Lead Levels in High-risk and Low-risk Young Children in the Minneapolis-St Paul Metropolitan Area

PEDIATRICS ◽  
1998 ◽  
Vol 101 (1) ◽  
pp. 72-76 ◽  
Author(s):  
James Nordin ◽  
Sharon Rolnick ◽  
Ed Ehlinger ◽  
Andrew Nelson ◽  
Tom Arneson ◽  
...  
Keyword(s):  
High Risk ◽  
Young Children ◽  
Metropolitan Area ◽  
Low Risk ◽  
Lead Levels

scholarly journals Resistance to temptation in toddlers at genetic risk for autism spectrum disorder

Autism ◽  
2018 ◽  
Vol 23 (4) ◽  
pp. 1018-1027
Author(s):  
Susan B Campbell ◽  
Jessie B Northrup ◽  
Amy B Tavares
Keyword(s):  
Autism Spectrum Disorder ◽  
High Risk ◽  
Young Children ◽  
Self Regulation ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Low Risk ◽  
Spectrum Disorder ◽  
Typically Developing ◽  
High Risk Children

Children with autism spectrum disorder often demonstrate difficulties with self-regulation, although studies of this construct in young children with autism spectrum disorder are limited. In this study, developmental changes were examined using a measure of self-regulation appropriate for young children, resistance to temptation. At 22, 28, and 34 months, toddlers with an older sibling with autism spectrum disorder (high risk) and toddlers with typically developing older siblings (low risk) were presented with an appealing toy and instructed not to touch it. Observers coded whether or not children touched the toy and the strategies they used to resist touching it. At 36 months, children were assessed for autism spectrum disorder, yielding three groups: high risk children with autism spectrum disorder, high risk children without autism spectrum disorder, and low risk children. At 22 months, most children, regardless of group, touched the forbidden toy; at 28 and 34 months, many high risk children without autism spectrum disorder and low risk children resisted the temptation to touch the toy, whereas most of the children with autism spectrum disorder did not. Differences in delay strategies were also evident. Some, but not all group differences, were accounted for by differences in language ability. Results highlight one early index of impulse control that differentiates children with emerging autism spectrum disorder from age-mates prior to the third birthday.

Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children

2021 ◽  
pp. 153537022110144
Author(s):  
Tonny J Oyana ◽  
Jagila Minso ◽  
Tamekia L Jones ◽  
Jonathan A McCullers ◽  
Sandra R Arnold ◽  
...  
Keyword(s):  
Particulate Matter ◽  
High Risk ◽  
Metropolitan Area ◽  
Mean Value ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Viral Etiology ◽  
Risk Areas ◽  
The Mean ◽  
Particulate Matter Exposure

Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 μg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 μg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- ( n = 126) or low-risk ( n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.

Lead Poisoning Risk Determination in a Rural Setting

PEDIATRICS ◽  
1996 ◽  
Vol 97 (1) ◽  
pp. 84-90
Author(s):  
Stanley J. Schaffer ◽  
Martha S. Kincaid ◽  
Nathan Endres ◽  
Michael Weitzman
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Lead Poisoning ◽  
Blood Lead ◽  
Low Risk ◽  
Blood Lead Levels ◽  
Rural Children ◽  
Elevated Blood ◽  
Lead Levels ◽  
Elevated Blood Lead Levels

Objectives. To determine the prevalence of elevated blood lead levels among children living in a rural area and to determine the effectiveness of the Centers for Disease Control and Prevention (CDC) Lead Risk Assessment Questionnaire and additional questionnaire items in correctly identifying rural children having elevated blood lead levels. Research Design. Comparison of results of a questionnaire that is intended to identify children as being at low or high risk for lead poisoning with children's blood lead levels. Setting. The three practice sites of the only pediatric group in a rural county of upstate New York. Patients. A consecutive sample of 705 children ages 6 to 72 months who were seen for health supervision visits between June and September 1993. Results. Sixty-nine percent of the children were considered to be at high risk for lead poisoning by the CDC questionnaire. Overall, 8.4% of the children in the study had blood lead levels of 10 µg/dL (0.48 µmol/L) or higher, and 2.1% had blood lead levels of 15 µg/dL (0.72 µmol/L) or higher. No significant difference was noted between the percentages of high-and low-risk children who had elevated blood lead levels. To devise a more effective lead risk assessment tool for children in this setting, the two items from the CDC questionnaire and the two additional items that had the greatest predictive utility were combined to form a short alternative questionnaire. The alternative questionnaire thus consisted of items concerning whether the child has a sibling or playmate with lead poisoning, whether the child lives near an industry that potentially may release lead, whether the child lives in rented or owner-occupied housing, and whether the child has a parent who is a migrant farm worker. Children categorized as high risk with the alternative questionnaire were much more likely to have elevated blood lead levels than those who were categorized as low risk. The alternative questionnaire was very effective in correctly identifying children with elevated blood lead levels. Eighty-eight percent of children having blood lead levels of 10 µg/dL or higher and 100% of children having blood lead levels of 15 µg/dL or higher were classified as high risk by the questionnaire. Children classified as low risk were very unlikely to have elevated blood lead levels; 98% of low-risk children had blood lead levels of less than 10 µg/dL, and 100% had blood lead levels of less than 15 µg/dL. Conclusions. These results suggest that the CDC lead risk assessment questionnaire is of limited benefit in identifying rural children with blood lead levels 10 µg/dL or higher or 15 µg/dL or higher. An alternative questionnaire, however, seems to have marked clinical utility for identifying rural children with elevated blood lead levels.

Lead Poisoning Risk Determination in an Urban Population Through the Use of a Standardized Questionnaire

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Stanley J. Schaffer ◽  
Peter G. Szilagyi ◽  
Michael Weitzman
Keyword(s):  
High Risk ◽  
Lead Poisoning ◽  
Urban Poor ◽  
Office Visit ◽  
Blood Lead ◽  
Low Risk ◽  
Blood Lead Levels ◽  
Prior History ◽  
High Dose ◽  
Lead Levels

Background. The Centers for Disease Control and Prevention (CDC) has recommended using a five-item questionnaire at every regular office visit for all children 6 to 72 months of age to identify those at risk of high-dose exposure to lead. Objective. To determine how well the questionnaire identifies children with elevated lead levels. Research design. Comparison of results of the questionnaire, which is intended to identify children as being low-risk or high-risk for lead poisoning, with children's blood lead levels. Setting. A pediatric continuity clinic located in a major teaching hospital in Rochester, NY. Patients. A consecutive sample of 476 children aged 6 to 72 months without a prior history of lead poisoning who were seen in the clinic in July and August 1992, and who had not had a lead screen in the previous 6 months (for those aged &lt;36 months) or 12 months (for those aged 36 to 72 months). Measurements and main results. Fingerstick lead samples were obtained from all children, and those ≥15 µg/dL (0.72 µmol/L) were confirmed by subsequent venous lead determinations. Twenty-eight percent had blood lead levels ≥10 µg/dL (0.48 µmol/L), 8% had levels ≥15 µg/dL (0.72 µmol/L), and 5% had lead levels ≥20 µg/dL (0.96 µmol/L). According to responses on the questionnaire, 44% were initially classified as low-risk, and 43% were high-risk. In 13% risk could not be determined because one or more items on the questionnaire had not been answered or were answered equivocally, whereas all other items were answered "No." Children for whom risk could not be determined were presumed to be at high risk and were added to that category, resulting in 56% of the study population so designated. The questionnaire was moderately effective in identifying children with elevated lead levels. Seventy percent of children having lead levels ≥10 µg/dL (0.48 µmol/L) and 82% of children having lead levels ≥15 µg/dL (0.72 ≥mol/L) had been classified as high-risk by the questionnaire. Children classified as low-risk were very unlikely to have elevated lead levels. Eighty-one percent of low-risk children had lead levels &lt;10 µg/dL, and 97% had lead levels &lt;15 µl/dL. An abbreviated questionnaire using only the first three items from the CDC questionnaire had almost identical effectiveness. Conclusions. In this clinical setting, in which children are largely urban, poor, and have a moderate to high risk of developing elevated lead levels, the CDC risk assessment questionnaire is effective in identifying children with elevated lead burdens. However, an abbreviated version of the questionnaire may be as effective as the complete questionnaire. Additional questions should be added to the questionnaire to improve its overall sensitivity, and the questionnaire should be tested in other settings to see if it is effective with children having different environmental exposures to lead.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

Risk and resilience in high-risk samples: How to promote positive outcomes for young children

2010 ◽  
Author(s):  
Margo Candelaria ◽  
Kathy Katz ◽  
Anna Quigg ◽  
Sarah Oberlander ◽  
Margo Candelaria
Keyword(s):  
High Risk ◽  
Young Children ◽  
Positive Outcomes ◽  
Risk And Resilience

Individuals at high risk for suicide are categorically distinct from those at low risk.

2017 ◽  
Vol 29 (4) ◽  
pp. 382-393 ◽  
Author(s):  
Tracy K. Witte ◽  
Jill M. Holm-Denoma ◽  
Kelly L. Zuromski ◽  
Jami M. Gauthier ◽  
John Ruscio
Keyword(s):  
High Risk ◽  
Low Risk

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

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