Archives of pediatrics & adolescent medicine最新文献

Objective: To evaluate the long-term outcome of children with urinary tract infection (UTI).

Design: Follow-up examination 6 to 17 years after childhood UTI.

Setting: Secondary to tertiary referral center.

Patients: From an original population-based cohort of 1185 children with a history of UTI on whom both ultrasonography (US) and voiding cystourethrography had been performed between January 1, 1993, and December 31, 2003, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract to form a study cohort of 1161 patients. We took a stratified random sample of 228 patients for follow-up, and a total of 193 (85%) participated. Of the 193 participating patients, 103 (53%) had received antibiotic prophylaxis and 42 (22%) had undergone surgery.

Main exposure: Urinary tract infection.

Main outcome measures: Renal growth and parenchymal damage in US examination, kidney function, and blood pressure.

Results: Unilateral renal parenchymal defect was found in 22 of the 150 patients (15%) studied with US at follow-up, and unilateral kidney growth retardation was found in 5 patients (3%). All but 1 of the renal parenchymal defects seen on US were in patients with grade III to V vesicoureteral reflux. Despite the parenchymal defects seen on US, the serum cystatin C concentration, estimated glomerular filtration rate, and blood pressure were within the normal ranges in all patients.

Conclusions: The risk of long-term consequences from childhood UTI seems to be very low. Owing to the observational nature of our study, we cannot exclude the effects of the given treatment on the outcome of our patients.

Objective: To evaluate the relationship between the parenting style of an adolescent's peers' parents and an adolescent's substance use.

Design: Longitudinal survey.

Setting: Adolescents across the United States were interviewed at school and at home.

Participants: Nationally representative sample of adolescents in the United States.

Main exposure: Authoritative vs neglectful parenting style of adolescent's parents and adolescent's friends' parents and adolescent substance use.

Main outcome measures: Adolescent alcohol abuse, smoking, marijuana use, and binge drinking.

Results: If an adolescent had a friend whose mother was authoritative, that adolescent was 40% (95% CI, 12%-58%) less likely to drink to the point of drunkenness, 38% (95% CI, 5%-59%) less likely to binge drink, 39% (95% CI, 12%-58%) less likely to smoke cigarettes, and 43% (95% CI, 1%-67%) less likely to use marijuana than an adolescent whose friend's mother was neglectful, controlling for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. These results were only partially mediated by peer substance use.

Conclusions: Social network influences may extend beyond the homogeneous dimensions of own peer or own parent to include extradyadic influences of the wider network. The value of parenting interventions should be reassessed to take into account these spillover effects in the greater network.

Objective: To examine the independent and cumulative effects of past-year exposure to several different types of child victimization (peer victimization, witnessing family violence, community violence, sexual assault, and maltreatment) on suicidal ideation in a nationally representative sample of adolescents.

Design: The study used 2 waves of longitudinal data from the National Survey of Children's Exposure to Violence.

Setting: Conducted in 2008 and 2010 on the telephone with respondents from the contiguous United States.

Participants: National sample of 1186 youth aged 10 to 17 years in wave 1.

Main exposures: Peer victimization, sexual assault, witnessing family violence, exposure to community violence, and maltreatment by a parent/caregiver.

Outcome measure: Self-report suicidal ideation in the past month.

Results: Controlling for demographic characteristics, internalizing disorder diagnoses, and wave 1 suicidal ideation, findings showed independent effects of peer victimization, sexual assault, and maltreatment by a parent/caregiver on suicidal ideation at wave 2. The risk of suicidal ideation was 2.4 times greater among youth who experienced peer victimization in the past year, 3.4 times greater among those who were sexually assaulted, and 4.4 times greater among those exposed to maltreatment, relative to children who were not exposed to these types of victimization. Findings also showed substantial effects of polyvictimization (exposure to 7 or more individual types of victimization in the past year), with polyvictims almost 6 times more likely to report suicidal ideation.

Conclusion: Findings point to the importance of recent victimization in increasing risk of suicidal ideation in adolescents and suggest the need for victimization assessments among all youth who are believed to be at risk for suicidal ideation.