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[PMID]: 26093139
[Au] Autor:Savoldi S; Giacchino F; Rollino C; Manganaro M; Besso L; Izzo C; Gianoglio B; Amore A; Fenoglio R; Stratta P
[Ti] Title:Indagine sulla terapia di prevenzione del danno osseo nei pazienti trattati con corticosteroidi in Piemonte e valle d'Aosta. [Bone protection in corticosteroid treated patients].
[So] Source:G Ital Nefrol;32(3), 2015 May-Jun.
[Is] ISSN:1724-5990
[Cp] Country of publication:Italy
[La] Language:ita
[Ab] Abstract:The Piedmont Group of Clinical Nephrology compared the activity of 15 nephrology centers in Piedmont and Aosta Valley as regards bone protection in patients on corticosteroids therapy. Fracture prevalence shows great variability: in 4/15 centers (27%) no fractures were found, in 6/15 centers (40%) fractures were present in 1-4% of cases, in 1 center in 18% of patients. Clinical risk of fracture was based on sex, age and postmenopausal status in 11/14 of the centers (79%), history of fractures and bone disease in 4/14 centers (27%), smoking and alcohol consumption in 3 and 2 centers respectively, glucocorticoid dose and duration in 4, in children bone age and calcium phosphorus status. Dual energy X-ray absorptiometry was performed in 12 centers based on risk factors, in 8 (57%) DXA was performed during the follow-up, in 4 it was performed after 12 months and in 2 after 2-3 years. DXA is not prescribed in children. Only in one center, risk assessment is based on FRAX. Most of the patients are treated with vitamin D supplementation at a dose of steroids of 5 mg/d (80%). Calcium carbonate is used in 9 centers (60%), in two it is used only in the presence of low ionized calcium or bone mineral density. Bisphosphonates are used following AIFA prescription, in particular alendronate in all centers, risedronate in seven and denosumab in one. The analysis shows the great variability of the clinical and therapeutic approach regarding bone protection in patients on corticosteroids therapy, in Piedmont and Aosta Valley.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1506
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 764365 MEDLINE  
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[PMID]: 25879990
[Au] Autor:Holden TR; Smith MA; Bartels CM; Campbell TC; Yu M; Kind AJ
[Ad] Address:1 Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin....
[Ti] Title:Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients.
[So] Source:J Palliat Med;18(7):601-12, 2015 Jul.
[Is] ISSN:1557-7740
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. OBJECTIVES: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. METHODS: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. RESULTS: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118-0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04-1.06), which persisted beyond that accounted for by individual hospice enrollment. CONCLUSIONS: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1089/jpm.2014.0395

  3 / 764365 MEDLINE  
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[PMID]: 25770032
[Au] Autor:Howard VJ; Tanner RM; Anderson A; Irvin MR; Calhoun DA; Lackland DT; Oparil S; Muntner P
[Ad] Address:Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Electronic address: vjhoward@uab.edu....
[Ti] Title:Apparent Treatment-resistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack.
[So] Source:Am J Med;128(7):707-714.e2, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Blood pressure control is a paramount goal in secondary stroke prevention; however, high prevalence of uncontrolled blood pressure and use of multiple antihypertensive medication classes in stroke patients suggest this goal is not being met. We determined the prevalence and factors associated with apparent treatment-resistant hypertension in persons with/without stroke or transient ischemic attack. METHODS: Data came from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based cohort of 30,239 black and white adults aged ≥45 years, enrolled 2003-2007, restricted to 11,719 participants with treated hypertension. Apparent treatment-resistant hypertension was defined as (1) uncontrolled blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) with ≥3 antihypertensive medication classes, or (2) use of ≥4 antihypertensive medication classes, regardless of blood pressure level. Poisson regression was used to calculate characteristics associated with apparent treatment-resistant hypertension. RESULTS: Among hypertensive participants, prevalence of apparent treatment-resistant hypertension was 24.9% (422 of 1694) and 17.0% (1708 of 10,025) in individuals with and without history of stroke or transient ischemic attack, respectively. After adjustment for cardiovascular risk factors, the prevalence ratio for apparent treatment-resistant hypertension for those with versus without stroke or transient ischemic attack was 1.14 (95% confidence interval, 1.03-1.27). Among hypertensive participants with stroke or transient attack, male sex, black race, larger waist circumference, longer duration of hypertension, and reduced kidney function were associated with apparent treatment-resistant hypertension. CONCLUSIONS: The high prevalence of apparent treatment-resistant hypertension among hypertensive persons with history of stroke or transient ischemic attack suggests the need for more individualized blood pressure monitoring and management.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  4 / 764365 MEDLINE  
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[PMID]: 26086513
[Au] Autor:Mark LJ; Herzer KR; Cover R; Pandian V; Bhatti NI; Berkow LC; Haut ER; Hillel AT; Miller CR; Feller-Kopman DJ; Schiavi AJ; Xie YJ; Lim C; Holzmueller C; Ahmad M; Thomas P; Flint PW; Mirski MA
[Ad] Address:From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland; Legal Department, The Johns Hopkins Hospital, Baltimore, Maryland; Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; ‖Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; #MD Program, Johns Hopkins School of Medicine, Baltimore, Maryland; **MD Program, University of Maryland School of Medicine, Baltimore, Maryland; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; and Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon.
[Ti] Title:Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies.
[So] Source:Anesth Analg;121(1):127-39, 2015 Jul.
[Is] ISSN:1526-7598
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1213/ANE.0000000000000691

  5 / 764365 MEDLINE  
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[PMID]: 26085983
[Au] Autor:de Campos GC
[Ad] Address:Gustavo C de Campos, Department of Orthopedic Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, So Paulo13087-000, Brazil.
[Ti] Title:Placebo effect in osteoarthritis: Why not use it to our advantage?
[So] Source:World J Orthop;6(5):416-20, 2015 Jun 18.
[Is] ISSN:2218-5836
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Osteoarthritis is a major cause of pain and reduced quality of life in the elderly, as well as a major economic burden. Unfortunately, there is no currently effective therapeutic strategy to prevent the progression of Osteoarthritis, and its treatment poses a great challenge to the medical community. Most of the treatment modalities currently available for osteoarthritis have small to moderate effect sizes, according to main meta-analyses and treatment guidelines. On the other hand, literature has demonstrated that placebo is considerably effective. The present article discusses the history of placebo effect and its scientific evidence, comments on ethical issues and provides insights about how it may be used to our advantage when treating osteoarthritic patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.5312/wjo.v6.i5.416

  6 / 764365 MEDLINE  
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[PMID]: 26085918
[Au] Autor:Pan JJ; Fisher-Hoch SP; Chen C; Feldstein AE; McCormick JB; Rahbar MH; Beretta L; Fallon MB
[Ad] Address:Jen-Jung Pan, Chaoru Chen, Michael B Fallon, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States....
[Ti] Title:Burden of nonalcoholic fatty liver disease and advanced fibrosis in a Texas Hispanic community cohort.
[So] Source:World J Hepatol;7(11):1586-94, 2015 Jun 18.
[Is] ISSN:1948-5182
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:AIM: To investigate the potential burden of nonalcoholic steatohepatitis (NASH) and advanced fibrosis in a hispanic community. METHODS: Four hundred and forty two participants with available ultrasonography data from the Cameron County Hispanic Cohort were included in this study. Each participant completed a comprehensive questionnaire regarding basic demographic information, medical history, medication use, and social and family history including alcohol use. Values of the nonalcoholic fatty liver disease fibrosis score (NFS), FIB4 index, BARD score, and Aspartate aminotransferase to Platelet Ratio Index (APRI) were computed using the blood samples collected within 6 mo of liver ultrasonography from each participant. Hepatic steatosis was determined by ultrasonography. As part of univariable analysis, for continuous variables, comparisons among groups were performed with student-t test, one way analysis of variance, and Mann-Whitney test. Pearson χ(2) and the Fisher exact test are used to assess differences in categorical variables. For multivariable analyses, logistic regression analyses were performed to identify characteristics associated with hepatic steatosis. All reported P values are based two-sided tests, and a P value of less than 0.05 was considered to indicate statistical significance. RESULTS: The mean age and body mass index (BMI) of the study participants were 49.1 years and 31.3 kg/m(2), respectively. Among them, 65.6% were females, 52% had hepatic steatosis, 49.5% had metabolic syndrome, and 29% had elevated aminotransferases. Based on established cut-offs for diagnostic panels, between 17%-63% of the entire cohort was predicted to have NASH with indeterminate or advanced fibrosis. Participants with hepatic steatosis had significantly higher BMI (32.9 5.6 kg/m(2) vs 29.6 6.1 kg/m(2), P < 0.001) and higher prevalence rates of elevation of ALT (42.2% vs 14.6%, P < 0.001), elevation of aspartate aminotransferase (38.7% vs 18.9%, P < 0.001), and metabolic syndrome (64.8% vs 33%, P < 0.001) than those without hepatic steatosis. The NFS scores (P = 0.002) and the APRI scores (P = 0.002) were significantly higher in those with steatosis but the scores of the FIB4 index and BARD were similar between the two groups. After adjusting for age, gender and BMI, elevated transaminases, metabolic syndrome and its components, intermediate NFS and APRI scores were associated hepatic steatosis in multivariable analysis. CONCLUSION: The burden of NASH and advanced fibrosis in the Hispanic community in South Texas may be more substantial than predicted from referral clinic studies.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.4254/wjh.v7.i11.1586

  7 / 764365 MEDLINE  
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[PMID]: 26085938
[Au] Autor:Venneugus RV; Macbeth A; Levell NJ
[Ad] Address:Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK.
[Ti] Title:Dramatic and persistent loss of eyelashes.
[So] Source:JRSM Open;6(5):2054270415579779, 2015 May.
[Is] ISSN:2054-2704
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Although most paediatric hair loss presenting to clinicians is due to alopecia areata, unusual patterns should prompt a careful history.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1177/2054270415579779

  8 / 764365 MEDLINE  
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[PMID]: 25732995
[Au] Autor:Bosdet T; Branov J; Selvage C; Yousefi M; Sirrs S
[Ad] Address:Adult Metabolic Diseases Clinic, Vancouver Hospital, Level 4 - 2775 Laurel Street, Vancouver, BC, Canada, V5Z 1M9.
[Ti] Title:Diet History Is a Reliable Predictor of Suboptimal Docosahexaenoic Acid Levels in Adult Patients with Phenylketonuria.
[So] Source:JIMD Rep;21:97-102, 2015.
[Is] ISSN:2192-8304
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Omega-3 long-chain polyunsaturated fatty acids (n3LCPUFA) levels are reduced in phenylketonuria (PKU). Recent care guidelines recommend essential fatty acid status is monitored in patients with PKU but access to such testing is limited. We hypothesized that information obtained on diet history would identify PKU adults with suboptimal levels of n3LCPUFA. METHODS: A 12-month single site prospective study was completed including 35 adults (age 18-46) attending a clinic for adults with inborn errors of metabolism. Levels of n3LCPUFA were correlated with estimated intake using a published food frequency questionnaire. n3LCPUFA levels were tested at a commercial laboratory and values > one SD below the laboratory mean value were considered suboptimal. RESULTS: Mean levels of docosahexaenoic acid (DHA) were lower and levels of eicosapentaenoic acid (EPA) and alpha-linoleic acid (ALA) higher in subjects with PKU than in laboratory controls. n3LCPUFA levels correlated with estimated intake (p <0.002). Diet history had a positive predictive value of 93% and negative predictive value of 90% to identify subjects with suboptimal n3LCPUFA levels. CONCLUSIONS: Diet history is sufficient to predict adult subjects who may have low DHA levels and can be used to target testing or supplementation to those at risk. DHA levels are low despite high levels of ALA suggesting that supplementation, if indicated, should be with preformed DHA rather than with its precursors.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1007/8904_2014_399

  9 / 764365 MEDLINE  
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[PMID]: 25712382
[Au] Autor:Angelini C; Nascimbeni AC; Fanin M
[Ad] Address:Fondazione San Camillo Hospital IRCCS, 30100, Lido Venice, Italy, corrado.angelini@unipd.it.
[Ti] Title:Autophagy in Natural History and After ERT in Glycogenosis Type II.
[So] Source:JIMD Rep;21:71-7, 2015.
[Is] ISSN:2192-8304
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:We studied the role of autophagy in a series of 10 infantile-, juvenile-, and adult-onset GSDII patients and investigated autophagy blockade in successive biopsies of adult cases during disease natural history. We also correlated the autophagosome accumulation and efficiency of enzyme replacement therapy (ERT) in four treated cases (two infantile and two juvenile-adult onsets).The autophagic flux was monitored by measuring the amount of p62-positive protein aggregates and compared, together with fibre vacuolisation, to fibre atrophy.A blocked autophagic flux resulted in p62 accumulation, increased vacuolisation, and progressive atrophy of muscle fibres in biopsies collected from patients during natural history. On the contrary, in the GSDII cases early treated with ERT, the autophagic flux improved and muscle fibre atrophy, fibre vacuolisation, and acid phosphatase activity decreased.The functionality of the autophagy-lysosome system is essential in GSDII muscle, which is characterised by the presence of swollen glycogen-filled lysosomes and autophagic build-up. Defining the role of autophagy and its relationship with muscle loss is critical for understanding the disease pathogenesis, for developing new therapies, and for improving ERT efficacy in GSDII.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1007/8904_2014_389

  10 / 764365 MEDLINE  
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[PMID]: 25712380
[Au] Autor:Waisbren SE; Rohr F; Anastasoaie V; Brown M; Harris D; Ozonoff A; Petrides S; Wessel A; Levy HL
[Ad] Address:Division of Genetics and Genomics, Boston Children's Hospital, 1 Autumn Street #525, Boston, MA, 02115, USA, susan.waisbren@childrens.harvard.edu.
[Ti] Title:Maternal Phenylketonuria: Long-term Outcomes in Offspring and Post-pregnancy Maternal Characteristics.
[So] Source:JIMD Rep;21:23-33, 2015.
[Is] ISSN:2192-8304
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Maternal phenylketonuria (MPKU) is a well-recognized complication of PKU and one of the most potent teratogenic syndromes of pregnancy. Virtually all offspring from untreated pregnancies in women with classic PKU have intellectual disabilities and microcephaly. Congenital heart disease and intrauterine growth retardation occur many times more often than expected in the general population. Control of maternal blood phenylalanine during pregnancy prevents most if not all of these complications. Previous studies demonstrated the benefits of treatment in terms of birth parameters and early development. In this study, physical examinations, a medical history, and neuropsychological evaluation were obtained in 47 children from 24 mothers with PKU who received treatment during pregnancy. Mothers were interviewed and administered an abbreviated IQ test. Associations between maternal factors and offspring outcomes were also analyzed.The 21 male and 26 female offspring ranged in age from 1 month to 26 years with 21 (62%) over 6 years. Results indicated mean intercanthal distances above the 70th percentile. Microcephaly was present in 19% of offspring, with head circumference below the third percentile. None of the offspring had cardiac anomalies. Mean offspring IQ was 94 19, with 12% performing in the range of intellectual disability (IQ < 70). Among children >5years of age, 25% had learning disabilities, 31% had attention deficit hyperactivity disorder (ADHD), 22% were on ADHD medication, and 34% had a diagnosis of anxiety and/or depression. Among the 24 mothers, 12 reported following the diet for PKU. Only one woman on diet had a blood phenylalanine concentration <360mol/L (recommended range) and the majority had indications of poor nutritional status. Mean maternal Full Scale IQ was 94 16 (range = 61-117), with 25% performing in the borderline intellectual range (IQ < 85). Verbal IQ was significantly lower than Performance IQ (p = 0.01, CI 2.7, 16.1). On the self-report Beck Depression Inventory, Second Edition, 25% received scores indicating mild to moderate depression, and on the Beck Anxiety Inventory, 46% reported mild to moderate anxiety. Offspring IQ correlated with maternal metabolic control during pregnancy (r = 0.51), maternal IQ (r = -0.62), and socioeconomic position (r = -0.48). Offspring with ADHD, learning disabilities, or emotional disturbances were more likely to have mothers with anxiety and/or depression. To ensure optimal offspring outcomes, healthcare providers need to assess maternal nutrition, blood phenylalanine concentrations, cognitive abilities, and socioeconomic position. Interventions can then be initiated that reduce psychosocial stressors and enhance adherence to diet and positive parenting, which in turn can lead to better cognitive functioning, behavior, and emotional well-being in their children.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Da] Date of entry for processing:150618
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1007/8904_2014_365


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