Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.

Background: Evidence on aerosol delivery via tracheostomy is lacking. The purpose of this study was to evaluate the effect of aerosol device and administration technique on drug delivery in a simulated spontaneously breathing pediatric model with tracheostomy. Methods: Delivery efficiencies during spontaneous breathing with assisted and unassisted administration techniques were compared using the jet nebulizer (JN- MicroMist), vibrating mesh nebulizer (VMN- Aeroneb Solo) and pressurized metered-dose inhaler (pMDI- ProAirHFA). The direct administration of aerosols in spontaneously breathing patients (unassisted technique) was compared to administration of aerosol therapy via a manual resuscitation bag (assisted technique) attached to the aerosol delivery device and synchronized with inspiration. An in-vitro lung model consisted of an uncuffed tracheostomy tube (4.5 mmID) was attached to a collecting filter (Respirgard) which was connected to a dual-chamber test lung (TTL) and a ventilator (Hamilton). The breathing parameters of a 2 years-old child were set at an RR of 25 breaths/min, a Vt of 150 mL, a Ti of 0.8 sec and PIF of 20 L/min. Albuterol sulfate was administered with each nebulizer (2.5 mg/3 ml) and pMDI with spacer (4 puffs, 108 µg/puff). Each aerosol device was tested five times with both administration techniques (n=5). Drug collected on the filter was eluted with 0.1 N HCl and analyzed via spectrophotometry. Results: The amount of aerosol deposited in the filter was quantified and expressed as inhaled mass and inhaled mass percent. The pMDI with spacer had the highest inhaled mass percent, while the VMN had the highest inhaled mass. The results of this study also found that JN had the least efficient aerosol device used in this study. The trend of higher deposition with unassisted versus assisted administration of aerosol was not significant (p>0.05). Conclusions: Drug deposited distal to the tracheostomy tube with JN was lesser than either VMN or pMDI. Delivery efficiency was similar with unassisted and assisted aerosol administration technique in this in vitro pediatric model.

Background: Aerosol therapy has been established as an efficient form of drug delivery to pediatric and adult patients with respiratory diseases; however, aerosol delivery to the pediatric population is quite challenging. While some studies compare jet nebulizer (JN), vibrating mesh nebulizer (VMN), or JN and pMDI, there is no study comparing these three devices in pediatric and young children. The aim of this study quantifies aerosol deposition using JN, VMN, and pMDI/VHC in a simulated pediatric with active and passive breathing patterns. Methods: Each aerosol generator was placed between manual resuscitator bag (Ambu SPUR II Disposable Resuscitator, Ambu Inc, Glen Burnie, MD) and infant facemask (Mercury Medical, Cleanwater, FL), which was held tightly against the SAINT model. Breathing parameters used in this study were Vt of 100 mL, RR of 30 breaths/min, and I:E ratio of 1: 1.4. Active and passive breathing patterns were used in this study with aerosol device; active breathing pattern was created using a ventilator (Esprit Ventilator, Respironics/Philips Healthcare, Murrysville, PA) connected to a dual chamber test lung (Michigan Instruments, Grand Rapids, MI), which was attached to an absolute filter (Respirgard II, Vital Signs Colorado Inc, Englewood, CO), to collect aerosolized drug, connected to the SAINT model. Pediatric resuscitator bag was run at 10 L/min of oxygen and attached to aerosol generator with facemask. In passive breathing pattern, SAINT model was attached to test lung and ventilated using the resuscitator bag with the same breathing parameters. Each aerosol device was tested three times (n=3) with each breathing patterns. Drug was eluted from the filter and analyzed using spectrophotometry. The amount of drug deposited on the filter was quantified and expressed as a percentage of the total drug dose. To measure the differences in the inhaled drug mass between JN, VMN, and pMDI/VHC in active or passive breathing, one-way analysis of variance (one-way ANOVA) was performed. To quantify the difference in aerosol depositions between the two breathing patterns, independent t-test was performed. A p < 0.05 was considered to be statistically significant. Results: Although the amount of aerosol deposition with the JN was the same in passive and active breathing without any significant difference, the VMN was more efficient in active breathing than the JN (p = 0.157 and p = 0.729, respectively). pMDI/VHC had the greatest deposition in the simulated spontaneous breathing (p=0.013) Conclusion: Aerosol treatment may be administered to young children using JN, VMN, or pMDI/VHC combined with resuscitator bag. Using pMDI/VHC with resuscitator bag is the best choice to deliver albuterol in spontaneously breathing children. Further studies are needed to determine the effectiveness of these aerosol generators with different type of resuscitator bag and different breathing parameters.

Thesis (M.A.)--Northern Kentucky University, 2009. / Made available through ProQuest. Publication number: AAT 1469758. ProQuest document ID: 1902458221. Includes bibliographical references (p. 23-25)

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Research indicates that children with Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) display a variety of neuro-developmental, cognitive, motor and nutritional deficiencies (Epstein el al., 1986:678; Davis-McFarland, 2000:20; Blanchette et al., 2001:50). Research also substantiates a need for additional intervention strategies such as improved nutrition and exercise programmes to improve the quality of life for HIV-infected children (Brady, 1994: 18; Stein et al., 1995:3 1 ; Parks & Danoff, 1999:527). The maintenance of motor skills in above-mentioned children is an important objective for intervention programmes, especially gross motor skills (Parks & Danoff, 1999:525). Literature indicates that growth retardation, exhaustion of fat storage and neuro-developmental deficiencies are related to HIV/AIDS (Aylward et al., 1992:218; Miller & Garg, 1998:368; Davis-McFarland, 2000:20; Miller et al., 200 1 : 1287). The monitoring of growth status is of outmost importance as children with serious stunting and wasting run the risk of early death. Growth retardation can also be an indication of infection or fast disease progression (Bobat et al, 200! :209). The aim of this study was firstly to determine the state of the motor development of 2, to 6-year old children infected with HIV and to compare it with that of affected (in that they are not infected with HIV, but have lost one or both parents to AIDS-related diseases) and non-affected children. Secondly the study aimed to determine the effect of a motor intervention programme for 2 to 6-year old children infected with and affected by HIV. A third aim was to determine the growth status of 2 to 6-year old children infected with HIV and to compare it with that of affected and non-affected children; and the last aim was to monitor the developmental tendencies of body composition and growth of 2 to 6-year old children infected with HIV in the course of nine months and to compare it with that of affected and non-affected children. The Peabody Developmental Motor Scales-:! (PDMS-2) (Folio & Fewell, 2000), which consist of six subtests, was used to determine the motor development of the children. Regarding the growth status the children were subjected to a series of anthropometric measurements of height, weight, circumference (upper arm - both tonic and relaxed), as well as skin folds (triceps, sub-scapular, calf), in accordance with standard procedures as prescribed by the International Society of Advanced Kinanthropometry (ISAK). The data was analysed using Statistica for Windows (Statsoft-, Inc S.A., 2001) and SAS (2000- 2003). Descriptive statistics were used to determine means (M), standard deviations (SD) and maximum and minimum values. One-way variance of analysis, forward stepwise discriminant analysis, independent T-testing, dependant T-testing and an ANCOVA, repeated measures ANOVA, and Bonferroni post hoc analysis were used to analyse the data in accordance with the above-mentioned aims. The level of statistic significance was set at p<0,05. Practical significance of differences (ES) between the testing sessions was calculated by dividing the mean difference (M) between the two testing sessions by the largest standard deviation (SD), as recommended by Cohen (1988) and Steyn (1999). Cohen (1988) set the following guidelines for interpreting practical significance, namely ES = 0,2 (small effect); ES = 0,5 (medium effect) and ES = 0,8 (large effect). Due to the small number of subjects it was considered practically significant if this effect size indicated a medium and larger effect. From the results of the study it seemed that the HIV-infected children performed the poorest of the groups regarding gross motor, fine motor and total motor skills. This group's gross motor skills showed larger deficits than their fine motor skills, while loco-motor skills contributed the most to the discrimination between the groups. The motor intervention programme led to a statistically significant improvement in loco-motor, fine motor, as well as total motor skills. The infected children showed better improvement compared to the affected children. The infected group displayed the poorest growth status of the three groups compared to the Centre for Disease Control (CDC) growth profiles, although they did not differ significantly from the affected children. The infected children differed significantly regarding height percentile, fat percentage and height-for-age 2-score (HAZ) from non-affected children. The infected group also displayed the least significant effects in the form of growth increases over the nine months monitoring period. It can be concluded from the results that motor deficiencies and growth impediments are part OF the life of HIV infected children. To address these problems, intervention strategies, such as motor intervention and nutrition programmes are needed. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2008.

Background: Positive emotional health is an important component of overall health, and it is linked to many social and health outcomes among youth. The natural environment is thought to influence emotional health. Psychological and experimental research have each shown links between exposure to nature and both stress reduction and attention restoration. Some population studies have suggested positive effects of green space on various indicators of health. However, there are limited large-scale epidemiological studies assessing this relationship, specifically for populations of young people and in the Canadian context. Objectives: To examine possible effects of natural space on positive emotional health among young adolescent Canadians. Methods: This cross-sectional study was based upon the Canadian 2009/10 Health Behaviour in School-aged Children Survey with linked geographic information system (GIS) data. Following exclusions, the sample included 17 249 (mostly grades 6 to 10) students from 317 schools. Features of the natural environment were extracted using GIS within a 5 km radius circular buffer surrounding each school. Multilevel logistic regression was used to examine the relationship between the presence of natural space and students’ reports of positive emotional health, while controlling for salient covariates and the clustered nature of the data. Results: Over half of Canadian youth reported positive emotional health (58.5% among boys and 51.6% among girls). Relationships between the amount of natural space and positive emotional health were weak and lacked consistency. Compared to the lowest quartile of natural space, the most notable protective effect existed for students who lived in the third quartile (RR: 1.05; 95% CI: 1.00-1.10). The relationship appeared to differ by urban/rural geographic location, suggesting protective effects in small cities. Positive emotional health was, however, more strongly associated with other factors including demographic characteristics, family affluence, and perceptions surrounding neighbourhoods. Conclusion: Exposure to natural space in youth’s immediate living environment may not be a leading determinant of their emotional health. The relationship between natural space and positive emotional health may be context specific, and hence different for Canadian youth compared to adult populations and those studied in other nations. The main contributors to emotional health among youth were personal factors. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-12-22 06:01:18.593

Background: This thesis sits within the arena of weight status during and after childhood acute lymphoblastic leukaemia (ALL), with a particular focus on the prevalence of unhealthy weight status amongst (ALL), Saudi and UK populations. Each chapter in the thesis explores different aspects of unhealthy weight status in ALL which had been highlighted as gaps in the literature at a conference in Puebla, Mexico, at the end of 2006. A summary of each study is given below. Study 1: Background: This study estimated prevalence of unhealthy weight status and metabolic syndrome (MS) amongst Saudi survivors of standard risk ALL. Methods: We recruited 56 survivors, mean age 13.4 years (SD 4.1), a mean of 9.1 years (SD 4.1) post-diagnosis. The BMI for age was used to define weight status relative to national (Saudi) and international (Cole et al., International Obesity Task Force (IOTF), World Health Organisation (WHO), and Centre for Disease Control and Prevention (CDC)) reference data. We measured body composition by dual energy X-ray absorptiometry (DXA), waist circumference, blood pressure, lipid profile (HDL-C, Triglycerides), fasting glucose and insulin. Results: According to international definitions based on BMI for age, around half of the sample had unhealthy weight status. All of the approaches based on BMI for age underestimated over-fatness, present in 27/51 (53%) of the sample according to DXA. Prevalence of MS was 7.1% (3/42 of those over 9-years old) and 5.4% (3/56) by applying the International Diabetes Federation (IDF) definition and National Cholesterol Education Program Third Adult Treatment panel Guidelines (NCEP III), respectively. However, MS by the NCEP III definition was present in 19% of the overweight and obese survivors and 7.1% of the sample had at least two of the components of MS. Conclusions: Unhealthy body weight and over-fatness may be common amongst adolescent Saudi survivors of standard risk ALL, though overweight and obesity may be no more common than in the general Saudi adolescent population. Defining weight status using BMI underestimates over-fatness in this population, as in other populations. Study 2: Background: Underweight, overweight, and obesity at diagnosis may all worsen prognosis in childhood ALL, but no studies have estimated prevalence of unhealthy weight status at diagnosis in large representative samples using contemporary definitions of weight status based on BMI for age. Methods: Retrospective study which aimed to estimate prevalence of underweight, overweight, and obesity at diagnosis for patients with childhood ALL on three successive UK treatment trials: UKALL X (1985-1990, n 1033), UKALL XI (1990- 1997, n 2031), UKALL 97/97-99 (1997-2002, n 898) .The BMI for age was used to define weight status with both UK 1990 BMI for age reference data and the IOTF definitions. Results: Prevalence of underweight was 6% in the most recent trial for which data were available. Prevalence of overweight and obesity was 35% in the most recent trial when expressed using IOTF definitions; 41% when expressed relative to UK 1990 reference data. Conclusions: Even with highly conservative estimates >40% of all UK patients with ALL were underweight, overweight, or obese at diagnosis in the most recent trial for which UK data are available (UKALL 97/99, 1997-2002). Study 3: Background: This study tested the hypothesis that overweight/obesity at diagnosis of childhood ALL was related to risk of relapse. Methods and results: In a national cohort of 1033 patients from the UK there was no evidence that weight status at diagnosis was related significantly to risk of relapse: log ranks test (p value= 0.90) with overweight and obesity as the exposure (n 917); individual (p value= 0.42) and stepwise (p value= 0.96) proportional hazards models, with BMI z score as the exposure (n 1033). Conclusion: The study does not support the hypothesis that overweight/obesity at diagnosis impairs prognosis in childhood ALL in the UK. Study 4: Background: In the sample of Saudi patients recruited to study 1 we compared DXA whole body and lumbar spine bone mineral density (BMD) using manufacturers software with a body size correction which derived bone mineral content (BMC) for bone area and Apparent bone mineral density of lumbar spine (BMADLS). Methods and results: The survivors of ALL were from Saudi Arabia (n 51, mean age 13.5 years). With no corrections, 29 patients (57%) had lumbar spine BMD z score < -1.0 and 21 (41%) had whole body BMD z score < -2. After correction, by using BMC for bone area method only 6 (12%) had lumbar spine BMC z score <-1.0 and 4 (8%) had whole body BMC z score <-2. By using BMADLS method, 18 (35%) had BMC <-1.0 and 6 (11%) had BMC Z score <-2. Conclusions: Correction for body size seems essential to accurate interpretation of DXA bone health data in adolescent survivors of ALL. The three correction methods provided different conclusions, but bone health remains a concern after treatment for ALL.

Research indicates that children with Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) display a variety of neuro-developmental, cognitive, motor and nutritional deficiencies (Epstein el al., 1986:678; Davis-McFarland, 2000:20; Blanchette et al., 2001:50). Research also substantiates a need for additional intervention strategies such as improved nutrition and exercise programmes to improve the quality of life for HIV-infected children (Brady, 1994: 18; Stein et al., 1995:3 1 ; Parks & Danoff, 1999:527). The maintenance of motor skills in above-mentioned children is an important objective for intervention programmes, especially gross motor skills (Parks & Danoff, 1999:525). Literature indicates that growth retardation, exhaustion of fat storage and neuro-developmental deficiencies are related to HIV/AIDS (Aylward et al., 1992:218; Miller & Garg, 1998:368; Davis-McFarland, 2000:20; Miller et al., 200 1 : 1287). The monitoring of growth status is of outmost importance as children with serious stunting and wasting run the risk of early death. Growth retardation can also be an indication of infection or fast disease progression (Bobat et al, 200! :209). The aim of this study was firstly to determine the state of the motor development of 2, to 6-year old children infected with HIV and to compare it with that of affected (in that they are not infected with HIV, but have lost one or both parents to AIDS-related diseases) and non-affected children. Secondly the study aimed to determine the effect of a motor intervention programme for 2 to 6-year old children infected with and affected by HIV. A third aim was to determine the growth status of 2 to 6-year old children infected with HIV and to compare it with that of affected and non-affected children; and the last aim was to monitor the developmental tendencies of body composition and growth of 2 to 6-year old children infected with HIV in the course of nine months and to compare it with that of affected and non-affected children. The Peabody Developmental Motor Scales-:! (PDMS-2) (Folio & Fewell, 2000), which consist of six subtests, was used to determine the motor development of the children. Regarding the growth status the children were subjected to a series of anthropometric measurements of height, weight, circumference (upper arm - both tonic and relaxed), as well as skin folds (triceps, sub-scapular, calf), in accordance with standard procedures as prescribed by the International Society of Advanced Kinanthropometry (ISAK). The data was analysed using Statistica for Windows (Statsoft-, Inc S.A., 2001) and SAS (2000- 2003). Descriptive statistics were used to determine means (M), standard deviations (SD) and maximum and minimum values. One-way variance of analysis, forward stepwise discriminant analysis, independent T-testing, dependant T-testing and an ANCOVA, repeated measures ANOVA, and Bonferroni post hoc analysis were used to analyse the data in accordance with the above-mentioned aims. The level of statistic significance was set at p<0,05. Practical significance of differences (ES) between the testing sessions was calculated by dividing the mean difference (M) between the two testing sessions by the largest standard deviation (SD), as recommended by Cohen (1988) and Steyn (1999). Cohen (1988) set the following guidelines for interpreting practical significance, namely ES = 0,2 (small effect); ES = 0,5 (medium effect) and ES = 0,8 (large effect). Due to the small number of subjects it was considered practically significant if this effect size indicated a medium and larger effect. From the results of the study it seemed that the HIV-infected children performed the poorest of the groups regarding gross motor, fine motor and total motor skills. This group's gross motor skills showed larger deficits than their fine motor skills, while loco-motor skills contributed the most to the discrimination between the groups. The motor intervention programme led to a statistically significant improvement in loco-motor, fine motor, as well as total motor skills. The infected children showed better improvement compared to the affected children. The infected group displayed the poorest growth status of the three groups compared to the Centre for Disease Control (CDC) growth profiles, although they did not differ significantly from the affected children. The infected children differed significantly regarding height percentile, fat percentage and height-for-age 2-score (HAZ) from non-affected children. The infected group also displayed the least significant effects in the form of growth increases over the nine months monitoring period. It can be concluded from the results that motor deficiencies and growth impediments are part OF the life of HIV infected children. To address these problems, intervention strategies, such as motor intervention and nutrition programmes are needed. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2008.

The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.