Pub Date : 2025-01-21DOI: 10.1001/jamapediatrics.2024.5552
Resthie R Putri,Pernilla Danielsson,Nils Ekström,Åsa Ericsson,Louise Lindberg,Claude Marcus,Emilia Hagman
IMPORTANCEData regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited.OBJECTIVETo evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood.Design, Setting, and ParticipantsThe study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area.EXPOSUREPediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission.MAIN OUTCOMESObesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed.RESULTSOf 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety.CONCLUSIONS AND RELEVANCEIn this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.
{"title":"Effect of Pediatric Obesity Treatment on Long-Term Health.","authors":"Resthie R Putri,Pernilla Danielsson,Nils Ekström,Åsa Ericsson,Louise Lindberg,Claude Marcus,Emilia Hagman","doi":"10.1001/jamapediatrics.2024.5552","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5552","url":null,"abstract":"IMPORTANCEData regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited.OBJECTIVETo evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood.Design, Setting, and ParticipantsThe study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area.EXPOSUREPediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission.MAIN OUTCOMESObesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed.RESULTSOf 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety.CONCLUSIONS AND RELEVANCEIn this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1001/jamapediatrics.2024.5559
Leonard H Epstein,Myles S Faith,Denise E Wilfley
{"title":"Pediatric Obesity Treatment Improves Young Adult Health.","authors":"Leonard H Epstein,Myles S Faith,Denise E Wilfley","doi":"10.1001/jamapediatrics.2024.5559","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5559","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"50 3 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1001/jamapediatrics.2024.5429
Viktor Wintzell,Philip Brenner,Linda Halldner,Samuel Rhedin,Tong Gong,Catarina Almqvist
ImportanceSpontaneous reports have indicated that montelukast increases the risk of neuropsychiatric adverse events, and the US Food and Drug Administration added a boxed warning about these risks in 2020. However, the potential mechanism is not well understood, and the observational evidence is scarce, particularly in children.ObjectiveTo assess the potential association between the use of montelukast and the risk of neuropsychiatric adverse events in children and adolescents.Design, Setting, and ParticipantsThis nationwide register-based cohort study used data from Sweden from January 1, 2007, to November 30, 2021. Participants included children aged 6 to 17 years who used montelukast and long-acting β-agonists (LABA). Data analysis was performed from December 2023 to April 2024.ExposureMontelukast vs LABA.Main Outcomes and MeasuresThe primary outcome, any neuropsychiatric adverse event, was a composite of secondary outcomes, including anxiety; depression; sleep-related disorders; suicide and suicidal actions; disrupted control of activity, attention, and behavior; and confusion and psychotic-like symptoms. Outcomes were defined on the basis of diagnosis codes and dispensings of prescription drugs for specific neuropsychiatric symptoms. Patients were followed up from drug initiation to discontinuation, and treatment and censoring weights were used to adjust for potential confounding on baseline and selection bias from informative censoring. Pooled logistic regression was used to estimate hazard ratios (HRs).ResultsThe final cohort included 74 291 children (mean [SD] age, 12.3 [3.3] years; 35 446 female [47.7%]); 26 462 used montelukast and 47 829 used LABA. During a mean (SD) follow-up of 5.8 (3.2) months, 310 neuropsychiatric adverse events in the montelukast patients and 566 events in the LABA patients were identified. In the weighted cohort, the incidence rates of neuropsychiatric adverse events were 2.39 per 100 patient-years among the montelukast users and 2.41 per 100 patient-years among the LABA users. This translated to a weighted HR of 0.99 (95% CI, 0.84-1.16). No substantial differences were observed between the montelukast and LABA patients when analyzing the risk of specific neuropsychiatric adverse events: the HRs were 0.79 (95% CI, 0.54-1.14) for anxiety; 1.16 (95% CI, 0.70-1.95) for depression; 0.93 (95% CI, 0.76-1.13) for sleep-related disorders; 1.31 (95% CI, 0.64-2.69) for suicide and suicidal actions; 1.27 (95% CI, 0.84-1.90) for disrupted control of activity, attention, and behavior; and 0.51 (95% CI, 0.05-5.53) for confusion and psychotic-like symptoms. The risk of the primary outcome was consistent over subgroups and a range of sensitivity analyses.Conclusions and RelevanceIn this large study of children and adolescents based on data from routine clinical practice, there was no association between use of montelukast and the risk of neuropsychiatric adverse events. In aggregation with other robust observational studies, the
{"title":"Montelukast Use and the Risk of Neuropsychiatric Adverse Events in Children.","authors":"Viktor Wintzell,Philip Brenner,Linda Halldner,Samuel Rhedin,Tong Gong,Catarina Almqvist","doi":"10.1001/jamapediatrics.2024.5429","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5429","url":null,"abstract":"ImportanceSpontaneous reports have indicated that montelukast increases the risk of neuropsychiatric adverse events, and the US Food and Drug Administration added a boxed warning about these risks in 2020. However, the potential mechanism is not well understood, and the observational evidence is scarce, particularly in children.ObjectiveTo assess the potential association between the use of montelukast and the risk of neuropsychiatric adverse events in children and adolescents.Design, Setting, and ParticipantsThis nationwide register-based cohort study used data from Sweden from January 1, 2007, to November 30, 2021. Participants included children aged 6 to 17 years who used montelukast and long-acting β-agonists (LABA). Data analysis was performed from December 2023 to April 2024.ExposureMontelukast vs LABA.Main Outcomes and MeasuresThe primary outcome, any neuropsychiatric adverse event, was a composite of secondary outcomes, including anxiety; depression; sleep-related disorders; suicide and suicidal actions; disrupted control of activity, attention, and behavior; and confusion and psychotic-like symptoms. Outcomes were defined on the basis of diagnosis codes and dispensings of prescription drugs for specific neuropsychiatric symptoms. Patients were followed up from drug initiation to discontinuation, and treatment and censoring weights were used to adjust for potential confounding on baseline and selection bias from informative censoring. Pooled logistic regression was used to estimate hazard ratios (HRs).ResultsThe final cohort included 74 291 children (mean [SD] age, 12.3 [3.3] years; 35 446 female [47.7%]); 26 462 used montelukast and 47 829 used LABA. During a mean (SD) follow-up of 5.8 (3.2) months, 310 neuropsychiatric adverse events in the montelukast patients and 566 events in the LABA patients were identified. In the weighted cohort, the incidence rates of neuropsychiatric adverse events were 2.39 per 100 patient-years among the montelukast users and 2.41 per 100 patient-years among the LABA users. This translated to a weighted HR of 0.99 (95% CI, 0.84-1.16). No substantial differences were observed between the montelukast and LABA patients when analyzing the risk of specific neuropsychiatric adverse events: the HRs were 0.79 (95% CI, 0.54-1.14) for anxiety; 1.16 (95% CI, 0.70-1.95) for depression; 0.93 (95% CI, 0.76-1.13) for sleep-related disorders; 1.31 (95% CI, 0.64-2.69) for suicide and suicidal actions; 1.27 (95% CI, 0.84-1.90) for disrupted control of activity, attention, and behavior; and 0.51 (95% CI, 0.05-5.53) for confusion and psychotic-like symptoms. The risk of the primary outcome was consistent over subgroups and a range of sensitivity analyses.Conclusions and RelevanceIn this large study of children and adolescents based on data from routine clinical practice, there was no association between use of montelukast and the risk of neuropsychiatric adverse events. In aggregation with other robust observational studies, the","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1001/jamapediatrics.2024.5562
Jessica K E Dunn,Pranesh Chakraborty,Emily Reuvers,Lauren Gallagher,Kristin D Kernohan,Melanie Lacaria,Michelle Barton,Kirk Leifso,Jeffrey M Pernica,Emeril Santander,Marie Pigeon,Sharon L Cushing,Johnna MacCormick,Soren Gantt,Stacey Weber,Ari Bitnun,Jason Brophy
ImportanceDetection of congenital cytomegalovirus (cCMV) infection has previously relied on targeted screening programs or clinical recognition; however, these approaches miss most cCMV-infected newborns and fail to identify those infants who are asymptomatic at birth but at risk for late-onset sensorineural hearing loss.ObjectiveTo determine the feasibility of using routinely collected newborn dried blood spots (DBS) in a population-based cCMV screen to identify infants at risk for hearing loss and describe outcomes of infants screened.Design, Setting, and ParticipantsThis diagnostic study of a population-based screening program in Ontario, Canada, took place from July 29, 2019, to July 31, 2023. All newborns with a DBS sample collected as part of routine care were screened using polymerase chain reaction (PCR) analysis for cCMV as a risk factor for hearing loss. Infants with positive DBS PCR results for cCMV were referred for confirmation of infection by urine PCR (the gold standard), as well as complete medical and audiologic assessments for sequelae of cCMV infection. Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation for potential treatment with valganciclovir.ExposureDetection of cCMV by polymerase chain reaction assay on a newborn DBS.Main Outcomes and MeasuresNumber of infants with positive screening results successfully retrieved and confirmed to have cCMV and the timeliness of retrieval and symptomatic evaluation.ResultsOf 565 987 infants born in the screening period, 551 034 (97.4%) received cCMV screening on the DBS (45.7% female, 54.3% male). Of these infants, 689 (0.13%) screened positive for cCMV; 601 (87.2%) had cCMV infection confirmed and a complete assessment of sequelae of their congenital infection. Ninety-six infants with completed assessments (16.0%) were deemed to have cCMV symptoms, and 63 of these (65.6%) began valganciclovir treatment. Sensorineural hearing loss was confirmed in 34 of 96 infants (35.4%).Conclusions and RelevanceThis program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance.
{"title":"Outcomes of a Population-Based Congenital Cytomegalovirus Screening Program.","authors":"Jessica K E Dunn,Pranesh Chakraborty,Emily Reuvers,Lauren Gallagher,Kristin D Kernohan,Melanie Lacaria,Michelle Barton,Kirk Leifso,Jeffrey M Pernica,Emeril Santander,Marie Pigeon,Sharon L Cushing,Johnna MacCormick,Soren Gantt,Stacey Weber,Ari Bitnun,Jason Brophy","doi":"10.1001/jamapediatrics.2024.5562","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.5562","url":null,"abstract":"ImportanceDetection of congenital cytomegalovirus (cCMV) infection has previously relied on targeted screening programs or clinical recognition; however, these approaches miss most cCMV-infected newborns and fail to identify those infants who are asymptomatic at birth but at risk for late-onset sensorineural hearing loss.ObjectiveTo determine the feasibility of using routinely collected newborn dried blood spots (DBS) in a population-based cCMV screen to identify infants at risk for hearing loss and describe outcomes of infants screened.Design, Setting, and ParticipantsThis diagnostic study of a population-based screening program in Ontario, Canada, took place from July 29, 2019, to July 31, 2023. All newborns with a DBS sample collected as part of routine care were screened using polymerase chain reaction (PCR) analysis for cCMV as a risk factor for hearing loss. Infants with positive DBS PCR results for cCMV were referred for confirmation of infection by urine PCR (the gold standard), as well as complete medical and audiologic assessments for sequelae of cCMV infection. Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation for potential treatment with valganciclovir.ExposureDetection of cCMV by polymerase chain reaction assay on a newborn DBS.Main Outcomes and MeasuresNumber of infants with positive screening results successfully retrieved and confirmed to have cCMV and the timeliness of retrieval and symptomatic evaluation.ResultsOf 565 987 infants born in the screening period, 551 034 (97.4%) received cCMV screening on the DBS (45.7% female, 54.3% male). Of these infants, 689 (0.13%) screened positive for cCMV; 601 (87.2%) had cCMV infection confirmed and a complete assessment of sequelae of their congenital infection. Ninety-six infants with completed assessments (16.0%) were deemed to have cCMV symptoms, and 63 of these (65.6%) began valganciclovir treatment. Sensorineural hearing loss was confirmed in 34 of 96 infants (35.4%).Conclusions and RelevanceThis program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"74 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1001/jamapediatrics.2024.6402
Thomas M McMillan,Joseph A Schwartz,Huw Williams
{"title":"Childhood Traumatic Brain Injury and Crime in Adolescence.","authors":"Thomas M McMillan,Joseph A Schwartz,Huw Williams","doi":"10.1001/jamapediatrics.2024.6402","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6402","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1001/jamapediatrics.2024.6167
Jeffrey M. Eugene, Maria Nelson, Rebecca Neergaard, Emma Edmondson, Sarah Capponi, M. Christina Herrera, Judy A. Shea, Katherine Yun, Nicole Jaffe, Julie Premo, George Dalembert
This study explores the barriers and facilitators to pediatricians discussing safely navigating police interactions with Black youth and their caregivers.
本研究探讨了障碍和促进儿科医生讨论安全导航警察互动与黑人青年和他们的照顾者。
{"title":"Pediatrician Perspectives on Incorporating Discussion of Police Encounters Into Anticipatory Guidance for Black Youth and Their Caregivers","authors":"Jeffrey M. Eugene, Maria Nelson, Rebecca Neergaard, Emma Edmondson, Sarah Capponi, M. Christina Herrera, Judy A. Shea, Katherine Yun, Nicole Jaffe, Julie Premo, George Dalembert","doi":"10.1001/jamapediatrics.2024.6167","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6167","url":null,"abstract":"This study explores the barriers and facilitators to pediatricians discussing safely navigating police interactions with Black youth and their caregivers.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"36 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1001/jamapediatrics.2024.6161
Scott P Oltman, Elizabeth E Rogers, Laura L Jelliffe-Pawlowski
{"title":"Queries on Sudden Infant Death Syndrome-Reply.","authors":"Scott P Oltman, Elizabeth E Rogers, Laura L Jelliffe-Pawlowski","doi":"10.1001/jamapediatrics.2024.6161","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.6161","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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