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Is Fetal Life Riskier Than Neonatal Life?
Abstracts / Annals of Epidemiology 22 (2012) 661e680
mothers 10-14 y of age compared to those who were 15 y was 1.92 (95% confidence interval [CI]): 0.51-6.67, exact p¼0.39), while the PLR OR for this factor was 1.96 (95% CI: 0.65-5.89, p¼0.23). The ELR OR for no/inadequate prenatal care (present vs. absent) was 2.75 (95% CI: 0.57- 10.95) while the PLR OR for this covariate was 2.88 (p¼0.098). Conclusion: We did not identify any significant predictors in this small sample; however, future similar studies should focus on prenatal care.
P74. Risk Factors for Abusive Head Trauma in Young Children d United States, 2000e2009 Thomas Niederkrotenthaler, L. Xu, S. Parks, D. Sugerman. National Center for Injury Prevention and Control, CDC, Atlanta, GA Purpose: Abusive head trauma (AHT) is the leading cause of child maltreatment-related fatalities in the United States. The goal of this study was to characterize young children who had AHT to better inform primary prevention efforts and post-injury response. Methods: Using the recent CDC AHT case definition, we performed a retrospective secondary analysis of 2000, 2003, 2006 and 2009 hospitalization data using the Kids Inpatient Database from the Healthcare Cost and Utilization Project. Logistic regression was used to compare AHT to non-abusive head trauma (NAHT) inpatients <2 years of age. Sociodemographic data and known indicators of socioeconomic status (i.e., insurance status and household income), injury severity (i.e., length of hospital stay and vital status), hospital specialization (i.e., teaching status), hospital region, and admission time (i.e., year and season) were used as independent variables. Results: Children with AHT were more often <1 year of age (adjusted odds ratio [aOR] ¼ 2.64; 95% confidence interval [CI]: 2.32e3.00); uninsured (aOR ¼ 1.72; 95% CI: 1.29e2.30), hospitalized longer (aOR ¼ 8.40; 95% CI: 7.39e9.54), died during hospitalization (aOR ¼ 5.16; 95%CI: 4.06e 6.56), and seen at teaching hospitals (aOR ¼ 1.46; 95% CI: 1.21e1.76) as compared to NAHT patients. Conclusion: Socioeconomically disadvantaged families with children <1 year of age are an important target population in primary prevention efforts. Hospitals need to continuously refine training to identify AHT in young children. identify and provide rapid treatment for AHT in young children.
P75. Longitudinal Evaluation of Religiosity, Psychosocial Factors and Suicidal Behaviors Among Adolescent in the United States S. Nkansah-Amankra, A. Diedhiou, S.K. Agbanu, H.L.K. Agbanu. School of Health Sciences, Central Michigan University Purpose: Relationships among religiosity and other psychosocial factors in determining suicidal behaviors in adolescence and in emerging adulthood have been inconclusive. We sought to investigate prospective relationships among religiosity, psychosocial factors and suicidal behaviors using a nationally representative sample of adolescents emerging in to adulthood. Methods: Analysis was based on 9412 respondents from four waves of National Longitudinal Study of Adolescent Health. A Generalized Estimating Equation (GEE) procedure was used to fit a series of models on the response variable (suicidal behaviors) and a set of psychosocial and religiosity predictors taking into account the correlated structure of the datasets. Results: Analyses showed that adolescent suicidality and religious activity participation showed significant declines over time. In adjusted models, baseline attendance of a church at least weekly was associated with 42% reduction (95% Confidence Interval: 0.35-0.98) of suicide ideation in Wave III. Across all waves, low support from fathers (compared with mothers) consistently explained variability in suicidal behaviors among genders emerging into adulthood. Conclusion: The findings of the study indicate that religious activity participation is associated with reduced suicidal behaviors among adolescents but this effect declines during emerging adulthood. Psychosocial supports particularly from fathers' have an enduring impact on reduced suicidal behaviors among adolescents and emerging adults. Prevention, identification and evaluation of disorders of suicidality need a careful assessment of underlying mental pain (psyache) to reduce the likelihood of aggravated suicide.
677
P76. Parental Risk-Perception and Influenza Vaccination of Children in Daycare T.N. Offutt-Powell, R.P. Ojha, R. Qualls-Hampton, S. Stonecipher, K.P. Singh, K.M. Cardarelli. Department of Epidemiology, University of North Carolina, Chapel Hill, NC Purpose: Given that childhood vaccination is parent-dependent, exploring parental perceptions of influenza vaccination is important for elucidating determinants of suboptimal influenza vaccination coverage of young children. We systematically explored the relation between parental risk perception and influenza vaccination in children attending daycare. Methods: We distributed a survey to parents of children aged 6 months to 59 months attending licensed daycares in Tarrant County, Texas. We used unconditional logistic regression to model the relations between parental risk-perception factors and influenza vaccine uptake and stabilized estimates using a semi-Bayesian method, which yielded odds ratios (OR) and 95% posterior limits (PL). Results: We observed that physician recommendation (OR¼4.5, 95% PL: 1.9, 11), parents with high levels of prevention behaviors (High: OR¼ 3.5, 95% PL: 1.5, 8.1), high or moderate perceived risk of vaccine-related adverse events (High: OR¼0.69, 95% PL: 0.19, 2.5; Moderate: OR¼0.60, 95% PL: 0.24, 1.5), and high or moderate perceived threat of influenza illness (High: OR¼1.9, 95% PL: 0.71, 0.5.2; Moderate: OR¼1.4, 95% PL: 0.52, 3.8) may influence influenza vaccination of daycare children. Conclusion: Our results suggest that the physician-parent interaction is a critical determinant of influenza vaccination of children in daycare and may provide a modifiable target for interventions to increase influenza vaccination coverage in healthy children attending daycare.
P77. Is Fetal Life Riskier Than Neonatal Life? J.S. Teji W Meadow. Pediatrics, University of Chicago and Mercy Hospital, Chicago, IL Purpose: Perinatal statistics are usually reported as a gestational-age based mortality, either as stillbirth or neonatal mortality rate per 1000 births during each week. There are no data on the outcome of pregnancies comparing the mortality risk whether intra- or extra-uterine for each gestational age. The aim of this study is to compare risk for fetal death with neonatal death for each gestational week for prevailing pregnancies. Design/Methods: The NCHS linked birth and infant death file from 1983 thru 2005 was used. Neonatal mortality risk, NMR, stillbirth risk, SBR and ratio of SBR/NMR was calculated using the neonatal deaths (ND) and stillbirths (S) divided by the prevailing pregnancies at risk at each gestational age. Results: There were over 60 million out of 92 million pregnancies considered during the study period for the years 1984 thru 1991(84to91) and 1996 thru 2002 (96to02). Total singleton pregnancies at risk were 52,616,246 while S were 351, 465, and ND were 238,544. NMR, SBR and the ratio of SBR/NMR was significantly higher for B than W for every week of gestation except for 23-25 for both periods. There was no difference in the groups with respect to SBR for either race. Conclusions: 1. Calculation of NMR and SBR with a common denominator of prevailing pregnancies allows us to compare lives lost as neonate or as fetus. 2. Fetal life is riskier than neonatal life. 3. The ratio of SBR/NMR increased for both races during (96to02) period due to a reduction in NMR while SBR remained unchanged. 4. Funding should be allocated to reduce SBR or death as fetus.
P78. Higher Environmental Temperature During Pregnancy Is Associated With Low Birth Weight (LBW) J.S. Teji A Gupta, K. Eldeirawi. Department of Pediatrics,, University of Chicago and Mercy Hospital, Chicago, IL Purpose: LBW is a major cause of infant morbidity and mortality in the world. Animal and human studies have shown that intrauterine growth retardation was inversely related to environmental temperature. The purpose of this study is to assess the associations of higher temperature and lower latitude with lower birth weights in the United States infant born between 1995 and 2002.
mothers 10-14 y of age compared to those who were 15 y was 1.92 (95% confidence interval [CI]): 0.51-6.67, exact p¼0.39), while the PLR OR for this factor was 1.96 (95% CI: 0.65-5.89, p¼0.23). The ELR OR for no/inadequate prenatal care (present vs. absent) was 2.75 (95% CI: 0.57- 10.95) while the PLR OR for this covariate was 2.88 (p¼0.098). Conclusion: We did not identify any significant predictors in this small sample; however, future similar studies should focus on prenatal care.
P74. Risk Factors for Abusive Head Trauma in Young Children d United States, 2000e2009 Thomas Niederkrotenthaler, L. Xu, S. Parks, D. Sugerman. National Center for Injury Prevention and Control, CDC, Atlanta, GA Purpose: Abusive head trauma (AHT) is the leading cause of child maltreatment-related fatalities in the United States. The goal of this study was to characterize young children who had AHT to better inform primary prevention efforts and post-injury response. Methods: Using the recent CDC AHT case definition, we performed a retrospective secondary analysis of 2000, 2003, 2006 and 2009 hospitalization data using the Kids Inpatient Database from the Healthcare Cost and Utilization Project. Logistic regression was used to compare AHT to non-abusive head trauma (NAHT) inpatients <2 years of age. Sociodemographic data and known indicators of socioeconomic status (i.e., insurance status and household income), injury severity (i.e., length of hospital stay and vital status), hospital specialization (i.e., teaching status), hospital region, and admission time (i.e., year and season) were used as independent variables. Results: Children with AHT were more often <1 year of age (adjusted odds ratio [aOR] ¼ 2.64; 95% confidence interval [CI]: 2.32e3.00); uninsured (aOR ¼ 1.72; 95% CI: 1.29e2.30), hospitalized longer (aOR ¼ 8.40; 95% CI: 7.39e9.54), died during hospitalization (aOR ¼ 5.16; 95%CI: 4.06e 6.56), and seen at teaching hospitals (aOR ¼ 1.46; 95% CI: 1.21e1.76) as compared to NAHT patients. Conclusion: Socioeconomically disadvantaged families with children <1 year of age are an important target population in primary prevention efforts. Hospitals need to continuously refine training to identify AHT in young children. identify and provide rapid treatment for AHT in young children.
P75. Longitudinal Evaluation of Religiosity, Psychosocial Factors and Suicidal Behaviors Among Adolescent in the United States S. Nkansah-Amankra, A. Diedhiou, S.K. Agbanu, H.L.K. Agbanu. School of Health Sciences, Central Michigan University Purpose: Relationships among religiosity and other psychosocial factors in determining suicidal behaviors in adolescence and in emerging adulthood have been inconclusive. We sought to investigate prospective relationships among religiosity, psychosocial factors and suicidal behaviors using a nationally representative sample of adolescents emerging in to adulthood. Methods: Analysis was based on 9412 respondents from four waves of National Longitudinal Study of Adolescent Health. A Generalized Estimating Equation (GEE) procedure was used to fit a series of models on the response variable (suicidal behaviors) and a set of psychosocial and religiosity predictors taking into account the correlated structure of the datasets. Results: Analyses showed that adolescent suicidality and religious activity participation showed significant declines over time. In adjusted models, baseline attendance of a church at least weekly was associated with 42% reduction (95% Confidence Interval: 0.35-0.98) of suicide ideation in Wave III. Across all waves, low support from fathers (compared with mothers) consistently explained variability in suicidal behaviors among genders emerging into adulthood. Conclusion: The findings of the study indicate that religious activity participation is associated with reduced suicidal behaviors among adolescents but this effect declines during emerging adulthood. Psychosocial supports particularly from fathers' have an enduring impact on reduced suicidal behaviors among adolescents and emerging adults. Prevention, identification and evaluation of disorders of suicidality need a careful assessment of underlying mental pain (psyache) to reduce the likelihood of aggravated suicide.
677
P76. Parental Risk-Perception and Influenza Vaccination of Children in Daycare T.N. Offutt-Powell, R.P. Ojha, R. Qualls-Hampton, S. Stonecipher, K.P. Singh, K.M. Cardarelli. Department of Epidemiology, University of North Carolina, Chapel Hill, NC Purpose: Given that childhood vaccination is parent-dependent, exploring parental perceptions of influenza vaccination is important for elucidating determinants of suboptimal influenza vaccination coverage of young children. We systematically explored the relation between parental risk perception and influenza vaccination in children attending daycare. Methods: We distributed a survey to parents of children aged 6 months to 59 months attending licensed daycares in Tarrant County, Texas. We used unconditional logistic regression to model the relations between parental risk-perception factors and influenza vaccine uptake and stabilized estimates using a semi-Bayesian method, which yielded odds ratios (OR) and 95% posterior limits (PL). Results: We observed that physician recommendation (OR¼4.5, 95% PL: 1.9, 11), parents with high levels of prevention behaviors (High: OR¼ 3.5, 95% PL: 1.5, 8.1), high or moderate perceived risk of vaccine-related adverse events (High: OR¼0.69, 95% PL: 0.19, 2.5; Moderate: OR¼0.60, 95% PL: 0.24, 1.5), and high or moderate perceived threat of influenza illness (High: OR¼1.9, 95% PL: 0.71, 0.5.2; Moderate: OR¼1.4, 95% PL: 0.52, 3.8) may influence influenza vaccination of daycare children. Conclusion: Our results suggest that the physician-parent interaction is a critical determinant of influenza vaccination of children in daycare and may provide a modifiable target for interventions to increase influenza vaccination coverage in healthy children attending daycare.
P77. Is Fetal Life Riskier Than Neonatal Life? J.S. Teji W Meadow. Pediatrics, University of Chicago and Mercy Hospital, Chicago, IL Purpose: Perinatal statistics are usually reported as a gestational-age based mortality, either as stillbirth or neonatal mortality rate per 1000 births during each week. There are no data on the outcome of pregnancies comparing the mortality risk whether intra- or extra-uterine for each gestational age. The aim of this study is to compare risk for fetal death with neonatal death for each gestational week for prevailing pregnancies. Design/Methods: The NCHS linked birth and infant death file from 1983 thru 2005 was used. Neonatal mortality risk, NMR, stillbirth risk, SBR and ratio of SBR/NMR was calculated using the neonatal deaths (ND) and stillbirths (S) divided by the prevailing pregnancies at risk at each gestational age. Results: There were over 60 million out of 92 million pregnancies considered during the study period for the years 1984 thru 1991(84to91) and 1996 thru 2002 (96to02). Total singleton pregnancies at risk were 52,616,246 while S were 351, 465, and ND were 238,544. NMR, SBR and the ratio of SBR/NMR was significantly higher for B than W for every week of gestation except for 23-25 for both periods. There was no difference in the groups with respect to SBR for either race. Conclusions: 1. Calculation of NMR and SBR with a common denominator of prevailing pregnancies allows us to compare lives lost as neonate or as fetus. 2. Fetal life is riskier than neonatal life. 3. The ratio of SBR/NMR increased for both races during (96to02) period due to a reduction in NMR while SBR remained unchanged. 4. Funding should be allocated to reduce SBR or death as fetus.
P78. Higher Environmental Temperature During Pregnancy Is Associated With Low Birth Weight (LBW) J.S. Teji A Gupta, K. Eldeirawi. Department of Pediatrics,, University of Chicago and Mercy Hospital, Chicago, IL Purpose: LBW is a major cause of infant morbidity and mortality in the world. Animal and human studies have shown that intrauterine growth retardation was inversely related to environmental temperature. The purpose of this study is to assess the associations of higher temperature and lower latitude with lower birth weights in the United States infant born between 1995 and 2002.