Background Acute i.v. treatment for pediatric headache varies widely. Objectives Our aim was to describe our experience with i.v. magnesium for acute treatment of pediatric headache. Methods We reviewed the electronic medical records of all patients ages 5 to 18 years old treated with a standard dose of i.v. magnesium for headache at our institution from January 2008 to July 2010. Charts were assessed for headache diagnosis, prior medications given, side effects, tolerability, and response to treatment. Individuals were excluded if they had an underlying unstable medical condition or a secondary etiology for headache. Only first encounters were included if the patient had multiple encounters. Results There were 34 episodes of children who received i.v. magnesium in the emergency department (ED) or hospital. Of these, 14 were excluded because the patients had complex medical conditions (n = 6), they were repeat encounters (n = 7), or known secondary etiology for the headache (n = 1). Of the 20 included charts (range 13–18 years old), 5 had migraine, 4 had tension-type headache, and 11 had status migrainosus. Thirteen were treated in the ED and seven as an inpatient with a standard i.v. dose of magnesium. Ten of thirteen adolescents receiving i.v. magnesium in the ED were admitted for further headache treatment but not for side effects, and three were discharged home. Side effects of treatment included pain (1 of 20), redness (1 of 20), burning (1 of 20), and decreased respiratory rate without change in oxygenation (1 of 20). Conclusions In our case series, adolescents given i.v. magnesium as an abortive therapy for headache experienced minimal side effects and further studies should evaluate for effectiveness.
Objective Long-term psychological stress is associated with BMI increases in children as they transition to adulthood, while long-term maintenance of physical activity can slow excess weight gain. We hypothesized that in addition to these main effects, long-term physical activity mitigates the relationship between long-term stress and BMI increase. Methods The NHLBI Growth and Health Study enrolled 2,379 10-year-old Black and White girls, following them annually for 10 measurement points. Growth curve modeling captured the dynamics of BMI, measured yearly, and stress and physical activity, measured every other year. Results At average levels of activity and stress, with all covariates remaining fixed, average BMI at baseline was 19.74 (SE = 0.38) and increased 0.64 BMI (SE= 0.01, p < .001) units every year. However, this increase in BMI significantly varied as a function of cumulative stress and physical activity. Slower BMI gain occurred in those girls who were less stressed and more active (0.62 BMI units/year, SE= .02, p < .001), whereas the most rapid and largest growth occurred in girls who were the more stressed and less active (0.92 BMI units/year, SE= .02, p < .001). Racial identification did not alter these effects. Conclusions As hypothesized, in girls who maintained long-term activity, BMI growth was mitigated, even when reporting high long-term stress, compared to less physically active girls. This study adds to a converging literature in which physical activity, a modifiable prevention target, functions to potentially limit the damaging health effects of long-term psychological stress.
Socioeconomic disadvantage during childhood has lasting effects on adult health. Children raised by less educated parents are at higher risk for later cardiovascular disease (CVD), Alzheimer's disease, and type 2 diabetes mellitus. The mechanisms through which childhood socioeconomic status (SES) affect health are unclear. Childhood SES may shape stress physiology, including neuroendocrine processes, which may negatively impact health in adulthood. Prior literature shows that less educated individuals have flatter cortisol slopes across the day compared to those higher in education. Flattened slopes have been linked to chronic stress, CVD outcomes, breast cancer mortality, and both all-cause and CVD mortality. It is unknown whether one's childhood SES, approximated by parental education level, predicts diurnal cortisol trajectories independent of one's individual education. To this end, we recruited 20 Black and 20 White women who previously participated in the National Heart, Lung, and Blood Institute (NHLBI)-supported National Growth and Health Study (NGHS) to complete a daily stress assessment, which included salivary cortisol sampling at four times per day over two consecutive days. Mixed modeling indicated that cortisol slope across the day was a function of individual education (b time×individual education= − 0.04, SE = 0.02, p=0.045). Simple slope analyses revealed that women with only a high school diploma had significantly flatter cortisol slopes (b= − 0.22, SE = 0.06, p<0.001) than those with more than a high school diploma (b= − 0.26, SE = 0.02, p<0.001). Cortisol slopes were also a function of parental education (b time*parental education= − 0.04, SE = 0.02, p=0.038). Simple slopes analyses revealed that women with parents who received only high school educations had significantly flatter cortisol slopes (b= − 0.20, SE = 0.06, p<0.001) compared to those with parents who received more than a high school diploma (b= − 0.24, SE = 0.02, p<0.001). Importantly, the effect of parental education was independent of individual education. These findings provide preliminary evidence that parental education, a marker of childhood SES, can influence neuroendocrine activity beyond childhood, having lasting effects into adulthood with important implications for health
Introduction: Obesity is a leading cause of cardiovascular disease. Adolescence is a period when behavior changes consolidate, setting a trajectory towards obesity. Both poor health behaviors and psychological stress promote obesity. Studies have shown that ongoing stress is related to weight gain while maintaining physical activity mitigates obesity in children as they transition to adulthood. We hypothesized that during childhood, physical activity maintenance would moderate the relationship between chronic stress and BMI increase. Methods: The NHLBI Growth and Health Study enrolled 2,379 Black and White girls aged 9-10 and assessed them annually over ten years. Perceived Stress was measured in years 2, 4, 6, 8, and 10 with the well-validated Perceived Stress Scale, simplified for use in children. The Physical Activity Patterns Questionnaire assessed duration and frequency of activities in and out of school at years 1, 3, 5, and 7-10. Body mass index (BMI; kg/m2) was available all years. Covariates included pubertal timing, race, parental income and education, and nutrient intake. Repeated measurement allows prediction of trajectories of BMI with growth curve modeling, i.e. rate of BMI change over time. Results: On average, baseline BMI was 20.79 and increased 0.63 BMI units/year. Yet, BMI increase varied significantly as a function of stress and physical activity (p = .005). Even when reporting high stress, girls who maintained activity had lower BMI growth than girls who were fairly inactive between ages 10 and 19. An average of two units less in BMI was seen at age 19 in those highly stressed yet active versus highly stressed and less active - a likely clinically significant difference, as the girls in the latter category neared 30 kg/m2 (see Figure). The slowest increase in BMI between ages 10 and 19 was evidenced in girls more active and lower in stress. Conclusion: This study adds to a converging literature showing that physical activity is a modifiable behavior that can limit the harmful health effects of ongoing stress.
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