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All-Terrain Vehicle-Related Nonfatal Injuries Among Young Riders in the United States, 2001-2010

Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate all-terrain vehicles (ATVs) properly, their risk of injury is greater.

During 2001–2010 in the United States, ~361 000 children aged ≤15 years were injured while riding ATVs. The decline in the injury rate during 2005–2010 might be related to the economic recession and decreased sales of new ATVs. (Read the full article)




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The Relationship Between Parents' and Children's Television Viewing

Many children exceed the American Academy of Pediatrics' recommendation to limit non-educational screen media to < 2 hours per day. The household media environment shapes children's television viewing (TVV), and heavy screen time is associated with poor health outcomes.

Parent TVV is a stronger predictor of child TVV than traditional media "access" and "rules" variables regardless of child age. This research highlights an important factor of child TVV that has been underemphasized in most studies and outreach efforts. (Read the full article)




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Television-Related Injuries to Children in the United States, 1990-2011

Previous research has demonstrated that pediatric injuries associated with television (TV) tip-overs are increasing, children aged ≤4 years are at highest risk for injury, and the head and neck are most commonly injured.

We analyzed a nationally representative sample comprising 22 years of data. On average, 17 313 children receive emergency treatment of a TV-related injury annually in the United States. The rate of injury attributable to falling TVs increased by 95% over 22 years. (Read the full article)




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Unexpected Relationship Between Tympanometry and Mortality in Children With Nontraumatic Coma

Tympanometry provides a measure of middle ear function. There has been no description of the relationship between measurements of middle ear function in the absence of gross anatomic defects and clinical outcome among children with acute nontraumatic coma.

This study reveals an unexpected association between abnormal middle ear function and death in childhood acute coma. These findings call for more investigations on the relationship between middle and inner ear anatomy and function and intracranial dynamics and clinical outcomes. (Read the full article)




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Randomized Trial of a Population-Based, Home-Delivered Intervention for Preschool Language Delay

Preschool language delay is associated with poorer academic performance, more limited employment opportunities, and relationship difficulties. Despite its importance within public health, there has been little progress toward effective population-based prevention and intervention approaches to improve outcomes.

It is feasible to identify low language in 4-year-olds on a population basis and deliver a 1-on-1 intervention. By age 5 years, this resulted in better phonological awareness and letter knowledge. There was weak evidence of better expressive, but not receptive, language. (Read the full article)




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ED Utilization Trends in Sports-Related Traumatic Brain Injury

Traumatic brain injury (TBI) in children causes significant morbidity and mortality. Parental and coach awareness about brain injury due to sports has recently increased. Since 2001, pediatric emergency departments have seen a significant increase in sports-related TBI.

Pediatric, sports-related TBIs cared for in the emergency department and admitted to the hospital have both increased, resulting in no change in the percentage being admitted. However, patients admitted have had a significant reduction in injury severity. (Read the full article)




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Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones

It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child’s risk for specific adverse health outcomes.

By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors. (Read the full article)




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Introduction of Complementary Foods and the Relationship to Food Allergy

Breast milk is protective against many conditions, but its role in allergy has not been established. Infant-feeding recommendations support exclusive breastfeeding for 26 weeks, whereas allergy prevention recommendations advise exclusive breastfeeding for 4 to 6 months with continued breastfeeding thereafter.

Evidence that continued breastfeeding while solids are introduced into the diet and delaying the introduction of solids until at least 17 weeks of age are associated with fewer food allergies. (Read the full article)




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Violent Film Characters' Portrayal of Alcohol, Sex, and Tobacco-Related Behaviors

Youth are frequent consumers of movies that contain high levels of violence, and violent content in films, especially those rated PG-13, has been increasing over time.

Content analyses seldom examine how violence is portrayed with other health risk behaviors, such smoking, drinking, and sex. This study presents an innovative way to characterize on-screen violent content and demonstrates the extent to which risk behaviors co-occur within films. (Read the full article)




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Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

Children with congenital heart disease demonstrate a high prevalence of low-severity developmental problems in the areas of language, motor skills, attention, and executive function. Systematic evaluation has been recommended to promote early detection of problems and ensure appropriate intervention.

This study presents results of longitudinal testing in early childhood. Developmental delays were common. Feeding difficulty and medical and genetic comorbidities increased risk for delays. Exposure to risk and prevalence of delay change over time; therefore, repeated evaluations are warranted. (Read the full article)




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Racial and Ethnic Differences Associated With Feeding- and Activity-Related Behaviors in Infants

Although expert consensus and previous literature document the importance of early feeding and activity behaviors and practices in preventing obesity and the risks of early rapid weight gain, few studies have rigorously assessed obesity-related behaviors by caregivers of infants.

This study demonstrates the high prevalence of behaviors thought to increase risk for obesity in a diverse, large sample of parent/2-month-old dyads and finds that many behaviors vary by race and ethnicity, suggesting the potential for culturally tailored interventions. (Read the full article)




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Effect of a URI-Related Educational Intervention in Early Head Start on ED Visits

Young children have multiple upper respiratory infections (URI) annually. Limited health literacy regarding URI can place families at risk for emergency department (ED) visits, inappropriate use of over-the-counter medications, and medication measurement errors.

Few educational interventions for URI have targeted groups with limited health literacy. Integrating an educational intervention into Early Head Start is a novel approach to increasing parental health literacy regarding URI and decreasing ED visits, with potential for wide dissemination. (Read the full article)




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Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay

Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like selective serotonin reuptake inhibitors (SSRIs). Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear.

This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays. However, underlying depression and its genetic underpinnings may be a confounder. (Read the full article)




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Delayed Primary HHV-7 Infection and Neurologic Disease

Primary HHV-7 infection is almost universal by age 5 years and is causally associated with exanthem subitum, febrile seizures, and febrile status epilepticus. The consequences of delayed primary infection are unknown, although encephalitis has been reported in one adult.

Delayed primary HHV-7 infection can cause serious neurologic disease as identified in 3 adolescents, 2 with encephalitis and 1 with Guillain-Barré syndrome. Serologic tests to distinguish primary from past HHV-7 infection are imperative when HHV-7 DNA is present in CSF. (Read the full article)




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Adverse Drug Event-Related Emergency Department Visits Associated With Complex Chronic Conditions

Children who experience outpatient adverse drug events represent 0.5% of pediatric emergency department visits. The subset of children with complex chronic conditions often take multiple medications, but the incidence and severity of adverse drug events in these children is unknown.

Children with complex chronic conditions have a higher risk of emergency department visits related to adverse drug events, compared with other children. The implicated drugs with the highest rates include psychotropic agents, antimicrobial agents, anticonvulsants, hormones/steroids, and analgesics. (Read the full article)




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Timely Versus Delayed Early Childhood Vaccination and Seizures

Reasons for childhood immunization delay include parental intent and barriers such as transportation. To date there has been 1 study of the association of delayed vaccination and seizures, which found measles-mumps-rubella and measles-mumps-rubella-varicella vaccines are both associated with a higher rate of seizures if received after 15 months of age.

Our study found no association between the timing of vaccination and occurrence of seizures in the first year of life. By using different methods, our results support the observation that delaying vaccination with measles-containing vaccines past 15 months of age increases the incidence of postvaccination seizures. (Read the full article)




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Acute Concussion Symptom Severity and Delayed Symptom Resolution

Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated.

Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms. (Read the full article)




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Atopic Dermatitis, Melatonin, and Sleep Disturbance

Sleep disturbance affects 47% to 60% of children with atopic dermatitis and is a leading cause of impaired quality of life for the patients and their family.

Sleep disturbance in children with atopic dermatitis can be predicted by a Scoring Atopic Dermatitis index of ≥48.7, and lower nocturnal melatonin secretion might play a role in the pathophysiology. (Read the full article)




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Delayed Diagnosis of Critical Congenital Heart Defects: Trends and Associated Factors

Delayed diagnosis of critical congenital heart defects (CCHDs) is associated with increased morbidity and mortality.

Despite increasing prenatal diagnosis rates, delayed diagnosis of CCHDs continues to occur, with rates highest among isolated cases and those delivered at nontertiary care hospitals. Better understanding of delayed diagnosis could help to improve screening efforts. (Read the full article)




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Cognitive Delay and Behavior Problems Prior to School Age

Children with cognitive delay have been shown to have more behavior problems than typically developing children; however, few studies have investigated this relationship over time or among very young children.

Our findings provide some of the first national, prospective evidence that having a cognitive delay may place children at risk for developing and maintaining behavior problems before school age. Early identification and intervention may improve outcomes for these children. (Read the full article)




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Sex-Related Online Behaviors and Adolescents' Body and Sexual Self-Perceptions

Research suggests that appearance-focused messages and exaggerated depictions of sexual activity in the media negatively influence adolescents’ body and sexual self-perceptions. As adolescents increasingly use the Internet to explore their sexuality, health risks related to online behaviors should be identified.

This 4-wave study examined the prevalence and development of 2 receptive and 2 interactive sex-related online behaviors and their relations with adolescents’ body and sexual self-perceptions. It further investigated which parental strategies regarding Internet use may reduce risky sex-related online behaviors. (Read the full article)




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Age-Based Risk Factors for Pediatric ATV-Related Fatalities

Younger age has been identified as an independent risk factor for all-terrain vehicle (ATV)-related injuries. Since the mid-1980s, one-third of ATV-related deaths have involved children younger than 18 years of age.

Using national data, we found both similarities and differences between pediatric age groups in the contribution of known risk factors to ATV-related deaths. The observed differences suggest the importance of targeting injury prevention approaches to specific age ranges. (Read the full article)




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Influenza-Related Hospitalization and ED Visits in Children Less Than 5 Years: 2000-2011

Influenza represents a leading cause of morbidity and a rare cause of death in children. Annual influenza vaccination was gradually expanded to include all children ≥6 months in 2008. The impact of these recommendations on disease burden is unclear.

We assessed the burden of influenza-related health care encounters in children aged 6 to 59 months from 2000 to 2011. In this ecologic exploration, influenza vaccination and influenza-related emergency department visits increased over time, whereas hospitalizations decreased. Influenza-related health care encounters were greater when A(H3N2) circulated. (Read the full article)




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Precollege and In-College Bullying Experiences and Health-Related Quality of Life Among College Students

American Public Health Association reported >3.2 million students in the United States are bullied each year; 160 000 students skip school every day for fear of bullying. Little is known about whether bullying affects health-related quality of life (HRQOL) among college students.

Different types of bullying experiences affected different domains of HRQOL. Precollege bullying had long-term effects on HRQOL. Verbal/relational bullying-victimization experiences, mediated via depression, affected psychological HRQOL. Findings inform preventive and clinical practice to ameliorate the impact of bullying. (Read the full article)




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A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

Adolescent relationship abuse (ARA) is prevalent in confidential clinic settings such as school health centers (SHCs) and is associated with poor health outcomes. No evidence-based interventions target reduction of ARA in the SHC setting.

This study provides the first evidence of the potential benefits of a brief provider-delivered universal education and counseling intervention in SHCs to address and prevent a major public health problem: ARA. (Read the full article)




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Independent Living and Romantic Relations Among Young Adults Born Preterm

Adults born very preterm or with very low birth weight have a lower likelihood of leaving their childhood home, and starting romantic relationships, and are older when experiencing first intercourse or having their first child than their term-born peers.

Compared with term-born individuals, those born preterm perceived themselves less attractive and were less likely to have cohabited or experienced first-time sexual intercourse by young adulthood. This outcome indicates that social outcomes are different among preterm-born individuals. (Read the full article)




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Medication-Related Emergency Department Visits in Pediatrics: a Prospective Observational Study

In adults, adverse drug events account for 5% to 25% of all hospital admissions and 12% of emergency department (ED) visits of which 50% to 70% are preventable. There remains a significant gap in our understanding of the magnitude and impact of medication-related ED visits in pediatrics.

This study is the largest and most rigorous study performed evaluating the impact of medication-related visits to the ED in pediatrics and provides important information regarding the magnitude of this problem in our health care system. (Read the full article)




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Early Intervention for Toddlers With Language Delays: A Randomized Controlled Trial

Early language delay is common in toddlers and is associated with poor academic outcomes, reading difficulties, and persistent communication problems. Despite these long-term sequelae, few interventions for toddlers with early language delays yield positive expressive and receptive language results.

A 28-session program delivered over 3 months can enhance parent language facilitation strategies. Unusually, the small short-term benefits were mainly in receptive, rather than expressive, language and vocabulary. Extended follow-up could determine the costs versus benefits of this promising approach. (Read the full article)




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Youth Drinking in the United States: Relationships With Alcohol Policies and Adult Drinking

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)




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Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

Delayed cord clamping is recommended for all premature births, despite some studies suggesting a decreased placental transfusion at cesarean delivery.

Umbilical cord milking appears to improve systemic blood flow and perfusion in preterm infants delivered by cesarean delivery more efficiently than delayed cord clamping. (Read the full article)




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Infection-Related Hospitalization in Childhood and Adult Metabolic Outcomes

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)




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Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

Preschool language delay predicts poorer academic performance, employment opportunities, and social relationships. Language for Learning, a systematic, population-based intervention for 4-year-olds with low language, is feasible, acceptable and has short-term benefits, but long-term benefits are unknown.

Population ascertainment at age 4 followed by a yearlong, one-on-one home program benefited phonological skills (an important literacy determinant) at age 6, but not the primary language outcomes. To be cost-effective, future follow-up would need to demonstrate lasting academic benefits. (Read the full article)




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Iceland stun Germany to end two-decade run

It had been 19 years since Germany lost a qualifier but Iceland ended that run in stunning style with a 3-2 away win that finished some incredible runs by the twice world champions.




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Education Department Can't Delay Special Education Bias Rule, Judge Says

The rule requires states to use a standard method in determining if districts are biased in how they identify minority students, discipline them, or place them in restrictive settings.




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Ministry made of relationships

For OMers working in Angola, the key to successful ministry has been time investing in relationships.




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The Mandela Effect: Prospects for Peace in Burundi




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International Criminal Tribunal for Rwanda: Justice Delayed




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Central African Republic: "Relancer le dialogue politique




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Telacebec for ultra-short treatment of Buruli ulcer in a mouse model [Clinical Therapeutics]

Telacebec (Q203) is a new anti-tubercular drug with extremely potent activity against Mycobacterium ulcerans. Here, we explored the treatment-shortening potential of Q203 alone or in combination with rifampin (RIF) in a mouse footpad infection model. The first study compared Q203 at 5 and 10 mg/kg doses alone and with rifampin. Q203 alone rendered most mouse footpads culture-negative in 2 weeks. Combining Q203 with rifampin resulted in relapse-free cure 24 weeks after completing 2 weeks of treatment, compared to a 25% relapse rate in mice receiving RIF+clarithromycin, the current standard of care, for 4 weeks.

The second study explored the dose-ranging activity of Q203 alone and with RIF, including the extended activity of Q203 after treatment discontinuation. The bactericidal activity of Q203 persisted for ≥ 4 weeks beyond the last dose. All mice receiving just 1 week of Q203 at 2-10 mg/kg were culture-negative 4 weeks after stopping treatment. Mice receiving 2 weeks of Q203 at 0.5, 2 and 10 mg/kg were culture-negative 4 weeks after treatment. RIF did not increase the efficacy of Q203. A pharmacokinetics sub-study revealed that Q203 doses of 2-10 mg/kg in mice produce plasma concentrations similar to those produced by 100-300 mg doses in humans, with no adverse effect of RIF on Q203 concentrations.

These results indicate the extraordinary potential of Q203 to reduce the duration of treatment necessary for cure to ≤ 1 week (or 5 doses of 2-10 mg/kg) in our mouse footpad infection model and warrant further evaluation of Q203 in clinical trials.




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A genotype-phenotype correlation study of SHV {beta}-lactamases - new insight into SHV resistance profiles [Mechanisms of Resistance]

The SHV β-lactamases (BLs) have undergone strong allele diversification that changed their substrate specificities. Based on 147 NCBI entries for SHV alleles, in silico mathematical models predicted five positions as relevant for the β-lactamase inhibitor (BLI) resistant (2br) phenotype, 12 as relevant for the extended-spectrum BL (ESBL) (2be) phenotype, and two positions were related to solely the narrow spectrum (2b) phenotype. These positions and additional 6 positions described in other studies (including one promoter mutation), were systematically substituted and investigated for their substrate specificities in a BL-free E. coli background, representing, to our knowledge, the most comprehensive substrate and substitution analysis for SHV alleles to date. An in vitro analysis confirmed the essentiality of the positions 238 and 179 for the 2be phenotype and 69 for the 2br phenotype. The substitutions E240K and E240R, which do not occur alone in known 2br SHV variants, led to a 2br phenotype, indicating a latent BLI-resistance potential of these substitutions. The substitutions M129V, A234G, S271I and R292Q conferred latent resistance to cefotaxime. In addition, 7 positions that were found to be not always associated with the ESBL phenotype resulted in increased resistance to ceftaroline. We also observed that coupling of a strong promoter (IS26) to a A146V mutant with the 2b phenotype resulted in a highly increased resistance to BLIs, cefepime and ceftaroline but not to 3rd generation cephalosporins, indicating that SHV enzymes represent an underestimated risk for empirical therapies that use piperacillin/tazobactam or cefepime to treat different infectious diseases caused by gram-negatives.




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Population Pharmacokinetics and Exposure-Response Relationships of Baloxavir Marboxil in Patients Infected with Influenza at High Risk of Influenza Complications [Clinical Therapeutics]

Baloxavir marboxil, a prodrug of cap-dependent endonuclease inhibitor, baloxavir acid, reduces the time to improvement of influenza symptoms in patients infected with type A or B influenza virus. To characterize its pharmacokinetics, a population pharmacokinetic model for baloxavir acid was developed using 11846 plasma concentration data items from 1827 subjects including 2341 plasma concentration data items from 664 patients at high risk of influenza complications. A three-compartment model with first-order elimination and first-order absorption with lag time well described the plasma concentration data. Body weight and race were found to be the most important factors influencing clearance and volume of distribution. The exposures in high-risk patients were similar to those in otherwise healthy patients, and no pharmacokinetic difference was identified regarding any risk factors for influenza complications.

Exposure-response analyses were performed regarding the time to improvement of symptoms and the reduction in the influenza virus titer in high-risk patients. The analyses suggested that body weight-based dosage, 40 mg for patients weighing < 80 kg and 80 mg for patients weighing ≥ 80 kg, can shorten the time to improvement of influenza symptoms and reduce virus titer for both type A and B influenza virus regardless of the exposure levels of the high-risk patients as well as for the otherwise healthy influenza patients.

The results of our population pharmacokinetic and exposure-response analyses in patients with risk factors of influenza complications should provide useful information on the pharmacokinetic and pharmacodynamic characteristics of baloxavir marboxil and also for the optimization of dose regimens.




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Development of Novel Anti-influenza Thiazolides with Relatively Broad-spectrum Antiviral Potentials [Antiviral Agents]

Seasonal and pandemic influenza causes 650,000 deaths annually in the world. The emergence of drug-resistance to specific anti-influenza drugs such as oseltamivir and baloxavir marboxil highlights the urgency of novel anti-influenza chemical entity discovery. In this study, we report a series of novel thiazolides derived from an FDA-approved drug nitazoxanide with antiviral activity against influenza and a broad range of viruses. The preferred candidates 4a and 4d showed significantly enhanced anti-influenza potentials with 10-fold improvement, compared with nitazoxanide, and were effective against a variety of influenza subtypes including oseltamivir-resistant strains. Notably, the combination using of compounds 4a/4d and oseltamivir carboxylate or zanamivir displayed synergistic antiviral effect against oseltamivir-resistant strain. Mode of action analysis demonstrated that compounds 4a/4d acted at the late phase of viral infection cycle through inhibiting viral RNA transcription and replication. Further experiments showed that treatment with compounds 4a/4d significantly inhibited influenza virus infection in human lung organoids, suggesting the druggability of the novel thiazolides. In-depth transcriptome analysis revealed a series of up-regulated cellular genes that may contribute to the antiviral activities of 4a/4d. Together, our study pointed the optimization direction of nitazoxanide as anti-influenza drug, and discovered two novel-structured candidates 4a/4d with relatively broad-spectrum antiviral potential.




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Manogepix (APX001A) displays potent in vitro activity against human pathogenic yeast, but with an unexpected correlation to fluconazole MICs [Susceptibility]

Manogepix (APX001A) is the active moiety of the novel drug candidate fosmanogepix (APX001). We previously reported the broad-spectrum activity of manogepix but also observed a correlation between increased manogepix and fluconazole MICs. Here we extended this study and included isolates with acquired fluconazole resistance.

Isolates (n=835) were identified using CHROMagar, MALDI-TOF and, when needed, ITS-sequencing. EUCAST E.Def 7.3.1 susceptibility testing included manogepix, amphotericin B, anidulafungin, micafungin, fluconazole and voriconazole. Manogepix wildtype-upper-limit (WT-UL) values were established following EUCAST-principles for ECOFF setting allowing wildtype/non-wildtype classification. Drug-specific MIC correlations were investigated using Pearson's correlation.

Manogepix modal MICs were low (range 0.004-0.06 mg/L against 16/20 included species). Exceptions were C. krusei and C. inconspicua, and to a lesser extent C. kefyr and Pichia kluyveri. The activity was independent of Fks echinocandin hot-spot alterations (n=17). Adopting the WT-UL established for C. albicans, C. dubliniensis, C. glabrata, C. parapsilosis and C. tropicalis, 14/724 (1.9%) isolates were non-wildtype for manogepix. Twelve of these (85.7%) were also non-wildtype for fluconazole. A statistically significant correlation was observed between manogepix and fluconazole MICs for C. albicans, C. dubliniensis, C. glabrata, C. parapsilosis and C. tropicalis (Pearson r=0.401-0.575), but not between manogepix and micafungin or amphotericin B MICs for any species except C. tropicalis (r=0.519 for manogepix versus micafungin).

Broad-spectrum activity was confirmed for manogepix against contemporary yeast. However, a 1-4 two-fold-dilution increase in manogepix MICs is observed in a subset of isolates with acquired fluconazole resistance. Further studies on the potential underlying mechanism and implication for optimal dosing are warranted.




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Efficacy of Melatonin in Children With Postconcussive Symptoms: A Randomized Clinical Trial

BACKGROUND:

Approximately 25% of children with concussion have persistent postconcussive symptoms (PPCS) with resultant significant impacts on quality of life. Melatonin has significant neuroprotective properties, and promising preclinical data suggest its potential to improve outcomes after traumatic brain injury. We hypothesized that treatment with melatonin would result in a greater decrease in PPCS symptoms when compared with a placebo.

METHODS:

We conducted a randomized, double-blind trial of 3 or 10 mg of melatonin compared with a placebo (NCT01874847). We included youth (ages 8–18 years) with PPCS at 4 to 6 weeks after mild traumatic brain injury. Those with significant medical or psychiatric histories or a previous concussion within the last 3 months were excluded. The primary outcome was change in the total youth self-reported Post-Concussion Symptom Inventory score measured after 28 days of treatment. Secondary outcomes included change in health-related quality of life, cognition, and sleep.

RESULTS:

Ninety-nine children (mean age: 13.8 years; SD = 2.6 years; 58% girls) were randomly assigned. Symptoms improved over time with a median Post-Concussion Symptom Inventory change score of –21 (95% confidence interval [CI]: –16 to –27). There was no significant effect of melatonin when compared with a placebo in the intention-to-treat analysis (3 mg melatonin, –2 [95% CI: –13 to 6]; 10 mg melatonin, 4 [95% CI: –7 to 14]). No significant group differences in secondary outcomes were observed. Side effects were mild and similar to the placebo.

CONCLUSIONS:

Children with PPCS had significant impairment in their quality of life. Seventy-eight percent demonstrated significant recovery between 1 and 3 months postinjury. This clinical trial does not support the use of melatonin for the treatment of pediatric PPCS.




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Transgender Youth Experiences and Perspectives Related to HIV Preventive Services

BACKGROUND:

In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services.

METHODS:

Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis.

RESULTS:

A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care).

CONCLUSIONS:

Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity.




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New guide curates COVID-19 related resources for researchers

Penn State University Libraries has developed a curated guide to COVID-19 related resources for researchers, including ongoing research at Penn State.




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Labor and Employment Relations student will be 2020 World Campus student marshal

As part of Penn State's 2020 spring commencement activities, Matthew Solovey will represent the College of the Liberal Arts as its World Campus student marshal.




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The Relation of Overweight to Cardiovascular Risk Factors Among Children and Adolescents: The Bogalusa Heart Study

David S. Freedman
Jun 1, 1999; 103:1175-1182
ARTICLES




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Hunger in Venezuela becoming 'a fuel more dangerous than gasoline'

Lima, Peru, Apr 26, 2020 / 06:18 am (CNA).- An archbishop in Venezuela warned that desperation is growing in the country, as the national coronavirus quarantine measures have compounded a tenuous political and economic situation. He urged people in the country to resist violence and social unrest.

Extreme hunger “does not reason or know rules,” said Archbishop Ulises Gutiérrez of Ciudad Bolívar, adding that this desperate hunger “is becoming a fuel more dangerous than gasoline.”

Gutiérrez spoke with ACI Prensa, CNA’s Spanish language news partner, in an April 23 interview, after looting and protests broke out in seven states in Venezuela.

Protestors objected to price hikes on food and a gasoline shortage exacerbated by the ongoing quarantine that was imposed last month to halt the spread of the COVID-19 pandemic. According to the latest government report, there have been 298 cases and 10 deaths in the country due to the virus.

Even before the coronavirus pandemic, Venezuela has been marred by violence and social upheaval under the socialist administration of Nicolas Maduro, with severe shortages of food and medicine, high unemployment, power outages, and hyperinflation. Some 4.5 million Venezuelans have emigrated since 2015.

The current COVID-19 quarantine is “aggravating the situation,” the archbishop said, noting that the quarantine was implemented without accompanying measures to protect the most vulnerable.

As a result, families are suffering, and many cannot access clean water, electricity or gasoline.

The country is experiencing “a totally destroyed economy in which agricultural producers can’t get their products out because they’re not getting gasoline supplied to them, or they have to buy it on the black market for 2 or 3 dollars a liter,” he said. In some cases, crops are rotting in farmers’ fields due to lack of fuel to transport them to market.

Gutiérrez voiced concern over the hunger-fueled looting and protests throughout the country, as well as the government’s violent suppression of the protests.

“The common denominator in all these protests is hunger,” he stressed.

With equipment in short supply and many of the country’s doctors have already emigrated due to the political and economic crisis, Gutiérrez acknowledged, the pandemic poses a significant threat.

“In short, the outlook is very dark,” he said.

But despite the desperate situation, the archbishop urged people not to resort to looting and violence.

“[S]atisfying hunger short term [by committing robbery] only leads to the destruction of regular commerce,” he said.

“The situation we’re going through is very tough, difficult, and fragile,” Gutiérrez said, likening the conditions to a pressure cooker, “which could lead us to unprecedented explosive social unrest, which nobody wants, and which would bring with it more hunger and greater suffering for the people.”

Still, the archbishop said he has reason for hope: “Our trust is in God and his providence keeps us going, encouraging and accompanying our people, assisting them with our Caritas social programs.”

“We have community soup kitchens, a medicine bank, outpatient medical care, programs for infant nutrition and nursing mothers, etc., which although it’s impossible to reach everyone, is a sign of God’s love through the Church,” he said.




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Cardinal Urosa: Coronavirus makes terrible crisis in Venezuela even worse

CNA Staff, Apr 29, 2020 / 04:30 pm (CNA).- Venezuela’s prolonged social, political and economic crisis has only been compounded by the coronavirus pandemic, the archbishop emeritus of Caracas, Cardinal Jorge Urosa Savino, charged Tuesday.

Even before the coronavirus pandemic, Venezuela has been marred by violence and social upheaval under the socialist administration of Nicolas Maduro, with severe shortages of food and medicine, high unemployment, power outages, and hyperinflation. Some 4.5 million Venezuelans have emigrated since 2015.

In response to the threat of the virus, the government imposed a nationwide stay at home order March 17. According to government statistics, to date there have been 329 cases of COVID-19 with ten deaths. The country is ill prepared to handle the crisis, with chronic shortages of medical supplies, and many doctors have left the country.

“The national reality is terrible,” and the government has no answers, Urosa said in an April 28 statement to ACI Prensa, CNA’s Spanish-language news partner.

While the cardinal acknowledged the lockdown has prevented the spread of the virus, he pointed out that “the quarantine has hurt a great many people because the economic, social and logistical conditions in the country weren’t taken into account,” including “the extremely serious problem of the gasoline shortage for transport, especially for food.”

In some cases, crops are rotting in farmers’ fields due to lack of fuel to transport them to market.

Especially hard hit, the cardinal said, are “informal” workers who are paid off the books,  and who are now  “barely surviving,” and only with “the help of family members, social organizations and the Church.”

On April 25, Venezuelan vice president Delcy Rodríguez announced state intervention and oversight of several food supply companies in order to control the prices of 27 products for 180 days.

Urosa criticized the intervention, calling it “an extremely serious mistake, since it will probably result in greater shortages. Price controls are acceptable, but intervening in efficient businesses is not. The government can’t even manage to supply gasoline.” “The state-run petroleum industry has collapsed, and now Venezuelans’ food is in danger!” 

 “The current government doesn’t have any answers for such elementary things such as the extremely serious problem of the gasoline shortage” and runaway inflation. “In the last 40 days, the dollar has doubled in value, which is undoubtedly the fundamental cause of the spike in prices,” the cardinal said.

Urosa decried political persecution, which “has gotten worse since March because amid the quarantine, the government has ramped up the repression. During these weeks the government has jailed, even without due process, many political activists, especially from the inner circle of Juan Guaidó, president of the National Assembly and leader of the Venezuelan opposition.”

Guaidó declared himself the nation's interim leader Jan. 23 last year following Maduro’s inauguration for a second term. Maduro won a May 2018 presidential election, which was boycotted by the opposition and has been rejected by much of the international community. The United States was swift to recognize Guaidó as interim president, eventually followed by over 60 countries. Both the National Assembly and the Venezuelan bishops' conference declared Maduro's reelection to be invalid.

With the military firmly in support of Maduro, however, opposition protests calling for his resignation have failed to oust the leader.

On March 30, Guaidó charged that the Maduro regime had unleashed a new wave of harassment against his close collaborators. Andrea Bianchi, the wife of close associate Rafael Rico, was kidnapped, beaten and then left naked on a highway. Two others, Rómulo García and Víctor Silio were also picked up and later charged with possession of marijuana and a handgun.

The NGO Venezuelan Program for Education-Action in Human Rights reported that during the state of emergency, 34 people have been arbitrarily arrested and attacks against politicians, journalists and healthcare workers have increased.

“The bishops have always strongly criticized the political repression by the government and once again I call for the release of all political prisoners. They are even in greater physical danger because of the pandemic situation we’re going through,” Urosa stressed.

On March 26, “the Trump administration unsealed sweeping indictments against Venezuelan President Nicolás Maduro and members of his inner circle on narcoterrorism charges, a dramatic escalation in the U.S. campaign to force the authoritarian socialist from power,” even offering “a $15 million reward for information leading to his capture or conviction,” the Washington Post reported.

In response, the Maduro regime activated a plan against the Venezuelan opposition called “Operation Bolivarian Fury.”

The archbishop emeritus denounced these recent “threats of violence by the government against Venezuelans. Maduro himself has spoken of a supposed ‘Bolivarian fury’ as a threat against members of the Venezuelan opposition in case of international problems. That’s illegal, unconstitutional and unacceptable from every point of view. That threat of violence is intolerable.” 

The cardinal said the government has used the quarantine simply as an opportunity to strengthen its social and political control.

On April 25, the Maduro regime placed shipping containers on the Caracas-La Guaira highway to prevent demonstrators from other cities who have been protesting the shortages of food, water and electricity in other cities from getting to the capital.

“Why restrict the right to free transit?” the cardinal asked.

The Maduro regime also blocked the highway in February 2019 to prevent humanitarian aid from entering the country from Colombia.

Guaidó charged April 24 on Twitter that “a dictatorship of corrupt and incapable people has brought us to a crisis where farmers are losing their crops while families are starving to death in the barrios. They turned the richest country in the region into a hell. They’ll leave here, the sacrifice has been enough already.”

As signs of hope, Urosa pointed to ongoing work of Caritas Venezuela and the creative ways the clergy has reached out to the faithful through social media. “Our message is one of encouragement, trust in God, solidarity and hope in this dark hour,” he said.

 Catholics “have an unshakeable faith in God who is love,” who had died and risen and “has shown us the merciful face of God.” “We’ll come out of this,” the archbishop said, “the suffering we are experiencing has united us closer to God and opens to us the gates of heaven.”

The archbishop encouraged Venezuelans to always stand in solidarity with each other and “to be the face of God to those in need. God is love and is with us. Let us join ourselves to him and the Blessed Virgin Mary, Mother of Mercy in this painful hour.”

 

A version of this story was first published by ACI Prensa, CNA's Spanish-language news partner. It has been adapted by CNA.