bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of green tea extract administration on the pharmacokinetics of clozapine in rats
Authors: Jang E H , Choi J Y , Park C S , Lee S-K , Kim C E , Park H J , Kang J S , Lee J W , Kang J H
Published: March 2005

The pharmacokinetic interaction between clozapine, an atypical antipsychotic with metabolic complications, including weight gain, and green tea consumption has not been evaluated, although green tea is responsible for beneficial effects, including weight reduction, and is widely consumed in the world. Commercial green tea extract (175 mg kg−1) or saline was administered orally for 4 days before the oral administration of clozapine (20 mg kg−1) to rats. Plasma concentrations of clozapine were measured up to 5 h after clozapine administration, and then hepatic CYP1A2 expression and activity were determined. There was no significant difference in the elimination half-life of clozapine between the green tea extract and saline groups. However, the time to reach peak concentration (Tmax) was significantly increased by green tea extract. The mean total area under the plasma concentration-time curve (AUC0-∞) and maximal peak plasma concentration (Cmax) of clozapine in the green tea extract group were significantly lower than those of controls. Green tea extract induced a ∼2-fold increase in hepatic CYP1A2 levels, while the activity increased slightly (by 10% of control). Because of this reduction in AUC and Tmax of clozapine by green tea extract pretreatment, we suggest that both the rate and amount of absorption of clozapine may be reduced by green tea extract, although the hepatic elimination phase may not be significantly altered. Therefore, the clinical implications of the effects of green tea on the bioavailability of clozapine in patients should be further evaluated.
A Note on a Simple Dynamic Programming Approach to the Single-Sink, Fixed-Charge Transportation Problem
Authors: Alidaee Bahram , Kochenberger Gary A.
Published: March 2005

The single-sink, fixed-charge transportation problem has a variety of applications, including supplier selection, product distribution/fleet selection, and process selection. In this paper we present a dynamic programming algorithm for solving this important problem that is very easy to implement and that improves considerably in terms of computational attractiveness on the best methods in the literature.
Vehicle Routing Problem with Time Windows, Part I: Route Construction and Local Search Algorithms
Authors: Bräysy Olli , Gendreau Michel
Published: March 2005

This paper presents a survey of the research on the vehicle routing problem with time windows (VRPTW). The VRPTW can be described as the problem of designing least cost routes from one depot to a set of geographically scattered points. The routes must be designed in such a way that each point is visited only once by exactly one vehicle within a given time interval, all routes start and end at the depot, and the total demands of all points on one particular route must not exceed the capacity of the vehicle. Both traditional heuristic route construction methods and recent local search algorithms are examined. The basic features of each method are described, and experimental results for Solomon’s benchmark test problems are presented and analyzed. Moreover, we discuss how heuristic methods should be evaluated and propose using the concept of Pareto optimality in the comparison of different heuristic approaches. The metaheuristic methods are described in the second part of this article.
Vehicle Routing Problem with Time Windows, Part II: Metaheuristics
Authors: Bräysy Olli , Gendreau Michel
Published: March 2005

This paper surveys the research on the metaheuristics for the Vehicle Routing Problem with Time Windows (VRPTW). The VRPTW can be described as the problem of designing least cost routes from one depot to a set of geographically scattered points. The routes must be designed in such a way that each point is visited only once by exactly one vehicle within a given time interval; all routes start and end at the depot, and the total demands of all points on one particular route must not exceed the capacity of the vehicle. Metaheuristics are general solution procedures that explore the solution space to identify good solutions and often embed some of the standard route construction and improvement heuristics described in the first part of this article. In addition to describing basic features of each method, experimental results for Solomon’s benchmark test problems are presented and analyzed.
Analysis of Dynamic Traffic Equilibrium with Departure Time Choice
Authors: Heydecker B. G. , Addison J. D.
Published: March 2005

We present and analyse a model of the combined choice of departure time and route in a congested road network. Using the property of equilibrium solutions that for each origin-destination pair the total cost associated with travel is identical for all travellers, we establish a general result that relates assignments to various components of cost. The analysis is developed to include time-varying tolls and to establish a formula that will induce any specified inflow profile as an equilibrium. We introduce an iteration operator to calculate equilibrium inflow profiles, and present the results of example calculations for a range of test problems.
Hub-Spoke Network Choice Under Competition with an Application to Western Europe
Authors: Adler Nicole
Published: March 2005

The aim of this paper is to present a model structure that analyzes the hub-spoke network design issue within a competitive framework. Under deregulation, airlines have developed hub-and-spoke networks, enabling them to increase frequency by aggregating demand and to prevent entry into the marketplace by reducing airfares. While liberalization in the United States and Europe was undertaken to increase competition, the results in this direction are unclear. This research evaluates airline profits based on a microeconomic theory of airline behavior under deregulation and the effect on hub-and-spoke networks. Through a two-stage, Nash best-response game, we search for equilibria in the air transportation industry. The game is applied to Western Europe, where profitable hubs and monopolistic equilibria are clearly identifiable, and duopolistic equilibria are potentially viable, given sufficient demand.
Convergence of a Discretised Travel-Time Model
Authors: Carey Malachy , Ge Y. E.
Published: March 2005

In network models for dynamic traffic assignment (DTA), the travel time on a link is often treated as a function of the number of vehicles on the link. Instead of applying this model to the whole link, we divide the link into segments, apply the model (suitably adjusted) sequentially to these segments, and investigate how the solution is affected by various levels of discretisation (as the discretisation is refined, the solution converges to the solution of the Lighthill-Whitham-Richards (LWR) model). We also restrict the link (and segment) travel-time function to ensure that it satisfies a first-in-first-out (FIFO) property and explore how this affects and restricts the form of the flow-density functions used in the LWR model. We numerically illustrate the solution of the discretised model for various travel-time functions and patterns of inflows, for both homogeneous and inhomogeneous links. Subject to the above restriction on the flow-density function, the numerical results suggest that dividing “long” links into even a few segments can make the model solution closely approximate the LWR solution, while retaining tractability in the network model. We also observe, for example, that the whole-link (undescretised) travel-time model has a “flattening” effect on the profiles of flows and travel times (this effect can be reduced to any desired extent by using discretisation); and that the travel time and outflow for an inhomogeneous link can be approximated very closely by treating the link as homogeneous, with capacity parameters set equal to the average capacity from the inhomogeneous link.
Self-Organized Pedestrian Crowd Dynamics: Experiments, Simulations, and Design Solutions
Authors: Helbing Dirk , Buzna Lubos , Johansson Anders , Werner Torsten
Published: March 2005

To test simulation models of pedestrian flows, we have performed experiments for corridors, bottleneck areas, and intersections. Our evaluations of video recordings show that the geometric boundary conditions are not only relevant for the capacity of the elements of pedestrian facilities, they also influence the time gap distribution of pedestrians, indicating the existence of self-organization phenomena. After calibration of suitable models, these findings can be used to improve design elements of pedestrian facilities and egress routes. It turns out that “obstacles” can stabilize flow patterns and make them more fluid. Moreover, intersecting flows can be optimized, utilizing the phenomenon of “stripe formation.” We also suggest increasing diameters of egress routes in stadia, theaters, and lecture halls to avoid long waiting times for people in the back, and shock waves due to impatience in cases of emergency evacuation. Moreover, zigzag-shaped geometries and columns can reduce the pressure in panicking crowds. The proposed design solutions are expected to increase the efficiency and safety of train stations, airport terminals, stadia, theaters, public buildings, and mass events in the future. As application examples we mention the evacuation of passenger ships and the simulation of pilgrim streams on the Jamarat bridge. Adaptive escape guidance systems, optimal way systems, and simulations of urban pedestrian flows are addressed as well.
A Rose by Any Other Name? Objective Knowledge, Perceived Knowledge, and Adolescent Male Condom Use
Authors: Rock Ellen M. , Ireland Marjorie , Resnick Michael D. , McNeely Clea A.
Published: March 2005

Objective. To investigate the role of objective and perceived knowledge about condoms in adolescent males’ condom use at first intercourse.

Methods. A longitudinal analysis was conducted of data from a nationally representative sample of 404 virgin male adolescents who were aged 15 to 17 years at wave 1 and reported becoming sexually experienced at the second wave of data collection. Objective knowledge was measured as a 5-item knowledge test about condoms. Perceived knowledge was measured as a 5-item scale regarding participants’ confidence about their answers on the objective knowledge test. Condom use was assessed by self-report.

Results. Objective and perceived knowledge were moderately correlated with each other. Male adolescents with low objective but high perceived knowledge were identified as being at particular risk for not using a condom in that they were nearly 3 times less likely to report using a condom at first intercourse (odds ratio: 0.35) than those with other levels of objective and perceived knowledge.

Conclusions. Previous evidence suggests that knowledge about sex does not accurately predict sexual behavior. This lack of predictive accuracy may be because studies have focused only on objective knowledge. Our results suggest that both objective and perceived knowledge serve as antecedents to male condom use at first intercourse. However, those with higher perceived knowledge, particularly in the context of low objective knowledge, may be at greater risk for not using condoms. Addressing not only objective but also perceived knowledge may increase the effectiveness of interventions that are designed to increase rates of condom use among male adolescents.
Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence
Authors: Lanou Amy Joy , Berkow Susan E. , Barnard Neal D.
Published: March 2005

Objective. Numerous nutrition policy statements recommend the consumption of 800 to 1500 mg of calcium largely from dairy products for osteoporosis prevention; however, the findings of epidemiologic and prospective studies have raised questions about the efficacy of the use of dairy products for the promotion of bone health. The objective of this study was to review existing literature on the effects of dairy products and total dietary calcium on bone integrity in children and young adults to assess whether evidence supports (1) current recommended calcium intake levels and (2) the suggestion that dairy products are better for promoting bone integrity than other calcium-containing food sources or supplements.

Methods. A Medline (National Library of Medicine, Bethesda, MD) search was conducted for studies published on the relationship between milk, dairy products, or calcium intake and bone mineralization or fracture risk in children and young adults (1–25 years). This search yielded 58 studies: 22 cross-sectional studies; 13 retrospective studies; 10 longitudinal prospective studies; and 13 randomized, controlled trials.

Results. Eleven of the studies did not control for weight, pubertal status, and exercise and were excluded. Ten studies were randomized, controlled trials of supplemental calcium, 9 of which showed modest positive benefits on bone mineralization in children and adolescents. Of the remaining 37 studies of dairy or unsupplemented dietary calcium intake, 27 studies found no relationship between dairy or dietary calcium intake and measures of bone health. In the remaining 9 reports, the effects on bone health are small and 3 were confounded by vitamin D intake from milk fortified with vitamin D. Therefore, in clinical, longitudinal, retrospective, and cross-sectional studies, neither increased consumption of dairy products, specifically, nor total dietary calcium consumption has shown even a modestly consistent benefit for child or young adult bone health.

Conclusion. Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralization.
Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants After Necrotizing Enterocolitis
Authors: Hintz Susan R. , Kendrick Douglas E. , Stoll Barbara J. , Vohr Betty R. , Fanaroff Avroy A. , Donovan Edward F. , Poole W. Kenneth , Blakely Martin L. , Wright Linda , Higgins Rosemary ,   for the NICHD Neonatal Research Network
Published: March 2005

Objectives. Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of SurgNEC and MedNEC with NoNEC at 18 to 22 months' corrected age.

Methods. Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight <1000 g in the National Institute of Child Health and Human Development Neonatal Research Network Registry. Neurodevelopment and growth were assessed at 18 to 22 months' postmenstrual age. χ2, t test, and logistic regression analyses were used.

Results. A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference <10 percentile at 18 to 22 months were significantly more likely among SurgNEC but not MedNEC compared with NoNEC infants. After correction for anthropometric measures at birth and adjusted age at follow-up, all growth parameters at 18 to 22 months for SurgNEC but not MedNEC infants were significantly less than for NoNEC infants. SurgNEC but not MedNEC was a significant independent risk factor for Mental Developmental Index <70 (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.05–2.50), Psychomotor Developmental Index <70 (OR: 1.95; 95% CI: 1.25–3.04), and neurodevelopmental impairment (OR: 1.78; 95% CI: 1.17–2.73) compared with NoNEC.

Conclusions. Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months' corrected age compared with NoNEC. MedNEC does not seem to confer additional risk. SurgNEC is likely to be associated with greater severity of disease.
Adverse Neurodevelopmental Outcomes Among Extremely Low Birth Weight Infants With a Normal Head Ultrasound: Prevalence and Antecedents
Authors: Laptook Abbot R. , O' Shea T. Michael , Shankaran Seetha , Bhaskar Brinda ,   and the NICHD Neonatal Network
Published: March 2005

Objective. Severe abnormalities of the head ultrasound (HUS) are important predictors of cerebral palsy (CP) and mental retardation, and a normal HUS usually ensures the absence of major impairments. With the increasing survival of extremely low birth weight (ELBW) infants (birth weight <1000 g), the prognostic significance of a normal HUS may differ. This study examined the prevalence of and risk factors for CP and impaired mental development among ELBW infants with a normal HUS.

Methods. Study infants were ELBW infants who were cared for in Neonatal Research Network centers in the years 1995–1999, had a normal early and late HUS, survived to discharge, and returned for follow-up assessments at 18 to 22 months' corrected age. The outcomes of interest were a score <70 on the Bayley Scales of Infant Development-II Mental Developmental Index (MDI) and CP. Risk factors included maternal demographics; infant characteristics; and interventions or morbidities related to the lung, infection, and nutrition. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A time-oriented approach was used to select variables for inclusion in logistic models.

Results. Of 1749 infants with a normal early and late HUS (performed at a mean age of 6 and 47 days, respectively), 1473 (84%) returned for follow-up assessment. Infants had a birth weight of 792 ± 134 g (mean ± SD) and gestational age of 26 ± 2 weeks. Rates of CP and MDI <70 were 9.4% and 25.3%, respectively, and 29.2% of infants had either CP or MDI <70. In multivariate analyses, factors associated with CP were male gender (OR: 1.8; 95% CI: 1.2–2.6), multiple birth, (OR: 1.6; 95% CI: 1.1–2.5), decreasing birth weight (OR: 1.3 for each 100-g decrease; 95% CI: 1.1–1.5), pneumothorax (OR: 2.3; 95% CI: 1.2–4.4), and days of conventional ventilation (OR: 1.2 for each additional 10 days; 95% CI: 1.1–1.3). With the exception of pneumothorax, these same factors were associated with MDI <70, in addition to less maternal education (OR: 1.4; 95% CI: 1.0–1.9) and Medicaid or lack of coverage for maternal insurance (OR: 1.7; 95% CI: 1.2–2.4).

Conclusions. Nearly 30% of ELBW infants with a normal HUS had either CP or a low MDI. Risk factors that are associated with this high rate of adverse outcomes include pneumothorax, prolonged exposure to mechanical ventilation, and educational and economic disadvantage. Improvements in pulmonary care to reduce duration of ventilation and avoid air leaks might improve neurodevelopmental outcome for ELBW infants.
Herpes Simplex Virus Encephalitis During Suppressive Therapy With Acyclovir in a Premature Infant
Authors: Fonseca-Aten Monica , Messina Allison F. , Jafri Hasan S. , Sánchez Pablo J.
Published: March 2005

Cutaneous herpes simplex virus type 2 (HSV-2) infection was recognized at 19 days of age in a 1415-g female infant born at 31 weeks of gestation. Cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) was negative, and MRI of the brain was normal. After a 14-day course of high-dose intravenous acyclovir, the infant developed a cutaneous recurrence at 38 days of age. CSF HSV PCR again was negative. She was subsequently begun on oral acyclovir to prevent cutaneous reactivation of HSV. At 3 months of age, the infant developed HSV encephalitis as manifested by fever, seizures, abnormal CSF indices, abnormal brain MRI, and positive CSF HSV PCR. No cutaneous disease was present. It is not known whether the HSV encephalitis in our patient represented reactivation of previously unrecognized central nervous system infection or new onset of central nervous system disease as a result of spread from other tissue or site to the brain. The failure of oral acyclovir to prevent such an occurrence, however, highlights gaps in our understanding of the pathogenesis of neonatal HSV disease and questions the use of acyclovir suppression to prevent neurologic sequelae.
Eyelid Mass as the Presenting Finding in a Child With Down Syndrome and Acute Megakaryoblastic Leukemia
Authors: Sandoval Claudio , Davis Adam , Jayabose Somasundaram
Published: March 2005

Children with Down syndrome are at increased risk of developing acute megakaryoblastic leukemia (AML). Therefore, physicians caring for children with Down syndrome should be familiar with the presenting features of AML. We describe a child with Down syndrome presenting with a left eyelid mass 1 month before a diagnosis of acute AML.
Follow-up at 15 Years of Preterm Infants From a Controlled Trial of Moderately Early Dexamethasone for the Prevention of Chronic Lung Disease
Authors: Gross Steven J. , Anbar Ran D. , Mettelman Barbara B.
Published: March 2005

Objective. Postnatal dexamethasone treatment of ventilator-dependent preterm infants results in rapid improvement in lung function and reduction in chronic lung disease. However, limited data are available on long-term outcomes after such therapy. We studied growth, neurodevelopmental, and pulmonary outcomes at adolescence in children who had participated in a double-blind, placebo-controlled trial of dexamethasone beginning at 2 weeks of age for the prevention of chronic lung disease.

Methods. Thirty-six infants (birth weight ≤1250 g and gestational age ≤30 weeks) who were dependent on mechanical ventilation at 2 weeks of age received a 42-day course of dexamethasone, an 18-day course of dexamethasone, or saline placebo. Twenty-two children survived to 15 years (69% of the 42-day dexamethasone group, 67% of the 18-day dexamethasone group and 45% of the control group), and all were evaluated. Intact survival was defined as survival with normal neurologic examination, IQ >70, and receiving education in the regular classroom.

Results. There were no differences among groups for growth or incidence of neurologic abnormalities. The mean IQ for the 42-day dexamethasone group was 85 ± 10 compared with 60 ± 20 for the 18-day dexamethasone group and 73 ± 23 for the control group. All children in the 42-day dexamethasone group were receiving education in the regular classroom compared with only 50% of the 18-day dexamethasone group and 40% of the control group. As a result, intact survival was significantly greater for the 42-day dexamethasone group (69%) than for either the 18-day dexamethasone group (25%) or the control group (18%). Pulmonary function was significantly better for the 42-day dexamethasone group compared with the 18-day dexamethasone group (eg, forced expiratory volume in 1 second: 90 ± 16 vs 71 ± 15% predicted, respectively).

Conclusion. A 42-day course of dexamethasone therapy beginning at 2 weeks of age in preterm infants who are at high risk for severe chronic lung disease was associated with improved long-term neurodevelopmental outcome. Although additional research is needed to establish the optimal steroid preparation, dosage, and duration of therapy, these data support the view that moderately early (beginning at 1-2 weeks) corticosteroid treatment is advantageous for a select group of ventilator-dependent preterm infants.
Epidemiologic Features of the Physical and Sexual Maltreatment of Children in the Carolinas
Authors: Theodore Adrea D. , Chang Jen Jen , Runyan Desmond K. , Hunter Wanda M. , Bangdiwala Shrikant I. , Agans Robert
Published: March 2005

Context. Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies.

Objective. The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports.

Design, Setting, and Participants. Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced.

Main Outcome Measures. The incidence of physical and sexual maltreatment determined through maternal reports.

Results. Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states.

Conclusions. Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.
State-of-the-Art Interventions for Office-Based Parental Tobacco Control
Authors: Winickoff Jonathan P. , Berkowitz Anna B. , Brooks Katie , Tanski Susanne E. , Geller Alan , Thomson Carey , Lando Harry A. , Curry Susan , Muramoto Myra , Prokhorov Alexander V. , Best Dana , Weitzman Michael , Pbert Lori ,   for the Tobacco Consortium, Center for Child Health Research of the American Academy of Pediatrics
Published: March 2005

Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A’s framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.
No License Required: Severe Pediatric Motorbike-Related Injuries in Ohio
Authors: Pomerantz Wendy J. , Gittelman Michael A. , Smith Gary A.
Published: March 2005

Objective. Motorbikes (MBs), including motorcycles and dirt bikes, are becoming increasingly popular among children and adolescents. MBs are intended for off-road use. Although children who are younger than 16 years cannot be licensed to drive cars, they can drive MBs off-road without licenses. The objective of this study was to determine the epidemiology of severe MB injuries to children who are younger than 16 years in Ohio.

Methods. Eight hospitals that admit the majority of pediatric trauma patients in Ohio were approached to participate. Cases were identified using hospital trauma registries and were defined as any hospitalized child who was younger than 16 years and sustained MB injuries between January 1, 1995, and December 31, 2001.

Results. Six hospitals participated. A total of 182 children were hospitalized with a mean age of 11.4 years (range: <1–15 years). A total of 89.6% were male, 89.0% were white, 68.7% had commercial medical insurance, and 71.4% were from urban areas. From 1995 to 1997, there were an average of 20 annual admissions; however, from 1998 to 2001, there were an average of 30 per year. Of the 85% of patients with injury events documented, 35.5% were riding in streets and 53.3% were unhelmeted. One patient died; 8 required rehabilitation. The mean injury severity score was 9.9 (median: 9), and mean length of hospitalization was 4.6 days (median: 3). Unhelmeted riders had significantly higher injury severity scores than helmeted ones (11.5 vs 8.4). The difference in mean length of hospitalization of unhelmeted compared with helmeted riders approached statistical significance (6.1 vs 3.7 days). Of the 163 patients with documented diagnoses, there were 510 injuries; 68.7% of patients sustained multiple injuries. Of all injuries, the most commonly injured body parts were lower extremity (23.4%), head (22.2%), abdomen/pelvis (13.4%), upper extremity (12.4%), and face (11.8%). The most common injuries were fractures (37.1%), abrasions/contusions (24.4%), lacerations (13.4%), intracranial injuries (7.5%), and solid abdominal organ injuries (7.5%). Central and Southwest Ohio had higher numbers of hospitalized injuries than other areas.

Conclusion. Urban, white boys with commercial medical insurance predominated among children with MB-related injuries in Ohio. Most injured children did not wear a helmet and sustained multiple injuries. Not wearing a helmet resulted in significantly increased injury severity and a trend toward increased lengths of stay in the hospital. MB-related injuries increased by ∼50% during the study period. Children should not operate MBs until they are old enough to obtain a motor vehicle driver’s license, which occurs at a minimum of 16 years of age. High-risk populations need to be targeted to reduce these injuries, and requiring helmet use while operating MBs should be pursued.
The Use of Folk Remedies Among Children in an Urban Black Community: Remedies for Fever, Colic, and Teething
Authors: Smitherman Lynn C. , Janisse James , Mathur Ambika
Published: March 2005

Background. Folk remedy use is universal, occurring in all cultures. Folk remedies have been and still are relied on in the black community. In this study, folk remedies refer to herbs, over-the-counter medications, and items traditionally used for cooking that are used to treat a variety of ailments.

Objective. To identify folk remedies used to treat fever, colic, and teething among black children in Detroit, Michigan.

Methods. Structured interviews were conducted with caregivers of healthy black children <2 years of age who were patients of the general pediatric clinic at Children's Hospital of Michigan. Descriptive analysis of the frequency distribution of the responses was performed.

Results. One hundred seven caregivers agreed to participate. All participants were familiar with the use of folk remedies. Most caregivers learned of these remedies from their mothers or grandmothers. Older parents were more likely to use folk remedies, but there was no difference in remedy use among different levels of maternal education.

Conclusions. The knowledge and use of folk remedies were active in this black community. Their use seems to be cultural, rather than attributable to decreased access to health care. Physicians should be aware of these remedies, to educate families about remedies that may be harmful. Most remedies used pose no threat to health. In some cases, remedies may be blended with traditional medical treatments to ensure better patient compliance.
Effects of Seating Position and Appropriate Restraint Use on the Risk of Injury to Children in Motor Vehicle Crashes
Authors: Durbin Dennis R. , Chen Irene , Smith Rebecca , Elliott Michael R. , Winston Flaura K.
Published: March 2005

Background. Currently, many states are upgrading their child restraint laws to include provisions for the use of age-appropriate restraints through 6 to 8 years of age, with some also requiring rear seating for children, enabling the laws to be in closer alignment with best-practice recommendations.

Objective. To evaluate the relationships of seating position and restraint status to the risk of injury among children in passenger vehicle crashes.

Methods. This was a cross-sectional study of children <16 years of age who were involved in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 17980 children in 11506 crashes, representing 229106 children in 146613 crashes, was collected between December 1, 1998, and November 30, 2002. Parent reports were used to define restraint status, seating position, and occurrence of clinically significant injuries, with the use of a previously validated instrument.

Results. Approximately 62% of the children used seat belts, 35% used child restraints, and 3% used no restraint. Nearly 4 of 5 children sat in the rear seat, with one half of all children being restrained appropriately for their age in the rear, although this varied according to the age of the child. Overall, 1.6% of children suffered serious injuries, 13.5% had minor injuries, and 84.9% did not have any injury. Unrestrained children in the front were at the highest risk of injury and appropriately restrained children in the rear were at the lowest risk, for all age groups. Inappropriately restrained children were at nearly twice the risk of injury, compared with appropriately restrained children (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.4–2.3), whereas unrestrained children were at >3 times the risk (OR: 3.2; 95% CI: 2.5–4.1). The effect of seating row was smaller than the effect of restraint status; children in the front seat were at 40% greater risk of injury, compared with children in the rear seat (OR: 1.4; 95% CI: 1.2–1.7). Had all children in the study population been appropriately restrained in the rear seat, 1014 serious injuries (95% CI: 675–1353 injuries) would have been prevented (with the assumption that restraint effectiveness does not depend on a variety of other driver-related, child-related, crash-related, vehicle-related, and environmental factors).

Conclusions. Age-appropriate restraint confers relatively more safety benefit than rear seating, but the 2 work synergistically to provide the best protection for children in crashes. These results support the current focus on age-appropriate restraint in recently upgraded state child restraint laws. However, it is important to note that considerable added benefit would be realized with additional requirements for rear seating.
Association of Race/Ethnicity with Emergency Department Wait Times
Authors: James Catherine A. , Bourgeois Florence T. , Shannon Michael W.
Published: March 2005

Objective. To determine whether wait times for children treated in emergency departments (EDs) nationally are associated with patient race/ethnicity.

Methods. Data were obtained from the National Hospital Ambulatory Medical Care Survey, which collects information on patient visits to EDs throughout the United States. We examined data for patients ≤15 years of age who presented to EDs during the 4-year period of 1997–2000. Sample weights were applied to the identified patient records to yield national estimates. For the purposes of this study, race/ethnicity was analyzed for 3 major groups, ie, non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic white (HW).

Results. During the 4-year study period, 20633 patient visits were surveyed, representing a national sample of 92.9 million children ≤15 years of age. The race/ethnicity distribution included 9019 NHW children (59.5%), 3910 NHB children (23.9%), and 2991 HW children (16.6%). The wait time for all groups was 43.6 ± 1.7 minutes (mean ± SEM). There were significant unadjusted intergroup differences in wait times (38.5 ± 1.6 minutes, 48.7 ± 0.5 minutes, and 54.5 ± 0.1 minutes for NHW, NHB, and HW children, respectively). Visit immediacy (triage status), when reported, was categorized as <15 minutes for 2203 children (17.1%), 15 to 60 minutes for 5324 (41.4%), 1 to 2 hours for 3010 (25.1%), and >2 to 24 hours for 1910 (16.4%). There were significant unadjusted differences in triage status according to race, with 14.6% of NHW patients being placed in the >2-hour immediacy range, compared with 18.8% of NHB patients and 20.0% of HW patients. In a linear regression analysis with logarithmically transformed wait time as a dependent variable and with adjustment for potential confounders, including hospital location, geographic region, and payer status, both NHB and HW patients waited longer than NHW patients, although the results were statistically significant only for HW patients.

Conclusions. These nationally representative data suggest that children who come to EDs have wait times that vary according to race/ethnicity. There are several potential explanations for this observation, including discrimination, cultural incompetence, language barriers, and other social factors. These data and similar data from the National Hospital Ambulatory Medical Care Survey are useful in identifying nonclinical influences on the delivery of pediatric emergency care.
National Hospitalization Impact of Pediatric All-Terrain Vehicle Injuries
Authors: Killingsworth Jeffrey B. , Tilford John M. , Parker James G. , Graham James J. , Dick Rhonda M. , Aitken Mary E.
Published: March 2005

Objective. All-terrain vehicle (ATV) injuries among children represent a significant and growing problem. Although state-level analyses have characterized some aspects of pediatric ATV-related injuries, little information on the national impact on hospitalization is available. This study was designed to characterize more fully the patterns of injury, hospital length of stay, and hospital charges associated with ATV-related injuries, with a nationally representative sample.

Methods. Analyses were based on the 1997 and 2000 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). The KID is the only national, all-payer database of hospital discharges for children. KID data were weighted to represent all discharges from general hospitals in the United States. Discharges with external cause-of-injury codes consistent with off-road ATV-related injuries were selected, and the affected population was described. Nationally representative rates of ATV-related injuries were calculated, and changes between 1997 and 2000 were documented.

Results. An estimated 5292 children were hospitalized because of ATV-related injuries during the 2-year period, and hospitalizations increased 79.1% between 1997 and 2000. Rates of ATV-related hospitalization were highest among adolescent white male subjects, consistent with previous studies. Most patients had hospital lengths of stay of <4 days (68%), but 10% had stays of >8 days. Injury severity varied considerably, with more than one third of patients sustaining moderate to severe injuries. Approximately 1% of hospitalizations resulted in in-hospital deaths. Total hospital charges for this injury mechanism were $74367677 for the 2-year study period. Most of these charges were paid by private insurers.

Conclusions. This study provides evidence supporting recent substantial increases in childhood ATV-related injuries. The hospitalization impact of ATV-related injuries among children is considerable. Our data support the need for ongoing creative attempts to identify effective strategies to decrease ATV injuries among children.
Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary
Authors: Lilienfeld Scott O.
Published: March 2005

Although numerous scientifically supported treatments are available for childhood psychiatric disorders, many of the most popular interventions for these conditions are based on weak or nonexistent data. This article offers basic guidelines for distinguishing scientifically supported from unsupported treatments for 3 important childhood psychiatric disorders: autistic disorder, attention-deficit/hyperactivity disorder, and conduct disorder. A key challenge for the future will be to place the treatment of childhood psychiatric disorders on firmer scientific footing.
National Autism Prevalence Trends From United States Special Education Data
Authors: Newschaffer Craig J. , Falb Matthew D. , Gurney James G.
Published: March 2005

Objective. Reports of large increases in autism prevalence have been a matter of great concern to clinicians, educators, and parents. This analysis uses a national data source to compare the prevalence of autism with that of other disabilities among successive birth cohorts of US school-aged children.

Design. Comparison of birth cohort curves constructed from administrative data.

Setting and Population. US children 6 to 17 years of age between 1992 and 2001.

Main Outcome Measures. A disability category classification of autism, mental retardation, speech and language impairment, traumatic brain injury, or other health impairment, as documented by state departments of education and reported to the Office of Special Education Programs, US Department of Education.

Results. Prevalences of disability category classifications for annual birth cohorts from 1975 to 1995 were calculated by using denominators from US Census Bureau estimates. For the autism classification, there were birth cohort differences, with prevalences increasing among successive (younger) cohorts. The increases were greatest for annual cohorts born from 1987 to 1992. For cohorts born after 1992, the prevalence increased with each successive year but the increases did not appear to be as great, although there were fewer data points available within cohorts. No concomitant decreases in categories of mental retardation or speech/language impairment were seen. Curves for other health impairments, the category including children with attention-deficit/hyperactivity disorder, also showed strong cohort differences.

Conclusions. Cohort curves suggest that autism prevalence has been increasing with time, as evidenced by higher prevalences among younger birth cohorts. The narrowing in vertical separation of the cohort curves in recent years may mark a slowing in the autism prevalence increase.
Severe Staphylococcal Sepsis in Adolescents in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus
Authors: Gonzalez Blanca E. , Martinez-Aguilar Gerardo , Hulten Kristina G. , Hammerman Wendy A. , Coss-Bu Jorge , Avalos-Mishaan Anna , Mason Edward O. , Kaplan Sheldon L.
Published: March 2005

Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods.

Methods. We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined.

Results. Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had ≥2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, Texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej).

Conclusions. Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.
Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse
Authors: Kulig John W. ,   and the Committee on Substance Abuse
Published: March 2005

This Clinical Report was retired July 2017.

Substance abuse remains a major public health concern, and pediatricians are uniquely positioned to assist their patients and families with its prevention, detection, and treatment. The American Academy of Pediatrics has highlighted the importance of such issues in a variety of ways, including its guidelines for preventive services. The harmful consequences of tobacco, alcohol, and other drug use are a concern of medical professionals who care for infants, children, adolescents, and young adults. Thus, pediatricians should include discussion of substance abuse as a part of routine health care, starting with the prenatal visit, and as part of ongoing anticipatory guidance. Knowledge of the nature and extent of the consequences of tobacco, alcohol, and other drug use as well as the physical, psychological, and social consequences is essential for pediatricians. Pediatricians should incorporate substance-abuse prevention into daily practice, acquire the skills necessary to identify young people at risk of substance abuse, and provide or facilitate assessment, intervention, and treatment as necessary.