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Abstracts / Annals of Epidemiology 22 (2012) 661e680
P69. Discovered Dead While Asleep in Causal Pathway of Mortality Among Children With Cerebral Palsy L. Holmes Jr., A. Karatas, K. Dabney, J. Connor, F. Miller. Nemours/AIDHC, Wilmington, DE Purpose: To report thirteen cases of children with cerebral palsies (CP) discovered dead while asleep (DDWA) and to synthesize the research literature on CP survival. Method: We utilized case series to describe the common features among patients DDWA between 1993 and 2011.Using our medical records, we extracted data on demographics, treatment, and co-morbidities. In addition using the appropriate search terms, we searched the Medline and other electronic data bases for articles published between 1966 and 2011. Further, we synthesized the literature and provided evidence on clinical conditions that could be associated with CP mortality in relation to DDWA, and obstructive sleep apnea syndrome (OSAS) and sleep related breathing disorders (SRBD) management. Results: Between 1993 and 2011 there were 177 reported deaths, of which 13 occurred as a result of being DDWA at home. All the deceased patients had Gastrointestinal feeding tube, seizure, respiratory disorders, and were nonambulatory. A greater proportion had scoliosis and hip dislocation surgeries. DDWA in our sample may be associated with these conditions; and OSAS/ SRBD as evidenced in literature. Conclusion: Pulmonary problems and disorders were the most common comorbidity, due probably to oxygen desaturation (< 70%), prolonged sleep apnea such OSAS and SRBD. Since there were no data on Polysomnography (PSG) and autopsy, it was difficult to account for specific sleep disorders that might have contributed to DDWA. We recommend a routine PSG and treatment of OSAS and SRBD, given their high prevalence among CP patients, especially those with disturbed nocturnal sleep and noisy breathing.
P70-S. Increased Youth Risk Behavior: Bullying by Location and by Reason M.A. Jagger, Y.J. Huang. Florida Department of Health, Bureau of Epidemiology, Tallahassee, FL Purpose: Bullying is when one or more students repeatedly tease, threaten, spread rumors about, hit, shove, or hurt another student. Compared to nonbullied students, bullied students are more likely to have engaged in many risk behaviors. The Florida Youth Risk Behavior Survey (YRBS) was used to determine the additional increased risk associated with having ever experienced less prevalent forms of bullying, by location (electronically) and by reason (perceived sexual orientation). Methods: The prevalence rates from the 2011 Florida YRBS (weighted to representation) of bullying and various risk behaviors are presented. Results are statistically significant at the .005 level. Results: In 2011, 33.0% of Florida public high school students were bullied. Among bullied students, e-bullying and bullying because of perceived sexual orientation were associated with additional increased risk in personal safety and violence; tobacco, drug, and alcohol use; sexual behavior; and self-harm and suicide ideation. For example, 40.6% of nonbullied students, 50.0% of students bullied at school, and 60.5% of e-bullied students have ever had oral sex, and 3.1% of non-bullied students, 16.7% of students bullied for physical reasons and 24.5% of students bullied for sexual reasons were threatened or injured with a weapon at school. Conclusion: Results indicate that 1) bullying is prevalence among high school students and 2) the form or reason for bullying is associated with increased risk behaviors. Raising awareness is important for preventing various risk behaviors in this population.
P71. Differences Between Adolescent and Young Adult Victims of Suicide: Findings From the Illinois Violent Death Reporting System S.G. McLone, A. Kouvelis, N. Tariq, T. Neumann, J. Cartland. Child Health Data Lab, The Maryann and J. Milburn Smith Child Health Research Program, Children's Memorial Hospital, Chicago, IL
Purpose: To investigate the differences in demographics, weapon used, precipitating circumstances, and potential opportunity for intervention between adolescent (ages 15-19 years) and young adult (ages 20-24) victims of suicide. Methods: Data from the Illinois Violent Death Reporting System (20052009) for 333 victims of suicide were analyzed using chi-square tests and multivariate logistic regression to examine the differences in factors associated with suicide between the two age groups. Results: Adolescent victims were more likely than young adults to disclose their intention to commit suicide to another (OR: 1.96 [95% CI: 1.11-3.47]) and to have a documented relationship problem with a relative, friend or acquaintance (OR: 2.33 [95% CI: 1.23-4.44]). Adolescents were less likely to be in an urban environment (OR: 0.59 [95% CI: 0.36-0.95) and to have a documented alcohol dependence problem (OR: 0.12 [95% CI: 0.03-0.55]) compared to young adults. No differences were found by sex, race/ethnicity or weapon type. Conclusion: Suicide is the third-leading cause of death among both adolescents and young adults in Illinois as well as the United States. Identifying factors associated with suicide specific to each age group with help to inform targeted prevention and intervention programs aimed at reducing the incidence of suicide in young people.
P72. Pregnancy Complications Associated With Asthma P. Mendola, S.K. Laughon, T. Männistö, J. Zhang, K. Leishear, U. Reddy, Z. Chen. Epidemiology Branch, NIH/NICHD, Rockville, MD Purpose: To examine the risk of pregnancy complications among women with asthma in a recent nationwide study, the Consortium on Safe Labor (CSL), 2002-2008. Methods: Electronic medical record data for 223,503 singleton pregnancies (204,171 women) from 12 clinical centers (19 hospitals) were analyzed. Maternal asthma was recorded in the chart or discharge summary ICD codes in 7.6% of deliveries (n¼17,043). Multivariable logistic regression models adjusted for maternal characteristics and lifestyle factors, and accounted for correlation from multiple deliveries per woman using generalized estimating equations. Results: Women with asthma were younger and more likely to be NonHispanic Black, unmarried, obese, smoke, consume alcohol, have public insurance and have diabetes and chronic hypertension prior to pregnancy. Asthmatics had a higher risk of mild preeclampsia (adjusted odds ratio (OR)¼ 1.2, 95% confidence interval (CI)¼1.1-1.3), superimposed preeclampsia (OR¼1.3, CI¼1.2-1.5), gestational diabetes (OR¼1.1, CI¼1.0- 1.2), preterm premature rupture of membranes (PROM)(OR¼1.2, CI¼1.0- 1.4), and were more likely to have a maternal ICU admission (OR¼1.4, CI¼1.1-1.8), preterm delivery (OR¼1.2, CI¼1.1-1.2), placental abruption (OR¼1.3, CI¼1.1-1.5), maternal hemorrhage (OR¼1.2, CI¼1.1-1.3), and cesarean delivery (OR¼1.2, CI¼1.1-1.2). No significant risks were observed for gestational hypertension, severe preeclampsia or term PROM. Conclusion: Women with asthma are at higher risk for pregnancy complications which affect both timing and route of delivery.
P73. Preeclampsia in Early Adolescence: Dealing With Sparse Data Z.D. Mulla, A.A. Eziefule, T. Carrillo. Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX Purpose: To identify factors associated with preeclampsia, a serious syndrome, in young women who delivered throughout Texas in 2007. Methods: A cross-sectional study was conducted using one-year's worth of Texas hospital discharge data (the Public Use Data File). Discharge diagnoses had been coded using ICD-9-CM. The sample was restricted to women who were in their first pregnancy and less than 16 years (y) old at the expected date of delivery (code V23.83), and who delivered during the hospital stay (code V27). Adjusted prevalence odds ratios (OR) were calculated using SAS 9.3 software. Ten exposures were initially examined. To deal with the situation of few outcome events, exact logistic regression (ELR) and penalized logistic regression (PLR) using Firth's bias correction were performed. Results: 138 patients were identified of which 16 had preeclampsia (11.6%). None were asthmatic, cocaine users, or depressed. Mothers aged 10-14 y composed 23.9% of the sample. The final model included race ethnicity, maternal age, and no/inadequate prenatal care. The adjusted ELR OR for