Friday, November 16, 2007

Children of HIV-Infected Parents

Children of HIV-Infected Parents: Custody Status in a Nationally Representative Sample

Burton O. Cowgill, MPH (a,b), Megan K. Beckett, PhD ( c), Rosalie Corona, PhD (a,d), Marc N. Elliott, PhD (c), Annie J. Zhou, MS (c) and Mark A. Schuster, MD, PhD (a,b,c)
a) Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine; b) Department of Health Services, School of Public Health, University of California, Los Angeles, California; d) Department of Psychology, Virginia Commonwealth University, Richmond, Virginia; c) Rand, Santa Monica, California

OBJECTIVE. The purpose of this work was to determine the rates and predictors of custody status for children of HIV-infected parents.

PARTICIPANTS AND METHODS. Data came from interviews of 538 parents with 1017 children (0–17 years old) from a nationally representative sample of HIV-infected adults receiving health care in the United States. Outcomes were collected at 2 survey waves and included child custody status and who, other than the HIV-infected parent, had custody of the child. Child custody status was categorized as (1) in custody of HIV-infected parent at both survey waves, (2) infected parent had custody at first survey wave but not second survey wave, (3) not in custody of infected parent at either survey wave, and (4) infected parent gained custody between survey waves. Potential custodians included (1) other biological parent, (2) state, foster, or adoptive parent, (3) grandparent, and (4) relative, friend, nonbiological parent, or other. Multinomial logistic regression modeled both outcomes.

RESULTS. Forty-seven percent of the children were in the custody of their HIV-infected parent at both survey waves, 4% were in the parent's custody at the first but not second survey wave, 42% were not in custody at either survey wave, and the parent of 7% gained custody between survey waves. Parents cited drug use (62%) and financial hardship (27%) as reasons for losing custody. Children of HIV-infected fathers, older parents, parents living without other adults, parents with low CD4 counts, drug-using parents, and parents with 1 hospital stay were less likely to be in their parent's custody at either survey wave.

CONCLUSIONS. More than half of the children were not in custody of their HIV-infected parent at some time during the study period. Pediatricians and others taking care of children with HIV-infected parents may be able to offer counseling or referrals to assist parents with child custody issues.

PEDIATRICS Vol. 120 No. 3 September 2007, pp. e494-e503
© 2007 American Academy of Pediatrics.

Wednesday, November 07, 2007

Black and White Patients With Stroke

Differences in Stroke Subtypes Between Black and White Patients With Stroke
Hugh S. Markus, FRCP; Usman Khan, MRCP; Jonathan Birns, MRCP; Andrew Evans, MRCP; Lalit Kalra, FRCP; Anthony G. Rudd, FRCP; Charles D.A. Wolfe, FRCP; Paula Jerrard-Dunne, MRCP
From the Centre for Clinical Neuroscience, St George’s University of London (H.S.M., U.K., P.J.-D.); Departments of Stroke Medicine and Health and Social Care Research, Kings College London (J.B., A.E., L.K.); and Guy’s and St Thomas’ NHS Foundation Trust (A.G.R., C.D.A.W.), London, UK

Determining whether the distribution of stroke subtypes differs between ethnic groups is important in understanding the mechanisms of the increased stroke incidence in black patients.

In this study, 600 black and 600 white patients with stroke were prospectively and consecutively recruited to determine differences in stroke subtypes. The pathophysiological Trial of Org 10172 (TOAST) classification was used and compared with a clinical (Oxfordshire Community Stroke Project) subtype classification. Stroke subtypes were determined by one investigator by review of original imaging.
Black patients with stroke were significantly younger and had higher prevalences of hypertension, diabetes, and obesity. They were less likely to be smokers and had lower prevalences of myocardial infarction and atrial fibrillation. In the black patients, 33% of stroke was due to cerebral small vessel disease compared with 14% in the white stroke cohort.
The black stroke cohort had less large vessel atherosclerosis (odds ratio, 0.49; 95% confidence interval, 0.29 to 0.82; P=0.007) and cardioembolic disease (odds ratio, 0.54; 95% confidence interval, 0.37 to 0.80; P=0.002). Using a classification based on clinical syndrome alone gave a higher estimate of the frequency of small vessel disease stroke, particularly in white patients.

A relative excess of small vessel disease was observed in black patients with stroke compared with an excess of extracranial atherosclerosis and cardioembolic stroke in white patients with stroke that was independent of conventional risk factors and social class. Whether these excesses are due to differences in genetic susceptibility or as-yet undetermined differences in environmental risk remains to be determined.

Circulation. 2007;116:2157-2164

Thursday, November 01, 2007

World Vegan Day

                                                         Vegan Children

Reed Mangels, PhD, RD and Sandra Hood, BSc (Hons), SRD

The number of vegans in the UK today is estimated at 0.5% but we do not know how many of these are children. In the US, a poll commissioned by the Vegetarian Resource Group in the year 2000 found that about 0.5% of 6 to 17-year-olds were vegan and did not eat meat, fish, poultry, dairy products or eggs.

Growth of Vegan Children
If a child's diet contains enough calories, normal growth and development can be expected and studies of vegan children have shown that their caloric intake is close to recommended levels and similar to intakes of non-vegan children of the same age.

Vegan children in the UK and the US have been found to be slightly shorter and lighter in weight than average but appeared to be growing at a normal rate. Children need a lot of energy in relation to their size and although healthy eating should be encouraged it is important that the diet be energy dense. Including foods such as vegetable oils, avocados, seeds, nut butters and pulses can provide both calories and nutrients. Dried fruits are also a concentrated source of energy and are an attractive food for many children. Children from an early age should be encouraged to brush teeth after eating dried fruits and other sweet foods to prevent tooth decay.

What Foods are Popular with Vegan Children?

Many vegan children like:
  • Bagels with nut butter or hummous
  • Bean burritos or tacos
  • Fresh or dried fruit
  • Mashed potatoes
  • Oven-cooked chips
  • Pancakes and waffles
  • Pasta with tomato sauce
  • Peanut butter and yeast extract sandwiches
  • Pizza without cheese, topped with vegetables and pulses, tofu, or fake meat
  • Raw vegetables with dips
  • Shakes made with soya milk and fruit
  • Spaghetti with tomato sauce
  • Tofu/vegetarian dogs
  • Veggie burgers