Digital Commons Network^™

Impact Of Pediatric Obesity On Diurnal Blood Pressure Assessment And Cardiovascular Risk Markers, Margaret O. Murphy, Hong Huang, John A. Bauer, Aric Schadler, Majd Makhoul, Jody L. Clasey, Aftab S. Chishti, Stefan G. Kiessling

Pediatrics Faculty Publications

Background: The prevalence of hypertension is increasing particularly among obese children and adolescents. Obese children and adolescents with hypertension are likely to remain hypertensive as they reach adulthood and hypertension is linked to an increased risk for cardiovascular disease. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has become one of the most important tools in diagnosing hypertension in children and adolescents and circadian patterns of blood pressure may be important disease-risk predictors.

Methods: A retrospective chart review was conducted in patients aged 6–21 years who underwent 24-h ABPM at Kentucky Children's Hospital (KCH) from August 2012 through June 2017. Exclusion criteria …

Vitamin D Supplementation Among Bangladeshi Children Under-Five Years Of Age Hospitalised For Severe Pneumonia: A Randomised Placebo Controlled Trial, Fahmida Chowdhury, Abu Sadat Mohammad Sayeem Bin Shahid, Mosharrat Tabassum, Irin Parvin, Probir Kumar Ghosh, Mohammad Iqbal Hossain, Nur Haque Alam, A. S. G. Faruque, Sayeeda Huq, Lubaba Shahrin, Nusrat Homaira, Zakiul Hassan, Zubair Akhtar, S. Mah-E-Muneer, George J. Fuchs Iii, Tahmeed Ahmed, Mohammod Jobayer Chisti

Pediatrics Faculty Publications

INTRODUCTION: Vitamin D is important for its immunomodulatory role and there is an independent association between vitamin D deficiency and pneumonia. We assessed the effect of vitamin D supplementation on the outcome in children hospitalized for severe pneumonia.

METHODS: This was a randomised, double blinded, placebo-controlled clinical trial in children aged >2–59 months with severe pneumonia attending Dhaka Hospital, icddr,b. Children received age-specific megadose of vitamin D3 (20,000IU: < 6 months, 50,000 IU: 6–12 months, 100,000 IU:13–59 months) or placebo on first day and 10,000 IU as maintenance dose for next 4 days or until discharge (if discharged earlier) along with standard therapy. This trial is registered at ClinicalTrials.gov, number NCT02185196.

FINDINGS: We enrolled 100 children in placebo group and 97 in vitamin D group. On admission, 50 (52%) and 49 (49%) of children in vitamin D and placebo groups, respectively were vitamin …

Low-Dose Antithymocyte Globulin Has No Disadvantages To Standard Higher Dose In Pediatric Kidney Transplant Recipients: Report From The Pediatric Nephrology Research Consortium, Isa F. Ashoor, Robbie A. Beyl, Charu Gupta, Amrish Jain, Stefan G. Kiessling, Asha Moudgil, Hiren P. Patel, Joseph Sherbotie, Donald J. Weaver Jr., Rima S. Zahr, Vikas R. Dharnidharka

Pediatrics Faculty Publications

Introduction
Rabbit antithymocyte globulin (rATG) dosing strategies for induction in pediatric kidney transplantation vary between centers. It is not known whether a lower rATG induction dose provides safe and effective immunosuppression compared with a “standard” higher dose.

Methods
We performed a retrospective multicenter study of all isolated first-time kidney transplant recipients < 21 years old who received rATG induction between 1 January 2010 and 31 December 2014 at 9 pediatric centers. An a priori cutoff of a 4.5-mg/kg cumulative rATG dose was used to identify low (≤ 4.5 mg/kg) and standard (> 4.5 mg/kg) exposure groups. Outcomes examined included 12 months posttransplant graft function (estimated glomerular filtration rate [eGFR]); the occurrence of acute rejection, donor-specific antibody (DSA), neutropenia, and viral infection …

General Education Learning Outcomes And Demographic Correlates In University Students In Hong Kong, Lu Yu, Daniel T. L. Shek, Xiaoqin Zhu

Pediatrics Faculty Publications

Although there are studies showing that higher education would benefit university students, empirical research that comprehensively assesses student general education learning outcomes and related demographic correlates based on longitudinal data is minimal, especially in the Chinese context. To address the research gaps, the present study was conducted to investigate learning outcomes amongst university students in one university in Hong Kong based on a four-year longitudinal design (N = 460). Four dimensions of student general education learning outcomes were measured, including effective reasoning and problem solving, leadership, moral character, and integration of learning. Results suggested a U-shaped pattern of student …

Bronchopulmonary Dysplasia: Comparison Between The Two Most Used Diagnostic Criteria, Enrique Gomez Pomar, Vanessa A. Concina, Aaron Samide, Philip M. Westgate, Henrietta S. Bada

Pediatrics Faculty Publications

Objectives: To compare the Shennan's and the consensus definition of Bronchopulmonary Dysplasia (BPD) from the National Institutes of Health (NIH) workshop and analyze specific risk factors associated with each definition.

Study design: Retrospective analysis of records of 274 infants admitted to a level IV intensive care unit. Infants were classified as having BPD or no BPD by both definitions. Differences in incidence and risk factors were analyzed. Statistical methods included descriptive statistics, comparative tests, and marginal logistic regression modeling.

Results: The estimated difference in prevalence was 32% [95% CI: (26%, 37%), (p < 0.0001)] between both criteria. The prevalence of BPD was 80% higher based on the NIH criteria [RR = 1.80; 95% CI: (1.58, 2.06)]. Infants with no BPD by the Shennan definition were breathing room air with or without positive or continuous pressure support and were most likely to be discharged home on oxygen [OR = 4.47, 95% CI: (1.20, 16.61), p = 0.03]. Gestational age, birth weight, …

Blood Transfusions In Preterm Infants: Changes On Perfusion Index And Intermittent Hypoxemia, Katrina T. Ibonia, Henrietta S. Bada, Philip M. Westgate, Enrique Gomez Pomar, Prasad Bhandary, Abhijit R. Patwardhan, Elie G. Abu Jawdeh

Pediatrics Faculty Publications

BACKGROUND

Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH.

STUDY DESIGN AND METHODS

We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO₂) …

Testing Longitudinal Relationships Between Internet Addiction And Well-Being In Hong Kong Adolescents: Cross-Lagged Analyses Based On Three Waves Of Data, Lu Yu, Daniel T. L. Shek

Pediatrics Faculty Publications

Using a panel design, this study examined the prospective relationships between Internet addiction and life satisfaction as well as hopelessness in a representative sample of Hong Kong adolescents. Starting from 2009/10 academic year, 3328 Secondary 1 students in 28 secondary schools in Hong Kong participated in this longitudinal study (Mean age = 12.59 years; SD = 0.74 years). All participants responded to a questionnaire that includes the Internet Addiction Test, Life Satisfaction Scale, and Hopelessness Scale on a yearly basis. Cross-lagged analyses based on three waves of data collected during three junior adolescent years showed that Internet addiction measured at …

The Influence Of Parental Control And Parent-Child Relational Qualities On Adolescent Internet Addiction: A 3-Year Longitudinal Study In Hong Kong, Daniel T. L. Shek, Xiaoqin Zhu, Cecilia M. S. Ma

Pediatrics Faculty Publications

This study investigated how parental behavioral control, parental psychological control, and parent-child relational qualities predicted the initial level and rate of change in adolescent internet addiction (IA) across the junior high school years. The study also investigated the concurrent and longitudinal effects of different parenting factors on adolescent IA. Starting from the 2009/2010 academic year, 3,328 Grade 7 students (M_age = 12.59 ± 0.74 years) from 28 randomly selected secondary schools in Hong Kong responded on a yearly basis to a questionnaire measuring multiple constructs including socio-demographic characteristics, perceived parenting characteristics, and IA. Individual growth curve (IGC) analyses …

Self-Reported Risk And Delinquent Behavior And Problem Behavioral Intention In Hong Kong Adolescents: The Role Of Moral Competence And Spirituality, Daniel T. L. Shek, Xiaoqin Zhu

Pediatrics Faculty Publications

Based on the six-wave data collected from Grade 7 to Grade 12 students (N = 3,328 at Wave 1), this pioneer study examined the development of problem behaviors (risk and delinquent behavior and problem behavioral intention) and the predictors (moral competence and spirituality) among adolescents in Hong Kong. Individual growth curve models revealed that while risk and delinquent behavior accelerated and then slowed down in the high school years, adolescent problem behavioral intention slightly accelerated over time. After controlling the background socio-demographic factors, moral competence and spirituality were negatively associated with risk and delinquent behavior as well as problem …

The Influence Of Personal Well-Being On Learning Achievement In University Students Over Time: Mediating Or Moderating Effects Of Internal And External University Engagement, Lu Yu, Daniel T. L. Shek, Xiaoqin Zhu

Pediatrics Faculty Publications

The current study examined the relationship between students' personal well-being and their learning achievement during university study, and whether such relationship would be mediated or moderated by university engagement. A total of 434 university students from one public university in Hong Kong participated in the study. The participants completed an online survey consisting of personal well-being (cognitive behavioral competence and general positive youth development), university engagement, and learning achievement measures (personal growth, and accumulated GPA as academic achievement) at four time points with a 1-year interval. Results showed that personal well-being measured at the beginning of university study positively predicted …

Prenatal Opioid Exposure And Intermittent Hypoxemia In Preterm Infants: A Retrospective Assessment, Elie G. Abu Jawdeh, Philip M. Westgate, Amrita Pant, Audra L. Stacy, Divya Mamilla, Aayush Gabrani, Abhijit R. Patwardhan, Henrietta S. Bada, Peter J. Giannone

Pediatrics Faculty Publications

Introduction: Intermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO₂). Preterm infants are at increased risk for IH due to their immature respiratory control/apnea of prematurity. The clinical relevance of IH is a relatively new observation with rising evidence linking IH to neonatal morbidities and long-term impairment. Hence, assessing factors that influence IH in preterm infants is imperative. Given the epidemic of opioid misuse in the USA, there is an urgent need to understand the impact of prenatal opioid exposure on neonatal outcomes. Hence, we wanted to assess the relationship between isolated prenatal opioid exposure …

Plasma Brain-Derived Neurotrophic Factor Levels In Newborn Infants With Neonatal Abstinence Syndrome, Lochan Subedi, Hong Huang, Amrita Pant, Philip M. Westgate, Henrietta S. Bada, John A. Bauer, Peter J. Giannone, Thitinart Sithisarn

Pediatrics Faculty Publications

Background: Brain-derived neurotrophic factor (BDNF) is a type of growth factor that promotes growth and survival of neurons. Fetal exposure to opiates can lead to postnatal withdrawal syndrome, which is referred as neonatal abstinence syndrome (NAS). Preclinical and clinical studies have shown an association between opiates exposure and alteration in BDNF expression in the brain and serum levels in adult. However, to date, there are no data available on the effects of opiate exposure on BDNF levels in infant who are exposed to opiates in utero and whether BDNF level may correlate with the severity of NAS.

Objective: To compare …

Secondhand Smoke Exposure And Preclinical Markers Of Cardiovascular Risk In Toddlers, Judith A Groner, Hong Huang, Mandar S. Joshi, Nicholas Eastman, Lisa Nicholson, John Anthony Bauer

Pediatrics Faculty Publications

Objective: Links between secondhand smoke (SHS) exposure and cardiovascular disease in adults are well established but seldom reported during childhood. Although rates of smoking have decreased, young children from low-income backgrounds remain likely to be exposed to SHS. The purpose of this study was to investigate relationships between SHS exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations.

Methods: 139 children, 2–5 years of age, were enrolled in a cross-sectional study. SHS exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (AM blood pressure, …

Negative Outcomes Of Teen Sexual Activity: A Review, Hannah Latta, Hatim A. Omar, Said Shahtahmasebi

Pediatrics Faculty Publications

A recent victory with respect to teen sexual behavior is the reduction of the national teen birthrate. In 1991, there were 61.8 births per 1000 females aged 15-19. By 2014, this rate plummeted to 24.2 births per 1000 adolescent females. Averages, however, do not reflect state-level variation. For example, in 2014, Kentucky reported 35.3 births per 1000 adolescent females, while New York reported a teen birth rate of 16.1 births per 1000 adolescent females. In this paper divergent outcomes in teen sexual behavior are reviewed which are likely due to numerous factors including socioeconomic status, educational attainment, and history of …

The Effects Of Perinatal Oxycodone Exposure On Behavioral Outcome In A Rodent Model, Thitinart Sithisarn, Sandra J. Legan, Philip M. Westgate, Melinda E. Wilson, Kristen Wellmann, Henrietta S. Bada, Susan Barron

Pediatrics Faculty Publications

Opiate addiction is now a major public health problem. Perinatal insults and exposure to opiates such as morphine in utero are well known to affect development of the hypothalamic–pituitary–adrenal axis of the offspring adversely and are associated with a higher risk of developing neurobehavioral problems. Oxycodone is now one of the most frequently abused pain killers during pregnancy; however, limited data are available regarding whether and how perinatal oxycodone exposure (POE) alters neurobehavioral outcomes of the offspring. We demonstrated that exposure to 0.5 mg/kg/day oxycodone in utero was associated with hyperactivity in adult rats in an open field. No significant …

Evaluation Of A Community-Based Positive Youth Development Program In Hong Kong: Views Of Program Implementers, Daniel T. L. Shek, Cecilia M. S. Ma, Xiaoqin Zhu

Pediatrics Faculty Publications

Using a subjective outcome evaluation method, the current study investigated program implementers’ perceptions of the Tier 1 Program of the community-based P.A.T.H.S. Project in Hong Kong. After completion of the program, 599 program implementers completed a valid and reliable scale (i.e. Form B) to give their ratings on program content, their own performance, and perceived program effectiveness. As expected, most program implementers perceived the program in a favorable way by giving very positive ratings on the three aspects measured in Form B. Grade differences on the ratings were observed, with implementers teaching the senior curriculum held more positive views on …

Association Between School Performance And Body Mass Index, Megan Rajagopal, Alissa Briggs, Hatim A. Omar

Pediatrics Faculty Publications

The purpose of this paper is to determine the relationship between grade point average and other factors, including: body mass index, exercise habits, and weight perception. Data from School-Based Health Promotion Centers (SBHC) were used for this study. Students in sixth, seventh, and eighth grades were screened at the SBHC for a variety of behaviors and lifestyle characteristics using the Perkins Adolescent Risk Screen (PARS). Data from a total 579 students (281 males and 298 females; 278 sixth graders, 151 seventh graders, and 150 eight graders) were obtained. Of these students, 145 were underweight, with a BMI less than 18.5; …

Individual Differences In Intentional And Unintentional Exposure To Online Pornography Among Hong Kong Chinese Adolescents, Cecilia M. S. Ma, Daniel T. L. Shek, Catie C. W. Lai

Pediatrics Faculty Publications

The current study aimed to test how gender and religion affect unintentional and intentional exposure to online pornography in Chinese adolescents. A total of 1401 secondary school students (age range from 11 to 16 years) participated in the study. Findings from multivariate analyses show that males reported higher levels of unintentional and intentional exposure to online pornography than females. Significant differences were found in adolescents’ religiosity, with students who had religious beliefs reporting a lower level of unintentional exposure to online pornography than their counterparts without religious beliefs. In terms of intentional exposure to online pornography, adolescents were more likely …

Individual And Family Protective Factors Of Intentional And Unintentional Consumption Of Online Pornography In Hong Kong, Cecilia M. S. Ma, Daniel T. L. Shek, Catie C. W. Lai

Pediatrics Faculty Publications

The purpose of the current study was to explore how positive youth development and family functioning were related to unintentional and intentional exposure to online pornography in Chinese adolescents. A total of 1401 secondary school students (mean age=12.43) participated in the study. Findings suggested that positive youth development and family functioning were associated with lower exposure to online pornography. In particular, higher levels of spirituality, social competence, mutuality and communication were associated with lower levels of both types of exposure to online pornography. Discussion focuses on the importance of promoting positive youth development and family functioning as protective factors against …

Psychological Needs, Self-Regulation, And Motivation Profiles Among A Sample Of Hong Kong Chinese University Students: A Person-Centered Approach, Cecilia M. S. Ma, Daniel T. L. Shek, Catie C. W. Lai

Pediatrics Faculty Publications

To better understand factors that influence individuals’ motivation to engage in physical activity, this study aimed to identify the motivational profiles among the Chinese university students, compare the motivational profiles between genders, and explore whether satisfaction of various psychological needs vary with different motivational profiles. Two thousand and twenty-two Chinese university students completed a battery of self-report questionnaires assessing motivation regulation and psychological needs satisfaction. Three motivational profiles were identified for both genders. The overall patterns of the motivational profiles for both genders were similar. However, males (44%) were more likely than their female counterparts (19%) in self-determined profile group. …

Hope, Aspirations, And Resilience In Children And Adolescents: A Review Of Research On Measurement And Related Antecedents, Hildie Leung, Florence K. Y. Wu, Daniel T. L. Shek

Pediatrics Faculty Publications

Hope, aspirations, and resilience are important developmental assets for children and adolescents. Based on the existing Western and Chinese literature, this review aims to identify instruments used to assess hope, aspirations, resilience, and conceptually related constructs as well as antecedents of the constructs in adolescents. A systematic literature search in the major databases was conducted. A total of 223 articles, with 144 being retrieved from international databases and 79 from China’s database, met the criteria and were included in the present review. Findings revealed that the majority of the existing scales were developed predominantly in the West and there were …

Dreams, Aspirations And Related Constructs In Children And Adolescents: A Literature Review, Daniel T. L. Shek, Florence K. Y. Wu, Hildie Leung

Pediatrics Faculty Publications

Although children and adolescents are often asked about their “dreams” about life, scientific studies of “dreams” and related constructs are grossly inadequate. This paper describes the findings arising from a review study exploring the concepts of dreams, aspirations and related constructs in children and adolescents. Besides an overview of the concept of dream, conceptual features and unique underpinnings of other concepts commonly related to dream, such as “aspirations”, “hope”, “future orientation” and “resilience” are presented in this paper. The research questions surrounding “dream” and related constructs in children and adolescents are presented and future research directions are discussed.

Dreams, Aspirations And Related Behavior In Children And Adolescents: Impacts On Child Developmental Outcomes, Florence K. Y. Wu, Daniel T. L. Shek, Hildie Leung

Pediatrics Faculty Publications

“Dreams”, “aspirations” and related constructs are traditionally regarded as facilitators of adolescent educational attainment in the Chinese context. Besides, there is an emergent need to widen the understanding of such constructs and their impact on children and adolescent developmental outcomes. This paper discusses the developmental outcomes of dreams, aspiration and related concepts based on a thorough review of the literature. Besides outlining the impacts of aspirations, dreams and related constructs on children and adolescents, features of related intervention programs, including themes of the intervention programs, program participants, methods of implementation and evaluation in both Western and Chinese contexts are also …

Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Abstract: Premature children are prone to severe viral respiratory infections in early life, but the age at which susceptibility peaks and disappears for each pathogen is unclear. Methods: A retrospective analysis was performed of the age distribution and clinical features of acute viral respiratory infections in full-term and premature children, aged zero to seven years. Results: The study comprised of a total of 630 hospitalizations (n = 580 children). Sixty-seven percent of these hospitalizations occurred in children born full-term (> 37 weeks), 12% in preterm (32–37 weeks) and 21% in severely premature children (< 32 weeks). The most common viruses identified were rhinovirus (RV; 60%) and respiratory syncytial virus (RSV; 17%). Age-distribution analysis of each virus identified that severely premature children had a higher relative frequency of RV and RSV in their first three years, relative to preterm or full-term children. Additionally, the probability of RV- or RSV-induced wheezing was higher overall in severely premature children less than three years old. Conclusions: Our results indicate that the …

Cardiac Remodeling And Dysfunction In Childhood Obesity: A Cardiovascular Magnetic Resonance Study, Linyuan Jing, Cassi M. Binkley, Jonathan D. Suever, Nivedita Umasankar, Christopher M. Haggerty, Jennifer Rich, Christopher D. Nevius, Gregory J. Wehner, Sean M. Hamlet, David K. Powell, Aurelia Radulescu, H. Lester Kirchner, Frederick H. Epstein, Brandon K. Fornwalt

Pediatrics Faculty Publications

Background: Obesity affects nearly one in five children and is associated with increased risk of premature death. Obesity-related heart disease contributes to premature death. We aimed to use cardiovascular magnetic resonance (CMR) to comprehensively characterize the changes in cardiac geometry and function in obese children.

Methods and results: Forty-one obese/overweight (age 12 ± 3 years, 56 % female) and 29 healthy weight children (age 14 ± 3 years, 41 % female) underwent CMR, including both standard cine imaging and displacement encoded imaging, for a complete assessment of left ventricular (LV) structure and function. After adjusting for age, LV mass index …

Unbalanced But Satisfied?, Asha N. Shenoi

Pediatrics Faculty Publications

No abstract provided.

Sexual Minority (Lgbtq) Youth And Role Of Health Care Provider, Mandakini Sadhir, Stephanie J. Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Adolescence is a time period of physical, psychological and cognitive changes. It is an important phase for an individual to discover who they really are (self-identity), how they are perceived (social identity) and how they fit into the environment they live in.¹ One of the major tasks of adolescence is sexual maturation and sexual and /or gender identity development.² Adolescents who are developing as gay, lesbian, bisexual or transgender face a tremendous challenge of establishing their identity which is often complex.³ They cope with the feelings of being different and are in constant dilemmas about revealing their …

Leadership And Mentorship: Service Leaders As Mentors Of The Followers, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, an effective service leader serves as a mentor for his/her followers. Aside from promoting their followers’ professional and personal growth, mentoring also contributes to the development of the service leaders themselves. In this paper, a lecture addressing the concept and functions of mentoring is outlined, along with its relationship with service leadership. The professional and psychosocial functions of mentoring to service leaders and followers and various ways to promote mentoring in service leadership are highlighted. Students are also encouraged to reflect on the potential harmful effects of mentoring on …

Women With Disabilities: Reproductive Care And Women’S Health, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Children, adolescents, and women with disabilities experience the same sexual development, pubertal changes, concerns, and desire to reproduce as their typically developing counterparts. However, society has tended to stigmatize women with disabilities as “asexual” and ignore this aspect of their health care. These women are less likely to receive gynecological exams, contraception, and evaluation of sexual dysfunction. Unfortunately, having a disability places women at risk for sexual exploitation and abuse as well as sexually transmitted infections. Therefore, reproductive health care for these women is imperative. A number of barriers to receiving reproductive care exist. However, with proper education and knowledge …

Factors Leading To The Creation, Development, And Maintenance Of Positive Social Relationship, Daniel T. L. Shek, Jocelyn L. Lin

Pediatrics Faculty Publications

In contrast to the manufacturing economy where the focus is primarily placed on the man-machine interface, social relationships are important building blocks in the service economy. Hence, identifyig the factors leading to creation, development, and maintenance of positive social relationships within the context of leadership is an important consideration. In this paper, a lecture covers the nature of social relationships and the related determinants (including trust, care, and respect) are outlined. Through this lecture, students can develop the ability to identify the characteristics and determinants of positive social relationships, appreciate the importance of positive relationships to service leaders, and evaluate …