Publications by authors named "Soyang Kwon"

59 Publications

Utility of Wearable Sensors to Assess Postoperative Recovery in Pediatric Patients After Appendectomy.

J Surg Res 2021 Mar 2;263:160-166. Epub 2021 Mar 2.

Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Background: Despite more than two million pediatric operations performed in the United States annually, normal postoperative recovery remains difficult to define. Wearable sensors that assess physical activity and vital signs in real time represent a tool to assess postoperative recovery. This study examined the use of a wearable, the FitBit Inspire HR, to describe recovery in children after appendectomy and to determine the sensitivity of wearable data to distinguish disease severity.

Materials And Methods: Children 3-18 y old undergoing appendectomy in a tertiary children's hospital were invited to participate. Participants wore the FitBit Inpire HR after surgery for 21 d. t-tests compared daily step counts, and piecewise linear regression models were fit to examine recovery trajectories for patients with simple and complicated appendicitis.

Results: Thirty-two patients were enrolled, and 26 met eligibility criteria. Nine (35%) children had complicated appendicitis, and 14 (54%) were female; the mean age was 9.1 y (standard deviation: 2.9). Four hundred nineteen postoperative days were captured (range: 8-22 d; median: 16 d). Step counts increased after surgery; however, piecewise models showed that patients with simple appendicitis had a more rapid increase (P < 0.01) and reached a plateau (approximately 8000 steps/d) on postoperative day 9, whereas patients with complicated appendicitis did not reach a plateau and had lower step counts during the entire 21-postoperative day period (P < 0.01).

Conclusions: Recovery in children after surgery can be characterized using wearables, which can also distinguish recovery trajectories based on disease severity. Establishing such "normative" recovery patterns may lead to earlier detection of complications.
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http://dx.doi.org/10.1016/j.jss.2021.01.030DOI Listing
March 2021

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
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http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

Youth Sports Participation Is More Important among Females than Males for Predicting Physical Activity in Early Adulthood: Iowa Bone Development Study.

Int J Environ Res Public Health 2021 02 2;18(3). Epub 2021 Feb 2.

Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA.

A gender difference in youth sports and physical activity participation is well documented. However, research is limited to understand potential gender difference in the long-term effects of youth sports participation. The study aim was to compare the likelihood of meeting the aerobic Physical Activity Guidelines (PAG) in early adulthood by youth sports participation patterns among females and males. The study sample included 582 Iowa Bone Development Study participants (Iowa, USA). Participation in organized sports was assessed using a physical activity questionnaire 19 times on average between age 6 and 17 years. Accelerometer and dual-energy X-ray absorptiometry assessments were conducted at an average age of 23 years. Group-based trajectory analysis was conducted to identify youth sports participation trajectory patterns. Multivariable logistic regression analysis was conducted to examine the association between youth sports participation patterns and meeting the PAG in adulthood. We identified three youth sports participation patterns: "continuous participation," "drop-out," and "no participation." Females in the continuous participation group were more likely to meet the aerobic PAG at age 23 years, compared to females in the no-participation group (OR = 2.63; 95% CI = 1.05, 6.55) or the drop-out group (OR = 2.55; 95% CI = 1.38, 4.69). However, among males, youth sports participation patterns were not significantly associated with meeting the aerobic PAG at age 23 years. In conclusion, this study suggests that youth sports participation could be more important among females than males for predicting physical activity in early adulthood.
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http://dx.doi.org/10.3390/ijerph18031328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908602PMC
February 2021

A Community-Engaged Stroke Preparedness Intervention in Chicago.

J Am Heart Assoc 2020 09 6;9(18):e016344. Epub 2020 Sep 6.

The Retirement Research Foundation Chicago IL.

Background We evaluated a community-engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, -0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of -0.3% per month [95% CI, -0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, -0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, -1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, -1.1% to 1.1%]) or St Louis hospitals (difference of -0.7% per month [95% CI, -1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2-1.6) and in the South Side (OR, 1.2; 95% CI, 1.1-1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9-1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02301299.
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http://dx.doi.org/10.1161/JAHA.120.016344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726971PMC
September 2020

Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES.

Int J Environ Res Public Health 2020 08 26;17(17). Epub 2020 Aug 26.

Department of Medicine and Preventive Medicine, Northwestern University, Chicago, IL 60611, USA.

The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.
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http://dx.doi.org/10.3390/ijerph17176187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504455PMC
August 2020

Socioeconomic and Familial Factors Associated with Gross Motor Skills among US Children Aged 3-5 Years: The 2012 NHANES National Youth Fitness Survey.

Int J Environ Res Public Health 2020 06 22;17(12). Epub 2020 Jun 22.

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.

The first aim of this study was to examine the prevalence of below average gross motor skills in a representative sample of US children aged 3 to 5 years. The second aim was to identify socioeconomic and familial characteristics that are associated with below average gross motor skills. Secondary analysis was conducted using the datasets from the 2012 National Health and Examination Survey National Youth Fitness Survey (NNYFS). The NNYFS assessed gross motor skills among 329 children aged 3-5 years, using the Test of Gross Motor Development-Second Edition (TGMD-2). Socioeconomic and familial characteristics of interest, such as family income and family structure, were asked in an in-person interview. This study estimated that one in three US children age 3 to 5 years old (33.9%) scored below average for gross motor quotient. In the gross motor subsets, one in four (24.4%) scored below average for locomotion and two in five (39.9%) scored below average for object control. Children living below the poverty threshold were more likely to have a higher gross motor quotient (odds ratio, OR = 2.76; 95% confidence interval, CI = 1.09-7.00). Girls were more likely to have a higher locomotor score (OR = 2.17; 95% CI = 1.10-4.25). Those living with other child(ren) aged ≤5 years were more likely to have a higher locomotor score (OR = 2.36; 95% CI = 1.01-5.54), while those living with child(ren) aged 6-17 years were more likely to have a higher object control score (OR = 1.83; 95% CI = 1.24-2.69). This study revealed risk factors associated with poor gross motor development, furthering our understanding of gross motor development in early childhood.
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http://dx.doi.org/10.3390/ijerph17124491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344580PMC
June 2020

Implementation of automatic data extraction from an enterprise database warehouse (EDW) for validating pediatric VTE decision rule: a prospective observational study in a critical care population.

J Thromb Thrombolysis 2020 Nov;50(4):782-789

Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 30, Chicago, IL, 60611, USA.

Multiple clinical risk prediction tools for hospital acquired venous thromboembolism (HA-VTE) have been developed. The objectives of this study were to develop and assess the feasibility of data extraction from Electronic Medical Records (EMR) from an enterprise database warehouse (EDW) and to test the validity of a previously developed Pediatric Clot Decision Rule (PCDR). This single-center prospective observational cohort study was conducted between March 2016 and March 2017 and included eligible patients admitted to the intensive care units. Risk score was calculated using the PCDR tool. Sensitivity, specificity, positive and negative predicted value (PPV and NPV) were calculated based on a cut-point of 3. A total of 2822 children were eligible for analysis and 5.1% (95% CI 4.2-6.2) children had a PCDR score of 3. Children with PCDR score of ≥ 3 had a 3 times higher odd of developing VTE compared to those with scores < 3 (OR 3.1; 95% CI 1.93-4.80; p < 0.001). The model performance showed that at the cutoff point of ≥ 3, both the specificity and sensitivity of the PCDR in predicting VTE was 69% and NPV of 98%. We successfully demonstrated using our EDW to populate a research database using an automatic data import. A PCDR score of ≥ 3 was associated with VTE. Collaboration through large registries will be useful in informing practices and guidelines for rare disorders such as pediatric VTE.
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http://dx.doi.org/10.1007/s11239-020-02158-9DOI Listing
November 2020

Hidden Markov model-based activity recognition for toddlers.

Physiol Meas 2020 03 6;41(2):025003. Epub 2020 Mar 6.

Department of Computer Science and Engineering, University of North Texas, Denton, TX, United States of America. Department of Biomedical Engineering, University of North Texas, Denton, TX, United States of America. Department of Computer Science, Loyola University Chicago, Chicago, IL, United States of America. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. Author to whom any correspondence should be addressed.

Objective: Physical activity has been shown to impact future health outcomes in adults, but little is known about the long-term impact of physical activity in toddlers. Accurately measuring the specific types and amounts of physical activity in toddlers will help us to understand, predict, and better affect their future health outcomes. Although activity recognition has been extensively developed for adults as well as older children, toddlers move in ways that are significantly different from older children, indicating the need for a more tailored approach.

Approach: In this study, 22 toddlers wore Actigraph waist-worn accelerometers which recorded their movements during guided play. The toddlers were videotaped and their activities were later annotated for the following eight distinct activity classes: lying down, being carried, riding in a stroller, sitting, standing, running/walking, crawling, and climbing up/down. Accelerometer data were extracted in 2 s signal windows and paired with the activities the toddlers were performing during that time interval.

Main Results: A variety of classifiers were tuned to a validation set. A random forest classifier was found to achieve the highest accuracy of 63.8% in a test set. To improve the accuracy, a hidden Markov model (HMM) was applied by providing the predictions of the static classifiers as observations. The HMM was able to improve the accuracy to 64.8% with all five classifiers increasing the accuracy an average of 1.3% points (95% confidence interval  =  0.7-1.9, p   <  0.01). When the three most misclassified activities (sitting, standing, and riding in a stroller) were collapsed together, the accuracy increased to 79.3%.

Significance: Further refinement of the toddler activity recognition classifier will enable more accurate measurements of toddler activity and improve future health outcomes of toddlers.
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http://dx.doi.org/10.1088/1361-6579/ab6ebbDOI Listing
March 2020

Baseline preoperative physical activity for surgical patients varies from healthy population controls.

J Pediatr Surg 2020 May 31;55(5):959-963. Epub 2020 Jan 31.

Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.

Background: Preoperative physical activity (PA) is an important reference point to evaluate recovery, yet is not attainable for emergent surgical admissions. We investigated the validity of PA of healthy children recruited from within the same community as surgical patients and a nationally representative sample as alternative baseline PA for pediatric surgical patients.

Methods: Patients undergoing an elective operation were matched to community-recruited healthy controls (CRHC) on sex, age, and weight, and their PA was assessed using an Actigraph accelerometer. National Health and Nutrition Examination Survey (NHANES) Actigraph PA data were used as a nationally representative match for baseline PA. Surgical patients wore the accelerometer for 2 days preoperatively, CRHC for 2 days, and NHANES participants for 7 days. PA was categorized as light (LPA) or moderate vigorous (MVPA). Means were compared between the 3 groups.

Results: Thirty patients were matched with 80 CRHC and 3147 NHANES participants. LPA was similar between surgical patients and CRHC. However, CRHC averaged 19 min/day more MVPA than surgery patients (p = 0.04), and both groups averaged 58 min and 67 min/day higher MVPA than the matched NHANES sample, respectively (p < 0.01).

Conclusions: CRHC LPA was similar to preoperative LPA in surgical patients and may be an alternative.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.01.033DOI Listing
May 2020

Physical education environment and student physical activity levels in low-income communities.

BMC Public Health 2020 Jan 31;20(1):147. Epub 2020 Jan 31.

Ann & Robert H. Lurie Children's Hospital of Chicago Stanley Manne Children's Research Institute, 225 E Chicago Ave. Box 157, Chicago, IL, 60611, USA.

Background: The purpose of this study was to examine the association of physical education (PE) class characteristics, such as lesson context, teacher's physical activity (PA) promotion behavior, and lesson location, with student engagement in moderate- and vigorous-intensity physical activity (MVPA) during PE lessons in elementary school (ES), middle school (MS), and high school (HS).

Methods: The study sample included 2106 PE classes from 40 schools located in low-income communities. The System for Observing Fitness Instruction Time (SOFIT) was used to assess lesson context, teacher's behavior, and student PA during PE lessons. Mixed models were used to examine the association between PE class characteristics and the probability of meeting the recommended level of MVPA during PE lessons (MVPA ≥50%), accounting for within-school random effects and school characteristics.

Results: Almost all PE classes (90%) with ≥60-70% of lesson time spent in motor content and ≥ 10-20% in teacher's in-class PA promotion met the recommended level of MVPA across the school levels. More specifically, among the sub-categories of motor content, more lesson time spent in fitness was significantly associated with MVPA ≥50% in all school levels. However, more lesson time spent in game play was a significant factor only in ES (OR = 2.1; 95% CI = 1.4-3.0). Outdoor lessons were a significant factor in ES (OR = 5.3; 95% CI = 3.1-9.0) and MS (OR = 21.0; 95% CI = 6.3-69.4), but not HS (OR = 1.4; 95% CI = 0.6, 3.2).

Conclusions: PE lessons with higher motor content and higher teacher's in-class PA promotion are more likely to meet the recommended level of MVPA in all school levels. However, the sub-categories of motor content and lesson location could impact student MVPA differently by school levels.
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http://dx.doi.org/10.1186/s12889-020-8278-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995192PMC
January 2020

Quantifying postoperative sleep loss associated with increased pain in children undergoing a modified Nuss operation.

J Pediatr Surg 2020 Sep 7;55(9):1846-1849. Epub 2020 Jan 7.

Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA.

Purpose: The presence of pain may interrupt sleep and impede normal postoperative recovery; however, no prior studies have quantified sleep loss due to pain in children undergoing inpatient surgery. Wearable accelerometers objectively measure sleep patterns in children. We aimed to quantify sleep loss associated with patient reported pain scores after a Modified Nuss operation.

Methods: Ten patients undergoing Modified Nuss operations were recruited during their inpatient stay. Children wore an Actigraph GT3X-BT accelerometer postoperatively during their hospital stay. Hourly sleep minutes were recorded using the Actigraph between 10 pm and 6 am. Patient reported pain scores were abstracted from patient charts. Mixed linear regression models, adjusting for within-subject random effects, were estimated to quantify the association between hourly sleep minutes and patient reported pain scores.

Results: Patients were 30% female, with an average age of 15.7 years (range 13-22). The majority (70%) of patients were white non-Hispanic. All patients received a patient controlled analgesic pump. Average postoperative length of stay was 4.8 days (range 4.0-6.0; SD = 0.8). A total of 240 sleep hours and associated pain scores were analyzed. Patients slept on average 48 min per hour. Mixed model analysis predicted that a 1-point increase in pain score was associated with 2.5 min per hour less sleep time.

Conclusion: Increases in patient-reported pain scores are associated with sleep loss after a Modified Nuss operation. Objectively quantifying sleep loss associated with postoperative pain using accelerometer data may help clinicians better understand their patient's level of pain control. Our findings provide the basis for future studies aimed at more accurately titrating pain medication to optimize sleep and speed up recovery.

Level Of Evidence: Case Series Without Comparison Group, Level IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.12.003DOI Listing
September 2020

Daily Physical Activity Among Toddlers: Hip and Wrist Accelerometer Assessments.

Int J Environ Res Public Health 2019 11 1;16(21). Epub 2019 Nov 1.

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.

Physical activity (PA) habits seem to track over time from as young as early childhood. For children under age 3 years, wearable sensor-measured PA levels have begun to be investigated. The aims of this study were to evaluate the feasibility of using hip- vs. wrist-worn accelerometers, and to report accelerometer-derived PA metrics among toddlers. A convenience sample of 22 toddlers aged 13 to 35 months and their mothers were recruited for this study. ActiGraph wGT3X-BT accelerometers were attached to wrist bands and waist belts. The mothers were asked to affix a wrist band and a waist belt to their participating children during waking hours for four days. They also completed an acceptability survey. Of the 22 toddlers, 19 (86%) had ≥ 3 valid days of hip data, while only 14 (64%) did so for wrist data ( = 0.16). In terms of acceptability, 18 mothers (82%) responded that the 4-day hip wear was easy, while only 13 (59%) responded that the 4-day wrist wear was easy ( = 0.19). Daily light-intensity PA (LPA) was on average 161 min, and daily moderate- and vigorous-intensity PA (MVPA) was on average 47 min, as determined using published hip accelerometer cut-points. There were no significant differences in LPA or MVPA by age or by sex. In conclusion, this study suggests that hip placement of an ActiGraph accelerometer is more feasible than wrist placement among toddlers.
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http://dx.doi.org/10.3390/ijerph16214244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862284PMC
November 2019

Correction to: A closer look at the relationship among accelerometer-based physical activity metrics: ICAD pooled data.

Int J Behav Nutr Phys Act 2019 08 8;16(1):62. Epub 2019 Aug 8.

Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.

Following publication of the original article [1], the author reported that the name of the collaborator group was missing from the author group.
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http://dx.doi.org/10.1186/s12966-019-0828-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686467PMC
August 2019

Noninvasive Diagnosis of Infection Using Plasma Next-Generation Sequencing: A Single-Center Experience.

Open Forum Infect Dis 2019 Aug;6(8)

Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Pediatric patients frequently present with illnesses strongly suggesting infection, but without a clearly identified etiology. Our center has recently added a commercially available plasma metagenomic sequencing assay to its available diagnostic testing. Our experience with the first 100 tests suggests that this technology has good clinical performance with >90% sensitivity.
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http://dx.doi.org/10.1093/ofid/ofz327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677669PMC
August 2019

Hip and Wrist-Worn Accelerometer Data Analysis for Toddler Activities.

Int J Environ Res Public Health 2019 07 21;16(14). Epub 2019 Jul 21.

Department of Computer Science, Loyola University Chicago, Chicago, IL 60660, USA.

Although accelerometry data are widely utilized to estimate physical activity and sedentary behavior among children age 3 years or older, for toddlers age 1 and 2 year(s), accelerometry data recorded during such behaviors have been far less examined. In particular, toddler's unique behaviors, such as riding in a stroller or being carried by an adult, have not yet been examined. The objective of this study was to describe accelerometry signal outputs recorded during participation in nine types of behaviors (i.e., running, walking, climbing up/down, crawling, riding a ride-on toy, standing, sitting, riding in a stroller/wagon, and being carried by an adult) among toddlers. Twenty-four toddlers aged 13 to 35 months (50% girls) performed various prescribed behaviors during free play in a commercial indoor playroom while wearing ActiGraph wGT3X-BT accelerometers on a hip and a wrist. Participants' performances were video-recorded. Based on the video data, accelerometer data were annotated with behavior labels to examine accelerometry signal outputs while performing the nine types of behaviors. Accelerometer data collected during 664 behavior assessments from the 21 participants were used for analysis. Hip vertical axis counts for walking were low (median = 49 counts/5 s). They were significantly lower than those recorded while a toddler was "carried" by an adult (median = 144 counts/5 s; < 0.01). While standing, sitting, and riding in a stroller, very low hip vertical axis counts were registered (median ≤ 5 counts/5 s). Although wrist vertical axis and vector magnitude counts for "carried" were not higher than those for walking, they were higher than the cut-points for sedentary behaviors. Using various accelerometry signal features, machine learning techniques showed 89% accuracy to differentiate the "carried" behavior from ambulatory movements such as running, walking, crawling, and climbing. In conclusion, hip vertical axis counts alone may be unable to capture walking as physical activity and "carried" as sedentary behavior among toddlers. Machine learning techniques that utilize additional accelerometry signal features could help to recognize behavior types, especially to differentiate being "carried" from ambulatory movements.
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http://dx.doi.org/10.3390/ijerph16142598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678133PMC
July 2019

Connecting Hospital to Home: Characteristics of and Rehospitalization Rates in Hospitalized Children With Private-Duty Nursing.

Hosp Pediatr 2019 07 12;9(7):530-537. Epub 2019 Jun 12.

Departments of Pediatrics.

Objectives: Children with medical complexity are frequently hospitalized and have extensive health care needs. Private-duty nursing (PDN) is a service on which some children with medical complexity rely to live at home, but little is known about patients discharged with PDN. Our objective for this study was to describe the characteristics and longitudinal outcomes of patients with PDN who are hospitalized.

Methods: This study was a 1-year retrospective study of patients receiving PDN who were hospitalized at a quaternary freestanding children's hospital; there was an additional 2-year follow-up. Patient characteristics, rehospitalization rates, length of stay, mortality, and hospital charges were identified. Descriptive statistics were performed to characterize trends, and a time-to-event analysis was used to characterize unplanned rehospitalization.

Results: Among 8187 unique patients who were hospitalized in the initial study year (June 1, 2014 to -May 31, 2015), 188 patients (2%) used PDN. Of patients using PDN, 94% used gastrointestinal devices. The median index length of stay was 4 days (interquartile range 2-6). Two-year mortality was 12%. Cumulative all-cause rehospitalization rates were 18% by 30 days, 62% by 365 days, and 87% within 2 years; the median rehospitalization frequency was 3 per patient. The most common reasons for unplanned rehospitalization were infection (41%) and device complication (10%). During the study period, 11% of both rehospitalizations and total hospital days were attributed to patients with PDN. Unplanned rehospitalizations of patients with PDN accounted for $117 million in hospital charges.

Conclusions: One in 50 patients hospitalized at a single center were discharged with PDN, which accounted for a disproportionate level of hospital use. Future research should be used to address whether the access and quality of PDN may impact rehospitalization.
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http://dx.doi.org/10.1542/hpeds.2018-0282DOI Listing
July 2019

A closer look at the relationship among accelerometer-based physical activity metrics: ICAD pooled data.

Int J Behav Nutr Phys Act 2019 04 29;16(1):40. Epub 2019 Apr 29.

Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.

Background: Accelerometers are widely used to assess child physical activity (PA) levels. Using the accelerometer data, several PA metrics can be estimated. Knowledge about the relationships between these different metrics can improve our understanding of children's PA behavioral patterns. It also has significant implications for comparing PA metrics across studies and fitting a statistical model to examine their health effects. The aim of this study was to examine the relationships among the metrics derived from accelerometers in children.

Methods: Accelerometer data from 24,316 children aged 5 to 18 years were extracted from the International Children's Accelerometer Database (ICAD) 2.0. Correlation coefficients between wear time, sedentary behavior (SB), light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate- and vigorous-intensity PA (MVPA), and total activity counts (TAC) were calculated.

Results: TAC was approximately 22X10 counts higher (p < 0.01) with longer wear time (13 to 18 h/day) as compared to shorter wear time (8 to < 13 h/day), while MVPA was similar across the wear time categories. MVPA was very highly correlated with TAC (r = .91; 99% CI = .91 to .91). Wear time-adjusted correlation between SB and LPA was also very high (r = -.96; 99% CI = -.96, - 95). VPA was moderately correlated with MPA (r = .58; 99% CI = .57, .59).

Conclusions: TAC is mostly explained by MVPA, while it could be more dependent on wear time, compared to MVPA. MVPA appears to be comparable across different wear durations and studies when wear time is ≥8 h/day. Due to the moderate to high correlation between some PA metrics, potential collinearity should be addressed when including multiple PA metrics together in statistical modeling.
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http://dx.doi.org/10.1186/s12966-019-0801-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489360PMC
April 2019

Nucleated Red Blood Cells in Children With Sickle Cell Disease Hospitalized for Pain.

J Pediatr Hematol Oncol 2019 Nov;41(8):e487-e492

Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago.

Acute chest syndrome (ACS) and transfusion requirements are common and difficult to predict during hospitalizations for acute vaso-occlusive episodes (VOE) among individuals with sickle cell disease (SCD). This study examined the relationship between nucleated red blood cell (NRBC) counts during hospitalization for VOE and development of ACS or transfusion requirement among children with SCD. Retrospective chart review was performed for 264 encounters of patients with SCD hospitalized for uncomplicated VOE who had NRBC count data at admission during a 5-year period. Multivariable logistic regression analysis was conducted to determine the relationship of admission and change in NRBC ([INCREMENT]NRBC) to ACS/transfusion requirement. Overall, 44 of 264 (16.7%) encounters resulted in ACS, transfusion, or both. Admission NRBC was not associated with development of ACS/transfusion requirement. Among 125 of 264 (47.3%) encounters in which a subsequent CBC was obtained, greater increases in NRBCs and greater decrease in hemoglobin were significantly associated with ACS/transfusion requirement (OR, 2.72; 95% CI, 1.16, 6.35; P=0.02 and OR, 2.52; 95% CI, 1.08, 5.89; P=0.03, respectively). Our finding that an increase in NRBC counts was associated with development of ACS/transfusion requirement suggests that [INCREMENT]NRBCs may represent a useful biomarker for predicting complications in children with SCD hospitalized for VOE.
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http://dx.doi.org/10.1097/MPH.0000000000001467DOI Listing
November 2019

Use of Metformin for Weight Management in Children and Adolescents With Obesity in the Clinical Setting.

Clin Pediatr (Phila) 2018 12 27;57(14):1677-1685. Epub 2018 Sep 27.

1 Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.

Use of metformin for weight loss for children in a clinical setting has not been well described; therefore, we aimed to identify characteristics of obese patients prescribed metformin in a clinical setting and evaluate changes in anthropometric measures. Records of obese patients aged 10 to 18 years without diabetes attending an academic endocrinology practice from 2009 to 2013 were reviewed. Analyses assessed changes in anthropometric measures (weight, body mass index [BMI], and BMI z-score) over 12 months between those prescribed metformin (n = 49) and those not prescribed metformin (n = 142). Outcomes were standardized before using multivariable linear regression models. Patients prescribed metformin were significantly older, more often female, and had larger baseline anthropometric measures (all P < .05). In the models, subjects prescribed metformin had significantly less gain in standardized weight, BMI, and BMI z-score over 6 and 12 months (all P < .05). Metformin may be a useful weight management aid in children in a clinical setting.
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http://dx.doi.org/10.1177/0009922818803404DOI Listing
December 2018

Evaluation of Pediatrician Adherence to the American Academy of Pediatrics Health Supervision Guidelines for Down Syndrome.

Am J Intellect Dev Disabil 2018 09;123(5):387-398

Meghan E. O'Neill, Alexandra Ryan, Soyang Kwon, and Helen J. Binns, Ann & Robert H. Lurie Children's Hospital of Chicago.

The American Academy of Pediatrics's guideline on health supervision for children with Down syndrome (DS) offers pediatricians guidance to improve detection of comorbid conditions. Pediatrician adherence has not yet been comprehensively evaluated. Medical records of 31 children with DS who received primary care at two urban academic clinic sites from 2008-2012 were reviewed. Data was extracted on adherence to age-specific individual guideline components for each subject by year-of-life (total 84 years-of-life). Overall adherence across all components was 83% (2001 guideline) and 67% (2011 guideline). Adherence to thyroid, hearing, vision, and developmental components was >85%, and anticipatory guidance regarding atlantoaxial instability and sexuality was <35%. Overall adherence was higher when a subject was younger and when a provider was an attending-level pediatrician.
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http://dx.doi.org/10.1352/1944-7558-123.5.387DOI Listing
September 2018

Investigating the Support Networks for Mothers of a High-density Public Housing Community and the Effects of Housing Closures on These Support Systems.

J Urban Health 2018 06;95(3):401-408

Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Over the past few decades, public housing initiatives have focused on the decentralization of poverty by replacing high-density public housing (HDPH) models with lower-density, mixed-income models. This action has resulted in the displacement of families who had lived in these developments for generations. In past studies, public housing residents have been shown to have stronger social ties than those living in other types of assisted housing. Research on the dismemberment of US public housing has demonstrated a "root shock" or disruption in the support infrastructure in these resource-limited communities. The purpose of this study was to use intergenerational analysis to analyze support systems of mothers in a low-income community and to investigate how the dismemberment of a Chicago HDPH community, Cabrini Green, affected parenting experiences and support infrastructure. Two generations of the former HDPH community were interviewed: (Gen1) mothers who raised their children in Cabrini Green and (Gen2) their daughter(s) who were raised in Cabrini Green but who now raise their children elsewhere. Interviews were analyzed for common themes in relation to mental health, social support networks, and parenting experiences. Four main components of parenting support were identified: familial support, father of child support, community support, and institutional support. Interviews suggest that the closing of Cabrini-Green high-rise buildings impacted relative contributions from specific components of mothers' support infrastructure, particularly community and institutional support. Mothers with support void in one component of support had better outcomes if they had the reserve to compensate by increasing one or more other areas of support. Programs that foster other sources of parenting support during and after public housing closures may help to improve outcomes for mothers and their families. By analyzing the experiences of mothers of both generations, we also gain insight into how experiences of motherhood and support systems compared before and after Cabrini Green's dissolution as well as insight into the participants' views on the impact of the housing closing on the parenting experience.
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http://dx.doi.org/10.1007/s11524-018-0242-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993699PMC
June 2018

Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit-A Case Control Study.

J Pediatr 2018 04 2;195:28-32. Epub 2018 Feb 2.

Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.

Objective: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit.

Study Design: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately.

Results: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P < .01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P = .04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P = .01).

Conclusions: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.
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http://dx.doi.org/10.1016/j.jpeds.2017.12.015DOI Listing
April 2018

Using accelerometers to characterize recovery after surgery in children.

J Pediatr Surg 2018 Aug 6;53(8):1600-1605. Epub 2017 Oct 6.

Departments of Surgery and Pediatrics, Feinberg School of Medicine; Center for Healthcare Studies, Northwestern University; Division of Pediatric Surgery, Department of Surgery.

Background: Assessment of recovery after surgery in children remains highly subjective. However, advances in wearable technology present an opportunity for clinicians to have an objective assessment of postoperative recovery. The aims of this pilot study are to: (1) evaluate acceptability of accelerometer use in pediatric surgical patients, (2) use accelerometer data to characterize the recovery trajectory of physical activity, and (3) determine if postoperative adverse events are associated with a decrease in physical activity.

Study Design: Children aged 3-18-years-old undergoing elective inpatient and outpatient surgical procedures were invited to participate. Physical activity was measured using an Actigraph GT3X wristworn accelerometer for ≥2days preoperatively and 5-14days postoperatively. Time spent performing light (LPA) and moderate-to-vigorous physical activity (MVPA) was expressed in minutes/day. Physical activity for each postoperative day was calculated as a percentage of preoperative activity, and recovery trajectories were produced. Adverse events were reported and mapped against recovery trajectories.

Results: Of 60 patients enrolled, 25 (10 inpatients, 15 outpatients) completed the study procedures and were included in the analysis. For outpatient procedures, LPA recovered to preoperative level on postoperative day (POD) 7 and MVPA peaked at 90% on POD 8. For inpatient procedures, LPA peaked at 70% on POD 11, and MVPA peaked at 53% on POD 10. Adverse events in 2 patients were associated with a decline in activity.

Conclusions: This study demonstrates that objective monitoring of postoperative physical activity using accelerometers is feasible in the pediatric surgical population. Recovery trajectories for inpatient and outpatient procedures differ. Accelerometer technology presents clinicians with a new potential tool for assessing and managing surgical recovery, and for determining if children are not recovering as expected.

Type Of Study: Diagnostic Study.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2017.09.016DOI Listing
August 2018

Physical Activity, Not Sedentary Time, Predicts Dual-Energy X-ray Absorptiometry-measured Adiposity Age 5 to 19 Years.

Med Sci Sports Exerc 2017 10 2;49(10):2071-2077. Epub 2017 Jun 2.

1Department of Health and Human Physiology, University of Iowa, Iowa City, IA; 2Department of Epidemiology, University of Iowa, Iowa City, IA; 3Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; 4Department of Pediatrics, University of Iowa, Iowa City, IA; and 5Department of Preventive and Community Dentistry, Iowa City, IA.

Purpose: To examine the associations among physical activity (PA), sedentary time (SED), and TV viewing (TV) with fat mass (FAT) and visceral adipose tissue mass (VAT) from childhood through adolescence (5-19 yr).

Methods: Participants in the Iowa Bone Development Study (n = 230 males and 233 females) were examined at ages 5, 8, 11, 13, 15, 17, and 19 yr. Accelerometers measured moderate- or vigorous-intensity PA (MVPA; min·d), light-intensity PA (LPA; min·d), and SED (h·d). Parent-proxy report (5 and 8 yr) and child-report (11, 13, 15, 17, and 19 yr) measured TV (h·d). X-ray absorptiometry scans measured FAT (kg) and VAT (g). Sex-specific growth models were used to create FAT and VAT growth curves for individual participants (level 1), and to test the effect of MVPA, LPA, SED, and TV (level 2) after adjusting for weight, height, linear age, nonlinear age, and maturity.

Results: Growth models indicated that low levels of MVPA were associated with high levels of FAT and VAT for males and high levels of FAT for females. TV viewing was positively associated with FAT and VAT for males and females. LPA was positively associated with FAT in males. Sedentary time was not associated with FAT or VAT for males or females (P > 0.05).

Conclusions: This study supports current PA guidelines focusing on MVPA rather than SED. The contribution of high TV, but not high SED, to high levels of adiposity suggests that TV's contribution to obesity is not just a function of low energy expenditure.
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http://dx.doi.org/10.1249/MSS.0000000000001336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712279PMC
October 2017

Self-Reported Physical Activity and Exercise Patterns in Children With Sickle Cell Disease.

Pediatr Exerc Sci 2017 08 22;29(3):388-395. Epub 2017 May 22.

1 Ann & Robert H. Lurie Children's Hospital of Chicago.

Purpose: Sickle cell disease (SCD) significantly affects physical functioning. We examined physical activity (PA) patterns in children with SCD versus a national sample and factors associated with PA and participation in physical education and organized sports.

Method: One hundred children with SCD completed a 58-item survey with questions from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) Physical Activity Questionnaire and others on physical education and sports, disease impact, and physical functioning.

Results: Compared with NHANES participants, more children with SCD (67 vs 42%, p < .01) reported doing at least 10 min of moderate-to-vigorous intensity PA (MVPA)/week. Children with SCD also reported spending more days in MVPA (2.3 vs. 1.4 days/week, p < .01). However, fewer reported spending ³ 60 min/day in either vigorous PA (VPA) (24 vs. 43%, p = .01) or MVPA (17 vs 23%, p < .01). In addition, 90% and 48% of children with SCD participated in physical education and sports, respectively. Greater disease impact on PA and physical functioning were associated with lower participation.

Conclusion: Children with SCD are active at moderate to vigorous intensity for shorter durations. Negative personal beliefs about disease impact and poor physical functioning represent barriers to PA in SCD.
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http://dx.doi.org/10.1123/pes.2016-0276DOI Listing
August 2017

Cardiovascular risk factor screening and management of obese patients at an outpatient pediatric cardiology center.

Springerplus 2016 24;5(1):1868. Epub 2016 Oct 24.

Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 21, Chicago, IL 60611-2605 USA ; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ; Center on Obesity Management and Prevention, Mary Ann & J. Milburn Smith Child Health Research Program, Stanley Manne Children's Research Institute, Chicago, IL USA.

Objective: To evaluate documentation of cardiovascular (CV) risk factors and obesity management by pediatric cardiologists.

Study Design: Review of medical records of obese (≥95th body mass index percentile) 2-17 year-old children presenting to outpatient pediatric cardiology over 1 year. Subjects were categorized as: ; ; or no HD. Data were evaluated on documentation of the assessment of seven CV risk factors [including recognition of elevated blood pressure (BP)] and management of obesity. Multivariable logistic regression (LR) examined physician documentation of obesity intervention by risk groups, including age and gender.

Results: Data on 730 subjects were analyzed; 16 % had , 41 % had , and 43 % had no HD. Documentation of risk factor assessment was highest for physical inactivity (53 %) and recognition of obesity (47 %). Other factors (child dyslipidemia, diet, dysglycemia, and cigarette exposure) were documented less frequently. Elevated BP was found in 144 patients (20 %); 53/144 (37 %) had documentation of elevated BP recognition. An obesity intervention was documented in 62 % of records and did not significantly differ between risk groups. In the multivariate LR, physician documentation of obesity intervention did not significantly differ between risk groups.

Conclusions: Complete assessment of CV risk factors in obese patients is low. The number of risk factors assessed was similar among patients with and . Increased care coordination between cardiologists and primary care providers may lead to uniform, comprehensive CV risk assessment.
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http://dx.doi.org/10.1186/s40064-016-3340-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078118PMC
October 2016

Association between body mass index percentile trajectories in infancy and adiposity in childhood and early adulthood.

Obesity (Silver Spring) 2017 01 2;25(1):166-171. Epub 2016 Nov 2.

Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA.

Objective: To identify distinct body mass index (BMI) percentile trajectories during early childhood and examine adiposity levels in childhood and early adulthood according to the BMI percentile trajectories.

Methods: Iowa Fluoride Study cohort parents (n = 1,093) reported their child's anthropometric data on average six times between ages 0 and 23 months. A subset of the cohort underwent DXA scans at approximately age 8 years (n = 495) and again at approximately age 19 years (n = 314). Group-based trajectory analysis was conducted to identify distinct BMI percentile trajectories from ages 0 to 23 months. Sex-specific age-adjusted linear regression analyses were conducted to compare fat mass index in childhood and early adulthood among subgroups that follow the distinct BMI percentile patterns.

Results: Four BMI percentile patterns were identified: consistently low (group 1: 9.8%), increase in the second year (group 2: 33.7%), increase in the first year (group 3: 23.9%), and consistently high (group 4: 32.6%). Compared with group 2 females, groups 3 and 4 females had higher fat mass index in childhood and early adulthood (P < 0.05). However, no significant difference was found in males.

Conclusions: Females who experience a steep increase of BMI percentile in the first year of life, as opposed to a steep increase in the second year of life, may have higher body fat later in life, but this was not found in males.
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http://dx.doi.org/10.1002/oby.21673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182145PMC
January 2017

Parental characteristic patterns associated with maintaining healthy physical activity behavior during childhood and adolescence.

Int J Behav Nutr Phys Act 2016 May 6;13:58. Epub 2016 May 6.

University of Iowa Department of Preventive and Community Dentistry, 801 Newton Road, Dental Science Building, Iowa City, IA, 52242, USA.

Background: Parental characteristics that influence child physical activity (PA) behavior often co-occur. An analytic approach that considers these co-occurring patterns can help researchers better understand the overall context of parental influence. The study aims were to: (1) identify diverse patterns of the relationships among parental characteristics, (2) examine the influence of these parental patterns on child sport participation and moderate-to vigorous-intensity PA (MVPA) trajectories during childhood and adolescence, and (3) examine whether family support mediates the influence of the parental patterns on child sport participation and MVPA trajectories.

Methods: We used data from 408 Iowa Bone Development Study cohort families (97% Caucasians; 65 % mothers with a 4-year college degree). From ages 5 to 19 years, the cohort participated in seven accelerometry assessments, reported sports participation every 6 months, and reported perceived family support for PA at age 15. Parents reported family income, education level, and regular PA participation in high school and adulthood. Structural equation modeling was conducted to identify the latent classes represented among these parental characteristics. Sex-adjusted multivariable logistic regression analyses were conducted to predict sports participation trajectories and MVPA trajectories by latent class and family support.

Results: Three parent latent classes were identified: higher family socioeconomic status (SES) and regular PA in both high school and adulthood by both the father and mother (Group 1); lower family SES and regular PA in high school by the father (Group 2); and lower family SES and no regular PA in high school by the father (Group 3). Sex-adjusted ORs of the "drop-out from sports participation" pattern for the children in Groups 1 and 2, compared to Group 3, were 0.38 (95% CI = 0.20, 0.72) and 0.51 (95% CI = 0.26, 1.00), respectively. Sex-adjusted ORs of the "decreasing from moderate MVPA" pattern for the children in Groups 1 and 2, compared to Group 3, were 0.29 (95% CI = 0.11, 0.75) and 1.16 (95% CI = 0.40, 3.37), respectively. Adding family support to the logistic regression model only slightly changed the ORs.

Conclusions: The findings from this study suggest that among lower SES families, the father's role may be important to promote youth to sustain sports participation.
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http://dx.doi.org/10.1186/s12966-016-0383-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859977PMC
May 2016

Parental characteristic patterns associated with maintaining healthy physical activity behavior during childhood and adolescence.

Int J Behav Nutr Phys Act 2016 May 6;13:58. Epub 2016 May 6.

University of Iowa Department of Preventive and Community Dentistry, 801 Newton Road, Dental Science Building, Iowa City, IA, 52242, USA.

Background: Parental characteristics that influence child physical activity (PA) behavior often co-occur. An analytic approach that considers these co-occurring patterns can help researchers better understand the overall context of parental influence. The study aims were to: (1) identify diverse patterns of the relationships among parental characteristics, (2) examine the influence of these parental patterns on child sport participation and moderate-to vigorous-intensity PA (MVPA) trajectories during childhood and adolescence, and (3) examine whether family support mediates the influence of the parental patterns on child sport participation and MVPA trajectories.

Methods: We used data from 408 Iowa Bone Development Study cohort families (97% Caucasians; 65 % mothers with a 4-year college degree). From ages 5 to 19 years, the cohort participated in seven accelerometry assessments, reported sports participation every 6 months, and reported perceived family support for PA at age 15. Parents reported family income, education level, and regular PA participation in high school and adulthood. Structural equation modeling was conducted to identify the latent classes represented among these parental characteristics. Sex-adjusted multivariable logistic regression analyses were conducted to predict sports participation trajectories and MVPA trajectories by latent class and family support.

Results: Three parent latent classes were identified: higher family socioeconomic status (SES) and regular PA in both high school and adulthood by both the father and mother (Group 1); lower family SES and regular PA in high school by the father (Group 2); and lower family SES and no regular PA in high school by the father (Group 3). Sex-adjusted ORs of the "drop-out from sports participation" pattern for the children in Groups 1 and 2, compared to Group 3, were 0.38 (95% CI = 0.20, 0.72) and 0.51 (95% CI = 0.26, 1.00), respectively. Sex-adjusted ORs of the "decreasing from moderate MVPA" pattern for the children in Groups 1 and 2, compared to Group 3, were 0.29 (95% CI = 0.11, 0.75) and 1.16 (95% CI = 0.40, 3.37), respectively. Adding family support to the logistic regression model only slightly changed the ORs.

Conclusions: The findings from this study suggest that among lower SES families, the father's role may be important to promote youth to sustain sports participation.
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http://dx.doi.org/10.1186/s12966-016-0383-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859977PMC
May 2016

Characteristics of Children Reported to Child Protective Services for Medical Neglect.

Hosp Pediatr 2016 Apr 1;6(4):204-10. Epub 2016 Jan 1.

Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Objectives: Medical neglect can have serious consequences. There is little evidence base to guide medical neglect management and research. Our objective was to describe a group of children reported to child protective services (CPS) for medical neglect to define this population as well as identify prevention and intervention approaches.

Methods: This was a retrospective descriptive study of all patients at a pediatric hospital reported to CPS for medical neglect over a 6-year period. Data about health, health care, CPS involvement, and social history were obtained through medical record review.

Results: Of the 154 patients reported for medical neglect, 140 (91%) had chronic illness. The most common diagnoses were type 1 diabetes, organ transplantation, and prematurity-related conditions. Most patients (83%) were black or Hispanic and 90% were publically insured. More than half of patients (54%) had >1 CPS report during the study period. Almost all patients (88%) returned to the hospital for care subsequent to the medical neglect report. Risk factors for child maltreatment, family stressors in the year preceding the report, and practical barriers to care were documented in more than two-thirds of patients.

Conclusions: Overall, children reported for medical neglect have serious chronic medical conditions. There is need and opportunity for improved interventions. Avenues for future study include interventions tailored to the underlying diagnosis, racial/ethnic disparities, effectiveness of CPS interventions, and targeted prevention for at-risk families with medically complex children.
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http://dx.doi.org/10.1542/hpeds.2015-0151DOI Listing
April 2016