The study objective was to identify demographic, medical, and health behavior factors that predict breastfeeding initiation in a rural population with low breastfeeding rates. Participants were 2323 women who experienced consecutive deliveries at 2 hospitals, with data obtained through detailed chart review. Only half the women initiated breastfeeding, which was significantly associated with higher levels of education, private insurance, nonsmoking and non-drug-using status, and primiparity, after controlling for confounders. Follow-up analyses revealed that smoking status was the strongest predictor of failure to breastfeed, with nonsmokers nearly twice as likely to breastfeed as smokers and with those who had smoked a pack per day or more the least likely to breastfeed. Findings reveal many factors placing women at risk for not breastfeeding and suggest that intervention efforts should encourage a combination of smoking cessation and breastfeeding while emphasizing that breastfeeding is not contraindicated even if the mother continues to smoke.

Objective: To examine sociodemographic, medical, and substance use factors associated with smoking continuation during pregnancy. Methods: Data from 221 consecutive prenatal patients were analyzed. Results: Of the 67% who were pre-pregnancy smokers (n=148), 27% quit during pregnancy, whereas another 43% reduced by > 1/4 pack/day. Women who continued to smoke had lower incomes, more prior pregnancies, were less likely to have adequate prenatal care, and smoked more and for more years than did women who quit during pregnancy. Conclusion: Several characteristics predicted pregnancy smoking in this sample. Results suggest ways to more effectively target pregnant women for successful smoking cessation.

Background: Although alcohol intake has been positively associated with breast cancer risk in epidemiologic studies, the mechanisms mediating this association are speculative. Objective: The Postmenopausal Women's Alcohol Study was designed to explore the effects of moderate alcohol consumption on potential risk factors for breast cancer. In the present analysis, we evaluated the relationship of alcohol consumption with antioxidant nutrients and a biomarker of oxidative stress. Design: Participants (n = 53) consumed a controlled diet plus each of three treatments (15 or 30 g alcohol/day or a no-alcohol placebo beverage), during three 8-week periods in random order. We measured the antioxidants, vitamin E (alpha (α)- and gamma (γ-tocopherols), selenium, and vitamin C in fasting blood samples which were collected at the end of diet periods, treated and frozen for assay at the end of the study. We also measured 15-F2t-IsoP isoprostane, produced by lipid peroxidation, which serves as an indicator of oxidative stress and may serve as a biomarker for conditions favorable to carcinogenesis. Results: After adjusting for BMI (all models) and total serum cholesterol (tocopherol and isoprostane models) we observed a significant 4.6% decrease (P=0.02) in α-tocopherol and a marginally significant 4.9% increase (P = 0.07) in isoprostane levels when women consumed 30 g alcohol/day (P = 0.06 and 0.05 for overall effect of alcohol on α-tocopherol and isoprostanes, respectively). The other antioxidants were not significantly modified by the alcohol treatment. Conclusions: These results suggest that moderate alcohol consumption increases some biomarkers of oxidative stress in postmenopausal women.

Objective. Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition. In this study, we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a provider survey published in 2010. Methods. In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition's Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings. Results. Over half of CARRA members completed the survey (202/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 years (49%). Most providers transferred patients prior to age 21 years (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in 3 of 12 transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (P < 0.001 for each). Nevertheless, the mean current assessment score was < 2 for each measurement. Conclusion. This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.

Objectives: Report a novel case of new-onset type 1 diabetes in a pediatric patient presenting with DKA and concurrent Streptococcus intermedius brain abscess. Case presentation: The following case report is that of a previously healthy 12 year-old girl presenting with new-onset type 1 diabetes with mild diabetic ketoacidosis and subsequently found to have a brain abscess. Over the course of her hospital stay, she developed seizures and was found to have a 1.3 × 1.0 × 1.2 cm right frontal parasagittal mass culture-positive for S. intermedius. Neurologic symptoms were unmasked once insulin treatment was initiated and ketosis improved, supporting the relationship between therapeutic ketosis and the management of medication-refractory epilepsy. Conclusions: This case both supports the relationship between therapeutic ketosis and the management of medication-refractory epilepsy and highlights the need to carefully consider comorbid conditions in patients with DKA and new onset neurological symptoms.

We investigated the prevalence of vaping among college students in South-central Appalachia in the United States and explored factors which were associated with and could predict vaping among the college students. A sample of 498 enrolled students voluntarily completed a self-report REDCap health survey questionnaire in 2018. Outcome variable was use of electronic cigarettes categorized as yes/no. Independent variables included risky behaviors such as texting or emailing while driving, riding in a car with someone who had been drinking, history of protected and unprotected sexual intercourse, age at first intercourse, and type of contraceptive used. Covariates were age, gender, ethnicity/race and high school location. The first category was used as reference. Binary logistic regression was used to identify factors associated with and predicting vaping. Mean age of participants was 20.93(± 8.26), 62.9% were female, a majority (76.5%) were non-Hispanic White, and 43.2% reported vaping at some point in their lives. Initial univariate analysis showed gender (p < 0.0001), seat belt usage (p = 0.002), texting or emailing while driving (p = 0.002), riding in a car with someone who had been drinking (p = 0.001), history of sexual intercourse (p < 0.001), coitarche (p = 0.026), use of birth control pills and withdrawal method were associated with vaping. Adjusting for co-variates, gender (p < 0.002), county of high school (p < 0.009) and texting and e-mailing while driving (0.05), seat belt usage (0.04) remained significant. Vaping was highly prevalent (43.2%) among our participants. Gender, location of high school, texting/emailing while driving and seat belt usage are predictors of vaping among these students.

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having an excellent safety profile in the pediatric population while providing an almost pain and anxiety free procedure. The program proposal will be used to improve pain and anxiety management for pediatric patients requiring procedures such as intravenous access, venipuncture, voiding cystourethrograms, lumbar puncture, bone marrow biopsy, port-a-cath access, PICC line insertion, dressing changes, chest tubes, and wound care. Key stakeholders and content experts were brought together to create the nitrous oxide program proposal which included a new practice guideline, a comprehensive policy and procedure for nitrous oxide administration, and an education plan. The program proposal included other key components necessary for a safe and efficient program such as a pre-assessment to determine if the child is a candidate, monitoring and documentation of nitrous oxide administration, and education for the child/parent(s). The nitrous oxide program for pediatrics was designed as a minimal sedation method to minimize procedural pain, fear, and anxiety in children where medical procedures are a necessary part of treatment.

Emergency department (ED) use for behavioral-health-associated diagnoses has steadily increased in adult and pediatric populations, accounting for 1 out of every 8 ED visits. The increase in pediatric behavioral health ED visits, combined with limited resources for treatment, has created a challenge for EDs faced with extended boarding and constant observation of this population. The generalized behavioral health guidelines used at the practice site have not been adapted for the pediatric population. This project focused on providing age- and developmentally appropriate best practice guidelines for children under constant observation in the children's emergency department (CED) using Havelock's theory of planned change as the framework. Practice in the CED was compared to best practice recommendations identified in the literature and community standards including workflow, defined roles and responsibilities, addressing the needs of the parent/guardians, and defined outcomes. These best practices were incorporated in a guideline developed to provide age- and developmentally appropriate recommendations. An expert panel comprising the behavioral health nurse manager and children's emergency department nurse manager reviewed the guideline using the AGREE II tool, and the guideline was revised based on the composite results from the 6 domains in the AGREE II tool. Based on these composite results and panel feedback, domain 5 was revised to include an auditing and monitoring plan. In addition to improving the safety and care for the CED patient population, this project also serves to increase awareness of the topic while emphasizing on the need for additional research and evidence-based practice focused on pediatric behavioral health patients.

Background: Extrauterine growth restriction (EUGR) is multifactorial in etiology and predisposes infants to multiple morbidities that can be significantly ameliorated by adequate nutrition and appropriate longitudinal growth. Current strategies to reduce the risk of EUGR include optimization of parental nutrition, varying schedules of feeding advances, and caloric supplementation. Very low birthweight (VLBW) preterm infants are particularly affected by EUGR, therefore ensuring adequate postnatal growth is an essential component in improving the long-term health outcomes for VLBW infants. The objectives of this observational study were to examine potential risk factors for growth failure among premature infants that did not respond to caloric and volume supplementation. Methods: We conducted a retrospective chart review of all infants born at the University of Massachusetts level III NICU from January 2016 to June 2020. Growth was tracked using PediTools electronic gestational age and growth calculators. (17) We reviewed the EMRs of infants who met the criteria for EUGR at the time of hospital discharge for a variety of potential factors affecting growth. Results: Overall, a total of 448 infants were screened with a final study cohort of 358 infants, of which 13% were discharge with EUGR. Analysis of demographic and clinical characteristics of infants with EUGR before and after nutritional intervention showed no statistically significant differences between the two cohorts. Pre-protocol, only weight percentiles and z-scores were statistically significant. Post-protocol, the change in z-score was also statistically significant. The only factor found to be statistically significantly different between was Necrotizing enterocolitis (NEC). Timing of EUGR in the pre-protocol groups occurred between 33-35 weeks, while in the post-protocol group EUGR occurred between 32 and 37 weeks (Figure 2). Conclusions: Our findings confirmed the presence of several factors that have been previously shown to increase risk for EUGR, including male sex, lower gestational age, lower birth weight, and the occurrence of NEC. It also identified an additional risk factor, that of being born “constitutionally small”. In the post-protocol cohort, the change in z-score was statistically significant in addition to birth weight percentile and z-score and discharge weight percentile in z-score. The window in which EUGR occurred as well as the interquartile range was significantly widened post-protocol. These data suggest that the volume supplementation protocol successfully addressed the causes of EUGR in some infants, but other mechanisms may have occurred in infants who were still discharged with EUGR post-protocol.

No description available.