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1.
Soc Work Public Health ; 29(7): 686-700, 2014.
Article in English | MEDLINE | ID: mdl-25350898

ABSTRACT

A simulation of enrollment in a high- or low-risk research study was conducted with low-income, mostly minority parents. Simulation participants were provided scenarios based on actual low-risk research involving premature babies or actual high-risk research involving devices designed as bridges to heart transplants when all other therapies had failed. Their understanding of the procedures, risks, and benefits was based only the information gained from consent materials for the high- or low-risk protocol. After reviewing the consent information, participants were asked to state their own decision as to whether to enroll their simulated child in the described study. The low-income sample of parents who participated in this simulation were overwhelmingly positive about enrolling a child in the two studies; 66% of those considering the high-risk study and 91% in the low-risk study indicated they would enroll a child. Parents in both conditions cited the value of learning ways to improve the health care of others as a primary reason for agreeing; they also valued knowledge for its own sake. Reasons for refusal varied according to the risk level. Many were unwilling to accept the risks involved in the high-risk study; parents considering the low-risk study of premature infants were concerned about possible discomforts for the infant. More of them also cited the length of the study and the need for repetitious follow-up visits. Information gained from the stated rationales gives insights into ways that researchers can enhance consent materials and the recruitment process.


Subject(s)
Decision Making , Heart Defects, Congenital/surgery , Human Experimentation , Parents/psychology , Adult , Female , Heart Transplantation , Humans , Infant, Newborn , Male , Poverty , Qualitative Research , Risk Factors
2.
Paediatr Perinat Epidemiol ; 28(1): 48-57, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24313667

ABSTRACT

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are persistent flame retardants found in the environment, in household dust, and in humans. Breast feeding is a prominent route of exposure in infancy. PBDEs adversely affect neurodevelopment in animals. Here, we estimate associations between PBDEs in breast milk and behaviour and cognitive skills in children at 36 months of age. METHODS: We prospectively studied 304 mothers and their children. We measured PBDEs in breast milk collected at 3 months postpartum. At 36 months, we measured child behaviour with the parent-rated Behavioral Assessment System for Children 2 (n = 192), and cognitive skills with the Mullen Scales of Early Learning (n = 184). We analysed data with robust regression. RESULTS: We detected BDE-28, -47, -99, -100, and -153 in >70% of milk samples. For each congener, the highest quartile of breast milk PBDE concentration, vs. the lowest, was associated with more anxious behaviour, after confounder adjustment. Select congeners were associated with increased withdrawal (BDE-28) and improved activity of daily living skills (BDE-153). Cognitive skills tended to be positively associated with PBDEs, especially language and fine motor skills. However, most estimates were imprecise. CONCLUSIONS: Here, lactational PBDE exposure was modestly and imprecisely associated with anxiety and withdrawal, but was also associated with improved adaptive and cognitive skills. Positive factors associated with breast feeding may have mitigated some of the hypothesised adverse neurodevelopmental outcomes associated with PBDEs. Further research is needed to inform our understanding of PBDE neurotoxicity and how sources of exposure might confound neurodevelopmental studies.


Subject(s)
Breast Feeding/adverse effects , Child Behavior Disorders/chemically induced , Environmental Pollutants/adverse effects , Flame Retardants/adverse effects , Halogenated Diphenyl Ethers/adverse effects , Milk, Human/chemistry , Adult , Child, Preschool , Cognition Disorders , Environmental Exposure/adverse effects , Environmental Monitoring , Environmental Pollutants/metabolism , Environmental Pollutants/toxicity , Female , Flame Retardants/metabolism , Flame Retardants/toxicity , Halogenated Diphenyl Ethers/metabolism , Halogenated Diphenyl Ethers/toxicity , Humans , Lactation/drug effects , Male , Mothers , North Carolina , Pregnancy , Prospective Studies
3.
Neuroimage ; 64: 156-66, 2013 Jan 01.
Article in English | MEDLINE | ID: mdl-22989623

ABSTRACT

Working memory emerges in infancy and plays a privileged role in subsequent adaptive cognitive development. The neural networks important for the development of working memory during infancy remain unknown. We used diffusion tensor imaging (DTI) and deterministic fiber tracking to characterize the microstructure of white matter fiber bundles hypothesized to support working memory in 12-month-old infants (n=73). Here we show robust associations between infants' visuospatial working memory performance and microstructural characteristics of widespread white matter. Significant associations were found for white matter tracts that connect brain regions known to support working memory in older children and adults (genu, anterior and superior thalamic radiations, anterior cingulum, arcuate fasciculus, and the temporal-parietal segment). Better working memory scores were associated with higher FA and lower RD values in these selected white matter tracts. These tract-specific brain-behavior relationships accounted for a significant amount of individual variation above and beyond infants' gestational age and developmental level, as measured with the Mullen Scales of Early Learning. Working memory was not associated with global measures of brain volume, as expected, and few associations were found between working memory and control white matter tracts. To our knowledge, this study is among the first demonstrations of brain-behavior associations in infants using quantitative tractography. The ability to characterize subtle individual differences in infant brain development associated with complex cognitive functions holds promise for improving our understanding of normative development, biomarkers of risk, experience-dependent learning and neuro-cognitive periods of developmental plasticity.


Subject(s)
Brain/anatomy & histology , Brain/physiology , Cognition/physiology , Memory, Short-Term/physiology , Nerve Fibers, Myelinated/physiology , Nerve Fibers, Myelinated/ultrastructure , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Statistics as Topic
4.
Am J Clin Nutr ; 96(6): 1465-72, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23134891

ABSTRACT

BACKGROUND: Choline is essential for fetal brain development, and it is not known whether a typical American diet contains enough choline to ensure optimal brain development. OBJECTIVE: The study was undertaken to determine whether supplementing pregnant women with phosphatidylcholine (the main dietary source of choline) improves the cognitive abilities of their offspring. DESIGN: In a double-blind, randomized controlled trial, 140 pregnant women were randomly assigned to receive supplemental phosphatidylcholine (750 mg) or a placebo (corn oil) from 18 wk gestation through 90 d postpartum. Their infants (n = 99) were tested for short-term visuospatial memory, long-term episodic memory, language development, and global development at 10 and 12 mo of age. RESULTS: The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory. CONCLUSIONS: Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants' brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.


Subject(s)
Child Development , Choline Deficiency/diet therapy , Cognition , Dietary Supplements , Lactation , Maternal Nutritional Physiological Phenomena , Phosphatidylcholines/therapeutic use , Choline Deficiency/etiology , Choline Deficiency/physiopathology , Diet/adverse effects , Dietary Supplements/adverse effects , Double-Blind Method , Female , Humans , Infant, Newborn , Language Development , Male , Memory, Long-Term , Memory, Short-Term , North Carolina , Phosphatidylcholines/adverse effects , Pregnancy , Pregnancy Complications/diet therapy , Pregnancy Complications/etiology , Pregnancy Complications/physiopathology , Severity of Illness Index
5.
Environ Health Perspect ; 120(10): 1438-42, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22814209

ABSTRACT

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) have been widely used as flame retardants and are ubiquitous environmental contaminants. PBDEs have been linked to adverse neurodevelopment in animals and humans. OBJECTIVES: We investigated the association between breast milk PBDE levels and social and emotional development in toddlers. METHODS: The Pregnancy Infection and Nutrition (PIN) and PIN Babies studies followed a cohort of North Carolina pregnant women and their children through 36 months of age. Breast milk samples obtained at 3 months postpartum were analyzed for PBDEs. The Infant-Toddler Social and Emotional Assessment (ITSEA) was completed by mothers when children were approximately 30 months of age (n = 222). We assessed the relationship between breast milk concentrations of five PBDE congeners-BDEs 28, 47, 99, 100, and 153-and children's social and emotional development, adjusting for other factors. RESULTS: A small, imprecise, yet consistent positive association was apparent between BDEs 47, 99, and 100 and increased externalizing behaviors, specifically activity/impulsivity behaviors. Externalizing domain T-scores ranged from 30 to 87 with a mean of 47.8. Compared with those with BDE-47 concentrations below the median, adjusted externalizing behavior domain scores were 1.6 [95% confidence interval (CI): -1.2, 4.4] and 2.8 (95% CI -0.1, 5.7) points higher for children born to women with breast milk concentrations in the 3rd and 4th quartiles, respectively. PBDEs were not associated with other social and emotional developmental domains. CONCLUSIONS: Our results, although imprecise, suggest a subtle association between early-life PBDE exposure and increased activity/impulsivity behaviors in early childhood. Confirmation of these results is needed in other longitudinal studies.


Subject(s)
Child Behavior Disorders/chemically induced , Child Behavior/drug effects , Child Development/drug effects , Environmental Exposure , Environmental Pollutants/toxicity , Flame Retardants/toxicity , Halogenated Diphenyl Ethers/toxicity , Milk, Human/chemistry , Child Behavior Disorders/epidemiology , Child, Preschool , Cohort Studies , Emotions/drug effects , Environmental Monitoring , Female , Humans , Infant , Longitudinal Studies , Male , North Carolina/epidemiology , Prospective Studies , Social Behavior , Surveys and Questionnaires
6.
Early Hum Dev ; 88(8): 691-8, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22445211

ABSTRACT

BACKGROUND: Enlargement of the lateral ventricles is thought to originate from abnormal prenatal brain development and is associated with neurodevelopmental disorders. Fetal isolated mild ventriculomegaly (MVM) is associated with the enlargement of lateral ventricle volumes in the neonatal period and developmental delays in early childhood. However, little is known about postnatal brain development in these children. METHODS: Twenty-eight children with fetal isolated MVM and 56 matched controls were followed at ages 1 and 2 years with structural imaging on a 3T Siemens scanner and assessment of cognitive development with the Mullen Scales of Early Learning. Lateral ventricle, total gray and white matter volumes, and Mullen cognitive composite scores and subscale scores were compared between groups. RESULTS: Compared to controls, children with prenatal isolated MVM had significantly larger lateral ventricle volumes at ages 1 and 2 years. Lateral ventricle volume at 1 and 2 years of age was significantly correlated with prenatal ventricle size. Enlargement of the lateral ventricles was associated with increased intracranial volumes and increased gray and white matter volumes. Children with MVM had Mullen composite scores similar to controls, although there was evidence of delay in fine motor and expressive language skills. CONCLUSIONS: Children with prenatal MVM have persistent enlargement of the lateral ventricles through the age of 2 years; this enlargement is associated with increased gray and white matter volumes and some evidence of delay in fine motor and expressive language development. Further study is needed to determine if enlarged lateral ventricles are associated with increased risk for neurodevelopmental disorders.


Subject(s)
Developmental Disabilities/epidemiology , Fetal Diseases , Hydrocephalus/complications , Cerebral Ventricles/diagnostic imaging , Cerebral Ventricles/embryology , Cerebral Ventricles/pathology , Child Development , Child, Preschool , Developmental Disabilities/etiology , Female , Fetal Diseases/diagnostic imaging , Fetal Diseases/pathology , Humans , Hydrocephalus/diagnostic imaging , Hydrocephalus/pathology , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Pregnancy , Ultrasonography, Prenatal
7.
Res Nurs Health ; 34(1): 35-48, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21243657

ABSTRACT

We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011.


Subject(s)
Adaptation, Psychological , Infant, Newborn, Diseases/prevention & control , Maternal Behavior/psychology , Mothers/psychology , Parenting/psychology , Role , Adult , Analysis of Variance , Educational Status , Female , Follow-Up Studies , Humans , Infant, Newborn , Infant, Newborn, Diseases/etiology , Infant, Newborn, Diseases/psychology , Linear Models , Male , Mother-Child Relations , Mothers/education , Nursing Methodology Research , Self Efficacy , Severity of Illness Index , Southeastern United States , Stress, Psychological/prevention & control , Stress, Psychological/psychology
8.
J Pediatr ; 157(1): 20-25.e1, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20227724

ABSTRACT

OBJECTIVE: To examine how infant overweight and high subcutaneous fat relate to infant motor development. STUDY DESIGN: Participants were from the Infant Care, Feeding, and Risk of Obesity Project, a prospective, longitudinal study of low-income African-American mother-infant dyads assessed from 3 to 18 months of age (836 observations on 217 infants). Exposures were overweight (weight-for-length z-score>or=90th percentile of 2000 Centers for Disease Control/National Center for Health Statistics growth reference) and high subcutaneous fat (sum of 3 skinfold measurements>90th percentile of our sample). Motor development was assessed by using the Bayley Scales of Infant Development-II. Developmental delay was characterized as a standardized Psychomotor Development Index score<85. Longitudinal models estimated developmental outcomes as functions of time-varying overweight and subcutaneous fat, controlling for age and sex. Alternate models tested concurrent and lagged relationships (earlier weight or subcutaneous fat predicting current motor development). RESULTS: Motor delay was 1.80 times as likely in overweight infants compared with non-overweight infants (95% CI,1.09-2.97) and 2.32 times as likely in infants with high subcutaneous fat compared with infants with lower subcutaneous fat (95% CI, 1.26-4.29). High subcutaneous fat was also associated with delay in subsequent motor development (odds ratio, 2.27; 95% CI, 1.08-4.76). CONCLUSIONS: Pediatric overweight and high subcutaneous fat are associated with delayed infant motor development.


Subject(s)
Black or African American , Child Development , Developmental Disabilities/etiology , Motor Skills , Overweight/etiology , Subcutaneous Fat , Black or African American/statistics & numerical data , Age Factors , Body Mass Index , Body Weight , Developmental Disabilities/epidemiology , Developmental Disabilities/ethnology , Developmental Disabilities/physiopathology , Female , Humans , Income , Infant , Male , North Carolina/epidemiology , Overweight/epidemiology , Overweight/ethnology , Overweight/physiopathology , Poverty , Prospective Studies , Risk Factors
9.
Res Nurs Health ; 33(1): 60-76, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20043296

ABSTRACT

Depressive symptoms may compromise the ability of low-income Latina mothers with limited English language proficiency to parent their infants or toddlers. Eighty Early Head Start Latina mothers with limited English language proficiency were randomized to an advanced practice nurse-delivered, culturally tailored, in-home psychotherapy intervention, or to usual care. Repeated measures regression analysis showed a significantly greater decrease in depressive symptoms for intervention mothers compared to the usual care group at 22 and 26 weeks (4 weeks post intervention). Intervention mothers' reports of their child's aggression diminished significantly from T1 to T4 compared to usual care mothers (p = .03). Self-efficacy appeared to only partially mediate the intervention effect, and maternal health moderated the intervention impact. Results indicate that the intervention reduced depressive symptoms and, compared to previous studies in this population, retention of mothers in both intervention and control conditions was improved.


Subject(s)
Depression/prevention & control , Early Intervention, Educational/methods , Hispanic or Latino/psychology , Home Nursing/methods , Mothers/psychology , Psychiatric Nursing/methods , Adult , Depression/psychology , Female , Humans , Infant , Male , Psychiatric Status Rating Scales , Regression Analysis , Self Efficacy
10.
Int J Behav Nutr Phys Act ; 6: 51, 2009 Aug 05.
Article in English | MEDLINE | ID: mdl-19656377

ABSTRACT

BACKGROUND: Prospective studies linking infant temperament, or behavioral style, to infant body composition are lacking. In this longitudinal study (3 to 18 months), we seek to examine the associations between two dimensions of infant temperament (distress to limitations and activity level) and two anthropometric indicators (weight-for-length z-scores (WLZ) and skin fold (SF) measures) in a population at high risk of overweight. METHODS: Data are from the Infant Care and Risk of Obesity Project, a longitudinal study of North Carolina low income African American mother-infant dyads (n = 206). Two temperament dimensions were assessed using the Infant Behavior Questionnaire-Revised. A high distress to limitations score denotes an infant whose mother perceives that s/he often cries or fusses, and a high activity level score one who moves his/her limbs and squirms frequently. Cross-sectional analyses were conducted using ordinary least squares regression. Fixed effects longitudinal models were used to estimate anthropometric outcomes as a function of time varying infant temperament. RESULTS: In longitudinal models, increased activity levels were associated with later decreased fatness and WLZ. In contrast, high levels of distress to limitations were associated with later increased fatness at all time points and later increased WLZ at 12 months. CONCLUSION: Infant temperament dimensions contribute to our understanding of the role of behavior in the development of the risk of overweight in the formative months of life. Identification of modifiable risk factors early in life may help target strategies for establishing healthy lifestyles prior to the onset of overweight.

11.
J Pediatr Psychol ; 34(8): 827-36, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19074489

ABSTRACT

OBJECTIVE: To describe the development of young boys with fragile X syndrome (FXS). METHODS: Fifty-five boys (aged 8-48 months at study entry) with the full mutation FXS received multiple developmental assessments. RESULTS: As expected, the boys' rate of development was significantly lower than chronological age expectations. No evidence of slowing in the rate of development was found. Autistic behavior was negatively associated with development, but maternal IQ was not. Developmental delays were evident in some domains as early as 9 months; however, initial detection of delays is complicated by measures and criteria used. Developmental age scores at 31 months of age were related to scores obtained at 61 months of age only in the global composite and visual reception domain. CONCLUSIONS: Developmental delays are evident in some infants with FXS as young as 9 months of age. Pediatric psychologists need to be informed about the developmental profiles in young children with FXS to accurately diagnose, treat, and support these children and their families.


Subject(s)
Autistic Disorder/diagnosis , Developmental Disabilities/diagnosis , Fragile X Syndrome/diagnosis , Age Factors , Autistic Disorder/psychology , Child, Preschool , Comorbidity , Developmental Disabilities/psychology , Developmental Disabilities/therapy , Diagnosis, Differential , Early Intervention, Educational , Fragile X Syndrome/psychology , Fragile X Syndrome/therapy , Humans , Infant , Intelligence , Longitudinal Studies , Male
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