ABSTRACT
BACKGROUND: Relationships between birthweight and future obesity risk remain unclear. OBJECTIVE: To assess associations between birthweight and later obesity in a nationally representative cohort of early school-aged children. METHODS: We used linear and logistic regression to evaluate 10 186 term- or preterm children in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 for relationships between birthweight and later obesity and change in BMI z-score from kindergarten-to-second grade. All analyses were adjusted for sex, race/ethnicity, parental education and household income. RESULTS: Compared to children born normal birthweight (NBW), high birthweight (HBW) term children and large-for-gestational-age (LGA) preterm children had significantly greater BMI z-scores from kindergarten-to-second grade (p < 0.001). Term children born HBW had higher odds of obesity by kindergarten (adjusted odds ratios [aOR] 1.91, p < 0.0001). Among preterm children, odds of obesity was higher among LGA children starting in first grade (aOR 2.34, p < 0.05) and among small-for-gestational age children in second grade (aOR 2.26, p < 0.05). Compared to NBW children, HBW children had greater change in BMI z-score between kindergarten-first grade (p < 0.01). CONCLUSIONS: High birthweight term and LGA preterm children had increased adjusted odds of obesity in school-age compared to their NBW counterparts. Physicians may provide counselling early in life for families of large infants to help prevent future obesity.
Subject(s)
Birth Weight/physiology , Pediatric Obesity/etiology , Anthropometry/methods , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Longitudinal Studies , Male , Pediatric Obesity/epidemiology , Pregnancy , Prevalence , Regression Analysis , Risk Factors , Schools , Weight GainABSTRACT
OBJECTIVES: Poor executive functioning is associated with life-long difficulty. Identification of children at risk for executive dysfunction is important for early intervention to improve neurodevelopmental outcomes. STUDY DESIGN: This study is designed to examine relationships between birthweight and executive functioning in US children during kindergarten. Our hypothesis was that children with higher birthweights would have better executive function scores. We evaluated data from 17506 US children from the Early Childhood Longitudinal Study-Kindergarten 2011 cohort. Birthweight and gestational age were obtained by parental survey. Executive functions were directly assessed using the number reverse test and card sort test to measure working memory and cognitive flexibility, respectively. Teacher evaluations were used for additional executive functions. Data were analyzed using SAS to run all linear and logistical regressions. RESULTS: For every kilogram of birthweight, scores of working memory increased by 1.47 (P<0.001) and cognitive flexibility increased by 0.28 (P<0.001) independent of gender, gestational age, parental education, and family income. Low birthweight infants were 1.5 times more likely to score in the bottom 20% of children on direct assessment OR=1.49 (CI 1.21-1.85) and OR=1.55 (CI 1.26-1.91). CONCLUSIONS: Infants born low birthweight are at increased risk of poor executive functioning. As birthweight increases executive function scores improve, even among infants born normal weight. Further evaluation of this population including interventions and progression through school is needed.
Subject(s)
Child Development , Early Intervention, Educational , Executive Function , Infant, Low Birth Weight/growth & development , Birth Weight , Child, Preschool , Female , Gestational Age , Humans , Infant , Infant, Newborn , Linear Models , Longitudinal Studies , Male , United StatesABSTRACT
UNLABELLED: Non-arteritic anterior ischaemic optic neuropathy (NAION) is caused by ischaemia of the optic nerve head. The pathophysiology of NAION is unclear, and no proven effective treatment exists. PATIENTS, METHODS: We analyzed thrombophilic risk factors and determinants of atherosclerosis and inflammation in 109 consecutive patients and 109 age- and sex-matched volunteers using a case-control design. RESULTS: High levels of fibrinogen (>384 mg/dl; OR 3.2, p = 0.003), factors VIII:C (>183%; OR 2.6, p = 0.02), IX (>153%; OR 2.6, p = 0.026), XI (>142%; OR 3.4, p = 0.006), von Willebrand factor (activity >205%; OR 3.1, p = 0.005; antigen >194%; OR 3.5, p = 0.002), and triglycerides (>228 mg/dl; OR 2.8, p = 0.026), higher platelet counts (>294,000/µl; OR 2.5, p = 0.04), low levels of HDL cholesterol (<40 mg/dl; OR 2.7, p = 0.032), and an accelerated erythrocyte sedimentation rate (>20 mm/h; OR 4.4, p = 0.003) were associated with NAION. CONCLUSION: Our findings support the contention of a complex pathogenesis of NAION resulting from the coincidence of proatherogenic, prothrombotic and proinflammatory processes. The alterations described could be causative, side effects, or just coincidental findings.
Subject(s)
Atherosclerosis/epidemiology , Inflammation/epidemiology , Optic Neuropathy, Ischemic/epidemiology , Optic Neuropathy, Ischemic/immunology , Thrombophilia/epidemiology , Thrombophilia/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Arteritis , Atherosclerosis/immunology , Biomarkers/blood , Case-Control Studies , Causality , Comorbidity , Female , Germany/epidemiology , Humans , Inflammation/immunology , Male , Middle Aged , Risk Factors , Young AdultABSTRACT
BACKGROUND: Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre-school children. METHODS: We used linear and logistic multivariable regression to evaluate body mass index (BMI) z-score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study-Birth Cohort, a representative sample of the United States. RESULTS: Cross-sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non-drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMIâ z-score by age 4 years than infrequent/non-drinkers (P < 0.0001), a difference driven by lesser increases in height z-score (P = 0.0003) and slightly greater increases in weight z-score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06-1.60). These differences in growth parameters were not noted between ages 4 and 5 years. CONCLUSIONS: Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children.
Subject(s)
Body Mass Index , Fruit and Vegetable Juices/adverse effects , Age Factors , Body Weight , Child, Preschool , Cross-Sectional Studies , Female , Fruit , Humans , Logistic Models , Longitudinal Studies , Male , Obesity/epidemiology , Odds Ratio , Overweight/epidemiology , United StatesSubject(s)
Anticoagulants/therapeutic use , Blood Coagulation Disorders/drug therapy , Fibrinolytic Agents/therapeutic use , Hemorrhage/chemically induced , Tissue Plasminogen Activator/therapeutic use , Anticoagulants/adverse effects , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/immunology , Evidence-Based Medicine , Fibrinolytic Agents/adverse effects , Hemorrhage/immunology , Hemorrhage/prevention & control , Humans , Tissue Plasminogen Activator/adverse effects , Treatment Outcome , Unnecessary ProceduresABSTRACT
Economizing health care systems has led to industrialized hospitals. The consequences and side effects are substantial and rather promote costs explosion due to the dictated increase in cases and efficiency. Hence, position sensing and change in direction are required. Effective ways to find out of the current crisis are discussed.
Subject(s)
Delivery of Health Care/economics , Health Care Costs/statistics & numerical data , Health Care Sector/economics , Hematologic Diseases/economics , Medical Overuse/prevention & control , Unnecessary Procedures/economics , Germany , Hematologic Diseases/diagnosis , Hematologic Diseases/therapy , Medical Overuse/economicsABSTRACT
Acquired haemophilia A (AHA) is caused by autoantibody inhibitors of coagulation factor VIII (FVIII : C). Recent onset of bleeds and isolated prolongation of the activated partial thromboplastin time (aPTT) are characteristic features of the disorder. Reduced FVIII : C activity and a detectable FVIII : C inhibitor in the Bethesda assay confirm the diagnosis. Patients should be referred to expert centres, whenever possible, and invasive procedures with a high risk of bleeding must be avoided, until haemostasis has been secured by adequate therapy. Bypassing agents capable of inducing sufficient thrombin formation in the presence of FVIII : C inhibitors are treatment of choice, including currently available recombinant factor VIIa (NovoSevenTM) and activated prothrombin complex concentrate (FEIBATM). These agents represent first line therapy to control acute or severe bleeds. To eradicate inhibitors, immunosuppressive treatment (IST) is indicated in patients with AHA. Glucocorticoids, cytotoxic agents and rituximab are most widely used. However, an ideal IST regimen has not been established so far. Adverse events of IST, including infections as the foremost cause death, are frequent complications in AHA.
Subject(s)
Factor VIII/analysis , Hemophilia A/diagnosis , Hemophilia A/drug therapy , Hemostatics/administration & dosage , Immunoassay/methods , Immunosuppressive Agents/administration & dosage , Biomarkers/blood , Evidence-Based Medicine , Hemophilia A/blood , Humans , Immunoglobulin G/administration & dosage , Immunoglobulin G/adverse effects , Immunosuppressive Agents/adverse effects , Immunotherapy/methods , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVE: Short night-time sleep duration is a possible factor contributing to childhood obesity. Our objective was to evaluate associations between sleep timing (including bedtime and waketime) and weight gain in 4- to 5-year-old children. METHODS: We used cross-sectional and longitudinal regression analyses of a large, nationally representative sample of children from the Early Childhood Longitudinal Study-Birth Cohort. Data regarding the timing and duration of weekday sleep were assessed via parent questionnaire. Short sleep duration, late bedtime and early waketime were defined as those greater than one standard deviation from the mean for the group. RESULTS: Using linear regression adjusted for confounders, sleep duration at 4 and 5 years and bedtime at 5 years were linked to body mass index (BMI) z-score (P < 0.001). Odds of obesity were higher at 4 years for children sleeping <9.44 h nightly (adjusted odds ratio 1.35, confidence interval 1.02-1.78, P < 0.05) and at 5 years for children going to bed at 9:00 pm or later (1.49, 1.16-1.45, P < 0.01) or waking before 6:30 am (1.23, 1.01-15.51, P < 0.05). Assessed longitudinally, both short sleep duration (P < 0.05) and later bedtime at 4 years (P < 0.01) were associated with increases in BMIâ z-score between 4 and 5 years. CONCLUSIONS: Children with shorter night-time sleep durations and later bedtimes were more likely to be obese and to gain weight over time. Pediatricians should encourage families to place children to bed at earlier times to promote longer sleep duration as a potential means of controlling weight gain.
Subject(s)
Parents/psychology , Pediatric Obesity/prevention & control , Sleep , Weight Gain , Body Mass Index , Child, Preschool , Cross-Sectional Studies , Female , Follow-Up Studies , Health Knowledge, Attitudes, Practice , Humans , Longitudinal Studies , Male , Parents/education , Pediatric Obesity/epidemiology , Pediatric Obesity/etiology , Surveys and Questionnaires , Time Factors , United States/epidemiologyABSTRACT
Venous thromboembolism (VTE) is associated with high morbidity and mortality. Therefore, effective methods for safe thromboprophylaxis remain an ongoing challenge in daily clinical practice. This is especially true for pregnant women and patients with gynaecological malignancies. Low-molecular weight heparins continue to be agents of choice for pharmacological thromboprophylaxis postoperatively, in pregnant patients at risk, and during the puerperium. However, these drugs can cause bleeds or heparin-induced thrombocytopenia (type II). Based on recent revisions of corresponding guidelines, this article provides an overview of the current state of pharmacological thromboprophylaxis and discusses prevailing problems and unresolved issues.
Subject(s)
Fibrinolytic Agents/adverse effects , Fibrinolytic Agents/therapeutic use , Genital Neoplasms, Female/complications , Hemorrhage/chemically induced , Pregnancy Complications, Cardiovascular/prevention & control , Thrombocytopenia/chemically induced , Venous Thromboembolism/prevention & control , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Evidence-Based Medicine , Female , Genital Neoplasms, Female/drug therapy , Hemorrhage/prevention & control , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/drug therapy , Thrombocytopenia/prevention & control , Treatment Outcome , Venous Thromboembolism/drug therapy , Venous Thromboembolism/etiologyABSTRACT
OBJECTIVES: In gram-positive sepsis, lipoteichoic acid (LTA) can induce alterations of haemostasis, potentially leading to disseminated intravascular coagulation. PATIENTS AND METHODS: Here, we demonstrate the effects of LTA on haemostasis in an in vitro model of gram-positive sepsis based on rotation thromboelastrography (ROTEM). RESULTS: In this model, LTA leads to time- and dose-dependent shortening of the clotting time (CT), whereas other ROTEM parameters are unaffected. Following heat shock simulation, the LTA effect was blunted with equal CTs in the presence and in the absence of LTA. In addition, the shortening of CT by LTA was inhibited by addition of the protein synthesis inhibitor. CONCLUSION: Our work demonstrates that the ROTEM system is capable of detecting the LTA effect on haemostasis and provides a sensitive in vitro tool for research into the links between gram-positive sepsis and coagulation.
Subject(s)
Blood Coagulation/drug effects , Disseminated Intravascular Coagulation/blood , Lipopolysaccharides/toxicity , Models, Biological , Sepsis/blood , Teichoic Acids/toxicity , Thrombelastography/methods , Disseminated Intravascular Coagulation/chemically induced , Female , Humans , Male , Sepsis/chemically inducedSubject(s)
Anticoagulants/therapeutic use , Neoplasms/complications , Neoplasms/drug therapy , Venous Thromboembolism/drug therapy , Anticoagulants/adverse effects , Heparin/administration & dosage , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Infusions, Intravenous , Injections, Subcutaneous , Long-Term Care , Neoplasms/mortality , Patient Acceptance of Health Care , Randomized Controlled Trials as Topic , Secondary Prevention , Survival Analysis , Thrombin/antagonists & inhibitors , Venous Thromboembolism/mortality , Vitamin K/antagonists & inhibitorsABSTRACT
Rotation thromboelastography (ROTEM) is a screening method that allows the rapid detection of plasma- and platelet-related haemostatic abnormalities. To use this procedure more efficiently, reference values depending on gender, age, and oral contraception are required. In this study, five cohorts of healthy subjects were examined by ROTEM upon activation of the extrinsic or intrinsic pathway of coagulation, or recalcification alone. The cohorts comprised male subjects below (1) and above (2) 45 years of age, female subjects below 45 years of age with (3) or without (4) oral contraception, and female subjects above 45 years (5) without hormone replacement therapy. A significant influence of gender, age, and oral contraception on parameters determined by ROTEM was observed. Thus, adjustment for age, gender, and oral contraception is required when ROTEM is used to screen for distinct abnormalities of haemostasis.
Subject(s)
Blood Coagulation/drug effects , Contraceptives, Oral/administration & dosage , Hemostasis/drug effects , Thrombelastography/methods , Adult , Age Factors , Cohort Studies , Female , Hormone Replacement Therapy , Humans , Male , Middle Aged , Observer Variation , Sex Factors , Thrombelastography/standardsSubject(s)
Pharmacogenetics , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Adenosine/adverse effects , Adenosine/analogs & derivatives , Adenosine/pharmacokinetics , Adenosine/therapeutic use , Clopidogrel , Cytochrome P-450 Enzyme System/genetics , Genetic Variation/genetics , Genotype , Hemorrhage/chemically induced , Humans , Isoenzymes/genetics , Piperazines/adverse effects , Piperazines/pharmacokinetics , Piperazines/therapeutic use , Platelet Aggregation/drug effects , Platelet Aggregation/genetics , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/pharmacokinetics , Prasugrel Hydrochloride , Risk Factors , Thiophenes/adverse effects , Thiophenes/pharmacokinetics , Thiophenes/therapeutic use , Ticagrelor , Ticlopidine/adverse effects , Ticlopidine/pharmacokinetics , Ticlopidine/therapeutic use , Treatment OutcomeSubject(s)
Hemostatic Disorders/genetics , Hemostatic Disorders/therapy , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Blood Platelets/physiology , Disease Susceptibility , Factor XII/physiology , Feedback, Physiological/drug effects , Fibrinolysis , Hemorrhagic Disorders/etiology , Hemorrhagic Disorders/therapy , Hemostasis/genetics , Hemostasis/physiology , Hemostatic Disorders/etiology , Hemostatics/therapeutic use , Humans , Thrombosis/etiology , Thrombosis/therapy , Vitamin K/physiologyABSTRACT
Platelet function can be abnormally increased, as in association with acute vascular events, or defective, as in a variety of clinical settings. Acquired platelet dysfunction may occur at any age and range in severity from mild to life-threatening haemorrhages. Diagnostic work-up of platelet disorders requires meticulous evaluation of medical history, specifically of any drugs interfering with platelet function, careful clinical examination and a staged laboratory protocol to assess the underlying platelet defect(s). To identify hyperactive platelets ex vivo, costly procedures may be required using flow cytometry and distict epitope-specific monoclonal antibodies. Currently, this approach can be recommended for research purposes only. Drugs represent the most common cause of platelet dysfunction in our overmedicated society. While aspirin, clopigogrel (more recently also prasugrel) and integrin αIIbß3 (GPIIb-IIIa) receptor antagonists (abciximab, eptifibatide and tirofiban) are well-known prototypes of antiplatelet drugs, other widely used agents (e.g. nonsteroidal anti-inflammatory drugs, antibiotics, serotonin reuptake inhibitors and volume expanders) can also impair platelet function and thus cause or aggravate hemorrhages. Identification of individual patients with pre-existing hemostatic defects remains crucial (i) to prevent bleeding complications, (ii) to manage symptoms adequately, (iii) to minimize the risk from invasive procedures, and (iv) to avoid unnecassary exposure to blood products. Screening for platelet dysfunction can be performed by point-of-care testing followed by platelet aggregometry in response to various agonists. While mild bleeding episodes due to antiplatelet therapy can be managed by withdrawal of the drug(s), severe hemorrhages may require immediate platelet transfusions. Apart from that, the prohemostatic armamentarium is limited to desmopressin, antifibrinolytic agents, and recombinant factor VIIa.