Anemia and statural growth impairment are both prevalent in children with nonglomerular chronic kidney disease (CKD) and are associated with poor quality of life and increased morbidity and ...mortality. However, to date no longitudinal studies have demonstrated a relationship between anemia and statural growth in this population.
The CKD in Children (CKiD) study is a multicenter prospective cohort study with over 15 years of follow-up observation.
CKiD participants younger than 22 years with nonglomerular CKD who had not reached final adult height.
Age-, sex-, and race-specific hemoglobin z score.
Age- and sex-specific height z score.
The relationship between hemoglobin and height was quantified using (1) multivariable repeated measures paired person-visit analysis, and (2) multivariable repeated measures linear mixed model analysis. Both models were adjusted for age, sex, body mass index, estimated glomerular filtration rate, acidosis, and medication use.
Overall, 67% of the 510 participants studied had declining hemoglobin z score trajectories over the follow-up period, which included 1,763 person-visits. Compared with average hemoglobin z scores of≥0, average hemoglobin z scores of less than −1.0 were independently associated with significant growth impairment at the subsequent study visit, with height z score decline ranging from 0.24 to 0.35. Importantly, in 50% of cases hemoglobin z scores of less than −1.0 corresponded to hemoglobin values higher than those used as cutoffs defining anemia in the KDIGO clinical practice guideline for anemia in CKD. When stratified by age, the magnitude of the association peaked in participants aged 9 years. In line with paired-visit analyses, our mixed model analysis demonstrated that in participants with baseline hemoglobin z score less than −1.0, a hemoglobin z score decline over the follow-up period was associated with a statistically significant concurrent decrease in height z score.
Limited ability to infer causality.
Hemoglobin decline is associated with growth impairment over time in children with mild to moderate nonglomerular CKD, even before hemoglobin levels reach the cutoffs that are currently used to define anemia in this population.
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Background
We investigated the putative associations of alcohol, cigarette, e-cigarette, and marijuana use with kidney function and proteinuria among adolescents and young adults (AYA) with ...pediatric-onset chronic kidney disease (CKD) enrolled in the Chronic Kidney Disease in Children (CKiD) study.
Methods
Participants responded to questions about past year and 30-day substance use. Associations between each substance and kidney function, proteinuria, nephrotic range proteinuria, and high blood pressure were separately estimated using repeated measures regression models, adjusting for sociodemographic characteristics. Models controlled for covariates at the present visit (contemporaneous) and additionally controlled for disease severity at the year prior to reporting substance use (lagged).
Results
A total of 441 participants ≥16 years contributed 1,245 person-visits with 39% reporting alcohol and 16%, 17%, and 15% reporting cigarette, e-cigarette, and marijuana use, respectively, over the previous year. In adjusted lagged models, past year and 30-day cigarette use were significantly associated with higher levels of proteinuria (+18.6%, 95%CI: +2.8%, +36.9%; and +20.0%, 95%CI: +0.7%, +43.1%, respectively). Inferences were similar when controlling for secondhand smoke exposure.
Conclusions
In a cohort of AYA with pediatric kidney diseases, substance use was non-trivial, and cigarette use was associated with higher proteinuria, although the prevalence of use was low. Occasional alcohol, e-cigarette, and marijuana use were not associated with proteinuria, disease progression, or elevated blood pressure. Pediatric nephrologists as specialty care providers are well-positioned to discuss substance use and should encourage tobacco prevention/treatment efforts among AYA at high risk for use in order to preserve kidney function and promote well-being.
The implementation of last-minute work scheduling practices, including fluctuations in work hours, shift cancellations, and short notice, reflects a new norm in employment in the United States. This ...study aimed to investigate whether work schedule notice of ≤2 weeks was associated with high depressive symptoms. We used data from the 2019 cycle of the National Longitudinal Survey of Youth 1997 (N = 4963 adults aged 37–42 years). Using adjusted gender-stratified modified Poisson models, we tested the association between schedule notice (≤2 weeks, >2 weeks, consistent scheduling) and high depressive symptoms. Presence of high depressive symptoms was assessed using the 7-item Center for Epidemiologic Studies Depression (CES-D) Short-Form scale and defined as CES-D-SF ≥8. Respondents reporting >2 weeks schedule notice (versus ≤2 weeks) were disproportionately non-Hispanic Black or Hispanic and resided in the South and/or in a rural area. High depressive symptoms were 39% more prevalent among women with schedule notice of ≤2 weeks compared to those with >2 weeks notice (Prevalence Ratio PR: 1.39, 95% Confidence Interval (CI): 1.07, 1.80). We did not observe an association among men (PR: 1.06, 95% CI: 0.75, 1.50). Schedule notice of ≤2 weeks was associated with a greater burden of high depressive symptoms among US women. Policies to reduce precarious work scheduling practices should be further evaluated for their impacts on mental health.
•Last-minute work scheduling practices across all industries reflect a new norm in employment in the US.•Non-Hispanic Black or Latinx respondents disproportionately report more last minute work scheduling notice.•Schedule notice of ≤2 weeks was associated with a greater burden of depressive symptoms among women in the US.
Purpose: This study aimed to describe substance use (SU) among adolescents and young adults (AYA) with chronic kidney disease, compare these findings with the general population, and identify ...associated risk factors.
Methods: 708 AYA participants contributing 2475 person-visits from the Chronic Kidney Disease in Children Study were used to estimate prevalence rates of past year and 30-day alcohol, cigarette, e-cigarette and marijuana use, and were compared with national surveys. Repeated measures logistic regression estimated the association between SU and participant characteristics.
Results: There was nearly no SU among those 12 to 14 years, but use increased with age, and past year alcohol use was about 80% for those greater than or equal to 22 years. Rates of use among males were constant or increased with age, while rates of use among females were lower after age 22 compared to ages 18 to 22. Associated risk factors included non-Black and non-Hispanic identity, older age, and worse disease severity. Participants were less likely to use substances compared to the general population, especially those 14–18 years.
Conclusions: SU was less common in AYA with chronic kidney disease than the general population, but differences were attenuated among those greater than or equal to 18 years. Ages 12–14 appear to be the ideal time for prevention efforts. As the landscape of e-cigarette and marijuana policies change, these results underscore the need to understand how similar high-risk populations engage in SU.
Abstract
The coronavirus disease 2019 (COVID-19) pandemic thrust the field of public health into the spotlight. For many epidemiologists, biostatisticians, and other public health professionals, this ...caused the professional aspects of our lives to collide with the personal, as friends and family reached out with concerns and questions. Learning how to navigate this space was new for many of us and required refining our communication style depending on context, setting, and audience. Some of us took to social media, utilizing our existing personal accounts to share information after sorting through and summarizing the rapidly emerging literature to keep loved ones safe. However, those in our lives sometimes asked unanswerable questions, or began distancing themselves when we suggested more stringent guidance than they had hoped for, causing additional stress during an already traumatic time. We often had to remind ourselves that we were also individuals experiencing this pandemic and that our time-intensive efforts were meaningful, relevant, and impactful. As this pandemic and other public health crises continue, we encourage members of our discipline to consider how we can best use shared lessons from this period and to recognize that our professional knowledge, when used in our personal lives, can promote, protect, and bolster confidence in public health.
Social influence can shape early childhood at different levels. We explored the association between social vulnerability and lifetime caregiver alcohol use with children’s psychiatric symptoms. ...Multivariable logistic regression assessed the association between child psychiatric symptoms and social vulnerability among 1275 preschool child-caregiver pairs with lifetime caregiver alcohol used as a control variable. Of the children, 15.78% (95% CI 15.17–16.42) had internalizing symptoms, 2.49% (95% CI 2.19–2.83) had externalizing symptoms, and 9.36% (95% CI 8.88–9.86) had internalizing/externalizing symptoms. High social vulnerability was positively correlated with internalizing (aRRR 1.54; 95% CI 1.41–1.68) and internalizing/externalizing symptoms (aRRR 1.77; 95% CI 1.58–2.00). Low family support was strongly associated with internalizing/externalizing symptoms (aRRR 2.60; 95% CI 2.20–3.10). Lifetime caregiver alcohol use was positively correlated with all three psychiatric symptoms (aRRR 1.33; 95% CI 1.18–1.51; aRRR 1.13; 95% CI 1.06–1.59; and aRRR 1.26; 95% CI 1.12–1.42). Their association with children’s mental health outcomes calls for social policy changes at the macrosystem level.
This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged children.
Data from children ...aged 4 to 5 years and their primary caregivers in Embu das Artes, a Brazilian municipality in the state of São Paulo, were collected in 2016. Maternal pregnancy intention was defined as intended or unintended, which was then further stratified as mistimed or unwanted. Outcomes included socioemotional developmental delay, internalizing and externalizing behaviors, and school readiness. We estimated risk ratios (RRs) for unadjusted and inverse-probability-weighted regression adjustment (IPWRA) analyses using 2-level (intended vs unintended) and 3-level (intended vs mistimed vs unwanted) exposure definitions.
Of 1,034 total mothers, 40.7% reported their pregnancy as intended, 46.0% as mistimed, and 13.4% as unwanted. In both unadjusted and IPWRA analyses comparing intended and unintended pregnancies, all associations failed to reach statistical significance. In the IPWRA analysis using the 3-level exposure definition, unwanted pregnancies were associated with higher risk of socioemotional developmental delay (RR = 1.14; 95% confidence interval CI, 1.01-1.28) and co-occurring internalizing and externalizing behaviors (RR = 1.11, 95% CI, 1.00-1.22), compared with intended pregnancies.
There was higher risk of poor child outcomes among unwanted compared with intended pregnancies, whereas mistimed pregnancies were not associated with poor outcomes. Further research using standardized definitions of pregnancy intention along with targeted interventions that increase access to family planning services and counseling for parents of children born after unintended pregnancies is needed.
Barriers to early childhood development (ECD) are a global concern. Limited research exists on prenatal smoking and ECD in vulnerable populations, especially as it relates to school readiness (SR).
...To examine how maternal cigarette use during pregnancy is associated with SR in a sample of Brazilian preschool-age children.
We used the Brazilian Preschool Mental Health Study, a cross-sectional, epidemiological study of preschool-age children in Embu das Artes, São Paulo. SR was assessed using the Engle Scale of Child Development (ESCD). We restricted analyses to biological mothers, who represented 81.9% (n = 591) of the total 722 with ESCD data. Logistic regression models, adjusting for birth and child characteristics (year of preschool, sex, race, history of head trauma, coma, convulsions or epilepsy), sociodemographic factors and school environment, were used to estimate odds ratios and 95% confidence intervals.
Prenatal smoking was negatively associated with SR. Children of mothers who smoked during pregnancy were more likely to be in the lowest ESCD quartile (aOR = 1.26, 95%CI: 1.02–1.55) compared to those of non-smoking mothers, and each cigarette resulted in additional risk (aOR = 1.03, 95%CI:1.01–1.05). Children of heavy smokers had worse ESCD scores compared to children of non-smokers (aOR = 1.69, 95%CI:1.18–2.44), as well as when compared to children of moderate and non-smokers combined (aOR = 1.77, 95%CI:1.22–2.57). This relationship was not seen when comparing children of moderate smokers to children of non-smokers. Inferences were robust when examining very heavy smoking.
Maternal tobacco use during pregnancy may affect child SR. Additional studies in other populations are needed to corroborate these results.
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