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Objective To investigate the features of cardiorespiratory events in infants born preterm during the transitional period, and to evaluate whether different neonatal characteristics may correlate with event type, duration, and severity. Study design Infants with gestational age (GA) less then 32 weeks and/or birth weight less then 1500 g were enrolled in this observational prospective study. Heart rate (HR) and peripheral oxygen saturation (SpO2) were recorded continuously over the first 72 hours. Cardiorespiratory events of ≥10 seconds were clustered into isolated desaturation (SpO2 less then 85%), isolated bradycardia (HR less then 100 bpm or less then 70% of baseline), or combined desaturation/bradycardia and classified as mild, moderate, or severe. The daily incidences of isolated desaturation, isolated bradycardia, and combined desaturation and bradycardia were analyzed. The effects of relevant clinical variables on cardiorespiratory event type and severity were assessed using generalized estimating d clinical approach may reduce the hypoxic burden in preterm infants aged 0-72 hours.Objectives To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method. Study design A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on BP in neonates less then 3 months of age (PROSPERO ID CRD42018092886). SPOPi6lc Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods. Results Of 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure less then 30 mm Hg. Conclusions Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.Objectives To describe patterns of overall, within-household, and community adverse childhood experiences (ACEs) among children in vulnerable neighborhoods and to identify which individual ACEs, over and above overall ACE level, predict need for behavioral health services. Study design This was a cross-sectional study that used a sample of 257 children ages 3-16 years who were seeking primary care services with co-located mental healthcare services at 1 of 2 clinics in Chicago, Illinois. The outcome variable was need for behavioral health services (Pediatric Symptom Checklist score ≥28). The independent variables were ACEs, measured with an adapted, 28-item version of the Traumatic Events Screening Inventory. Results Six ACE items were individually predictive of a clinical-range Pediatric Symptom Checklist score after adjusting for sociodemographic covariates emotional abuse or neglect (OR 2.93, 95% CI 1.32-6.52, P less then .01), natural disaster (OR 3.89, 95% CI 1.18-12.76, P = .02), forced separation from a parent or caregiver (OR 2.95, 95% CI 1.50-5.83, P less then .01), incarceration of a family member (OR 2.43, 95% CI 1.20-4.93, P = .01), physical attack (OR 2.84, 95% CI 1.32-6.11, P less then .01), and community violence (OR 2.35, 95% CI 1.18-4.65, P = .01). After adjusting for overall ACE level, only 1 item remained statistically significant forced separation from a parent or caregiver (OR 2.44, 95% CI 1.19-5.01, P = .02). Conclusions ACEs that disrupt attachment relationships between children and their caregivers are a significant predictor of risk for child emotional or behavioral problems.Objective To assess the role of trust when adolescents search for and appraise online health information. Study design A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, and ERIC) was performed. Google Scholar and reference lists for included studies were manually searched for additional articles. Studies were included if they examined the role of trust when adolescents (in the 13- to 18-year-old age range) searched for and/or appraised online health information. Findings were synthesized using thematic analysis. Results There were 22 studies that met the inclusion criteria. Four key themes were identified adolescents generally distrust the Internet but use it anyway (subthemes were why adolescents distrust online health information; why adolescents still use online health information), adolescents use heuristics to appraise the trustworthiness of online health information (subthemes were different heuristics used by different adolescents, range of heuristics used by adolescents), adolescents trust websites more than social media or social networking sites, and adolescents' level of trust in online health information guides their actions and responses. Conclusions Adolescents often distrust health information from the Internet, but continue to use it. Adolescents are aware of the need to evaluate the trustworthiness of online health information; however, their approaches vary in sophistication. As the reach and content of the Internet expands, it is important to equip adolescents with effective eHealth literacy to assess the trustworthiness of online health information.Objective To determine the interobserver agreement of history and physical examination findings in children undergoing evaluation in the emergency department (ED) for headaches. Study design We conducted a prospective, cross-sectional study of children aged 2-17 years evaluated at 3 tertiary-care pediatric EDs for non-traumatic headaches. Two clinicians independently completed a standardized assessment of each child and documented the presence or absence of history and physical examination variables. Unweighted κ statistics were determined for 68 history and 24 physical examination variables. Results We analyzed 191 paired observations; median age was 12 years, with 19 (9.9%) children younger than 7 years. Interrater reliability was at least moderate (κ ≥ 0.41) for 41 (60.3%) patient history variables. Eleven (61.1%) of 18 physical examination variables for which κ statistics could be calculated had a κ that was at least moderate. Conclusions A substantial number of history and physical examination findings demonstrated at least moderate κ statistic values when assessed in children with headaches in the ED.
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