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Background and purposeThere are limited data about the reliability of subtype classification in childhood arterial ischemic stroke, an issue that prompted the IPSS (International Pediatric Stroke Study) to develop the CASCADE criteria (Childhood AIS Standardized Classification and Diagnostic Evaluation). Our purpose was to determine the CASCADE criteria's reliability in a population of children with stroke.MethodsEight raters from the IPSS reviewed neuroimaging and clinical records of 64 cases (16 cases each) randomly selected from a prospectively collected cohort of 113 children with arterial ischemic stroke and classified them using the CASCADE criteria. Clinical data abstracted included history of present illness, risk factors, and acute imaging. Agreement among raters was measured by unweighted κ statistic.ResultsThe CASCADE criteria demonstrated a moderate inter-rater reliability, with an overall κ statistic of 0.53 (95% confidence interval [CI]=0.39-0.67). Cardioembolic and bilateral cerebral arteriopathy subtypes had much higher agreement (κ=0.84; 95% CI=0.70-0.99; and κ=0.90; 95% CI=0.71-1.00, respectively) than cases of aortic/cervical arteriopathy (κ=0.36; 95% CI=0.01-0.71), unilateral focal cerebral arteriopathy of childhood (FCA; κ=0.49; 95% CI=0.23-0.76), and small vessel arteriopathy of childhood (κ=-0.012; 95% CI=-0.04 to 0.01).ConclusionsThe CASCADE criteria have moderate reliability when used by trained and experienced raters, which suggests that it can be used for classification in multicenter pediatric stroke studies. However, the moderate reliability of the arteriopathic subtypes suggests that further refinement is needed for defining subtypes. Such revisions may reduce the variability in the literature describing risk factors, recurrence, and outcomes associated with childhood arteriopathy.

A multicenter, randomized, double-blind, double-dummy, noninferiority trial of rituximab was conducted to compare rituximab with standard cytotoxic therapy for the induction of complete remission by 6 months in patients with severe ANCA-associated vasculitis. Rituximab therapy was not found to be inferior to daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and might be superior in relapsing disease.

Objectives. We compared the prevalence of serious psychological distress among parenting adults with the prevalence among nonparenting adults and the sociodemographic correlates of serious psychological distress between these 2 populations. Methods. We drew data from 14240 parenting adults and 19224 nonparenting adults who responded to the 2002 National Survey on Drug Use and Health. We used logistic regression procedures in our analysis. Results. An estimated 8.9% of parenting adults had serious psychological distress in the prior year compared with 12.0% of nonparenting adults of similar age. In both groups, the adjusted odds of having serious psychological distress were higher among adults who were women, younger (between the ages of 18 and 44 years), low income, or receiving Medicaid. We found some differences in the correlates of serious psychological distress between parenting adults and nonparenting adults. The odds of having serious psychological distress were lower among parenting adults after we controlled for demographic characteristics. Conclusions. Serious psychological distress is fairly prevalent among parenting adults, and high-risk sociodemographic groups of parenting adults should be targeted to ensure access to coordination of services.

News coverage is associated with a variety of health behaviors, but studies have yet to assess the indirect effects of news coverage generated by a health promotion campaign. The Florida Tobacco Control Program (FTCP), a youth-led marketing and grassroots campaign launched in Florida in 1998, provides the opportunity to examine the effects of program-related newspaper coverage on youth smoking behavior. Articles were collected from Florida daily newspapers, content analyzed to identity the prevalence of topic-specific coverage, and merged by county and year to the Florida Youth Tobacco Survey, a statewide, representative survey of Florida middle school and high school students administered between 1998 and 2002. Trend comparisons and logistic regression models, controlling for alternate explanations, show that FTCP newspaper coverage (particularly coverage of youth advocacy efforts) contributed to observed declines in current smoking. Newspaper coverage of health communication campaigns may represent a meaningful, indirect source of campaign effects. Keywords: news coverage; smoking; media effects; indirect effects; health communication

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