No description available.

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Abstract available in the Journal of Adolescent Health.

Objective: To examine associations between in utero marijuana exposure and birth outcomes. Study design: In two separate cohorts (Appalachian, Rocky Mountain), data were collected from medical records. Marijuana exposure was positive based on urine drug screening at delivery, with nonexposed controls matched on multiple factors including other substance exposure. Result: Marijuana-exposed newborns (n = 531) had significantly worse birth outcomes than controls (n = 531), weighing 218 g less, 82%, 79%, and 43% more likely to be low birth weight, preterm, or admitted to the NICU, respectively, and significantly lower Apgar scores. Conclusion: Marijuana exposure in utero predicted newborn factors linked to longer-term health and development issues. Effects were not attributable to other comorbidities in this study due to rigorous matching and biochemical verification of marijuana and other drug use. Findings add to growing evidence linking marijuana exposure to adverse birth and longer-term outcomes. Women should be encouraged to avoid marijuana use during pregnancy.

Book Summary: This book is really a reflection of the past more than 20 years of work with teens and suicide prevention in the state of Kentucky. The work to establish the “Stop Youth Suicide Campaign (SYS)” has resulted in contact with many young adults, and we have found that the most important thing for all of them was finding a caring person they trust and can talk to. Because of the constant need, the SYS went from a goal of being a one year awareness campaign to becoming a major community resource, working with the state and local governments and state legislators to add as many resources as possible. We have witnessed for the first time a drop of youth suicide rates below the national average, according to the 2013 Youth Risk Behavior Surveillance done biannually by the Center for Disease Control. In this book, we will tackle various topics and specific populations in relation to suicide written by people who work with teens and care about them.

No description available.

No description available.

Background: The relative importance of malaria anaemia as a cause of childhood morbidity and mortality varies between and within regions. However, malaria anaemia remains an important cause of childhood morbidity and mortality. It has been estimated that globally, severe malaria anaemia occurs 1.42 to 5.66 million times per annum and kills an estimated 190,000 to 974,000 under-5 children. Studies from different countries endemic for malaria have emphasised the importance of anaemia in malaria-associated morbidity and mortality. Most of these studies have conclusively shown that severe malaria anaemia increases the risk of death in children with malaria; and in many reports, children with severe malaria anaemia often die before blood transfusion could be commenced. In addition, blood transfusion, which is the standard management for severe malaria anaemia, apart from not being available in many rural clinics, exposes the child to transfusion related infections such as human immunodeficiency virus (HIV). Better understanding of the pathogenesis of malaria anaemia therefore will enhance its prevention and management. The pathogenesis of malaria anaemia is multifactorial and involves such mechanisms as immune and non-immune mediated haemolysis of parasitized and non-parasitized erythrocytes, bone marrow dysfunction, altered cytokine balance, nutritional deficits and interactions with common haemoglobinopathies and red cell defects such as glucose-6-phosphate dehydrogenase (G6PD) deficiency. An important component of the pathogenesis of malaria anaemia is iron delocalisation characterised by the sequestration of iron by the reticulo-endothelial tissues (the monocyte-macrophage system) as a result of malaria-induced inflammation. Iron sequestration creates a state of false iron deficiency which recovers after the inflammation has subsided. Therefore if the malaria-induced inflammation can be resolved more quickly, the degree and duration of malaria anaemia will be reduced. In addition, since the destruction of non-parasitized erythrocytes accounts for more than 90% of erythrocyte loss, use of anti-inflammatory drugs could minimize red cell loss. Chloroquine is an antimalarial with proven anti-inflammatory properties. In addition, it is cheap, safe and has been shown to reduce iron delocalisation in vitro. A proof of concept study was designed to investigate its potential use in the management of children with mild malaria anaemia. Aims and hypothesis: The goal of the study was to investigate the effect of acute and continuing administration of chloroquine on haemopoietic response after a malaria episode. My hypothesis was that the anti-inflammatory and anti-macrophageal iron-loading effects of chloroquine will enhance erythropoietic recovery after a malaria episode. Methodology: The study was designed as a randomised placebo controlled trial and was conducted over two malaria seasons. In the first year, the study consisted of four arms with a 2x2 design and only two arms in the second year. In the first year, the participants were initially randomised to receive antimalarial treatment with either chloroquine-sulphadoxine-pyrimethamine or co-artemether. All children with negative peripheral smear for malaria parasite by day three were subsequently randomised to receive either weekly chloroquine or weekly placebo until day 90. In the second year of the study, all the children were initially treated with co-artemether; subsequently, those with negative peripheral smear for malaria parasites were randomised to weekly chloroquine or weekly placebo as in the first year. Children randomised to weekly chloroquine and weekly placebo were followed up for three months. Various clinical and laboratory measurements were conducted on days 0, 3, 7, 15, 30, 45, 70 and 90. In year two of the study, no data were collected on days seven and 70. The main outcome measure was change in haemoglobin from day three to day 30 and from day three to day 90. Other outcome measures were 1. Changes in Hb in the placebo arms of the CQ-SP and ACT treatment groups 2. Changes in measures of inflammation – neopterin and cytokines 3. Changes in markers of iron status 4. Prevalence of sub-microscopic parasitaemia Results: In 2007, 1445 children were placed under malaria surveillance, of which 105 malaria cases were recorded and 61 completed the 90 days follow-up. In 2008, of 1220 children under surveillance, 49 malaria cases were recorded, and 31 completed 90 days follow-up. There was no difference in Hb change from day three to day 30 and from day three to day 90 between the weekly chloroquine and weekly placebo arms. Although not statistically significant, the Hb change in children treated CQ-SP in 2007 was nearly twice the change in children treated with ACT at both days 30 and 90. The changes in the markers of iron status – MCV, MCH and ZnPP did not differ by treatment group and by randomisation group. During the acute malaria phase, neopterin concentration was high but by day 15, the levels had fallen to near zero levels and remained at this low level until day 30. Prevalence of sub-microscopic parasitaemia in the group was 15.1% and was similar in both randomisation arms. Iron deficiency was highly prevalent among the study participants. The independent predictors of Hb change were Hb at day 0, presence of iron deficiency, age of the child and height-for-age z score. Conclusions: Giving weekly chloroquine at a dose of 5mg/kg to children with mild anaemia associated with malaria did not confer any advantage to bone marrow recovery compared to children who received placebo. The data, however, suggests that the initial therapeutic dose of chloroquine (10mg/kg/day over three days) could have some positive effects on bone marrow recovery post malaria. The Hb recovery following treatment for malaria is determined by the age of the child, the Hb at diagnosis, the presence or absence of iron deficiency, and the height-for-age z score.

Time use studies are an effective way of finding out more about individuals’ daily lives and when used with semi-structured interviews can provide a form of participant observation. Large multinational studies have been performed over the past 40 years providing comprehensive data on general populations, including couples with children. However, little is known about the daily lives of couples with children with complex disabilities, and whether there are differences in time use decisions and quality of life for this group of parents. Quantities of time spent on different activities can affect quality of life; the way activities are performed can affect their quality. This study considers these issues of quality versus quantity in the time use of parents. Aims and Objectives: 1) To explore the time use of parents with a young child with complex disabilities and compare this with the time use of similar parents with young children without any identified disabilities; 2) To explore what factors influence parents’ time use decisions, and relate these to quality of life and parental satisfaction and 3) To use this knowledge to guide service delivery. Methodology and Methods: This is a critical ethnographic mixed methods study. Three group of parents participated: 1) Parents with a preschool child with complex health needs dependent on technology; 2) Parents with a healthy preschool child with autism and 3) Parents with a healthy preschool child without any identified disabilities. All parents completed the PedsQLTM Family Impact Module Survey followed by a specifically designed precoded time use diary for seven consecutive days. Parents in groups one and two were then interviewed to explore their feelings around time use and family life. Secondary analysis of the Multinational Time Use Survey (MTUS) data from the UK 2000/1 provided a further comparison data set. Results: Data are available on 28 couples and an additional 200 couples from the MTUS data. Significant differences in time use were found between the groups with regard to sleep, leisure, social contact, work, and quality of life measures with parents in groups one and two disadvantaged in these aspects compared to the parents in group three. Five main themes emerged from analysis of the interviews: ‘feeling trapped at home’; ‘twenty-four seven caring’; ‘trying to achieve a balance’; ‘discovering a whole new world’; and ‘evolving roles’ with ‘trust’ emerging as a unifying theme. Trust was found to provide the threads that linked parents in a complex web of relationships. The quality and quantity of these trust threads affected parents’ time use decisions and quality of life as highlighted by the reduced quality and quantity of sleep and leisure experienced. The interparental trust relationship varied between couples with different levels of trust defining ‘dictatorship’, ‘coalition’ and ‘democracy’ groups. Conclusion: Quality and quantity of sleep and leisure time are reduced for parents with a disabled preschool child. This decreases opportunities for parents to ‘re-charge’ and hence can impact on parents’ health and wellbeing. Levels of trust between mothers and fathers influence parental time use and are an important determinant of parental quality of life.

Paediatric gastroenteritis [GE] is a common and important condition that causes a considerable burden on the NHS, the families and the patient. Despite this, the evidence for effective management is limited. Only a proportion of patients (and parents) consult, but we know little about their reasons for consulting and how they manage the illness at home. Using a mix of methods this project aimed to explore the current management of paediatric gastroenteritis in the United Kingdom, focussing specifically on home management and primary care consultations. A prospective case series was designed in which primary care clinicians within Wales identified and invited paediatric patients (and their parent) to take part in the study. Baseline information was recorded for all eligible patients. Parents of eligible patients were invited to take part in a qualitative telephone interview as well as being identified through social media. Clinicians were approached to take part in a separate qualitative study. Anonymous patient records of paediatric patients presenting to primary care between 2003 and 2012 were extracted from CPRD Results show a decrease in consultation rates over 10 years however hospital referrals and stool sample requests have increased. Parents’ attitudes toward GE management impacted on their actions around prevention of illness and transmission. The variety of beliefs around causes of and threats from GE also influenced their actions. Reported clinical decisions and advice to parents were often not in line with current guidance from expert bodies. Many clinicians were not aware of guidelines on managing paediatric GE which might account for some of the variability in their management. Variation can ultimately result in inappropriate management and thus increase the burden of illness on both families and the NHS. Parent and clinician beliefs need to be addressed in order to ensure management of GE is appropriate and not detrimental to patients.