Archives of pediatrics & adolescent medicine最新文献

Objective: To determine whether the amount, type, and patterns of television viewing predict the onset or the persistence of externalizing problems in preschool children.

Design: Longitudinal study of a prospective population-based cohort in the Netherlands.

Setting: Parents reported time of television exposure and type of programs watched by children. Externalizing problems were assessed using the Child Behavior Checklist at 18 and 36 months.

Participants: A population-based sample of 3913 children.

Main exposure: Television viewing time, content, and patterns of exposure (at 24 and 36 months) in children with and without preexisting problems to assess the incidence and persistence of externalizing problems.

Main outcome measures: Externalizing problems at 36 months.

Results: Program content and time of television exposure assessed at 24 months did not predict the incidence of externalizing problems at 36 months (odds ratio, 2.24; 95% CI, 0.97-5.18). However, the patterns of exposure over time reflecting high levels of television viewing were associated with the incidence of externalizing problems (odds ratio, 2.00; 95% CI, 1.07-3.75) and the persistence of the preexisting externalizing problems (2.59; 1.03-6.55).

Conclusions: Our study showed that high television exposure increases the risk of the incidence and the persistence of externalizing problems in preschool children.

Objective: To examine the effects of different levels of goal specificity and difficulty on Latino children's performance and physical activity (PA) levels in an after-school program incorporating an interactive dance program (Dance Dance Revolution [DDR]; Konami Corporation).

Design: Comparison study.

Setting: Rose Park Elementary School, Salt Lake City, Utah.

Participants: Ninety-eight Latino children in the first through sixth grades, aged 7 to 13 years.

Intervention: After the pretest, the participants were randomly assigned into 1 of the following 3 goal-setting conditions: (1) easy, (2) difficult, and (3) best effort (hereinafter referred to as do-your-best goal).

Main outcome measures: Participants' PA levels were measured using piezoelectric pedometers, and steps per minute were used as the outcome variable. Participants' total points for their dance on television screens were retrieved as their performance scores. These outcome variables were assessed again 8 weeks later (posttest score).

Results: The multivariate analysis of covariance yielded a significant main effect for the goal-setting condition. Follow-up tests revealed that children who set specific (easy or difficult) goals had significantly greater increased PA levels (mean scores, 10.34 for easy and 22.45 for difficult) and DDR performance (0.011 for easy and 0.67 for difficult) than those in the do-your-best group (0.83 for PA and 0.17 for performance). In addition, children's increased PA levels in the difficult-goal group were significantly higher than those in the easy-goal group.

Conclusions: The easy- and difficult-goal groups show a significant improvement on DDR performance. The difficult- goal group also displays the highest improvement on PA levels. Strategies to enhance children's DDR performance and PA levels are discussed in relation to the extant goal-setting literature.

Objective: To describe pathogens identified through routine clinical practice and factors associated with identifying Shiga toxin-producing Escherichia coli (STEC) infection in patients with postdiarrheal hemolytic uremic syndrome (DHUS).

Design: Population-based active surveillance.

Setting: Hospitals in the FoodNet surveillance areas from 2000 through 2010.

Participants: Children younger than 18 years with DHUS.

Main exposures: Testing for STEC and demographic and clinical characteristics.

Main outcome measures: Percentage of patients with evidence of infection with likely HUS-causing agents and associations between exposures and evidence of STEC infection.

Results: Of 617 patients, 436 (70.7%) had evidence of infection with likely HUS-causing agents: STEC O157 (401 patients), non-O157 STEC (21 patients), O157 and non-O157 STEC (1 patient), Streptococcus pneumoniae (11 patients), and other pathogens (2 patients). Among patients without microbiological evidence of STEC, 76.9% of those tested had serologic evidence of STEC infection. Children more likely to have evidence of STEC infections included those patients tested for STEC less than 4 days after diarrhea onset, 12 months or older (71.6% vs 27.8% if <12 months of age), with infections as part of an outbreak (94.3% vs 67.3%), with bloody diarrhea (77.2% vs 40.4%), with onset during June through September (76.9% vs 60.1%), with a leukocyte count greater than 18 000/μL (to convert to ×10(9)/L, multiply by 0.001) (75.7% vs 65.3%), or with only moderate anemia (hemoglobin 7.0 g/dL [to convert to grams per liter, multiply by 10] or hematocrit greater than 20% [to convert to a proportion of 1, multiply by 0.01]) (75.1% vs 66.3%). However, many of these associations were weaker among children with thorough STEC testing.

Conclusions: Early stool collection for E coli O157 culture and Shiga toxin testing of all children with possible bacterial enteric infection will increase detection of STEC strains causing HUS. In the absence of microbiological evidence of STEC, serologic testing should be performed.