mortality. With advances in surgical intervention in recent years, survival of infants with HLHS has improved, but information on long-term survival using population-based data is limited.

In this population-based study, survival to adolescence of children with HLHS has significantly improved in recent years. Among infant survivors, >90% survived up to 18 years. Gestational age, birth weight, and neighborhood poverty may affect survival. (Read the full article)

Guidelines for postdischarge monitoring of hyperbilirubinemia for neonates of white descent are available from the American Academy of Pediatrics; however, such information for healthy term and late preterm Chinese neonates is lacking.

A classification model for predicting the risk of significant hyperbilirubinemia in Chinese neonates was developed that combines a transcutaneous bilirubin–based nomogram with clinical risk factors. It classified newborns into 6 risk groups, which can guide clinicians in planning appropriate follow-up strategies. (Read the full article)

Urethral catheterization is a painful, yet common procedure to obtain a sterile urine sample in young children. There are conflicting results regarding the effectiveness of lidocaine to reduce pain, and it is unclear if it should be routinely used.

In young children, combined topical and intraurethral lidocaine does not reduce pain during urethral catheterization and is associated with more pain than nonanesthetic lubricant during instillation. Clinicians should use noninvasive methods of analgesia during this painful procedure. (Read the full article)

There are no validated claims-based algorithms for identifying children with disabilities (CWD) to facilitate larger-scale studies of care quality for CWD.

This study develops the CWD algorithm, a claims-based algorithm for identifying diagnostic codes with a ≥75% chance of indicating CWD, and triangulates the algorithm against parent report and physician chart abstraction. (Read the full article)

Children with life-threatening complex chronic conditions (LT-CCCs) experience high hospital use.

Hospital use in the last year of life for these children varies by type and number of LT-CCCs. Most children with ≥3 LT-CCCs are admitted to the hospital for more than 2 months in the last year of life. (Read the full article)

Several injuries have been suggested to be disproportionately associated with abuse in young children, but rates of abuse among children with these injuries are not currently known.

Abuse is diagnosed commonly in children with sentinel injuries, including the majority of children <24 months with rib fractures. (Read the full article)

Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.

This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article)

Maternal–child relationships among women raising children from sexual violence-related pregnancies (SVRPs) are not well understood. Limited case reports suggest widely varied and complex relationships. The determinants of these relationships are unknown.

With its large sample size, this article quantifies and analyzes maternal–child relationships among women raising children from SVRPs, and assesses the impact of stigma, acceptance, and maternal mental health on these relationships. (Read the full article)

A number of studies have reported an association between birth by cesarean delivery and adverse childhood health outcomes such as obesity, asthma, atopy, and a number of neurodevelopmental abnormalities. However, these studies have had limited capacity to control for confounders.

Using a prospective cohort while controlling for birth factors, social vulnerability, maternal BMI, and breastfeeding, we found few differences between children delivered by cesarean delivery and those born vaginally. Higher child BMI was explained by maternal BMI. (Read the full article)

Seven percent of children in the United States receive mental health services each year. There are more pediatric outpatient mental health care visits to primary care physicians (PCPs) than to psychiatrists. Mental health utilization patterns regarding different conditions and medication prescribing are unknown.

One-third of children with mental health conditions see PCPs only. A greater proportion of children with attention-deficit/hyperactivity disorder see PCPs for this than do those with anxiety/mood disorders. Children seeing PCPs are prescribed psychotropic medications more often than those seeing psychiatrists. (Read the full article)

Strictly-defined pediatric bipolar I disorder (BP-I) is a serious condition. Although lithium is a benchmark treatment and has shown effectiveness in adults for decades, no definitive efficacy or long-term safety studies had been performed in pediatric patients with BP-I.

This study provides evidence to support the efficacy of lithium in the acute treatment of youths with BP-I who are currently in a manic or mixed state. Lithium had an adverse effect profile that was acceptable for most patients. (Read the full article)

Children with marked cerebral palsy (CP) are considered at greater risk of adverse events (AEs) after intramuscular injections of BoNT-A. To date there has been no randomized controlled trial examining safety of intramuscular BoNT-A injections in children with marked CP.

Children with nonambulatory CP had no greater risk of moderate or serious AEs after intramuscular injections of BoNT-A compared with a sham/control group. There was no greater risk of AEs for children receiving 2 compared with 1 episode of BoNT-A. (Read the full article)

Children with cystic fibrosis demonstrate gas exchange abnormalities and increased respiratory loads during sleep independent of lung function, age, and BMI. Assessment of breathing patterns during sleep provides an opportunity for detection of early lung disease progression.

Children with cystic fibrosis demonstrated increased respiratory loads and gas exchange abnormalities during sleep compared with controls. Based on these findings, sleep assessment in this patient population can identify markers for the early detection of lung disease progression. (Read the full article)

Many families share genetic cancer risk information with their children, and some parents and providers believe BRCA1/2 testing should be permitted in adolescence. The psychosocial effects and impact on health and risk behaviors of this knowledge is unknown.

In our cohort of 869 mother-daughter pairs, we found no differences in general adjustment, but 10- to 13-year-old girls with breast cancer family histories reported higher breast cancer–specific distress and perceived breast cancer risk. Mother distress was associated with daughter distress. (Read the full article)

Maternal gestational weight gain is associated with childhood overweight. It is unknown whether gestational weight gain programs the child’s health or whether gestational weight gain is an indicator of postnatal behavioral factors.

We disentangled these influences by studying the effect of gestational weight gain simultaneously with postdelivery maternal weight change as an indicator for shared family lifestyle on child’s weight development and found that both had an independent effect. (Read the full article)

Children with Down syndrome (DS) grow differently from other children. Advances in medical care, access to care, and improved life expectancy suggest that contemporary growth patterns may have improved over recent decades for children with DS in the United States.

New growth charts are presented for length/height, weight, head circumference, and BMI for children with DS (birth to 20 y). Weight gain in children <36 months, and stature for males are improved compared with older growth charts. (Read the full article)

Interactive mobile media devices have revolutionized children’s access to and experience of media, but research is lagging behind its adoption. A critical first step is to understand when and how young children adopt mobile media devices.

Our study found almost universal exposure, early adoption, and use of mobile media devices among young children in an urban, low-income, minority community. Studies are needed to update guidelines on the use of mobile media by young children. (Read the full article)

Source: www.letfreedomringblog.com - Saturday, May 09, 2020
John Solomon has worked overtime and then some to rip Adam Schiff’s mask off. So have Catherine Herridge, Sara Carter, Lee Smith, Gregg Jarrett, Kim Strassel, Mollie Hemmingway and Byron York. Solomon’s article highlights how utterly dishonest Adam Schiff is. Ditto with the upper echelon of the FBI. Strap yourself in. This isn’t a short ride. The pursuit of the truth ended Thursday when the Justice Department formally asked a court to vacate Flynn’s conviction and end the criminal case, acknowledging the former general had indeed been cleared by FBI agents and that the bureau did not have a lawful purpose when it interviewed him in January 2017. Attorney General William Barr put it more bluntly in an interview Thursday : “They kept it open for the express purpose of trying to catch, to lay a perjury trap for General Flynn.” According to Solomon’s reporting, the FBI didn’t have a reason to investigate Gen. Flynn: 3. Case closed memo. FBI agents wrote a memo to close the investigation of Flynn on Jan. 4, 2017, writing they found “no derogatory” evidence that Flynn committed a crime or posed a national security threat. FBI management then ordered the closure to be rescinded and pivoted toward trying lure Flynn into an interview. https://justthenews.com/accountability/russia-and-ukraine-scandals/fbi-found-no-derogatory-russia-evidence-flynn-planned Corrupt FBI agent Peter Strzok allegedly ordered Crossfire Razor, the codename for th

Source: www.mediaite.com - Saturday, May 09, 2020
(() => { window.amJwVideos = window.amJwVideos || []; const iframe = document.createElement('iframe'); const jwBaseUrl = 'https://content.jwplatform.com/players/'; iframe.setAttribute('allowfullscreen', true); iframe.jwUrlWithAds = jwBaseUrl + 'tmqgnsNB-KfS9hzfO.html'; iframe.jwUrlWithNoAds = jwBaseUrl + 'tmqgnsNB-I23UVzQH.html'; amJwVideos.push(iframe); })(); Want to avoid video ads? Subscribe to Mediaite+ Marcus Arbery , father of slain unarmed jogger Ahmaud Arbery , gave a wrenching description of his son’s killing even as he said he did not believe the suspects who have been arrested in the crime should be put to death. On Friday night’s edition of CNN’s Cuomo PrimeTime , Mr. Arbery and family attorney Benjamin Crump joined host Chris Cuomo to discuss the Feb. 23 killing that was captured on a video that was leaked this week, but which police have had since the crime was committed. “What do you want people to know about your son, and what this means to you?” Cuomo asked. “I just want people to know that he was a very good young man, and he loved the people, and I just want people to remember him as a good-hearted young man,” Mr. Arbery said, adding that his late son “was the type of young man, if he had one dollar, and you needed that one dollar, he would give it to you. That’s just how good his heart was.” Mr. Arbery went on to say that “to see him just get lynched like that by a racial mob, it’s just devastating to our fam

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