Tara Haelle

Teenagers’ use of electronic devices before bed and their high screen usage during the day both independently increase the likelihood of sleep deprivation, a study found.

“While the frequency of use differed between the various devices, the relation between different types of electronic devices and sleep remained significant,” Mari Hysing of Uni Research Health in Bergen, Norway, and her associates reported online. “This suggests that the established relationship between TV and sleep found in previous studies can be generalized to newer technology,” they wrote (BMJ Open 2015 Feb. 2 [doi:10.1136/bmjopen-2014-006748]).

The researchers gathered data from 9,846 teens in Hordaland County, Norway, aged 16-19 years, regarding their use of electronic devices during daytime and nighttime and regarding their sleep quantity and quality. They asked about six different device types: personal computer (PC), cellphone, MP3 player, tablet, video game console, and television.

They assessed whether the teens used any of these devices in their bedrooms during the hour before they went to sleep, how often they used them during the daytime, and for what reasons they used the devices. The sleep data included typical bedtimes, rise times, time in bed, and total sleep on weekends and weekdays.

Nearly all teens used at least one, and often more than one, electronic device in the hour before bed. More than 80% reported using a PC, more than half reported watching TV, and approximately 90% of girls and 80% of boys had used a cellphone.

Total daily daytime screen use averaged approximately 5.5 hours for girls and more than 6.5 hours for boys.

Teens who used an electronic device in the hour before bed, used screens more than 4 hours total a day, or used any individual electronic device at least 2 hours a day were more likely to have a sleep deficiency of at least 2 hours a day.

Those using a PC or a cellphone in the hour before bed were 52% and 48% more likely, respectively, to take more than 60 minutes to fall asleep. Before-bed PC or cellphone use increased the likelihood of at least 2 hours’ sleep deficit by 53% and 35%, respectively.

Teens were 2.7 times more likely to get less than 5 hours sleep with PC use before bed and 1.85 times more likely with cellphone use before bed. Getting less than 5 hours sleep was 3.6 times more likely with at least 4 hours of total daily screen time.

The research was funded by Uni Research Health and the Norwegian Directorate for Health and Social Affairs. The authors reported no relevant financial disclosures.

Teenagers’ use of electronic devices before bed and their high screen usage during the day both independently increase the likelihood of sleep deprivation, a study found.

“While the frequency of use differed between the various devices, the relation between different types of electronic devices and sleep remained significant,” Mari Hysing of Uni Research Health in Bergen, Norway, and her associates reported online. “This suggests that the established relationship between TV and sleep found in previous studies can be generalized to newer technology,” they wrote (BMJ Open 2015 Feb. 2 [doi:10.1136/bmjopen-2014-006748]).

The researchers gathered data from 9,846 teens in Hordaland County, Norway, aged 16-19 years, regarding their use of electronic devices during daytime and nighttime and regarding their sleep quantity and quality. They asked about six different device types: personal computer (PC), cellphone, MP3 player, tablet, video game console, and television.

They assessed whether the teens used any of these devices in their bedrooms during the hour before they went to sleep, how often they used them during the daytime, and for what reasons they used the devices. The sleep data included typical bedtimes, rise times, time in bed, and total sleep on weekends and weekdays.

Nearly all teens used at least one, and often more than one, electronic device in the hour before bed. More than 80% reported using a PC, more than half reported watching TV, and approximately 90% of girls and 80% of boys had used a cellphone.

Total daily daytime screen use averaged approximately 5.5 hours for girls and more than 6.5 hours for boys.

Teens who used an electronic device in the hour before bed, used screens more than 4 hours total a day, or used any individual electronic device at least 2 hours a day were more likely to have a sleep deficiency of at least 2 hours a day.

Those using a PC or a cellphone in the hour before bed were 52% and 48% more likely, respectively, to take more than 60 minutes to fall asleep. Before-bed PC or cellphone use increased the likelihood of at least 2 hours’ sleep deficit by 53% and 35%, respectively.

Teens were 2.7 times more likely to get less than 5 hours sleep with PC use before bed and 1.85 times more likely with cellphone use before bed. Getting less than 5 hours sleep was 3.6 times more likely with at least 4 hours of total daily screen time.

The research was funded by Uni Research Health and the Norwegian Directorate for Health and Social Affairs. The authors reported no relevant financial disclosures.

Teenagers’ use of electronic devices before bed and their high screen usage during the day both independently increase the likelihood of sleep deprivation, a study found.

“While the frequency of use differed between the various devices, the relation between different types of electronic devices and sleep remained significant,” Mari Hysing of Uni Research Health in Bergen, Norway, and her associates reported online. “This suggests that the established relationship between TV and sleep found in previous studies can be generalized to newer technology,” they wrote (BMJ Open 2015 Feb. 2 [doi:10.1136/bmjopen-2014-006748]).

The researchers gathered data from 9,846 teens in Hordaland County, Norway, aged 16-19 years, regarding their use of electronic devices during daytime and nighttime and regarding their sleep quantity and quality. They asked about six different device types: personal computer (PC), cellphone, MP3 player, tablet, video game console, and television.

They assessed whether the teens used any of these devices in their bedrooms during the hour before they went to sleep, how often they used them during the daytime, and for what reasons they used the devices. The sleep data included typical bedtimes, rise times, time in bed, and total sleep on weekends and weekdays.

Nearly all teens used at least one, and often more than one, electronic device in the hour before bed. More than 80% reported using a PC, more than half reported watching TV, and approximately 90% of girls and 80% of boys had used a cellphone.

Total daily daytime screen use averaged approximately 5.5 hours for girls and more than 6.5 hours for boys.

Teens who used an electronic device in the hour before bed, used screens more than 4 hours total a day, or used any individual electronic device at least 2 hours a day were more likely to have a sleep deficiency of at least 2 hours a day.

Those using a PC or a cellphone in the hour before bed were 52% and 48% more likely, respectively, to take more than 60 minutes to fall asleep. Before-bed PC or cellphone use increased the likelihood of at least 2 hours’ sleep deficit by 53% and 35%, respectively.

Teens were 2.7 times more likely to get less than 5 hours sleep with PC use before bed and 1.85 times more likely with cellphone use before bed. Getting less than 5 hours sleep was 3.6 times more likely with at least 4 hours of total daily screen time.

The research was funded by Uni Research Health and the Norwegian Directorate for Health and Social Affairs. The authors reported no relevant financial disclosures.

Mandatory folic acid fortification of grain products has resulted in 1,326 fewer neural tube defects among U.S. births each year, according to a report from the Centers for Disease Control and Prevention.

This estimate is one-third higher than previous calculations, which estimated that fortification averted 1,000 neural tube-affected pregnancies a year.

“Factors that could have helped contribute to the difference include a gradual increase in the number of annual live births in the United States during the postfortification period and data variations caused by differences in surveillance methodology,” Jennifer Williams of the CDC and her colleagues wrote in the Jan. 16 issue of the Morbidity and Mortality Weekly Report.

Courtesy Daniel Sone/National Cancer Institute

Insufficient folic acid intake increases the risk of neural tube defects, which can lead to conditions such as anencephaly and spina bifida. To address folic acid deficiencies in women, the United States mandated in 1998 that all enriched cereal grain products be fortified with 140 mcg of folic acid per 100 g.

From 1995-1996 to the postfortification period of 1999-2011, incidence of anencephaly and spina bifida declined 28% overall, with declines in neural tube defects seen for white, black, and Hispanic pregnancies. But the rates of neural tube defects were the highest among Hispanic women, potentially due to genetic factors or to insufficient folic acid intake. One strategy to reduce rates among Hispanic women would be to fortify corn masa flour, thereby averting an estimated 40 additional neural tube defects a year, the researchers wrote (MMWR 2015;64:1-5).

The drop in neural tube defects carries a financial benefit, as well. Anencephaly, which is always fatal, costs an estimated $5,415 per case, and spina bifida costs an estimated $560,000 over a lifetime. Overall, the averted cases represent about $508 million in annual savings.

In addition to fortification, the CDC recommends that all women of childbearing age take 400 mcg of folic acid daily if they might become pregnant. Women with a previous neural tube defect–affected pregnancy are recommended to take a higher dose of 4 mg/day, beginning at least 4 weeks before conception and continuing through the first trimester.

The researchers reported having no financial disclosures.

Mandatory folic acid fortification of grain products has resulted in 1,326 fewer neural tube defects among U.S. births each year, according to a report from the Centers for Disease Control and Prevention.

This estimate is one-third higher than previous calculations, which estimated that fortification averted 1,000 neural tube-affected pregnancies a year.

“Factors that could have helped contribute to the difference include a gradual increase in the number of annual live births in the United States during the postfortification period and data variations caused by differences in surveillance methodology,” Jennifer Williams of the CDC and her colleagues wrote in the Jan. 16 issue of the Morbidity and Mortality Weekly Report.

Courtesy Daniel Sone/National Cancer Institute

Insufficient folic acid intake increases the risk of neural tube defects, which can lead to conditions such as anencephaly and spina bifida. To address folic acid deficiencies in women, the United States mandated in 1998 that all enriched cereal grain products be fortified with 140 mcg of folic acid per 100 g.

From 1995-1996 to the postfortification period of 1999-2011, incidence of anencephaly and spina bifida declined 28% overall, with declines in neural tube defects seen for white, black, and Hispanic pregnancies. But the rates of neural tube defects were the highest among Hispanic women, potentially due to genetic factors or to insufficient folic acid intake. One strategy to reduce rates among Hispanic women would be to fortify corn masa flour, thereby averting an estimated 40 additional neural tube defects a year, the researchers wrote (MMWR 2015;64:1-5).

The drop in neural tube defects carries a financial benefit, as well. Anencephaly, which is always fatal, costs an estimated $5,415 per case, and spina bifida costs an estimated $560,000 over a lifetime. Overall, the averted cases represent about $508 million in annual savings.

In addition to fortification, the CDC recommends that all women of childbearing age take 400 mcg of folic acid daily if they might become pregnant. Women with a previous neural tube defect–affected pregnancy are recommended to take a higher dose of 4 mg/day, beginning at least 4 weeks before conception and continuing through the first trimester.

The researchers reported having no financial disclosures.

Mandatory folic acid fortification of grain products has resulted in 1,326 fewer neural tube defects among U.S. births each year, according to a report from the Centers for Disease Control and Prevention.

This estimate is one-third higher than previous calculations, which estimated that fortification averted 1,000 neural tube-affected pregnancies a year.

“Factors that could have helped contribute to the difference include a gradual increase in the number of annual live births in the United States during the postfortification period and data variations caused by differences in surveillance methodology,” Jennifer Williams of the CDC and her colleagues wrote in the Jan. 16 issue of the Morbidity and Mortality Weekly Report.

Courtesy Daniel Sone/National Cancer Institute

Insufficient folic acid intake increases the risk of neural tube defects, which can lead to conditions such as anencephaly and spina bifida. To address folic acid deficiencies in women, the United States mandated in 1998 that all enriched cereal grain products be fortified with 140 mcg of folic acid per 100 g.

From 1995-1996 to the postfortification period of 1999-2011, incidence of anencephaly and spina bifida declined 28% overall, with declines in neural tube defects seen for white, black, and Hispanic pregnancies. But the rates of neural tube defects were the highest among Hispanic women, potentially due to genetic factors or to insufficient folic acid intake. One strategy to reduce rates among Hispanic women would be to fortify corn masa flour, thereby averting an estimated 40 additional neural tube defects a year, the researchers wrote (MMWR 2015;64:1-5).

The drop in neural tube defects carries a financial benefit, as well. Anencephaly, which is always fatal, costs an estimated $5,415 per case, and spina bifida costs an estimated $560,000 over a lifetime. Overall, the averted cases represent about $508 million in annual savings.

In addition to fortification, the CDC recommends that all women of childbearing age take 400 mcg of folic acid daily if they might become pregnant. Women with a previous neural tube defect–affected pregnancy are recommended to take a higher dose of 4 mg/day, beginning at least 4 weeks before conception and continuing through the first trimester.

The researchers reported having no financial disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

Teens advised to rest for 5 days after a concussion reported more post-concussive symptoms than teens who rested for 1-2 days and gradually returned to activity, based on results of a randomized, controlled study of 88 adolescents, aged 11 to 22.

“Although poor compliance with strict physical rest may have contributed to a lack of efficacy, previous adult studies that have assessed strict rest after concussion found similar results,” lead author Dr. Danny George Thomas and his associates at the Medical College of Wisconsin in Milwaukee reported online. The researchers also noted that “adolescents’ symptom reporting may be influenced by restricting activity” (Pediatrics 2015 Jan. 5 [doi: 10.1542/peds.2014-0966]).

Study participants reported to the Children’s Hospital of Wisconsin Emergency Department and Trauma Center between May 2010 and December 2012 within 24 hours of a concussion or mild traumatic brain injury. Most had injured their head during sports, primarily football, and about a third had lost consciousness. Those with an IQ below 70, a mental health or developmental condition or learning disability, or an intracranial injury were excluded.

After an initial neurocognitive, balance, and symptom assessment in the emergency department, 45 participants were randomly assigned to strict rest and 43 controls were randomly assigned to usual care. (Initial randomization involved 99 participants, but 11 did not complete all procedures.)

Usual care involved 24-48 hours of rest, followed by a return to school and a stepwise return to physical activity after symptoms resolved. The strict rest group were instructed to rest for 5 days at home with no school, work, or physical activity, and then gradually return to activity.

In addition to maintaining daily diaries of physical and mental activities, energy exertion and post-concussive symptoms, the participants underwent neurocognitive and balance assessments again at 3 and 10 days after their injury. The post-concussive symptoms recorded in the daily diaries came from the 19-symptom post concussion symptom scale, which rated physical, cognitive, emotional and sleep domains from 0 (none) to 6 (severe).

Energy exertion and physical activity levels were approximately 20% lower during the first 5 days post-concussion in both groups, but those assigned to strict rest had lower school and after-school activity attendance and mental activity during the 2-5 days after their injuries.

The strict rest group spent an average 3.8 hours in school or after-school activities, compared to 6.7 hours among the usual care group (P<.05). The strict rest participants also reported an average 4.9 hours of moderate and high mental activity during days 2-5 post-concussion, compared to an average 8.3 hours among the usual care participants.

Post-concussion neurocognitive and balance assessments did not identify any significant differences between the two groups. However, the strict rest group had a total average symptom score of 188 over 10 days, compared to a total score of 132 for the usual care group (P<.03). Total post-concussive symptoms during follow-up numbered 70 in the strict rest group and 50 in the usual care group.

Approximately 63% of the strict rest participants had their symptoms fully resolve during follow-up, compared to 67% of the usual care participants. Although this difference was not significant, it took took 3 days longer for half of the strict rest group to report fully resolved symptoms.

Results tended to vary slightly, however, depending on individuals’ concussion history and their symptoms at diagnosis. Those who had a history of concussion or were diagnosed based only on post-concussive symptoms had a higher post-concussive symptom score on the 10th day after injury if assigned to strict rest. But, those still experiencing immediate concussion symptoms at diagnosis had slightly lower post-concussive symptom scores at day 10 on strict rest, and those with a first concussion showed no differences between groups in post-concussive symptoms at day 10.

“There are many potential explanations for the difference in symptom reporting,” Dr. Thomas’s team wrote. “It is possible that discharge instructions influenced the perception of illness, augmenting symptom reporting” or that the slightly older strict rest group were better able to articulate their symptoms.

The authors also suggested that emotional distress caused by restrictions on school and activities may have caused emotional distress.

“Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms,” they wrote. “Similarly, activity restrictions and lack of exercise may contribute to sleep abnormalities and adversely affect mood. Alternatively, attending less school may have resulted in more time and fewer distractions to thoughtfully complete symptom diaries or perseverate on symptoms.”The research was funded by the Injury Research Center of the Medical College of Wisconsin. The authors reported no disclosures.

The use of assisted reproductive technology appears to be low risk for women, according to new data showing that maternal complications were consistently low over a decade.

Among more than 1.1 million fresh autologous cycles of assisted reproductive technology (ART), 14,960 complications of any kind occurred, a rate of 131.8 per 10,000 autologous cycles. Complications were even lower among the 112,254 fresh donor cycles studied. A total of 336 complications of any kind occurred, a rate of 27.3 per 10,000 donor cycles.

Researchers examined complications reported between 2000 and 2011 to the Centers for Disease Control and Prevention’s National ART Surveillance System, which receives reports from 94% of all ART clinics in the United States.

The most common complication for both autologous and donor cycles was ovarian hyperstimulation syndrome (OHHS), reported Dr. Jennifer F. Kawwass of Emory University, Atlanta, and her colleagues. The study was published Jan. 6 in JAMA.

“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complications,” the researchers wrote (JAMA 2015;313:88-90).

OHSS peaked at 153.5 per 10,000 autologous cycles. The next most common complication, hospitalizations, peaked at 34.8 per 10,000 autologous cycles.

All other complications – infection, hemorrhage requiring transfusion, medication adverse event, anesthetic complication, and patient death – occurred less than 10 times per 10,000 autologous cycles. Both medication adverse events and hospitalizations declined over the period studied, but there were no other changes in complication trends for autologous cycles.

Among the 58 deaths reported, 18 were attributed to stimulation, and 40 occurred during pregnancy prior to infant birth.

Among donor cycles, OHSS was the most common complication, peaking at 31 per 10,000 donor cycles, followed by hospitalizations, peaking at 10.5 per 10,000 cycles.

All other complications occurred less than 5 times per 10,000 cycles. There were no donor deaths, and 13 maternal deaths before birth occurred. But the researchers cautioned that complications may have been underreported to the surveillance system.

The study authors reported having no financial disclosures. 

The use of assisted reproductive technology appears to be low risk for women, according to new data showing that maternal complications were consistently low over a decade.

Among more than 1.1 million fresh autologous cycles of assisted reproductive technology (ART), 14,960 complications of any kind occurred, a rate of 131.8 per 10,000 autologous cycles. Complications were even lower among the 112,254 fresh donor cycles studied. A total of 336 complications of any kind occurred, a rate of 27.3 per 10,000 donor cycles.

Researchers examined complications reported between 2000 and 2011 to the Centers for Disease Control and Prevention’s National ART Surveillance System, which receives reports from 94% of all ART clinics in the United States.

The most common complication for both autologous and donor cycles was ovarian hyperstimulation syndrome (OHHS), reported Dr. Jennifer F. Kawwass of Emory University, Atlanta, and her colleagues. The study was published Jan. 6 in JAMA.

“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complications,” the researchers wrote (JAMA 2015;313:88-90).

OHSS peaked at 153.5 per 10,000 autologous cycles. The next most common complication, hospitalizations, peaked at 34.8 per 10,000 autologous cycles.

All other complications – infection, hemorrhage requiring transfusion, medication adverse event, anesthetic complication, and patient death – occurred less than 10 times per 10,000 autologous cycles. Both medication adverse events and hospitalizations declined over the period studied, but there were no other changes in complication trends for autologous cycles.

Among the 58 deaths reported, 18 were attributed to stimulation, and 40 occurred during pregnancy prior to infant birth.

Among donor cycles, OHSS was the most common complication, peaking at 31 per 10,000 donor cycles, followed by hospitalizations, peaking at 10.5 per 10,000 cycles.

All other complications occurred less than 5 times per 10,000 cycles. There were no donor deaths, and 13 maternal deaths before birth occurred. But the researchers cautioned that complications may have been underreported to the surveillance system.

The study authors reported having no financial disclosures. 

The use of assisted reproductive technology appears to be low risk for women, according to new data showing that maternal complications were consistently low over a decade.

Among more than 1.1 million fresh autologous cycles of assisted reproductive technology (ART), 14,960 complications of any kind occurred, a rate of 131.8 per 10,000 autologous cycles. Complications were even lower among the 112,254 fresh donor cycles studied. A total of 336 complications of any kind occurred, a rate of 27.3 per 10,000 donor cycles.

Researchers examined complications reported between 2000 and 2011 to the Centers for Disease Control and Prevention’s National ART Surveillance System, which receives reports from 94% of all ART clinics in the United States.

The most common complication for both autologous and donor cycles was ovarian hyperstimulation syndrome (OHHS), reported Dr. Jennifer F. Kawwass of Emory University, Atlanta, and her colleagues. The study was published Jan. 6 in JAMA.

“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complications,” the researchers wrote (JAMA 2015;313:88-90).

OHSS peaked at 153.5 per 10,000 autologous cycles. The next most common complication, hospitalizations, peaked at 34.8 per 10,000 autologous cycles.

All other complications – infection, hemorrhage requiring transfusion, medication adverse event, anesthetic complication, and patient death – occurred less than 10 times per 10,000 autologous cycles. Both medication adverse events and hospitalizations declined over the period studied, but there were no other changes in complication trends for autologous cycles.

Among the 58 deaths reported, 18 were attributed to stimulation, and 40 occurred during pregnancy prior to infant birth.

Among donor cycles, OHSS was the most common complication, peaking at 31 per 10,000 donor cycles, followed by hospitalizations, peaking at 10.5 per 10,000 cycles.

All other complications occurred less than 5 times per 10,000 cycles. There were no donor deaths, and 13 maternal deaths before birth occurred. But the researchers cautioned that complications may have been underreported to the surveillance system.

The study authors reported having no financial disclosures. 

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

istockphoto.com

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

istockphoto.com

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

The risk of substance use and delinquent behavior is higher in teens whose mothers were depressed when their children were aged 6-10 years, a study showed.

“Engagement in risky behaviors, which are increasingly prevalent during the adolescent years, may be associated with severe immediate and future morbidity and mortality risks,” Maeve E. Wickham of the University of Alberta, Edmonton, and her associates wrote. “Consequently, identification and treatment of depressed mothers during midchildhood years may have an impact in reducing the engagement in health risk behaviors in adolescence and associated long-term sequelae,” the investigators wrote (Pediatrics 2014 Dec. 22 [doi: 10.1542/peds.2014-0628]).

Ms. Wickham’s team gave questionnaires every 2 years to 2,910 pairs of mothers and their children in a nationally representative Canadian cohort, from 1994-1995 through 2008-2009. The children were aged 2-5 years at the start of the study and 16-17 years at the conclusion; they filled out their own questionnaires starting at ages 10-11 years.

istockphoto.com

After accounting for family socioeconomic status and the child’s sex, the researchers identified several trends among the children of mothers who experienced depressive symptoms when the children were aged 6-10.

Compared with children whose mothers had few depressive symptoms, the teens with depressed mothers in the teens’ middle childhood years were twice as likely to start smoking (hazard ratio, 2.15) or use marijuana (HR, 1.91); 1.4 times more likely to use alcohol (HR, 1.43); and over three times more likely to use hallucinogens (HR, 3.51).

The adolescents whose mothers experienced depression in middle childhood also were more likely to engage in violent and nonviolent delinquent behaviors, such as stealing, fighting, carrying a weapon, attacking someone, driving or riding with someone under the influence, selling drugs, or intentionally causing damage.

“The results of this study suggest that exposure to maternal depressive symptoms in childhood is associated with greater, earlier engagement in health risk behaviors, and they suggest a sensitive period in midchildhood during which exposure to maternal depressive symptoms appears to have the strongest effects on adolescent engagement in delinquent and substance use behaviors,” the researchers wrote.

The study was funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the Canada Research Chairs program. The authors reported no financial disclosures.

Starting menstruation before age 11 or after age 16 is associated with a higher risk of coronary heart disease later in life, compared with starting menstruation at age 13, according to a new study.

“This pattern did not differ significantly between lean, overweight, and obese women; between current, past smokers, and never smokers; or between women in low, middle, and high socioeconomic groups,” Dr. Dexter Canoy of the University of Oxford (England) and his colleagues wrote in the Dec. 15 issue of Circulation (doi:10.1161/circulationaha.114.010070).

The researchers also found similar risks for “incident cerebrovascular and hypertensive disease, although the magnitude of the risks for early and late menarche was weaker than that observed for coronary heart disease,” Dr. Canoy and his colleagues wrote.

Compared to the women who began menstruating at 13 years old, those who started at or before 10 years old were 27% more likely to have coronary heart disease, with an adjusted hazard ratio of 1.27). The risk was 23% greater for those who began menstruating at age 17 or older, with an adjusted hazard ratio of 1.23.

The researchers used data from the Million Women Study, which enrolled English and Scottish women, aged 50-64, who had been invited to routine breast cancer screenings between 1996 and 2001. Among the 1.2 million women assessed in the study, a quarter of the women started menstruation at 13 years old, the average across the sample. Those with menarche at age 10 or younger comprised 3.9% of the participants, and 1.4% of the women started menstruating at age 17 or older.

Over an average of 11.6 years of follow-up, more than 73,000 women had coronary heart disease, more than 25,000 had cerebrovascular disease, and nearly 250,000 had hypertensive disease. Women with menarche at age 13 had the lowest risk of these diseases.

The research was funded by Cancer Research UK, the Medical Research Council, and the NHS Cancer Screening Programme, with support from the British Heart Foundation. The authors reported no disclosures.

Starting menstruation before age 11 or after age 16 is associated with a higher risk of coronary heart disease later in life, compared with starting menstruation at age 13, according to a new study.

“This pattern did not differ significantly between lean, overweight, and obese women; between current, past smokers, and never smokers; or between women in low, middle, and high socioeconomic groups,” Dr. Dexter Canoy of the University of Oxford (England) and his colleagues wrote in the Dec. 15 issue of Circulation (doi:10.1161/circulationaha.114.010070).

The researchers also found similar risks for “incident cerebrovascular and hypertensive disease, although the magnitude of the risks for early and late menarche was weaker than that observed for coronary heart disease,” Dr. Canoy and his colleagues wrote.

Compared to the women who began menstruating at 13 years old, those who started at or before 10 years old were 27% more likely to have coronary heart disease, with an adjusted hazard ratio of 1.27). The risk was 23% greater for those who began menstruating at age 17 or older, with an adjusted hazard ratio of 1.23.

The researchers used data from the Million Women Study, which enrolled English and Scottish women, aged 50-64, who had been invited to routine breast cancer screenings between 1996 and 2001. Among the 1.2 million women assessed in the study, a quarter of the women started menstruation at 13 years old, the average across the sample. Those with menarche at age 10 or younger comprised 3.9% of the participants, and 1.4% of the women started menstruating at age 17 or older.

Over an average of 11.6 years of follow-up, more than 73,000 women had coronary heart disease, more than 25,000 had cerebrovascular disease, and nearly 250,000 had hypertensive disease. Women with menarche at age 13 had the lowest risk of these diseases.

The research was funded by Cancer Research UK, the Medical Research Council, and the NHS Cancer Screening Programme, with support from the British Heart Foundation. The authors reported no disclosures.

Starting menstruation before age 11 or after age 16 is associated with a higher risk of coronary heart disease later in life, compared with starting menstruation at age 13, according to a new study.

“This pattern did not differ significantly between lean, overweight, and obese women; between current, past smokers, and never smokers; or between women in low, middle, and high socioeconomic groups,” Dr. Dexter Canoy of the University of Oxford (England) and his colleagues wrote in the Dec. 15 issue of Circulation (doi:10.1161/circulationaha.114.010070).

The researchers also found similar risks for “incident cerebrovascular and hypertensive disease, although the magnitude of the risks for early and late menarche was weaker than that observed for coronary heart disease,” Dr. Canoy and his colleagues wrote.

Compared to the women who began menstruating at 13 years old, those who started at or before 10 years old were 27% more likely to have coronary heart disease, with an adjusted hazard ratio of 1.27). The risk was 23% greater for those who began menstruating at age 17 or older, with an adjusted hazard ratio of 1.23.

The researchers used data from the Million Women Study, which enrolled English and Scottish women, aged 50-64, who had been invited to routine breast cancer screenings between 1996 and 2001. Among the 1.2 million women assessed in the study, a quarter of the women started menstruation at 13 years old, the average across the sample. Those with menarche at age 10 or younger comprised 3.9% of the participants, and 1.4% of the women started menstruating at age 17 or older.

Over an average of 11.6 years of follow-up, more than 73,000 women had coronary heart disease, more than 25,000 had cerebrovascular disease, and nearly 250,000 had hypertensive disease. Women with menarche at age 13 had the lowest risk of these diseases.

The research was funded by Cancer Research UK, the Medical Research Council, and the NHS Cancer Screening Programme, with support from the British Heart Foundation. The authors reported no disclosures.