bluuebunny/crossref_metadata_2025 huggingface dataset:
Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children
Authors: Sorof Jonathan M. , Lai Dejian , Turner Jennifer , Poffenbarger Tim , Portman Ronald J.
Published: August 2004

Objectives. To describe the current prevalence of pediatric hypertension and the relationships between gender, ethnicity, overweight, and blood pressure.

Methods. School-based screening was performed in 5102 children (13.5 ± 1.7 years) from May through November 2002. Age, gender, ethnicity, weight, and height were ascertained, and body mass index (BMI) was calculated as weight (kg)/height (m2). Overweight was defined as BMI ≥95th percentile. Students with blood pressure >95th percentile on the first screening underwent a second screening 1 to 2 weeks later, and then a third screening if blood pressure was >95th percentile at the second screening.

Results. Ethnicity distribution was 44% white, 25% Hispanic, 22% African American, and 7% Asian. Overall, overweight prevalence was 20%, which varied significantly by ethnicity (31% Hispanic, 20% African American, 15% white, and 11% Asian). The prevalence of elevated blood pressure after first, second, and third screenings was 19.4%, 9.5%, and 4.5%, respectively. Elevated blood pressure on first screening was highest among Hispanics (25%) and lowest among Asians (14%). Ethnic differences in the prevalence of hypertension (elevated blood pressure on 3 screenings) were not significant after controlling for overweight. The prevalence of hypertension increased progressively as the BMI percentile increased from ≤5th percentile (2%) to ≥95th percentile (11%). After adjustment for gender, ethnicity, overweight, and age, the relative risk of hypertension was significant for gender (relative risk: 1.50; confidence interval: 1.15, 1.95) and overweight (relative risk: 3.26; confidence interval: 2.50, 4.24).

Conclusions. These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.
The Effects of Access to Pediatric Care and Insurance Coverage on Emergency Department Utilization
Authors: Johnson William G. , Rimsza Mary E.
Published: August 2004

Objective. To compare children who used the emergency department (ED) in a rural, border community with those who did not over a 1-year period to estimate the effects of access to pediatric care, insurance coverage, ethnicity, gender, age, and area of residence on ED utilization.

Design. Multivariate logit models are used to estimate the independent influence of demographic characteristics, insurance coverage, and access to pediatric care on ED utilization during 1999 by children 0 to 19 years of age.

Results. Controlling for age, gender, ethnicity, and area of residence, children who received care from a private practice pediatric group were 73% less likely to utilize the ED if insured and 93% less likely if uninsured to use the ED than children who had not visited a pediatrician. Uninsured children were nearly 4 times more likely to use the ED than insured children. Among insured children, those covered by Medicaid were 54% less likely to use the ED than children with private insurance. Compared with white, non-Hispanic children, Asian or Hispanic children were no more likely to use the ED. Insured Native American children were more than twice as likely as white, non-Hispanic children to utilize the ED.

Conclusions. Access to pediatric care is associated with a marked decrease in ED utilization regardless of insurance status. This decrease in ED utilization is especially large for uninsured children.
Developmental and Behavioral Status of Infants and Young Children Awaiting Heart or Heart-Lung Transplantation
Authors: Wray Jo , Radley-Smith Rosemary
Published: August 2004

Objective. Research into cognitive development and behavior in children undergoing heart or heart-lung transplantation has focused mainly on older children, with investigation of children undergoing transplantation as infants or toddlers being largely retrospective. This study was conducted, therefore, to obtain pretransplant baseline measures of development and behavior for preschool-aged children.

Methods. Children <3.5 years old were assessed before transplantation (n = 35) and compared with a group of children awaiting conventional cardiac surgery, a group undergoing bone marrow transplantation, and a group of healthy children. Development was measured by using the Ruth Griffiths Mental Development Scales, and behavior was measured with the Achenbach Child Behavior Checklist.

Results. Within the transplant group, 17 had congenital heart disease (CHD), and 18 had cardiomyopathy (CM). Although the overall mean developmental scores were within the normal range for the transplant, conventional cardiac surgery, and bone marrow transplantation groups, scores were significantly lower than those of the healthy group. Within the transplant group, those with CHD had a significantly lower mean developmental quotient than those with CM. Furthermore, the CHD patients obtained significantly lower scores than those with CM on areas of development covering locomotor abilities, speech and hearing, eye-hand coordination, and performance.

Conclusions. In common with other groups of ill children, patients awaiting heart or heart-lung transplantation are at risk for developmental delay. Diagnosis is a salient factor in determining outcome in most areas of development. Psychosocial interventions need to be targeted to maximize developmental potential before transplantation.
Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program
Authors: Shields Alexandra E. , Comstock Catherine , Weiss Kevin B.
Published: August 2004

Objective. To examine differences in the process of care for Medicaid-enrolled white, Hispanic, and black children with asthma.

Design. Retrospective cohort study using Medicaid claims data to analyze the process of asthma care in 1994, including all white (non-Hispanic), black (non-Hispanic), and Hispanic children (aged 2–18 years) with asthma in the non-health maintenance organization portion of the Massachusetts Medicaid program (N = 5773). Main outcome measures included performance on 6 claims-based process-of-care measures that reflect national guidelines. Measures addressed primary and specialty care for asthma, appropriate asthma pharmacotherapy, and timely follow-up care after asthma emergency department (ED) visits and hospitalizations.

Results. Controlling for case mix, provider type, disability status, age, and gender, Hispanic children with asthma were 39% less likely than white children to have a specialist visit for asthma (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46–0.81) and 41% less likely to receive a follow-up visit within 5 days of being seen in the ED for asthma (OR: 0.59; CI: 0.36–0.95). However, Hispanic children received better care in 2 respects. They were 16% more likely than white children to receive a minimum of 2 asthma visits per year (CI: 1.01–1.34) and 27% less likely to be overprescribed β-agonist medications (OR: 0.73; CI: 0.54–0.99). Black children were 64% less likely than white children to receive timely follow-up care after being seen in the ED for asthma (OR: 0.36; CI: 0.18–0.73). There were no racial/ethnic differences in the prescribing of antiinflammatory medications or timely follow-up care after an asthma hospitalization.

Conclusions. This study demonstrates important differences in the process of care experienced by racial/ethnic subpopulations within a Medicaid population, which may help explain differential outcomes. Efforts to improve asthma outcomes should target specific areas in which black and Hispanic children may be receiving suboptimal care.
Evaluation of Neonatal Intensive Care for Extremely Low Birth Weight Infants in Victoria Over Two Decades: II. Efficiency
Authors: Doyle Lex W. ,   the Victorian Infant Collaborative Study Group
Published: August 2004

Context. Although the increasing effectiveness of neonatal programs for extremely low birth weight (ELBW, birth weight <1000 g) infants has been established from cohort studies, there is a paucity of data on the relationship between the costs and the consequences of neonatal intensive care.

Objective. To determine the changes in the efficiency of neonatal intensive care for ELBW infants in Victoria, Australia over 2 decades.

Design. Economic evaluation (cost-effectiveness and cost-utility analyses) in a population-based cohort study of consecutive ELBW infants born during 4 distinct eras (1979–1980, 1985–1987, 1991–1992, and 1997) followed to at least 2 years of age.

Setting. The state of Victoria.

Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979–1980: n = 351; 1985–1987: n = 560; 1991–1992: n = 429; 1997: n = 233).

Main Outcome Measures. Costs were assessed primarily by the consumption of hospital resources. The consequences included survival and quality-adjusted survival rates at 2 years of age.

Results. The cost-effectiveness ratios (expressed in Australian dollars for 1997) were similar between successive eras at $5270, $3130, and $4050 per life-year gained, respectively. The cost-utility ratios were similar between successive eras at $5270, $3690, and $5850 per quality-adjusted life-year gained, respectively, and were similar to the cost-effectiveness ratios. The cost-effectiveness and cost-utility ratios were generally higher in lower birth-weight subgroups, but there were consistent gains in efficiency over time in infants of lower birth weight.

Conclusions. As there have been large increases in effectiveness from the late 1970s to the late 1990s, the efficiency of neonatal intensive care for ELBW infants in Victoria has remained relatively stable.
Neurodevelopment in Children Born Small for Gestational Age: A Randomized Trial of Nutrient-Enriched Versus Standard Formula and Comparison With a Reference Breastfed Group
Authors: Morley Ruth , Fewtrell Mary S. , A. Abbott Rebecca , Stephenson Terence , MacFadyen Una , Lucas Alan
Published: August 2004

Objective. Many studies have shown that children born small for gestational age (SGA) are at a neurodevelopmental disadvantage. We have shown that nutrient enrichment of formula fed to term SGA infants improves their growth and hypothesized that it also would improve their neurodevelopmental outcome.

Design. A randomized, controlled trial of standard term-infant (n = 147) or nutrient-enriched (n = 152) formula for the first 9 months. A reference group of 175 breastfed SGA infants was also recruited.

Setting. Subjects were recruited in 5 maternity hospitals in Cambridge, Nottingham, and Leicester, all in the United Kingdom.

Participants. Healthy, term infants (gestation: ≥37 weeks) with birth weight <10th centile.

Outcome Measures. Bayley mental and psychomotor scores at 18 months (primary) and developmental scores from Knobloch, Pasamanick, and Sherrard’s developmental screening inventory at 9 months (secondary).

Results. There was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. However, at 9 months, children fed the enriched formula had a significantly lower developmental quotient (99.5 vs 102.0; 95% confidence interval [CI] for difference: −4.6, −0.4). A significant disadvantage was seen in girls (−5.1; 95% CI: −7.8, −2.4) but not in boys (0.9; 95% CI: −2.4, 4.2).

Breastfed infants had significantly higher MDI and PDI scores at 18 months than formula-fed infants. Confounding factors accounted for ∼34% of the observed association between breastfeeding and MDI score and none of the association between breastfeeding and PDI score.

Conclusions. The previously reported enhanced linear growth in SGA children fed enriched formula was not matched by a neurodevelopmental advantage. At 9 months, girls fed the enriched formula had a significant developmental disadvantage, although this was not seen at 18 months. Later follow-up will determine any long-term effects on health or development. Meanwhile, use of enriched formula for term SGA children should not be promoted.

It seems that breastfeeding may be especially beneficial for neurodevelopment in children born SGA.
Patterns of Injury in Children: A Population-Based Approach
Authors: Spady Donald William , Saunders Duncan Leslie , Schopflocher Donald Peter , Svenson Lawrence Walter
Published: August 2004

Objective. We describe the frequency and patterns of injury affecting 96 359 children between 0 and 10 years old and living in Alberta, Canada.

Design. This population-based, longitudinal study involved children born in the 3 fiscal years of April 1, 1985 to March 31, 1988, recruited before age 1, and who remained in the study until at least age 5. We used the International Classification of Diseases, Ninth Revision, Clinical Modification chapter-17 diagnostic codes provided by physicians. Codes were grouped into 17 categories; injury episodes were calculated, and age- and gender-specific incidence rates for each category were calculated. The age, pattern, times of greatest risk, and the effect of gender on the type and incidence of injury were determined.

Setting. Health care administrative data were obtained from all fee-for-service health care venues in Alberta between April 1, 1985 and March 31, 1998 providing services to children registered with the Alberta Health Care Insurance Plan and otherwise meeting entrance criteria.

Results. Nearly 84% of children received care for an injury during the study period, and in any given year ∼21% of the population studied had at least 1 injury. Repeat injury was common (73%), and boys were more likely than girls to be injured and to have repeat injury. The most common injuries were dislocations and sprains, open wounds, and superficial injuries and contusions. Burns, poisoning, intracranial injury, and foreign bodies were the next most common, and fractures were least common. Approximately 10% of injuries were multiple-category injuries. Rates varied greatly by injury category, age, and gender. Hospitalization rates varied in a similar manner and commonly accounted for ∼10% of all services. Males were most likely to have an injury, and aboriginal children or children who had received welfare at some time were at greatest risk.

Conclusions. Administrative data can be used to estimate the incidence of injury in a pediatric population. Distinct patterns of injury occur at different ages. Recurrent injury is common. Almost identical proportions of injury (46%) are treated in emergency departments and physicians’ offices.
Predictors of Future Fight-Related Injury Among Adolescents
Authors: Borowsky Iris Wagman , Ireland Marjorie
Published: August 2004

Objective. Nonfatal fight-related injuries among youths result in lost capacity and high costs of medical care and rehabilitation and constitute a major public health problem. This study identifies factors that predict the occurrence of a fight-related injury that requires medical attention among boys and girls.

Methods. We analyzed data from 14 787 adolescents who completing 2 interviews, approximately 1 year apart, in the National Longitudinal Study of Adolescent Health, a nationally representative, school-based sample of youths. We identified time 1 factors at the community, family, and individual levels that predicted any self-reported fight-related injury that required medical treatment at time 2.

Results. Factors that predict future injury among both boys and girls in multivariate models were violence-related factors: witnessing or being a victim of violence (odds ratio [OR]: 3.69; 95% confidence interval [CI]: 1.81–7.49 for boys; OR: 5.13; 95% CI: 1.25–21.09 for girls), history of a violence-related injury (OR: 2.30; 95% CI: 1.60–3.29 for boys; OR: 3.18; 95% CI: 1.87–5.41 for girls), and physical fighting (OR: 2.02; 95% CI: 1.44–2.84 for boys; OR: 5.15; 95% CI: 3.18–8.34 for girls). Among boys, illicit drug use was also an independent predictor of future injury (OR: 1.72; 95% CI: 1.24–2.37), whereas excellent perceived general health (OR: 0.48; 95% CI: 0.25–0.93) and a high grade point average (OR: 0.52; 95% CI: 0.29–0.95) were significant protective factors against fight-related injury. Girls who reported a high level of depressive symptoms were much more likely to report fight-related injury than nondepressed girls (OR: 8.98; 95% CI: 2.43–33.25).

Conclusions. Factors related to violence, substance use, school achievement, and physical and mental health predicted a future fight-related injury that required medical treatment. The results could assist health and social service providers, educators, and others in identifying youths who are at high risk for fight-related injury and may benefit from appropriate intervention.
Utility of Follow-up Renal Sonography in Children With Vesicoureteral Reflux and Normal Initial Sonogram
Authors: Lowe Lisa H. , Patel Manish N. , Gatti John M. , Alon Uri S.
Published: August 2004

Objective. The purpose of this study was to determine the value of follow-up renal sonography in children who presented with urinary tract infection and were found to have a voiding cystogram diagnosis of vesicoureteral reflux while having a normal initial renal sonogram.

Methods. We retrospectively reviewed the medical records of 64 consecutive children who presented for follow-up renal sonography with a voiding cystogram diagnosis of vesicoureteral reflux and a normal initial sonogram conducted as part of the routine evaluation after urinary tract infection. Data recorded included gender, age, initial grade of reflux, time to follow-up sonogram, and abnormalities on follow-up sonogram. Children with conditions that may predispose to vesicoureteral reflux were excluded.

Results. Children who were studied (7 boys, 57 girls) ranged in age from 1 month to 10 years, 10 months (mean: 35.6 months; median: 24 months). Ninety-four (73.4%) of 128 renal units demonstrated vesicoureteral reflux on voiding cystogram; 89 (94.7%) of 94 of them were grade 1 to 3. The mean time to follow-up was 22 months (range: 4 months to 5 years, 2 months; median: 18 months). All 128 (95% confidence interval: 0%–2.8%) renal units were normal on follow-up sonography.

Conclusion. Routine performance of repeat sonography seems unnecessary among children, particularly girls, with low- to medium-grade vesicoureteral reflux, who have had a previous normal sonogram and no conditions that predispose to vesicoureteral reflux.
Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits
Authors: Chaudron Linda H. , Szilagyi Peter G. , Kitzman Harriet J. , Wadkins Holly I.M. , Conwell Yeates
Published: August 2004

Objective. To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening.

Methods. The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals.

Results. The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores ≥10, and 27% of women who completed the EPDS had scores ≥10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]).

Conclusions. Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.
Behavioral Differences Among Subjects With Prader-Willi Syndrome and Type I or Type II Deletion and Maternal Disomy
Authors: Butler Merlin G. , Bittel Douglas C. , Kibiryeva Nataliya , Talebizadeh Zohreh , Thompson Travis
Published: August 2004

Objective. To determine whether phenotypic differences exist among individuals with Prader-Willi syndrome with either type I or type II deletions of chromosome 15 or maternal disomy 15 leading to a better understanding of cause and pathophysiology of this classical genetic syndrome.

Methods. We analyzed clinical, anthropometric, and behavioral data in 12 individuals (5 men, 7 women; mean age: 25.9 ± 8.8 years) with PWS and a type I (TI) deletion, 14 individuals (6 men, 8 women; mean age: 19.6 ± 6.5 years) with PWS and a type II (TII) deletion, and 21 individuals (10 men, 11 women; mean age: 23.6 ± 9.2 years) with PWS and maternal disomy 15 (UPD). The deletion type was determined by genotyping of DNA markers between proximal chromosome 15 breakpoints BP1 and BP2. TI deletions are ∼500 kb larger than TII deletions. Several validated psychological and behavioral tests were used to assess phenotypic characteristics of individuals with PWS representing the 3 genetic subtypes.

Results. Significant differences were found between the 2 deletion groups and those with UPD in multiple psychological and behavorial tests, but no differences were observed in other clinical or anthropometric data studied. Adaptive behavior scores were generally worse in individuals with PWS and the TI deletion, and specific obsessive-compulsive behaviors were more evident in the TI individuals compared with those with UPD. Individuals with PWS with TI deletions also had poorer reading and math skills as well as visual-motor integration.

Conclusions. Our study indicates that individuals with TI deletion generally have more behavioral and psychological problems than individuals with the TII deletion or UPD. Four recently identified genes have been identified in the chromosome region between BP1 and BP2 with 1 of the genes (NIPA-1) expressed in mouse brain tissue but not thought to be imprinted. It may be important for brain development or function. These genes are deleted in individuals with TI deletion and are implicated in compulsive behavior and lower intellectual ability in individuals with TI versus TII.
Predictors of Urban Fathers’ Involvement in Their Child’s Health Care
Authors: Moore Trevena , Kotelchuck Milton
Published: August 2004

Objective. Fathers make important contributions to many aspects of children’s well-being, but relatively few studies have evaluated father involvement in their child’s health care. The objective of this study was to explore the extent to which fathers are involved in their children’s health care and identify those factors that are associated with greater involvement.

Methods. A convenience sample of 104 English-speaking, urban fathers with children younger than 7 years were recruited to complete an anonymous, structured interview. Fathers self-reported the number of well-child visits (WCVs) that they had ever attended and which factors had influenced their attendance. Bivariate and multivariate analyses were used to identify those factors that predicted greater involvement.

Results. Eighty-nine percent of the fathers had attended at least 1 WCV. Fifty-three percent had high involvement, ie, had attended ≥40% of the American Academy of Pediatrics recommended visits for their child’s age. In multivariate modeling, factors that were significantly associated with high involvement in attending WCVs included attendance at the child’s delivery (odds ratio [OR]: 7.3 [1.7–30.4]), younger child age (OR: 0.96 [0.94–0.99]), older father age (OR: 1.2 [1.2–1.3]), the child’s having health insurance (OR: 4.1 [1.3–12.0]), and having >1 child (OR: 0.22 [0.06–0.72]).

Conclusions. The factors identified suggest ways that pediatric providers can support fathers’ involvement in their children’s health care. Providers should focus on encouraging greater involvement early, especially for younger fathers and those with older children. In addition, support of universal health coverage for children might, in addition to other obvious benefits, enhance a father’s engagement with his child’s health care.
Teen Home Pregnancy Test Takers: More Worried or More Wishful?
Authors: Kelly Lisa , Sheeder Jeanelle , Stevens-Simon Catherine
Published: August 2004

Objective. To test the hypothesis that teenagers who have taken home pregnancy tests are more ambivalent about remaining nonpregnant than those who have not and, for this reason, use contraceptives less consistently.

Methods. A racially diverse group of 340 inadequately contracepting, nulligravida teens, 94 (28%) of whom had taken a home pregnancy test, was studied. At enrollment, participants completed a self-administered questionnaire, were counseled about contraceptive options, and were given the opportunity to initiate their method of choice. The enrollment tool assessed traditional teen-pregnancy risk factors, expectations about the effects of childbearing, common deterrents to contraceptive use, the desirability of remaining nonpregnant, and contraceptive use and plans.

Results. Home pregnancy test takers were more apt to be unsure that they wanted to remain nonpregnant (relative risk [RR]:1.3; 95% confidence interval [CI]:1.1–1.6), principally because they were more likely to lack negative expectations about the effects of childbearing on their lives (odds ratio: 2.2; 95% CI = 1.2–4.0). Although no more likely to perceive deterrents to contraceptive use, pregnancy-test-kit users were more apt to have had unprotected sexual intercourse in the past (RR:1.3; 95% CI:1.1–1.5) and to plan to do so in the future (RR:1.7; 95% CI:1.1–3.3). Group differences in the desire to remain nonpregnant accounted for differences in contraceptive behavior and plans.

Conclusion. Home pregnancy test taking should be regarded as a red flag by those who care for adolescents; although they are as capable of using contraceptives as their peers, test takers are less apt to do so because they expect less negative consequences from childbearing and, for this reason, may benefit more from discussing childbearing expectations than contraceptive options.
Health Status and Health-Related Quality of Life in a Population-Based Sample of Neonatal Intensive Care Unit Graduates
Authors: Klassen Anne F. , Lee Shoo K. , Raina Parminder , Chan Herbert W.P. , Matthew Derek , Brabyn David
Published: August 2004

Objective. To measure the health status (HS) and health-related quality of life (HRQL) of preschoolers who were admitted to a neonatal intensive care unit (NICU) at birth and their family caregivers and to investigate differences in HS and HRQL in relation to gestational age and major morbidity experienced during the NICU stay.

Methods. Retrospective cross-sectional survey was conducted in the province of British Columbia, Canada. A total of 1140 of 2221 children who were admitted at birth to the 3 tertiary care NICUs in the province and 393 of 718 healthy full-term children recruited from 2 of these hospitals were studied. The main outcome measures were Infant and Toddler Quality of Life Questionnaire (ITQOL), Health Status Classification System Preschool Version (HSCS-PS), and Child Behavior Checklist/1.5–5 (CBCL)

Results. The overall response rate was 55%; the response rate for families that we located was 67.1%. NICU children differed from healthy children on the ITQOL in physical abilities, growth and development, temperament/moods, behavior, and general health perceptions, and caregivers differed on both parent-impact scales. On the HSCS-PS, proportionally more NICU children had a health problem in the following areas: sight, speech, getting around, using hands and fingers, taking care of self, learning and remembering, thinking and solving problems, pain and discomfort, general health, and behavior. The NICU sample reported more behavioral problems on the CBCL/1.5–5. Poorer HS and HRQL were reported for infants who were born at <27 weeks’ gestation and for children who experienced ≥1 major morbidities during their NICU stay.

Conclusions. Preschool-aged children with conditions that require NICU care and their family caregivers had poorer HS and HRQL in a range of domains compared with healthy children. There were also differences within the sample by gestational age and major morbidity. The differences in health were small using the ITQOL and CBCL/1.5–5 but larger using the HSCS-PS.
Not All Child Safety Seats Are Created Equal: The Potential Dangers of Shield Booster Seats
Authors: Edgerton Elizabeth A. , Orzechowski Kelly M. , Eichelberger Martin R.
Published: August 2004

Objective. Children are safest when traveling in a child safety seat appropriate for their age and size. Previous research indicates that children are often transitioned to shield booster seats (SBSs) before reaching the 40-lb weight limit for their forward-facing child safety seat (FFCSS). These children could have otherwise been restrained in a FFCSS as is currently recommended by the American Academy of Pediatrics and the National Highway Traffic Safety Administration. The objective of this study was to compare the injury patterns among children who were restrained in SBSs and FFCSSs. Children in FFCSSs were chosen as a comparison group because SBS are predominately used to restrain children who are <40 lb and could have been restrained in an FFCSS, and SBSs are no longer certified for use in children who are >40 lb.

Methods. This is a cohort study involving restrained crash victims who were admitted to a level 1 pediatric trauma center between 1991 and 2003. Patients were older than 1 year, weighed between 20 and 40 lb, and were restrained in an SBS (N = 16) or an FFCSS (N = 30). Injury Severity Score, Abbreviated Injury Scale, Glasgow coma score, intensive care admission, length of stay, and acute care charges served as outcomes of interest.

Results. No significant differences regarding crash and occupant characteristics were found (mean Delta V, crash type, passenger compartment intrusion, driver restraint use). Odds of severe injury were greater for children in SBSs compared with children in FFCSSs as measured by Injury Severity Score >15 (odds ratio [OR]: 8.3; 95% confidence interval [CI]: 2.1–33.6), intensive care admission (OR: 5.5; 95% CI: 1.5–20.5), length of stay >2 days (OR: 6.3; 95% CI: 1.6–24.6), and Abbreviated Injury Scale ≥3 (OR: 4.4; 95% CI: 1.2–16.1). Furthermore, SBS cases had greater odds of head (OR: 4.5; 95% CI: 1.2–17.3), chest (OR: 29.0; 95% CI: 3.1–267.3), and abdominal/pelvic injury (25% vs 0%).

Conclusion. This study provides information about the increased risk of injury associated with shield boosters when compared with FFCSSs. The challenge for pediatricians is not only to promote the use of child restraints but also to ensure that parents use the most appropriate restraint for their child’s age and weight.
Transition to Adulthood: The Important Role of the Pediatrician
Authors: Olsen Donna Gore , Swigonski Nancy L.
Published: August 2004

This article, written by a parent of 2 youths with special health care needs and a pediatrician, builds on the Medical Home framework to give concrete examples of what physicians and families can and should do to prepare families for transition(s). The article consists of 3 parts. The first part is an introduction giving an overview of the importance of transition. “Developing a Life (not Illness) Plan: Begin With the End in Mind,” emphasizes that no matter how challenging the disability or compromising the chronic illness, we owe it to our children to take the risk of thinking about the future and beginning to help them to develop a life (not illness) plan. The third part, “With a Little Help from My Friends,” looks at how linking families with other parents, young adults, and adults living with disabilities and serious chronic illness can be a source of information to both families and physicians as they plan for the future.
Referral Patterns to a Pediatric Orthopedic Clinic: Implications for Education and Practice
Authors: Reeder Brian M. , Lyne E. Dennis , Patel Dilip R. , Cucos Diana R.
Published: August 2004

Objective. Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists.

Methods. A chart review of successive new referrals (n = 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms “appropriate” and “inappropriate” were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively.

Results. This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate.

Conclusions. Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.
Temporal Association of the Appearance of Mucoid Strains ofStreptococcus PyogenesWith a Continuing High Incidence of Rheumatic Fever in Utah
Authors: Veasy L. George , Tani Lloyd Y. , Daly Judy A. , Korgenski Kent , Miner Lonnie , Bale James , Kaplan Edward L. , Musser James M. , Hill Harry R.
Published: August 2004

Objective. Our objective was to confirm an observed temporal association of increased numbers of rheumatic fever cases concomitant with the appearance of an increased prevalence of mucoid strains of Streptococcus pyogenes. During the resurgence of rheumatic fever (RF) that has occurred in the Intermountain area surrounding Salt Lake City, Utah, since 1985, the largest number of cases occurred in 1985 and 1986 and 12 years later in 1997 and 1998. During the initial outbreak and the later exacerbation of the resurgence, an increased number of mucoid strains of S pyogenes were present in the community.

Methods. The referred cases of RF that fulfilled Jones criteria have been systematically reviewed by the medical staff at Primary Children’s Medical Center yearly since 1985. Before the resurgence of RF, a program was initiated by the microbiology laboratory at Primary Children’s Medical Center to store frozen isolates of S pyogenes. All frozen specimens were randomly selected and entered into a log; the coded entry allowed for comments regarding the origin of the isolate and whether the isolate had a mucoid appearance on the blood agar culture plate. This log was reviewed in October 2002 to determine whether the percentage of frozen mucoid isolates stored during the resurgence of RF would support the clinical and epidemiologic suspicion that mucoid isolates seemed to be present with a higher frequency during the 2 periods of high incidence of RF. The percentage of mucoid isolates was compared with the yearly number of cases of RF. A Pearson r correlation analysis was completed to determine whether there was a significant association between the percentage of mucoid isolates and the number of cases of RF.

Results. The highest number of cases of RF was temporally associated with the highest percentage of mucoid isolates. There was statistically significant correlation between percentage of mucoid strains and the number of RF cases.

Conclusions. The Utah experience with the resurgence of RF in a civilian population during the last decade and a half of the 20th century confirmed the temporal association of mucoid strains of S pyogenes, primarily M-type 18, with a high incidence of RF.
Patterns of Vision Care Among Medicaid-Enrolled Children
Authors: Kemper Alex R. , Cohn Lisa M. , Dombkowski Kevin J.
Published: August 2004

Objective. To describe patterns of vision care among Medicaid-enrolled children.

Methods. We evaluated claims data over a 1-year period among children who were 18 years and younger, living in Michigan, and continuously enrolled in Medicaid but did not have a complex medical condition or were disabled. For this study, vision care comprised eye care services provided by optometrists or ophthalmologists and lens services, including dispensing and fitting of corrective lenses.

Results. Children in rural counties had increased odds of receiving eye care (odds ratio [OR]: 1.24) or lens services (OR: 1.22) compared with those in urban counties. In urban counties, non-Hispanic white children had greater odds than Hispanic or nonwhite children to have eye care (OR: 1.37) and lens services (OR: 1.37). An increasing supply of eye care professionals per population within a county was associated with decreased vision care in urban counties and slightly increased eye care and no changes in lens services in rural counties. Urban children who received mostly fee-for-service Medicaid had greater odds of receiving vision care than those with longer periods of managed care. Rural children who received mostly fee-for-service Medicaid had greater odds of eye care but similar odds of lens services. Regardless of urban/rural status, girls had increased odds of receiving eye care (OR: 1.24 for urban, 1.20 for rural) and lens services (OR: 1.36 for urban, 1.24 for rural).

Conclusions. Patterns emerged that suggest underutilization or overutilization of vision care services. Such differences may have an impact on the development of children or waste limited health care resources.
Determinants of Physical Fitness in Children With Asthma
Authors: Pianosi Paul T. , Davis Heather S.
Published: August 2004

Rationale. This study was designed to examine the relationships among weight, asthma severity, physical activity, and aerobic fitness in children with asthma.

Subjects and Methods. Sixty-four asthmatic children 8 to 12 years old (53% female) were assessed while attending a summer asthma camp. Measures included height and weight, spirometry, histamine bronchial provocation challenge, maximal aerobic power, and questionnaires to quantify habitual activity, perceived activity limitations due to asthma, perceived competence in physical activity, and attitudes toward physical activity. Asthma severity was determined from spirometric indices (forced expiratory volume during the first second), degree of airway hyperresponsiveness, and amount of medication prescribed.

Results. There was no correlation between asthma severity and aerobic fitness. Only perceived competence at physical activity was found to have a significant correlation with aerobic fitness. Appropriate-weight, overweight, or obese (defined by body mass index) children all had similar results for maximum aerobic power and level of habitual activity. However, overweight or obese children reported greater limitation of physical activity. Their asthma-impairment scores were higher than the scores of appropriate-weight peers, although standard measures of pulmonary function were no different among groups. The higher asthma-severity scores were related to greater medication needs in the overweight or obese children with asthma.

Conclusions. Lower maximum aerobic power in asthmatic children is related more to how capable they perceive themselves than to asthma severity. Overweight asthmatic children experience greater limitation of physical activity and thus are prescribed more medication, although by standard measures of asthma severity, they are very similar to normal-weight peers with asthma. Efforts should be directed at understanding the reasons responsible for reduced exercise tolerance before escalating pharmacologic treatment.
Behind Schedule: Improving Access to Care for Children One Practice at a Time
Authors: Randolph Greg D. , Murray Mark , Swanson Jill A. , Margolis Peter A.
Published: August 2004

Access to health care, the timely use of personal health services to achieve the best possible health outcomes, remains a fundamental problem for children in the United States. To date, research and interventions addressing children’s access to care have largely focused on policy-level features of the health care system (such as health insurance and geographic availability of providers) with some, although limited, success. Ultimately, access to health care implies entry into the health care system. Practice scheduling systems are the point of entry to primary care health services for children and thus directly determine access to care in pediatric and family medicine practices. Here we explore the rationale for improving access to care for children from an additional angle: through improving practice scheduling systems. It is our hypothesis that some of the most promising contemporary interventions to improve children’s access involve improving primary care scheduling systems. These approaches should complement successful policy-level interventions to improve access to care for children.
Otitis Media and Speech and Language: A Meta-analysis of Prospective Studies
Authors: Roberts Joanne E. , Rosenfeld Richard M. , Zeisel Susan A.
Published: August 2004

Objective. Considerable controversy surrounds whether a history of otitis media with effusion (OME) in early childhood causes later speech and language problems. We conducted a meta-analysis of prospective studies to determine: 1) whether a history of OME in early childhood is related to receptive language, expressive language, vocabulary, syntax, or speech development in children 1 to 5 years old and 2) whether hearing loss caused by otitis media in early childhood is related to children’s receptive language or expressive language through 2 years of age.

Methods. We searched online databases and bibliographies of OME studies and reviews for prospective or randomized clinical trials published between January 1966 and October 2002 that examined the relationship of OME or OME-associated hearing loss in early childhood to children’s later speech and language development. The original search identified 38 studies, of which 14 had data suitable for calculating a pooled correlation coefficient (correlational studies) or standard difference between parallel groups (group studies). Random-effects meta-analysis was used to pool data when at least 3 studies had usable data for a particular outcome.

Results. We performed 11 meta-analyses. There were no significant findings for the analyses of OME during early childhood versus receptive or expressive language during the preschool years in the correlation studies. Similarly, there were no significant findings for OME versus vocabulary, syntax, or speech during the preschool years. Conversely, there was a significant negative association between OME and preschoolers’ receptive and expressive language (lower language) (0.24 and 0.25 standard difference, respectively) in the group studies. Additionally, hearing was also related to receptive and expressive language in infancy (3%–9% of variance).

Conclusions. Our results indicate no to very small negative associations of OME and associated hearing loss to children’s later speech and language development. These findings may overestimate the impact of OME on outcomes, because most studies did not adjust for known confounding variables (such as socioeconomic status) and excluded data not suitable for statistical pooling, especially from methodologically sound studies. Although some OME language differences were detectable by meta-analysis due to increased statistical power, the clinical relevance for otherwise healthy children is uncertain.
Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series
Authors: Henry Michael , Driscoll M. Catherine , Miller Marijean , Chang Taeun , Minniti Caterina P.
Published: August 2004

Headache is a frequent symptom in sickle cell disease (SCD) that usually is attributable to anemia or cerebrovascular disease. We report 3 pediatric patients with SCD (1 patient with SCD-SC and 2 patients with SCD-SS) who presented with headache and were diagnosed with pseudotumor cerebri (PC). All 3 patients had elevated opening pressures during a lumbar puncture with normal cerebrospinal fluid studies. Magnetic resonance imaging revealed no evidence of hydrocephalus or arteriopathy in all 3 cases. Magnetic resonance venograms performed in 2 of the patients at diagnosis revealed no evidence of cerebral sinus thrombosis. Each patient received a thorough ophthalmologic examination. A diagnostic funduscopic examination revealed bilateral papilledema without signs of retinopathy in all 3 patients. There were no clinically significant changes in visual acuity or abnormalities of color vision in any patient. Goldmann or Humphrey visual-field assessment was abnormal only in patient 1, who demonstrated bilaterally enlarged blind spots at diagnosis and later developed reduced sensitivity in the inferomedial quadrant of the left eye in an arcuate pattern (which later resolved). The diagnosis of PC was made in all 3 patients, and acetazolamide treatment was started. Two of the patients’ symptoms resolved completely with medical treatment, whereas the third patient’s symptoms improved. None of these patients had permanent visual-field deficits as a result of their syndrome. PC has been reported in several other types of anemia including SCD-SC, but these cases are the first reported in conjunction with pediatric SCD. Early recognition of the signs and symptoms of PC in patients with SCD who present with headache can expedite proper diagnosis and treatment and prevent long-term ophthalmologic sequelae.