Tara Haelle

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Rates of self-inflicted injuries among teens visiting the emergency department increased by 45% between 2009 and 2012, according to a recent study. Teens with a history of a self-inflicted injury had 13 times the odds of death than those with other injuries, reported Gretchen J. Cutler, Ph.D., and her associates at the Children’s Hospitals and Clinics of Minnesota, Minneapolis.

“These findings highlight the importance of addressing and preventing self-harm behavior in this age group,” the authors wrote. “A positive finding was a significant decrease in adolescent ED visits for self-inflicted firearm injuries, which may reflect a rise in strategies focused on reducing access to highly lethal means, including firearms, in suicidal youth.”

The researchers analyzed the de-identified records of 286,678 teen trauma patients reported in the National Trauma Data Bank (NTDB) between 2009 and 2012. The rate of emergency department visits for a self-inflicted injury increased from 1.1% in 2009 to 1.6% in 2012 (P = .02). Self-inflicted firearm visits dropped during this period from 27.3% in 2009 to 21.9% in 2012 (P = .02). Only 4.9% of the teens with self-inflicted injuries had a mental disorder diagnosis (Pediatrics 2015 June 15 [doi:10.1542/peds.2014-3573]).

Females, who predominantly had cuts or piercing injuries (48%), had 41% greater odds of a self-inflicted injury than males, who predominantly used firearms (34.4%) (odds ratio, 1.41). The authors noted, however, that males tend to have a greater risk of death from their injuries because they typically choose more lethal means, such as firearms.

Older teens (aged 15-18 years), Asian teens, those with any of 24 comorbid conditions, and those with public or self-pay insurance (compared with private insurance) also had greater odds of self-inflicted injury (ORs of 2.73, 1.67, 1.64, and 1.44, respectively). African American teens had lower odds than did whites for self-inflicted injury.

The investigators cited several limitations. For example, the NTDB is not a sample that is nationally representative. Also, not all poisoning cases are reported to the NTDB, which means that the findings “are not generalizable to all ED visits for self-harm behavior.”

Nevertheless, the results contribute to the public health discussion about self-harm prevention efforts for adolescents. “Emergency department providers have a unique opportunity to intervene with self-inflicted injury patients during a high-risk period,” Dr. Cutler and her associates wrote. “Our findings provide potential targets for self-inflicted injury prevention efforts specific to the emergency department setting or for the general population.”

The authors used no external funding and reported no disclosures.

Expectant mothers can reduce the likelihood that they will gain too much weight during pregnancy by improving their diet, increasing their exercise, or using a combined diet and exercise program, according to an updated Cochrane review.

The original review published in 2012 found too little evidence to conclude that diet and exercise interventions could benefit pregnant women and their newborns, but the update includes an additional 41 randomized controlled studies published between October 2011 and November 2014, along with 24 studies from the original review.

“Moderate-intensity exercise appears to be an important part of controlling weight gain in pregnancy; however, the evidence on the risk of preterm birth is limited, and more research is needed to establish safe guidelines,” wrote Benja Muktabhant of Khon Kaen (Thailand) University and associates (Cochrane Database Syst. Rev. 2015 June 10 [doi:10.1002/14651858.CD007145.pub3]).

©Comstock/thinkstockphotos.com

Excessive weight gain in pregnancy is well known to increase the risk for poor maternal and neonatal outcomes, including gestational diabetes, hypertension, cesarean delivery, macrosomia, and stillbirth. But research shows that pregnant women continue to struggle to stay within recommended weight limits. In 2009, the Institute of Medicine (IOM) recommended that normal weight women with singleton pregnancies gain 25-35 pounds, while overweight women should gain 15-25 pounds. For obese women with a body mass index of 30 kg/m2 or greater, the IOM recommendation is 11-20 pounds of weight gain.

In the current review, the researchers identified a total of 65 randomized controlled trials that focused on using exercise, diet, or both to prevent excessive gestational weight gain. The 49 studies that were part of the quantitative meta-analysis included 11,444 women, but the methodologies varied greatly among the studies, and 20 studies had a moderate to high risk of bias. Further, the majority of studies included participants from high-income countries, primarily the United States, Canada, Australia, and European countries, making generalization to lower-income populations difficult to assess.

Using diet, exercise, or both reduced the risk of excessive weight gain in pregnancy by 20% based on 24 studies involving 7,096 participants. This evidence, rated high quality, found that low-glycemic-load diets, exercise with and without supervision, and combined diet and exercise programs all reduced women’s weights by similar amounts. Diet and/or exercise programs also increased the likelihood by 14% that women would have a low gestational weight gain, based on 4,422 participants in 11 studies with moderate-quality evidence.

Exercise programs included moderate exercise such as walking, dance, or aerobics.

The risk of maternal hypertension was lower in the diet and/or exercise intervention groups based on 11 studies involving 5,162 participants, but the researchers graded the evidence as low quality because of inconsistency and risk of bias concerns. The researchers found no reduced risk for preeclampsia in the 15 studies that included it as an outcome.

Similarly, the 16 studies assessing preterm birth and the 28 studies assessing risk of cesarean delivery found no difference between the intervention and control groups. However, when the researchers looked only at a combined diet and exercise intervention, they found a 13% reduction in cesarean delivery, which had borderline statistical significance.

The potential risk reduction of infant macrosomia depended on a woman’s prepregnancy weight, with only the findings for overweight or obese women, or those with or at risk for gestational diabetes, barely reaching statistical significance. Among the 27 studies with 8,598 participants that included macrosomia as an outcome, the 7% lower risk for oversized newborns just missed statistical significance. Among high-risk women, combined diet and exercise counseling reduced macrosomia risk by 15% (P = .05) with moderate-quality evidence from 3,252 participants in nine studies.

There was no difference between the two groups in risk for shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, and birth trauma, according to the review.

The project was supported by the National Institute for Health Research in the United Kingdom, and the World Health Organization. The researchers reported having no relevant financial conflicts.

Expectant mothers can reduce the likelihood that they will gain too much weight during pregnancy by improving their diet, increasing their exercise, or using a combined diet and exercise program, according to an updated Cochrane review.

The original review published in 2012 found too little evidence to conclude that diet and exercise interventions could benefit pregnant women and their newborns, but the update includes an additional 41 randomized controlled studies published between October 2011 and November 2014, along with 24 studies from the original review.

“Moderate-intensity exercise appears to be an important part of controlling weight gain in pregnancy; however, the evidence on the risk of preterm birth is limited, and more research is needed to establish safe guidelines,” wrote Benja Muktabhant of Khon Kaen (Thailand) University and associates (Cochrane Database Syst. Rev. 2015 June 10 [doi:10.1002/14651858.CD007145.pub3]).

©Comstock/thinkstockphotos.com

Excessive weight gain in pregnancy is well known to increase the risk for poor maternal and neonatal outcomes, including gestational diabetes, hypertension, cesarean delivery, macrosomia, and stillbirth. But research shows that pregnant women continue to struggle to stay within recommended weight limits. In 2009, the Institute of Medicine (IOM) recommended that normal weight women with singleton pregnancies gain 25-35 pounds, while overweight women should gain 15-25 pounds. For obese women with a body mass index of 30 kg/m2 or greater, the IOM recommendation is 11-20 pounds of weight gain.

In the current review, the researchers identified a total of 65 randomized controlled trials that focused on using exercise, diet, or both to prevent excessive gestational weight gain. The 49 studies that were part of the quantitative meta-analysis included 11,444 women, but the methodologies varied greatly among the studies, and 20 studies had a moderate to high risk of bias. Further, the majority of studies included participants from high-income countries, primarily the United States, Canada, Australia, and European countries, making generalization to lower-income populations difficult to assess.

Using diet, exercise, or both reduced the risk of excessive weight gain in pregnancy by 20% based on 24 studies involving 7,096 participants. This evidence, rated high quality, found that low-glycemic-load diets, exercise with and without supervision, and combined diet and exercise programs all reduced women’s weights by similar amounts. Diet and/or exercise programs also increased the likelihood by 14% that women would have a low gestational weight gain, based on 4,422 participants in 11 studies with moderate-quality evidence.

Exercise programs included moderate exercise such as walking, dance, or aerobics.

The risk of maternal hypertension was lower in the diet and/or exercise intervention groups based on 11 studies involving 5,162 participants, but the researchers graded the evidence as low quality because of inconsistency and risk of bias concerns. The researchers found no reduced risk for preeclampsia in the 15 studies that included it as an outcome.

Similarly, the 16 studies assessing preterm birth and the 28 studies assessing risk of cesarean delivery found no difference between the intervention and control groups. However, when the researchers looked only at a combined diet and exercise intervention, they found a 13% reduction in cesarean delivery, which had borderline statistical significance.

The potential risk reduction of infant macrosomia depended on a woman’s prepregnancy weight, with only the findings for overweight or obese women, or those with or at risk for gestational diabetes, barely reaching statistical significance. Among the 27 studies with 8,598 participants that included macrosomia as an outcome, the 7% lower risk for oversized newborns just missed statistical significance. Among high-risk women, combined diet and exercise counseling reduced macrosomia risk by 15% (P = .05) with moderate-quality evidence from 3,252 participants in nine studies.

There was no difference between the two groups in risk for shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, and birth trauma, according to the review.

The project was supported by the National Institute for Health Research in the United Kingdom, and the World Health Organization. The researchers reported having no relevant financial conflicts.

Expectant mothers can reduce the likelihood that they will gain too much weight during pregnancy by improving their diet, increasing their exercise, or using a combined diet and exercise program, according to an updated Cochrane review.

The original review published in 2012 found too little evidence to conclude that diet and exercise interventions could benefit pregnant women and their newborns, but the update includes an additional 41 randomized controlled studies published between October 2011 and November 2014, along with 24 studies from the original review.

“Moderate-intensity exercise appears to be an important part of controlling weight gain in pregnancy; however, the evidence on the risk of preterm birth is limited, and more research is needed to establish safe guidelines,” wrote Benja Muktabhant of Khon Kaen (Thailand) University and associates (Cochrane Database Syst. Rev. 2015 June 10 [doi:10.1002/14651858.CD007145.pub3]).

©Comstock/thinkstockphotos.com

Excessive weight gain in pregnancy is well known to increase the risk for poor maternal and neonatal outcomes, including gestational diabetes, hypertension, cesarean delivery, macrosomia, and stillbirth. But research shows that pregnant women continue to struggle to stay within recommended weight limits. In 2009, the Institute of Medicine (IOM) recommended that normal weight women with singleton pregnancies gain 25-35 pounds, while overweight women should gain 15-25 pounds. For obese women with a body mass index of 30 kg/m2 or greater, the IOM recommendation is 11-20 pounds of weight gain.

In the current review, the researchers identified a total of 65 randomized controlled trials that focused on using exercise, diet, or both to prevent excessive gestational weight gain. The 49 studies that were part of the quantitative meta-analysis included 11,444 women, but the methodologies varied greatly among the studies, and 20 studies had a moderate to high risk of bias. Further, the majority of studies included participants from high-income countries, primarily the United States, Canada, Australia, and European countries, making generalization to lower-income populations difficult to assess.

Using diet, exercise, or both reduced the risk of excessive weight gain in pregnancy by 20% based on 24 studies involving 7,096 participants. This evidence, rated high quality, found that low-glycemic-load diets, exercise with and without supervision, and combined diet and exercise programs all reduced women’s weights by similar amounts. Diet and/or exercise programs also increased the likelihood by 14% that women would have a low gestational weight gain, based on 4,422 participants in 11 studies with moderate-quality evidence.

Exercise programs included moderate exercise such as walking, dance, or aerobics.

The risk of maternal hypertension was lower in the diet and/or exercise intervention groups based on 11 studies involving 5,162 participants, but the researchers graded the evidence as low quality because of inconsistency and risk of bias concerns. The researchers found no reduced risk for preeclampsia in the 15 studies that included it as an outcome.

Similarly, the 16 studies assessing preterm birth and the 28 studies assessing risk of cesarean delivery found no difference between the intervention and control groups. However, when the researchers looked only at a combined diet and exercise intervention, they found a 13% reduction in cesarean delivery, which had borderline statistical significance.

The potential risk reduction of infant macrosomia depended on a woman’s prepregnancy weight, with only the findings for overweight or obese women, or those with or at risk for gestational diabetes, barely reaching statistical significance. Among the 27 studies with 8,598 participants that included macrosomia as an outcome, the 7% lower risk for oversized newborns just missed statistical significance. Among high-risk women, combined diet and exercise counseling reduced macrosomia risk by 15% (P = .05) with moderate-quality evidence from 3,252 participants in nine studies.

There was no difference between the two groups in risk for shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, and birth trauma, according to the review.

The project was supported by the National Institute for Health Research in the United Kingdom, and the World Health Organization. The researchers reported having no relevant financial conflicts.

Breastfeeding for 6 months or more may lower the risk of childhood leukemia, according to a recent systematic review and meta-analysis of 18 case-controlled studies.

Breastfeeding for at least 6 months may prevent approximately 14%-19% of all childhood leukemia cases, estimated Efrat Amitay, Ph.D., and Dr. Lital Keinan-Boker of the University of Haifa (Israel) School of Public Health (JAMA Pediatr. 2015 June 1;169:e151025 [doi:10.1001/jamapediatrics.2015.1025]).

©Lev Olkha/iStockphoto.com

Among all case-controlled studies in PubMed, the Cochrane Library, and Scopus between January 1960 and December 2014, the researchers identified 18 articles comparing exposure to breastfeeding to outcomes of leukemia, involving 10,292 leukemia cases and 17,517 controls. In the full meta-analysis of all the studies, children were 19% less likely to develop leukemia if breastfed for at least 6 months than if they were breastfed for less than 6 months or not at all (odds ratio, 0.81).

An analysis of 15 studies with data on never-breastfed infants found that leukemia risk dropped 11% for children ever breastfed, compared with those never breastfed, although studies defined “never breastfed” differently (OR, 0.89).

When researchers considered only the 11 studies that examined acute lymphoblastic leukemia, with a total of 5,745 cases and 12,764 controls, breastfeeding for at least 6 months reduced acute lymphoblastic leukemia risk by 18%. Separately, six studies involving 854 cases and 9,542 control individuals found no association between acute myeloid leukemia and breastfeeding.

The authors suggested several possible mechanisms for the findings, including differences in the gut flora of breastfed infants, compared with nonbreastfed infants and the ingestion of stem cells in the breast milk that may, based on animal model research, provide active immunity.

“Breast milk is a live substance, containing antibodies and having a prebiotic effect that promotes a healthy microbiome in the intestines, some specific to the baby such as antibodies to pathogens to which each baby’s mother was exposed,” the researchers wrote.

Breast milk contains immunologically active components and multifactorial anti-inflammatory defense mechanisms that influence the development of the immune system of the breastfed infant, the researchers wrote, including secretory IgA antibodies, oligosaccharides, and lactoferrin, which can reduce inflammatory responses. They also noted that studies have found a higher concentration of natural-killer cells in breastfed babies than in formula-fed infants.

Among the meta-analysis’s limitations were the observational and noncausal nature of case-controlled studies and the wide range in response rates in the studies: 47%-98% for cases in 13 studies and 71%-95% for controls in 10 studies. Further, not all studies clearly distinguished between exclusive and partial breastfeeding.

The researchers reported having no financial disclosures.

Breastfeeding for 6 months or more may lower the risk of childhood leukemia, according to a recent systematic review and meta-analysis of 18 case-controlled studies.

Breastfeeding for at least 6 months may prevent approximately 14%-19% of all childhood leukemia cases, estimated Efrat Amitay, Ph.D., and Dr. Lital Keinan-Boker of the University of Haifa (Israel) School of Public Health (JAMA Pediatr. 2015 June 1;169:e151025 [doi:10.1001/jamapediatrics.2015.1025]).

©Lev Olkha/iStockphoto.com

Among all case-controlled studies in PubMed, the Cochrane Library, and Scopus between January 1960 and December 2014, the researchers identified 18 articles comparing exposure to breastfeeding to outcomes of leukemia, involving 10,292 leukemia cases and 17,517 controls. In the full meta-analysis of all the studies, children were 19% less likely to develop leukemia if breastfed for at least 6 months than if they were breastfed for less than 6 months or not at all (odds ratio, 0.81).

An analysis of 15 studies with data on never-breastfed infants found that leukemia risk dropped 11% for children ever breastfed, compared with those never breastfed, although studies defined “never breastfed” differently (OR, 0.89).

When researchers considered only the 11 studies that examined acute lymphoblastic leukemia, with a total of 5,745 cases and 12,764 controls, breastfeeding for at least 6 months reduced acute lymphoblastic leukemia risk by 18%. Separately, six studies involving 854 cases and 9,542 control individuals found no association between acute myeloid leukemia and breastfeeding.

The authors suggested several possible mechanisms for the findings, including differences in the gut flora of breastfed infants, compared with nonbreastfed infants and the ingestion of stem cells in the breast milk that may, based on animal model research, provide active immunity.

“Breast milk is a live substance, containing antibodies and having a prebiotic effect that promotes a healthy microbiome in the intestines, some specific to the baby such as antibodies to pathogens to which each baby’s mother was exposed,” the researchers wrote.

Breast milk contains immunologically active components and multifactorial anti-inflammatory defense mechanisms that influence the development of the immune system of the breastfed infant, the researchers wrote, including secretory IgA antibodies, oligosaccharides, and lactoferrin, which can reduce inflammatory responses. They also noted that studies have found a higher concentration of natural-killer cells in breastfed babies than in formula-fed infants.

Among the meta-analysis’s limitations were the observational and noncausal nature of case-controlled studies and the wide range in response rates in the studies: 47%-98% for cases in 13 studies and 71%-95% for controls in 10 studies. Further, not all studies clearly distinguished between exclusive and partial breastfeeding.

The researchers reported having no financial disclosures.

Breastfeeding for 6 months or more may lower the risk of childhood leukemia, according to a recent systematic review and meta-analysis of 18 case-controlled studies.

Breastfeeding for at least 6 months may prevent approximately 14%-19% of all childhood leukemia cases, estimated Efrat Amitay, Ph.D., and Dr. Lital Keinan-Boker of the University of Haifa (Israel) School of Public Health (JAMA Pediatr. 2015 June 1;169:e151025 [doi:10.1001/jamapediatrics.2015.1025]).

©Lev Olkha/iStockphoto.com

Among all case-controlled studies in PubMed, the Cochrane Library, and Scopus between January 1960 and December 2014, the researchers identified 18 articles comparing exposure to breastfeeding to outcomes of leukemia, involving 10,292 leukemia cases and 17,517 controls. In the full meta-analysis of all the studies, children were 19% less likely to develop leukemia if breastfed for at least 6 months than if they were breastfed for less than 6 months or not at all (odds ratio, 0.81).

An analysis of 15 studies with data on never-breastfed infants found that leukemia risk dropped 11% for children ever breastfed, compared with those never breastfed, although studies defined “never breastfed” differently (OR, 0.89).

When researchers considered only the 11 studies that examined acute lymphoblastic leukemia, with a total of 5,745 cases and 12,764 controls, breastfeeding for at least 6 months reduced acute lymphoblastic leukemia risk by 18%. Separately, six studies involving 854 cases and 9,542 control individuals found no association between acute myeloid leukemia and breastfeeding.

The authors suggested several possible mechanisms for the findings, including differences in the gut flora of breastfed infants, compared with nonbreastfed infants and the ingestion of stem cells in the breast milk that may, based on animal model research, provide active immunity.

“Breast milk is a live substance, containing antibodies and having a prebiotic effect that promotes a healthy microbiome in the intestines, some specific to the baby such as antibodies to pathogens to which each baby’s mother was exposed,” the researchers wrote.

Breast milk contains immunologically active components and multifactorial anti-inflammatory defense mechanisms that influence the development of the immune system of the breastfed infant, the researchers wrote, including secretory IgA antibodies, oligosaccharides, and lactoferrin, which can reduce inflammatory responses. They also noted that studies have found a higher concentration of natural-killer cells in breastfed babies than in formula-fed infants.

Among the meta-analysis’s limitations were the observational and noncausal nature of case-controlled studies and the wide range in response rates in the studies: 47%-98% for cases in 13 studies and 71%-95% for controls in 10 studies. Further, not all studies clearly distinguished between exclusive and partial breastfeeding.

The researchers reported having no financial disclosures.

The risk of developing venous thromboembolism is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

“Women exposed to drospirenone, gestodene, cyproterone, and desogestrel within the last 28 days had around a four times increased risk of venous thromboembolism,” the investigators found. Women exposed to levonorgestrel, norethisterone, and norgestimate had about a 2.5 times greater risk of venous thromboembolism than did women not exposed in the past year, said Yana Vinogradova and her colleagues at the University of Nottingham (England) (BMJ. 2015 May 26 [doi:10.1136/bmj.h2135]).

The researchers conducted two nested case-control studies using data from 618 primary care practices in the Clinical Practice Research Datalink (CPRD) and 722 practices in the QResearch primary care database. A total of 5,062 cases from CPRD and 5,500 cases from QResearch were matched one to five with 19,638 and 22,396 controls, respectively.

areeya_ann/Thinkstock.com

Approximately 29% of CPRD patients and 26% of QResearch patients used oral contraceptives, most commonly levonorgestrel. Overall, any use of combined oral contraceptives resulted in a three times increased risk for venous thromboembolism, compared with no use in the past year.

After accounting for smoking, obesity, a wide range of other health conditions, alcohol consumption, polycystic ovary syndrome and recent infections, surgeries, leg/hip fractures, and hospital admission, the researchers calculated an increased odds ratio for each hormone: desogestrel (4.28), cyproterone (4.27), drospirenone (4.12), gestodene (3.64), levonorgestrel (2.38), norgestimate (2.53), and norethisterone (2.56). The increased VTE risk in patients on these hormones was compared with no exposure to oral contraceptives in the previous year.

In terms of numbers needed to harm, the researchers estimated that use of levonorgestrel and norgestimate resulted in 6 extra cases of VTE each year per 10,000 treated women aged 15-49, and 7 extra cases for women aged 25-49.

Desogestrel and cyproterone each contributed 14 additional cases of VTE each year per 10,000 treated women aged 15-49, and drospirenone, desogestrel, and cyproterone each contributed to an extra 17 cases of VTE each year per 10,000 women aged 25-49.

“We believe this study has the statistical power and sufficient adjustment for relevant confounders to be regarded as an important clarifying study, which has produced the most reliable possible risk estimates using currently available U.K. prescription data,” the researchers wrote.

There was no external funding for the study. Julia Hippisley-Cox is the unpaid director of QResearch, a not-for-profit organization that is a joint partnership between the University of Nottingham and EMIS, a commercial IT supplier. She is also a paid director of ClinRisk, which produces clinical risk algorithm-related software.

The risk of developing venous thromboembolism is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

“Women exposed to drospirenone, gestodene, cyproterone, and desogestrel within the last 28 days had around a four times increased risk of venous thromboembolism,” the investigators found. Women exposed to levonorgestrel, norethisterone, and norgestimate had about a 2.5 times greater risk of venous thromboembolism than did women not exposed in the past year, said Yana Vinogradova and her colleagues at the University of Nottingham (England) (BMJ. 2015 May 26 [doi:10.1136/bmj.h2135]).

The researchers conducted two nested case-control studies using data from 618 primary care practices in the Clinical Practice Research Datalink (CPRD) and 722 practices in the QResearch primary care database. A total of 5,062 cases from CPRD and 5,500 cases from QResearch were matched one to five with 19,638 and 22,396 controls, respectively.

areeya_ann/Thinkstock.com

Approximately 29% of CPRD patients and 26% of QResearch patients used oral contraceptives, most commonly levonorgestrel. Overall, any use of combined oral contraceptives resulted in a three times increased risk for venous thromboembolism, compared with no use in the past year.

After accounting for smoking, obesity, a wide range of other health conditions, alcohol consumption, polycystic ovary syndrome and recent infections, surgeries, leg/hip fractures, and hospital admission, the researchers calculated an increased odds ratio for each hormone: desogestrel (4.28), cyproterone (4.27), drospirenone (4.12), gestodene (3.64), levonorgestrel (2.38), norgestimate (2.53), and norethisterone (2.56). The increased VTE risk in patients on these hormones was compared with no exposure to oral contraceptives in the previous year.

In terms of numbers needed to harm, the researchers estimated that use of levonorgestrel and norgestimate resulted in 6 extra cases of VTE each year per 10,000 treated women aged 15-49, and 7 extra cases for women aged 25-49.

Desogestrel and cyproterone each contributed 14 additional cases of VTE each year per 10,000 treated women aged 15-49, and drospirenone, desogestrel, and cyproterone each contributed to an extra 17 cases of VTE each year per 10,000 women aged 25-49.

“We believe this study has the statistical power and sufficient adjustment for relevant confounders to be regarded as an important clarifying study, which has produced the most reliable possible risk estimates using currently available U.K. prescription data,” the researchers wrote.

There was no external funding for the study. Julia Hippisley-Cox is the unpaid director of QResearch, a not-for-profit organization that is a joint partnership between the University of Nottingham and EMIS, a commercial IT supplier. She is also a paid director of ClinRisk, which produces clinical risk algorithm-related software.

The risk of developing venous thromboembolism is generally greater for women using oral contraceptives with newer types of progestogen hormones than for those taking older, second-generation birth control pills, study results showed.

“Women exposed to drospirenone, gestodene, cyproterone, and desogestrel within the last 28 days had around a four times increased risk of venous thromboembolism,” the investigators found. Women exposed to levonorgestrel, norethisterone, and norgestimate had about a 2.5 times greater risk of venous thromboembolism than did women not exposed in the past year, said Yana Vinogradova and her colleagues at the University of Nottingham (England) (BMJ. 2015 May 26 [doi:10.1136/bmj.h2135]).

The researchers conducted two nested case-control studies using data from 618 primary care practices in the Clinical Practice Research Datalink (CPRD) and 722 practices in the QResearch primary care database. A total of 5,062 cases from CPRD and 5,500 cases from QResearch were matched one to five with 19,638 and 22,396 controls, respectively.

areeya_ann/Thinkstock.com

Approximately 29% of CPRD patients and 26% of QResearch patients used oral contraceptives, most commonly levonorgestrel. Overall, any use of combined oral contraceptives resulted in a three times increased risk for venous thromboembolism, compared with no use in the past year.

After accounting for smoking, obesity, a wide range of other health conditions, alcohol consumption, polycystic ovary syndrome and recent infections, surgeries, leg/hip fractures, and hospital admission, the researchers calculated an increased odds ratio for each hormone: desogestrel (4.28), cyproterone (4.27), drospirenone (4.12), gestodene (3.64), levonorgestrel (2.38), norgestimate (2.53), and norethisterone (2.56). The increased VTE risk in patients on these hormones was compared with no exposure to oral contraceptives in the previous year.

In terms of numbers needed to harm, the researchers estimated that use of levonorgestrel and norgestimate resulted in 6 extra cases of VTE each year per 10,000 treated women aged 15-49, and 7 extra cases for women aged 25-49.

Desogestrel and cyproterone each contributed 14 additional cases of VTE each year per 10,000 treated women aged 15-49, and drospirenone, desogestrel, and cyproterone each contributed to an extra 17 cases of VTE each year per 10,000 women aged 25-49.

“We believe this study has the statistical power and sufficient adjustment for relevant confounders to be regarded as an important clarifying study, which has produced the most reliable possible risk estimates using currently available U.K. prescription data,” the researchers wrote.

There was no external funding for the study. Julia Hippisley-Cox is the unpaid director of QResearch, a not-for-profit organization that is a joint partnership between the University of Nottingham and EMIS, a commercial IT supplier. She is also a paid director of ClinRisk, which produces clinical risk algorithm-related software.

Delaying the clamping of the umbilical cord at least 3 minutes after birth appears to improve social and fine motor skills in children at age 4 years, a follow-up study showed.

No differences in IQ were found, however, between those with early vs. delayed cord clamping.

“The included children constitute a group of low-risk children born in a high-income country with a low prevalence of iron deficiency,” Dr. Ola Andersson of Uppsala (Sweden) University and her associates wrote (JAMA Pediatr. 2015 May 26 [doi:10.1001/jamapediatrics.2015.0358]). “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they added. “Delaying umbilical cord clamping by 2-3 minutes after delivery allows fetal blood remaining in the placental circulation to be transfused to the newborn.”

In the original trial, 382 term infants from low-risk pregnancies were randomized to have their umbilical cords clamped within 10 seconds after birth or else at least 3 minutes after birth at a Swedish county hospital between April 2008 and May 2010. Four years later, 263 children underwent IQ testing with the Wechsler Preschool and Primary Scale of Intelligence and motor skills testing with the Movement Assessment Battery for Children. In addition, parents filled out questionnaires regarding the children’s behavior and developmental stages.

Average IQ scores did not differ between the two groups, but fewer children in the delayed cord-clamping group had an immature pencil grip: 13.2% percent, compared with 25.6% of those who had immediate cord clamping. Further, 3.8% of children who had delayed clamping and 12.9% of children who had immediate clamping fell below average on another fine motor test (the bicycle-trail task).

“In girls, there were no differences between the groups for any of the assessments. An at-risk result in the bicycle-trail task was less prevalent in boys who received delayed cord clamping, compared with those who received early cord clamping (3.6% vs. 23.1%); findings were similar in the Ages and Stages Questionnaire, Third Edition, fine-motor domain (8.9% vs 23.6%),” Dr. Andersson and her associates wrote.

“The effect by sex is consistent with previous results from the same study population at 12 months,” they said, because past studies have shown lower iron stores in boys, compared with girls, at birth and in infancy.

The research was funded by the Regional Scientific Council of Halland, the Linnéa and Josef Carlsson Foundation, the Southern Health care Region, H.R.H. Crown Princess Lovisa’s Society for Child Care, Uppsala University, the Little Childs Foundation, and the Swedish Research Council for Health, Working Life, and Welfare. The authors reported no relevant financial disclosures.

Delaying the clamping of the umbilical cord at least 3 minutes after birth appears to improve social and fine motor skills in children at age 4 years, a follow-up study showed.

No differences in IQ were found, however, between those with early vs. delayed cord clamping.

“The included children constitute a group of low-risk children born in a high-income country with a low prevalence of iron deficiency,” Dr. Ola Andersson of Uppsala (Sweden) University and her associates wrote (JAMA Pediatr. 2015 May 26 [doi:10.1001/jamapediatrics.2015.0358]). “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they added. “Delaying umbilical cord clamping by 2-3 minutes after delivery allows fetal blood remaining in the placental circulation to be transfused to the newborn.”

In the original trial, 382 term infants from low-risk pregnancies were randomized to have their umbilical cords clamped within 10 seconds after birth or else at least 3 minutes after birth at a Swedish county hospital between April 2008 and May 2010. Four years later, 263 children underwent IQ testing with the Wechsler Preschool and Primary Scale of Intelligence and motor skills testing with the Movement Assessment Battery for Children. In addition, parents filled out questionnaires regarding the children’s behavior and developmental stages.

Average IQ scores did not differ between the two groups, but fewer children in the delayed cord-clamping group had an immature pencil grip: 13.2% percent, compared with 25.6% of those who had immediate cord clamping. Further, 3.8% of children who had delayed clamping and 12.9% of children who had immediate clamping fell below average on another fine motor test (the bicycle-trail task).

“In girls, there were no differences between the groups for any of the assessments. An at-risk result in the bicycle-trail task was less prevalent in boys who received delayed cord clamping, compared with those who received early cord clamping (3.6% vs. 23.1%); findings were similar in the Ages and Stages Questionnaire, Third Edition, fine-motor domain (8.9% vs 23.6%),” Dr. Andersson and her associates wrote.

“The effect by sex is consistent with previous results from the same study population at 12 months,” they said, because past studies have shown lower iron stores in boys, compared with girls, at birth and in infancy.

The research was funded by the Regional Scientific Council of Halland, the Linnéa and Josef Carlsson Foundation, the Southern Health care Region, H.R.H. Crown Princess Lovisa’s Society for Child Care, Uppsala University, the Little Childs Foundation, and the Swedish Research Council for Health, Working Life, and Welfare. The authors reported no relevant financial disclosures.

Delaying the clamping of the umbilical cord at least 3 minutes after birth appears to improve social and fine motor skills in children at age 4 years, a follow-up study showed.

No differences in IQ were found, however, between those with early vs. delayed cord clamping.

“The included children constitute a group of low-risk children born in a high-income country with a low prevalence of iron deficiency,” Dr. Ola Andersson of Uppsala (Sweden) University and her associates wrote (JAMA Pediatr. 2015 May 26 [doi:10.1001/jamapediatrics.2015.0358]). “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they added. “Delaying umbilical cord clamping by 2-3 minutes after delivery allows fetal blood remaining in the placental circulation to be transfused to the newborn.”

In the original trial, 382 term infants from low-risk pregnancies were randomized to have their umbilical cords clamped within 10 seconds after birth or else at least 3 minutes after birth at a Swedish county hospital between April 2008 and May 2010. Four years later, 263 children underwent IQ testing with the Wechsler Preschool and Primary Scale of Intelligence and motor skills testing with the Movement Assessment Battery for Children. In addition, parents filled out questionnaires regarding the children’s behavior and developmental stages.

Average IQ scores did not differ between the two groups, but fewer children in the delayed cord-clamping group had an immature pencil grip: 13.2% percent, compared with 25.6% of those who had immediate cord clamping. Further, 3.8% of children who had delayed clamping and 12.9% of children who had immediate clamping fell below average on another fine motor test (the bicycle-trail task).

“In girls, there were no differences between the groups for any of the assessments. An at-risk result in the bicycle-trail task was less prevalent in boys who received delayed cord clamping, compared with those who received early cord clamping (3.6% vs. 23.1%); findings were similar in the Ages and Stages Questionnaire, Third Edition, fine-motor domain (8.9% vs 23.6%),” Dr. Andersson and her associates wrote.

“The effect by sex is consistent with previous results from the same study population at 12 months,” they said, because past studies have shown lower iron stores in boys, compared with girls, at birth and in infancy.

The research was funded by the Regional Scientific Council of Halland, the Linnéa and Josef Carlsson Foundation, the Southern Health care Region, H.R.H. Crown Princess Lovisa’s Society for Child Care, Uppsala University, the Little Childs Foundation, and the Swedish Research Council for Health, Working Life, and Welfare. The authors reported no relevant financial disclosures.

A concussion can affect a child’s or teen’s ability to focus at school and keep up with schoolwork, according to a recent study.

Concerns about keeping up with grades and concentrating on work mean that those who have had a concussion may require accommodations until their symptoms have fully subsided, Danielle Ransom, Psy.D., of the George Washington University, Washington, and her associates reported online (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3434].

©Antonio_Diaz/thinkstockphotos.com

“The high level of concern about post-injury school performance implies the need to deliver early reassurance to students and families that their academic needs will be met,” Dr. Ransom and her team wrote. “Furthermore, the range of reported post-injury school problems (e.g., increased time spent on homework, headaches interfering with learning) suggests the need to provide actively symptomatic students with targeted supports during the post-injury recovery period.”

Among 349 youths, aged 5-18 years, who were undergoing evaluation and neurocognitive assessments within 28 days of concussion, 240 remained symptomatic or had impaired performance on testing while 109 had recovered from their concussion (had no elevation of symptoms and no impairments on neurocognitive tests). The researchers gave questionnaires about academic concerns to 239 student-parent pairs and 110 parents of students. The questions asked about concern over how the concussion affected the student’s school learning or grades and new or worsening academic problems since the concussion.

More of the students (59%) and parents (64%) from the unrecovered group had higher levels of concern about school than the students (16%) and parents (30%) in the recovered group. Concerns were highest among older children. Among those not yet recovered, 67% of high school students, 52% of middle school students, and 38% of elementary school students reported feeling moderately or very concerned about the concussion’s effect on their schoolwork.

In addition, 88% of unrecovered students reported having at least one problem at school as a result of symptoms such as headaches, fatigue, or concentration difficulty, compared with 38% of recovered students. Further, 77% of unrecovered students and 44% of recovered students said that they had trouble taking notes, were spending more time on homework, had difficulty studying, or had other problems with academic skills.

“Adverse postinjury academic effects (e.g., failure to complete schoolwork, problems keeping pace with an expanding workload, perception of poorly controlled symptoms) with no supports may be linked to the onset of depression and anxiety,” Dr. Ransom and her associates said.

The study did not receive external funding, and Dr. Ransom and her associates reported no relevant financial disclosures.

A concussion can affect a child’s or teen’s ability to focus at school and keep up with schoolwork, according to a recent study.

Concerns about keeping up with grades and concentrating on work mean that those who have had a concussion may require accommodations until their symptoms have fully subsided, Danielle Ransom, Psy.D., of the George Washington University, Washington, and her associates reported online (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3434].

©Antonio_Diaz/thinkstockphotos.com

“The high level of concern about post-injury school performance implies the need to deliver early reassurance to students and families that their academic needs will be met,” Dr. Ransom and her team wrote. “Furthermore, the range of reported post-injury school problems (e.g., increased time spent on homework, headaches interfering with learning) suggests the need to provide actively symptomatic students with targeted supports during the post-injury recovery period.”

Among 349 youths, aged 5-18 years, who were undergoing evaluation and neurocognitive assessments within 28 days of concussion, 240 remained symptomatic or had impaired performance on testing while 109 had recovered from their concussion (had no elevation of symptoms and no impairments on neurocognitive tests). The researchers gave questionnaires about academic concerns to 239 student-parent pairs and 110 parents of students. The questions asked about concern over how the concussion affected the student’s school learning or grades and new or worsening academic problems since the concussion.

More of the students (59%) and parents (64%) from the unrecovered group had higher levels of concern about school than the students (16%) and parents (30%) in the recovered group. Concerns were highest among older children. Among those not yet recovered, 67% of high school students, 52% of middle school students, and 38% of elementary school students reported feeling moderately or very concerned about the concussion’s effect on their schoolwork.

In addition, 88% of unrecovered students reported having at least one problem at school as a result of symptoms such as headaches, fatigue, or concentration difficulty, compared with 38% of recovered students. Further, 77% of unrecovered students and 44% of recovered students said that they had trouble taking notes, were spending more time on homework, had difficulty studying, or had other problems with academic skills.

“Adverse postinjury academic effects (e.g., failure to complete schoolwork, problems keeping pace with an expanding workload, perception of poorly controlled symptoms) with no supports may be linked to the onset of depression and anxiety,” Dr. Ransom and her associates said.

The study did not receive external funding, and Dr. Ransom and her associates reported no relevant financial disclosures.

A concussion can affect a child’s or teen’s ability to focus at school and keep up with schoolwork, according to a recent study.

Concerns about keeping up with grades and concentrating on work mean that those who have had a concussion may require accommodations until their symptoms have fully subsided, Danielle Ransom, Psy.D., of the George Washington University, Washington, and her associates reported online (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3434].

©Antonio_Diaz/thinkstockphotos.com

“The high level of concern about post-injury school performance implies the need to deliver early reassurance to students and families that their academic needs will be met,” Dr. Ransom and her team wrote. “Furthermore, the range of reported post-injury school problems (e.g., increased time spent on homework, headaches interfering with learning) suggests the need to provide actively symptomatic students with targeted supports during the post-injury recovery period.”

Among 349 youths, aged 5-18 years, who were undergoing evaluation and neurocognitive assessments within 28 days of concussion, 240 remained symptomatic or had impaired performance on testing while 109 had recovered from their concussion (had no elevation of symptoms and no impairments on neurocognitive tests). The researchers gave questionnaires about academic concerns to 239 student-parent pairs and 110 parents of students. The questions asked about concern over how the concussion affected the student’s school learning or grades and new or worsening academic problems since the concussion.

More of the students (59%) and parents (64%) from the unrecovered group had higher levels of concern about school than the students (16%) and parents (30%) in the recovered group. Concerns were highest among older children. Among those not yet recovered, 67% of high school students, 52% of middle school students, and 38% of elementary school students reported feeling moderately or very concerned about the concussion’s effect on their schoolwork.

In addition, 88% of unrecovered students reported having at least one problem at school as a result of symptoms such as headaches, fatigue, or concentration difficulty, compared with 38% of recovered students. Further, 77% of unrecovered students and 44% of recovered students said that they had trouble taking notes, were spending more time on homework, had difficulty studying, or had other problems with academic skills.

“Adverse postinjury academic effects (e.g., failure to complete schoolwork, problems keeping pace with an expanding workload, perception of poorly controlled symptoms) with no supports may be linked to the onset of depression and anxiety,” Dr. Ransom and her associates said.

The study did not receive external funding, and Dr. Ransom and her associates reported no relevant financial disclosures.

Prenatal vaccination, followed by cocooning, is the most effective strategy for reducing pertussis complications and death in young infants, according to recommendations from the Global Pertussis Initiative (GPI).

GPI is an expert scientific forum that aims to reduce the worldwide burden of pertussis, particularly in infants under 6 weeks old who are too young to be vaccinated.

Infants under 6 months of age are at the highest risk for death and complications from pertussis, but the first pertussis vaccine dose is not recommended in most countries until 6-8 weeks of age.

“There is strong evidence that the pregnancy booster directly protects young infants through the transfer of maternal pertussis antibodies, in addition to being effective, safe, and well tolerated,” Dr. Kevin Forsyth of Flinders University in Adelaide, Australia, and his associates reported online. “A key benefit of this approach is that it provides protection to the very young from birth until infant-generated immunity is achieved from the primary series of pertussis immunization,” they wrote (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3925]).

The U.S. Advisory Committee on Immunization Practices recommends the Tdap booster during the third trimester of pregnancy, and similar recommendations exist in Argentina, Belgium, Israel, New Zealand, and the United Kingdom. Multiple studies have found higher levels of maternal pertussis antibodies and lower disease burden among infants born to mothers who received a pregnancy booster, compared with those who did not. Based on this evidence, the GPI recommends maternal prenatal vaccination as the primary strategy for protecting infants from pertussis. If prenatal immunization is not possible or families want extra protection, the GPI recommends that all individuals with close contact with infants under 6 months old be vaccinated with Tdap during pregnancy or immediately post partum.

“A high priority should be given to achieving a complete cocoon, defined as full immunization of the family, since the robustness of protection against pertussis is a function of the number of infant contacts vaccinated,” the authors wrote. If not everyone can be vaccinated, the parents should be vaccinated, or at least the mother, though little real-world data exist regarding the effectiveness of the cocooning strategy.

Support for this writing and the Global Pertussis Initiative are funded by Sanofi Pasteur. Drs. Forsyth, Plotkin, Tan, and Wirsing von König have received honoraria, consulting fees and/or grants from Sanofi Pasteur, Merck, GlaxoSmithKline and/or Novartis. Dr. Tan has received personal fees from GlaxoSmithKline Biologicals and Sanofi Pasteur.

Prenatal vaccination, followed by cocooning, is the most effective strategy for reducing pertussis complications and death in young infants, according to recommendations from the Global Pertussis Initiative (GPI).

GPI is an expert scientific forum that aims to reduce the worldwide burden of pertussis, particularly in infants under 6 weeks old who are too young to be vaccinated.

Infants under 6 months of age are at the highest risk for death and complications from pertussis, but the first pertussis vaccine dose is not recommended in most countries until 6-8 weeks of age.

“There is strong evidence that the pregnancy booster directly protects young infants through the transfer of maternal pertussis antibodies, in addition to being effective, safe, and well tolerated,” Dr. Kevin Forsyth of Flinders University in Adelaide, Australia, and his associates reported online. “A key benefit of this approach is that it provides protection to the very young from birth until infant-generated immunity is achieved from the primary series of pertussis immunization,” they wrote (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3925]).

The U.S. Advisory Committee on Immunization Practices recommends the Tdap booster during the third trimester of pregnancy, and similar recommendations exist in Argentina, Belgium, Israel, New Zealand, and the United Kingdom. Multiple studies have found higher levels of maternal pertussis antibodies and lower disease burden among infants born to mothers who received a pregnancy booster, compared with those who did not. Based on this evidence, the GPI recommends maternal prenatal vaccination as the primary strategy for protecting infants from pertussis. If prenatal immunization is not possible or families want extra protection, the GPI recommends that all individuals with close contact with infants under 6 months old be vaccinated with Tdap during pregnancy or immediately post partum.

“A high priority should be given to achieving a complete cocoon, defined as full immunization of the family, since the robustness of protection against pertussis is a function of the number of infant contacts vaccinated,” the authors wrote. If not everyone can be vaccinated, the parents should be vaccinated, or at least the mother, though little real-world data exist regarding the effectiveness of the cocooning strategy.

Support for this writing and the Global Pertussis Initiative are funded by Sanofi Pasteur. Drs. Forsyth, Plotkin, Tan, and Wirsing von König have received honoraria, consulting fees and/or grants from Sanofi Pasteur, Merck, GlaxoSmithKline and/or Novartis. Dr. Tan has received personal fees from GlaxoSmithKline Biologicals and Sanofi Pasteur.

Prenatal vaccination, followed by cocooning, is the most effective strategy for reducing pertussis complications and death in young infants, according to recommendations from the Global Pertussis Initiative (GPI).

GPI is an expert scientific forum that aims to reduce the worldwide burden of pertussis, particularly in infants under 6 weeks old who are too young to be vaccinated.

Infants under 6 months of age are at the highest risk for death and complications from pertussis, but the first pertussis vaccine dose is not recommended in most countries until 6-8 weeks of age.

“There is strong evidence that the pregnancy booster directly protects young infants through the transfer of maternal pertussis antibodies, in addition to being effective, safe, and well tolerated,” Dr. Kevin Forsyth of Flinders University in Adelaide, Australia, and his associates reported online. “A key benefit of this approach is that it provides protection to the very young from birth until infant-generated immunity is achieved from the primary series of pertussis immunization,” they wrote (Pediatrics 2015 May 11 [doi:10.1542/peds.2014-3925]).

The U.S. Advisory Committee on Immunization Practices recommends the Tdap booster during the third trimester of pregnancy, and similar recommendations exist in Argentina, Belgium, Israel, New Zealand, and the United Kingdom. Multiple studies have found higher levels of maternal pertussis antibodies and lower disease burden among infants born to mothers who received a pregnancy booster, compared with those who did not. Based on this evidence, the GPI recommends maternal prenatal vaccination as the primary strategy for protecting infants from pertussis. If prenatal immunization is not possible or families want extra protection, the GPI recommends that all individuals with close contact with infants under 6 months old be vaccinated with Tdap during pregnancy or immediately post partum.

“A high priority should be given to achieving a complete cocoon, defined as full immunization of the family, since the robustness of protection against pertussis is a function of the number of infant contacts vaccinated,” the authors wrote. If not everyone can be vaccinated, the parents should be vaccinated, or at least the mother, though little real-world data exist regarding the effectiveness of the cocooning strategy.

Support for this writing and the Global Pertussis Initiative are funded by Sanofi Pasteur. Drs. Forsyth, Plotkin, Tan, and Wirsing von König have received honoraria, consulting fees and/or grants from Sanofi Pasteur, Merck, GlaxoSmithKline and/or Novartis. Dr. Tan has received personal fees from GlaxoSmithKline Biologicals and Sanofi Pasteur.

Devices used to carry infants or allow them to play under supervision can pose asphyxiation risks if a baby is left sleeping or unattended in them, according to a recent study.

A retrospective review of deaths reported to the U.S. Consumer Product Safety Commission between 2004 and 2008 investigated the circumstances of 47 deaths of children under age 24 months in car seats, bouncers, swings, strollers, and slings. The study offers more of a case series, not a statistical sample of deaths because no data exist regarding how many infants are placed in these devices or what proportion are injured in them.

“With median elapsed times of 18 and 30 minutes for slings and strollers, respectively, and up to 9 hours for swings, it should be recognized that there may not be a safe amount of time that infants can be left unsupervised in these devices,” reported Dr. Erich K. Batra of Penn State College of Medicine in Hershey, Pa., and his colleagues (J. Pediatr. 2015 April 27 [doi: 10.1016/j.jpeds.2015.03.044]).

Although head injuries and broken bones have been reported from use of these devices, asphyxiation from suffocation or strangulation was the primary cause of death in all but one of these cases. Among the 31 (66%) cases occurring in car seats, 52% occurred from strangulation from the straps, and the others were positional asphyxia. Five deaths occurred in wearable slings, four in swings, four in bouncers, and three in strollers. Most (89%) car seat deaths occurred outside the car.

“The unfortunate irony is that the mechanism that makes an infant so safe in a car, i.e., buckled straps, may be extremely hazardous when used incorrectly,” Dr. Batra and his associates wrote. Similarly, “caregivers who own slings that do not keep the baby ‘visible and kissable’ at all times should not use those products,” they said.

The mean elapsed time between a child being left by a caregiver in a device and being discovered deceased was 26 minutes in slings (ranging from 10 minutes to 1 hour), 32 minutes in strollers (ranging from 5 minutes to 1 hour), 140 minutes in car seats (ranging from 4 minutes to 11 hours), 150 minutes in bouncers (ranging from 1.5 to 4 hours), and 300 minutes in swings (ranging from 1 to 9 hours).

Among the 27 cases with information on why the child was in the device, 17 infants had been left to sleep in the device.

In accordance with the 2011 American Academy of Pediatrics policy statement on sudden infant death syndrome or SIDS, “sitting devices such as car safety seats, strollers, swings, infant car seats, and infant slings are not recommended for sleeping because of the potential for upper airway obstruction and oxygen desaturation,” Dr. Batra and his associates wrote.

The authors declared no conflicts of interest.

Devices used to carry infants or allow them to play under supervision can pose asphyxiation risks if a baby is left sleeping or unattended in them, according to a recent study.

A retrospective review of deaths reported to the U.S. Consumer Product Safety Commission between 2004 and 2008 investigated the circumstances of 47 deaths of children under age 24 months in car seats, bouncers, swings, strollers, and slings. The study offers more of a case series, not a statistical sample of deaths because no data exist regarding how many infants are placed in these devices or what proportion are injured in them.

“With median elapsed times of 18 and 30 minutes for slings and strollers, respectively, and up to 9 hours for swings, it should be recognized that there may not be a safe amount of time that infants can be left unsupervised in these devices,” reported Dr. Erich K. Batra of Penn State College of Medicine in Hershey, Pa., and his colleagues (J. Pediatr. 2015 April 27 [doi: 10.1016/j.jpeds.2015.03.044]).

Although head injuries and broken bones have been reported from use of these devices, asphyxiation from suffocation or strangulation was the primary cause of death in all but one of these cases. Among the 31 (66%) cases occurring in car seats, 52% occurred from strangulation from the straps, and the others were positional asphyxia. Five deaths occurred in wearable slings, four in swings, four in bouncers, and three in strollers. Most (89%) car seat deaths occurred outside the car.

“The unfortunate irony is that the mechanism that makes an infant so safe in a car, i.e., buckled straps, may be extremely hazardous when used incorrectly,” Dr. Batra and his associates wrote. Similarly, “caregivers who own slings that do not keep the baby ‘visible and kissable’ at all times should not use those products,” they said.

The mean elapsed time between a child being left by a caregiver in a device and being discovered deceased was 26 minutes in slings (ranging from 10 minutes to 1 hour), 32 minutes in strollers (ranging from 5 minutes to 1 hour), 140 minutes in car seats (ranging from 4 minutes to 11 hours), 150 minutes in bouncers (ranging from 1.5 to 4 hours), and 300 minutes in swings (ranging from 1 to 9 hours).

Among the 27 cases with information on why the child was in the device, 17 infants had been left to sleep in the device.

In accordance with the 2011 American Academy of Pediatrics policy statement on sudden infant death syndrome or SIDS, “sitting devices such as car safety seats, strollers, swings, infant car seats, and infant slings are not recommended for sleeping because of the potential for upper airway obstruction and oxygen desaturation,” Dr. Batra and his associates wrote.

The authors declared no conflicts of interest.

Devices used to carry infants or allow them to play under supervision can pose asphyxiation risks if a baby is left sleeping or unattended in them, according to a recent study.

A retrospective review of deaths reported to the U.S. Consumer Product Safety Commission between 2004 and 2008 investigated the circumstances of 47 deaths of children under age 24 months in car seats, bouncers, swings, strollers, and slings. The study offers more of a case series, not a statistical sample of deaths because no data exist regarding how many infants are placed in these devices or what proportion are injured in them.

“With median elapsed times of 18 and 30 minutes for slings and strollers, respectively, and up to 9 hours for swings, it should be recognized that there may not be a safe amount of time that infants can be left unsupervised in these devices,” reported Dr. Erich K. Batra of Penn State College of Medicine in Hershey, Pa., and his colleagues (J. Pediatr. 2015 April 27 [doi: 10.1016/j.jpeds.2015.03.044]).

Although head injuries and broken bones have been reported from use of these devices, asphyxiation from suffocation or strangulation was the primary cause of death in all but one of these cases. Among the 31 (66%) cases occurring in car seats, 52% occurred from strangulation from the straps, and the others were positional asphyxia. Five deaths occurred in wearable slings, four in swings, four in bouncers, and three in strollers. Most (89%) car seat deaths occurred outside the car.

“The unfortunate irony is that the mechanism that makes an infant so safe in a car, i.e., buckled straps, may be extremely hazardous when used incorrectly,” Dr. Batra and his associates wrote. Similarly, “caregivers who own slings that do not keep the baby ‘visible and kissable’ at all times should not use those products,” they said.

The mean elapsed time between a child being left by a caregiver in a device and being discovered deceased was 26 minutes in slings (ranging from 10 minutes to 1 hour), 32 minutes in strollers (ranging from 5 minutes to 1 hour), 140 minutes in car seats (ranging from 4 minutes to 11 hours), 150 minutes in bouncers (ranging from 1.5 to 4 hours), and 300 minutes in swings (ranging from 1 to 9 hours).

Among the 27 cases with information on why the child was in the device, 17 infants had been left to sleep in the device.

In accordance with the 2011 American Academy of Pediatrics policy statement on sudden infant death syndrome or SIDS, “sitting devices such as car safety seats, strollers, swings, infant car seats, and infant slings are not recommended for sleeping because of the potential for upper airway obstruction and oxygen desaturation,” Dr. Batra and his associates wrote.

The authors declared no conflicts of interest.