Cynthia J. Mears

Active healthy living: Prevention of childhood obesity through increased physical activity

The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.

Chronic Fatigue Syndrome After Infectious Mononucleosis in Adolescents

OBJECTIVE: The goal was to characterize prospectively the course and outcome of chronic fatigue syndrome in adolescents during a 2-year period after infectious mononucleosis. METHODS: A total of 301 adolescents (12–18 years of age) with infectious mononucleosis were identified and screened for nonrecovery 6 months after infectious mononucleosis by using a telephone screening interview. Nonrecovered adolescents underwent a medical evaluation, with follow-up screening 12 and 24 months after infectious mononucleosis. After blind review, final diagnoses of chronic fatigue syndrome at 6, 12, and 24 months were made by using established pediatric criteria. RESULTS: Six, 12, and 24 months after infectious mononucleosis, 13%, 7%, and 4% of adolescents, respectively, met the criteria for chronic fatigue syndrome. Most individuals recovered with time; only 2 adolescents with chronic fatigue syndrome at 24 months seemed to have recovered or had an explanation for chronic fatigue at 12 months but then were reclassified as having chronic fatigue syndrome at 24 months. All 13 adolescents with chronic fatigue syndrome 24 months after infectious mononucleosis were female and, on average, they reported greater fatigue severity at 12 months. Reported use of steroid therapy during the acute phase of infectious mononucleosis did not increase the risk of developing chronic fatigue syndrome. CONCLUSIONS: Infectious mononucleosis may be a risk factor for chronic fatigue syndrome in adolescents. Female gender and greater fatigue severity, but not reported steroid use during the acute illness, were associated with the development of chronic fatigue syndrome in adolescents. Additional research is needed to determine other predictors of persistent fatigue after infectious mononucleosis.

Testing for drugs of abuse in children and adolescents: Addendum - Testing in schools and at home

The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent. Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home. The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented. The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.

Exercise Tolerance Testing in a Prospective Cohort of Adolescents with Chronic Fatigue Syndrome and Recovered Controls following Infectious Mononucleosis

OBJECTIVE Six months after acute infectious mononucleosis (IM), 13% of adolescents meet criteria for chronic fatigue syndrome (CFS). We measured exercise tolerance in adolescents with CFS and control subjects 6 months after IM. STUDY DESIGN Twenty-one adolescents with CFS 6 months after IM and 21 recovered control subjects performed a maximal incremental exercise tolerance test with breath-by-breath gas analysis. Values expressed are mean+/-standard deviation. RESULTS The adolescents diagnosed with CFS and control subjects did not differ in age, weight, body mass index, or peak work capacity. Lower oxygen consumption peak percent of predicted was seen in adolescents with CFS compared with control subjects (CFS 99.3+/-16.6 vs control subject 110.7+/-19.9, P=.05). Peak oxygen pulse also was lower in adolescents with CFS compared with recovered control subjects (CFS 12.4+/-2.9 vs control subjects 14.9+/-4.3, P=.03). CONCLUSIONS Adolescents with CFS 6 months after IM have a lower degree of fitness and efficiency of exercise than recovered adolescents. Whether these abnormal exercise findings are a cause or effect of CFS is unknown. IM can lead to both fatigue and measurable changes in exercise testing in a subset of adolescents.

Autonomic Symptoms at Baseline and Following Infectious Mononucleosis in a Prospective Cohort of Adolescents

Chronic fatigue syndrome (CFS) is a complex condition involving fatigue and musculoskeletal and cognitive symptoms. Six, 12, and 24 months following monospot-positive acute infectious mononucleosis (IM), 13%, 7%, and 4%, respectively, of adolescents met criteria for CFS.1 As part of their evaluation at baseline and 6, 12, and 24 months following IM, adolescents diagnosed with CFS and recovered controls completed questionnaires regarding autonomic symptoms.

Efficacy of LAIV-T on Absentee Rates in a School-Based Health Center Sample

PURPOSE To determine the effectiveness of the intranasal LAIV-T in decreasing school absenteeism in a school-based vaccination initiative and to compare the acceptability of LAIV-T versus TIV among adolescents. METHODS This study was conducted within a single, urban community high school in the Fall of 2006. Participation was offered to all students in grades 6 to 10, aged 11 to 17 years. In December, school health center staff administered influenza vaccines to the students whose parents had returned written consent. Students received LAIV-T (n = 86), unless they were medically ineligible or objected; in those cases the injectable inactivated trivalent influenza vaccine (TIV) (n = 41) was offered. Students that did not receive either vaccination served as a control group (n = 234). Nonsuspension absences between January and June of 2007 were tracked for all three groups. RESULTS Students who received the LAIV-T had significantly less nonsuspension absences (mean absences = 5.53, SD = 5.00) compared to both the TIV (mean absences = 9.45, SD = 9.07) and control groups (mean absences = 7.97, SD =7.59). CONCLUSIONS LAIV-T was associated with a reduction in nonsuspension absences and was well accepted by students. Administration of LAIV-T may be a convenient and effective method to mass-immunize students in a school setting and help establish herd immunity within the community.

Predictors of post-infectious chronic fatigue syndrome in adolescents

This study focused on identifying risk factors for adolescent post-infectious chronic fatigue syndrome (CFS), utilizing a prospective, nested case–control longitudinal design in which over 300 teenagers with infectious mononucleosis (IM) were identified through primary care sites and followed. Baseline variables that were gathered several months following IM, included autonomic symptoms, days in bed since IM, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders. A number of variables were predictors of post-infectious CFS at six months; however, when autonomic symptoms were used as a control variable, only days spent in bed since mono was a significant predictor. Step-wise logistic regression findings indicated that baseline autonomic symptoms as well as days spent in bed since mono, which reflect the severity of illness, were the only significant predictors of those who met CFS criteria at six months.

The Occupational and Quality of Life Consequences of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in Young People

Introduction: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). Purpose: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. Method: Three hundred and one people (12–18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. Results: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. Conclusion: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.

Perceived Factors Affecting Asthma Among Adolescents: Experiences and Findings From the Student Asthma Research Team Pilot Study

Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year...

Issues in estimating rates of pediatric chronic fatigue syndrome and myalgic encephalomyelitis in a community-based sample.

There is a need to examine the prevalence of pediatric chronic fatigue syndrome (CFS) and Myalgic Encephalomyelitis (ME) in the general community, as well as the relative frequency of CFS and ME among various groups (e.g., different age groups, genders, racial/ethnic groups, and socioeconomic strata) and to compare these individuals with community controls. In the present study, we describe an ongoing NIH-funded study, which uses a multiple-stage design, beginning with a brief screening for CFS- and ME-like symptomatology, followed by a more rigorous medical and psychiatric diagnostic evaluation to determine the prevalence of pediatric CFS and ME status in the general community. We provide two case studies showing the types of data we are collecting, and how the data are being used to inform diagnostic decisions.