bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Homes for Children With Autism: A Physician Survey
Authors: Golnik Allison , Ireland Marjorie , Borowsky Iris Wagman
Published: March 2009

BACKGROUND. Primary care physicians can enhance the health and quality of life of children with autism by providing high-quality and comprehensive primary care.

OBJECTIVE. To explore physicians’ perspectives on primary care for children with autism.

METHODS. National mail and e-mail surveys were sent to a random sample of 2325 general pediatricians and 775 family physicians from April 2007 to October 2007.

RESULTS. The response rate was 19%. Physicians reported significantly lower overall self-perceived competency, a greater need for primary care improvement, and a greater desire for education for children with autism compared with both children with other neurodevelopmental conditions and those with chronic/complex medical conditions. The following barriers to providing primary care were endorsed as greater for children with autism: lack of care coordination, reimbursement and physician education, family skeptical of traditional medicine and vaccines, and patients using complementary alternative medicine. Adjusting for key demographic variables, predictors of both higher perceived autism competency and encouraging an empirically supported therapy, applied behavior analysis, included having a greater number of autism patient visits, having a friend or relative with autism, and previous training about autism.

CONCLUSIONS. Primary care physicians report a lack of self-perceived competency, a desire for education, and a need for improvement in primary care for children with autism. Physician education is needed to improve primary care for children with autism. Practice parameters and models of care should address physician-reported barriers to care.
Parents of Preschoolers: Expert Media Recommendations and Ratings Knowledge, Media-Effects Beliefs, and Monitoring Practices
Authors: Funk Jeanne B. , Brouwer Jason , Curtiss Kathleen , McBroom Evan
Published: March 2009

OBJECTIVE. Given the increase in screen media targeted at the very young, the purpose of this study was to examine preschooler parents’ knowledge about expert recommendations for young children's screen media experience, their knowledge of specific screen media ratings, their beliefs about screen media effects, and actual monitoring practices.

METHOD. Parents of 94 children <5 years of age (mean age: 2.95 years) were surveyed. Questionnaires were distributed in day care centers and completed at the parents’ convenience. The questionnaire included background questions about parental education, age and gender of child, and parents’ perceptions of their child's favorite television show and favorite video or computer game. Eleven multiple-choice questions assessed the respondent's knowledge of expert recommendations for screen media for preschoolers and the meaning of television and video game content ratings. Fourteen questions addressed the typical amount of their preschooler's screen media exposure, parental rules regarding screen media use, and parents’ beliefs about appropriate use of screen media for preschoolers.

RESULTS. Preschoolers were exposed to an average of ∼12 hours of screen media in a typical week. Parents believe that media do have either short- or long-term effects on preschoolers. Performance on factual questions was poor (mean score: 2.83 of 11). In particular, only 34% of the parents correctly identified the expert recommendation for children >2 years of age.

CONCLUSIONS. Parents should continue to be educated about the need for preschoolers to participate in activities that promote language development, socialization, imagination, and physical activity. Although professionals should work to improve the ratings, and ultimately to implement a universal ratings system for all screen media, parents need to be encouraged to improve their understanding of current recommendations for screen media exposure and television and video game ratings.
Pediatric Off-label Use of Recombinant Factor VIIa
Authors: Alten Jeffrey A. , Benner Kim , Green Kelsey , Toole Benjamin , Tofil Nancy M. , Winkler Margaret K.
Published: March 2009

OBJECTIVE. Our goal was to report our institutional experience with recombinant factor VIIa for the treatment and/or prevention of bleeding in nonhemophiliac children.

METHODS. This was a retrospective case series in a tertiary pediatric referral hospital.

RESULTS. During 1999–2006, 135 patients received recombinant factor VIIa for off-label use. The median number of doses was 2; the median dose was 88 μg/kg. The most common diagnoses among patients receiving recombinant factor VIIa were disseminated intravascular coagulation/sepsis (28), surgical bleeding (19), procedural prophylaxis (16), and trauma (15). The median volume of blood products administered 24 hours before recombinant factor VIIa treatment was 29.7 vs 11.7 mL/kg 24 hours after treatment. Only 1 high-risk patient had significant bleeding after receiving prophylactic recombinant factor VIIa before an invasive procedure. Nonsurvivors had significantly increased incidence of multiple organ dysfunction syndrome (75%) compared with survivors (23%). The largest group of patients (n = 28) received recombinant factor VIIa for bleeding and/or coagulopathy because of disseminated intravascular coagulation; the mortality in this group was 26 (93%) of 28. Eleven patients received multiple doses of recombinant factor VIIa to treat bleeding complications after hematopoietic stem cell transplant, without improvement in blood use. Mortality in medical patients was 58% vs 16% in surgical patients. Three patients had significant thrombotic adverse events after receiving recombinant factor VIIa, resulting in 2 deaths and 1 leg amputation.

CONCLUSIONS. Off-label use of recombinant factor VIIa significantly decreases blood-product administration; surgical patients had control of life-threatening bleeding with low associated mortality. Prophylactic recombinant factor VIIa may be effective in preventing bleeding if given before invasive procedures in children at high risk. Prolonged use of recombinant factor VIIa for bleeding complications after hematopoietic stem cell transplant is not effective in preventing packed red blood cell transfusion. Presence of disseminated intravascular coagulation and mulitorgan dysfunction syndrome may help predict futility of recombinant factor VIIa treatment. Off-label use of recombinant factor VIIa is associated with thromboembolic events in children.
Performance of Commercial Blood Tests for the Diagnosis of Latent Tuberculosis Infection in Children and Adolescents
Authors: Bergamini Barbara Maria , Losi Monica , Vaienti Francesca , D'Amico Roberto , Meccugni Barbara , Meacci Marisa , De Giovanni Donatella , Rumpianesi Fabio , Fabbri Leonardo M. , Balli Fiorella , Richeldi Luca
Published: March 2009

BACKGROUND. The accurate diagnosis of latent tuberculosis infection reduces the risk of progression to severe disseminated disease. However, in young children, a major limitation of the standard tuberculin skin test is that false-negative results cannot be detected. The new interferon-γ release assays QuantiFERON-TB Gold (Cellestis Carnegie Victoria, Australia), QuantiFERON-TB In-Tube (Cellestis), and T-SPOT.TB (Oxford Immunotec, Abingdon, United Kingdom) show promise of greater accuracy, but they may also be affected by impaired cellular immunity, resulting in indeterminate results (ie, insufficient response in positive-control wells).

OBJECTIVE. To evaluate the impact of age on the performance of interferon-γ release assays when used in a routine hospital setting among children tested for suspected active or latent TB infection.

METHODS. We retrospectively studied 496 children 0 to 19 years of age who had been tested with the tuberculin skin test and at least 1 interferon-γ release assay: 181 with QuantiFERON-TB Gold and 315 with QuantiFERON-TB In-Tube. In 154 of the children, paired interferon-γ release assay testing was available: 87 with QuantiFERON-TB Gold/T-SPOT.TB and 67 with QuantiFERON-TB In-Tube/T-SPOT.TB.

RESULTS. Compared with T-SPOT.TB, the rates of indeterminate results were significantly higher for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube. QuantiFERON-TB Gold and QuantiFERON-TB In-Tube also gave indeterminate results more frequently in children <4 years of age than in those ≥4 years of age. Indeterminate results were associated with younger age for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube but not for T-SPOT.TB. Considering age as a binary variable (<4 and ≥4 years of age), a significantly higher concentration of phytohaemagglutinin-produced interferon-γ was observed in older children with both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube.

CONCLUSIONS. Different blood tests for the diagnosis of latent tuberculosis infection in children seem to perform differently, because both QuantiFERON-TB tests were more likely than T-SPOT.TB to give indeterminate results in children <4 years of age.
Alternating Hemiplegia of Childhood: Early Characteristics and Evolution of a Neurodevelopmental Syndrome
Authors: Sweney Matthew T. , Silver Kenneth , Gerard-Blanluet Marion , Pedespan Jean-Michel , Renault Francis , Arzimanoglou Alexis , Schlesinger-Massart Mylynda , Lewelt Aga J. , Reyna Sandra P. , Swoboda Kathryn J.
Published: March 2009

OBJECTIVES. Alternating hemiplegia of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology. In more than 3 decades since its description, little progress has been made in understanding its etiology or in identifying effective treatments. In 1998, in collaboration with the Alternating Hemiplegia of Childhood Foundation, an international registry was established to help document clinical outcomes and promote research efforts.

PATIENTS AND METHODS. We present phenotypic data on 103 patients who met existing diagnostic criteria for alternating hemiplegia of childhood. Although some of these subjects may have been included in previously published reviews, our focus was directed toward the earliest manifestations of symptoms and evolution of features over time. Data sources included written questionnaires, face-to-face and telephone interviews, clinical examination, and medical charts. Characteristics of disease onset, medical comorbidities, episode triggers, diagnostic workup, and treatment are presented.

RESULTS. Paroxysmal eye movements were the most frequent early symptom, manifesting in the first 3 months of life in 83% of patients. Hemiplegic episodes appeared by 6 months of age in 56% of infants. Background slowing shown by electroencephalography during typical paroxysmal events, including hemiplegic, tonic, or dystonic episodes was frequent (21 of 42 cases). Distinct convulsive episodes with altered consciousness believed to be epileptic in nature were reported in 41% of patients. Ataxia (96%) and cognitive impairment (100%) were frequent nonepisodic symptoms. Empiric pharmacologic treatment approaches offered little benefit in most subjects and resulted in adverse effects in 20% of patients. Prolonged episodes were completely or temporarily aborted during sleep in all subjects.

CONCLUSIONS. This descriptive analysis of a large cohort of children indicates that paroxysmal ocular movements are an early, highly suggestive symptom, followed by paroxysmal episodes of focal dystonia or flaccid, alternating hemiplegia in early infancy in the majority of subjects. Current challenges in diagnosis and management contribute to poor outcomes. Early diagnosis and multicenter collaboration are needed to facilitate trials to identify more effective therapies.
Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
Authors: Vennemann M.M. , Bajanowski T. , Brinkmann B. , Jorch G. , Yücesan K. , Sauerland C. , Mitchell E.A. ,   and the GeSID Study Group
Published: March 2009

BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful. In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not.

OBJECTIVE. To examine the association between type of infant feeding and sudden infant death syndrome.

METHODS. The German Study of Sudden Infant Death is a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls.

RESULTS. A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding at the age of 1 month also reduced the risk of sudden infant death syndrome, but after adjustment this risk was not significant. Being exclusively breastfed in the last month of life/before the interview reduced the risk, as did being partially breastfed. Breastfeeding survival curves showed that both partial breastfeeding and exclusive breastfeeding were associated with a reduced risk of sudden infant death syndrome.

CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ∼50% at all ages throughout infancy. We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages.
Flat-Footedness Is Not a Disadvantage for Athletic Performance in Children Aged 11 to 15 Years
Authors: Tudor Anton , Ruzic Lana , Sestan Branko , Sirola Luka , Prpić Tomislav
Published: March 2009

OBJECTIVE. Because the controversy about the relation of foot morphology and foot function is still present, we find it surprising that there are no studies published dealing with motor skills and athletic performance in flat-footed school children. Our aim in this study was to determine if there is an association between the degree of foot flatness and several motor skills that are necessary for sport performance.

METHODS. The feet of 218 children aged 11 to 15 years were scanned, and the arch index was determined. The value of the arch index was corrected for the influence of age, and then the entire sample was categorized into 4 groups according to the flatness of their feet. The children were tested for eccentric-concentric contraction and hopping on a Kistler force platform, speed-coordination polygon (Newtest system), balance (3 tests), toe flexion (textile crunching), tiptoe standing angle, and repetitive leg movements. Altogether, 17 measures of athletic performance were measured.

RESULTS. No significant correlations between the arch height and 17 motor skills were found. Categorizing the sample into 4 groups did not reveal any differences between the groups in athletic performance. Also, several multivariate analysis of variance sets of multiple independent variables referring to a particular motor ability were not found to be significant. The differences were not found even after comparing only the 2 extreme groups, meaning children with very low and children with very high arches.

CONCLUSIONS. No disadvantages in sport performance originating from flat-footedness were confirmed. Children with flat and children with “normal” feet were equally successful at accomplishing all motor tests; thus, we suggest that there is no need for treatment of flexible flat feet with the sole purpose of improving athletic performance, as traditionally advised by many.
Characteristics of Children Whose Siblings Have Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome
Authors: Kvigne Valborg L. , Leonardson Gary R. , Borzelleca Joseph , Neff-Smith Martha , Welty Thomas K.
Published: March 2009

OBJECTIVE. To describe the clinical features of American Indian children born just before and just after a sibling with fetal alcohol syndrome or incomplete fetal alcohol syndrome.

METHODS. Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome or incomplete fetal alcohol syndrome identified from 1981 to 1993 by using International Classification of Diseases, Ninth Revision, Clinical Modification code 760.71.

RESULTS. Compared with the controls, the 39 siblings born just before children with fetal alcohol syndrome (study 1) and 30 siblings born just before children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (23.1% and 16.7%, respectively), growth delay (38.5% and 10.0%), and central nervous system impairment (48.7% and 33.3%). The 20 siblings born just after children with fetal alcohol syndrome (study 1) and 22 siblings born just after children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (20.0% and 9.1%, respectively), growth delay (45.0% and 22.7%), and central nervous system impairment (50.0% and 31.8%) than the control siblings.

CONCLUSIONS. The “before” siblings had characteristics of fetal alcohol syndrome that could have predicted that the next child was at risk for fetal alcohol syndrome. The “after” siblings had better outcomes than the previous siblings with fetal alcohol syndrome, a finding that was associated with a decrease in maternal alcohol consumption during the after-sibling pregnancy.
Adherence to American Academy of Pediatrics Recommendations for Cardiac Care Among Female Carriers of Duchenne and Becker Muscular Dystrophy
Authors: Bobo Janet Kay , Kenneson Aileen , Kolor Katherine , Brown Michael A.
Published: March 2009

Objective. The goal was to assess women's knowledge and heart health behaviors consistent with the American Academy of Pediatrics recommendations for cardiac care among female carriers of Duchenne/Becker muscular dystrophy.

Methods. Using an advocacy group mailing list and working with 50 Muscular Dystrophy Association clinics, we surveyed women who had given birth to a son with Duchenne/Becker muscular dystrophy, thought that they were definitely or probably (≥50% likelihood) a Duchenne/Becker muscular dystrophy carrier, or both. Self-report data classified respondents as carriers, noncarriers, or women with unknown status.

Results. The respondents included 833 Duchenne/Becker muscular dystrophy carriers, 376 noncarriers, and 192 women with unknown status. Carriers were more likely than noncarriers and women in the unknown-status group to have ever undergone electrocardiography or other heart testing and to have seen a cardiologist in the past year, but they were not more likely to report a recent blood pressure or cholesterol level check. Only 64.4% of the carriers had ever had a heart test; 18.3% had seen a cardiologist in the past year. Only 62.9% of the carriers were aware of their cardiomyopathy risks before participating in the survey; 69.3% had informed their health care provider of their carrier status. Among carriers who had informed their provider, 70.2% had ever had a heart test and 21.4% had seen a cardiologist in the past year. In adjusted logistic regression models, factors that significantly increased the likelihood among carriers of ever having had a heart test and seeing a cardiologist in the previous year included older age (≥50 years), feeling informed about their cardiomyopathy risks before the survey, and having told their provider about their carrier status.

Conclusion. More health education efforts are needed for both patients and their providers, to improve adherence to the American Academy of Pediatrics cardiac care guidelines for female Duchenne/Becker muscular dystrophy carriers.
Prevalence of Developmental and Behavioral Disorders in a Pediatric Hospital
Authors: Petersen Mario Cesar , Kube David Arnold , Whitaker Toni M. , Graff Joyce Carolyn , Palmer Frederick B.
Published: March 2009

OBJECTIVE. The objective of this study was to estimate the prevalence of developmental and behavioral disorders in a convenience sample of children in an acute care pediatric hospital setting. We hypothesized that hospitalized children would have a higher prevalence of developmental and behavioral disorders than the general population.

METHODS. Data for this cross-sectional study were collected during interviews with primary caregivers of 325 children from infancy throughout childhood who were admitted to a general pediatric service. Screening tests included the Child Development Inventory (3 months to 6 years), Parents’ Evaluation of Developmental Status (0–8 years), Pediatric Symptom Checklist (4–18 years), and Vanderbilt Attention-Deficit/Hyperactivity Disorder Parent Rating Scale (6–18 years). Children were classified as having a known developmental and behavioral disorder, a suspected developmental and behavioral disorder, or no developmental and behavioral disorder.

RESULTS. The prevalence of developmental and behavioral disorders among the hospitalized children 6 months to 17 years of age was 33.5%. A total of 72 children (22.1%) had known developmental and behavioral disorders and 37 (11.4%) had suspected developmental and behavioral disorders. This high prevalence of developmental and behavioral disorders included high rates of cerebral palsy (6.1%) and mental retardation or developmental delay (8.6%).

CONCLUSION. Hospitalization for treatment of acute conditions provides another opportunity for developmental surveillance. This higher prevalence of developmental and behavioral disorders in hospitalized children emphasizes the need to screen for developmental disabilities at every opportunity. Strategies to implement systematic screening of hospitalized children should be examined.
Television Viewing in Infancy and Child Cognition at 3 Years of Age in a US Cohort
Authors: Schmidt Marie Evans , Rich Michael , Rifas-Shiman Sheryl L. , Oken Emily , Taveras Elsie M.
Published: March 2009

OBJECTIVE. To examine the extent to which infant television viewing is associated with language and visual motor skills at 3 years of age.

MEASURES. We studied 872 children who were participants in Project Viva, a prospective cohort. The design used was a longitudinal survey, and the setting was a multisite group practice in Massachusetts. At 6 months, 1 year, and 2 years, mothers reported the number of hours their children watched television in a 24-hour period, from which we derived a weighted average of daily television viewing. We used multivariable regression analyses to predict the independent associations of television viewing between birth and 2 years with Peabody Picture Vocabulary Test III and Wide-Range Assessment of Visual Motor Abilities scores at 3 years of age.

RESULTS. Mean daily television viewing in infancy (birth to 2 years) was 1.2 (SD: 0.9) hours, less than has been found in other studies of this age group. Mean Peabody Picture Vocabulary Test III score at age 3 was 104.8 (SD: 14.2); mean standardized total Wide-Range Assessment of Visual Motor Abilities score at age 3 was 102.6 (SD: 11.2). After adjusting for maternal age, income, education, Peabody Picture Vocabulary Test III score, marital status, and parity, and child's age, gender, birth weight for gestational age, breastfeeding duration, race/ethnicity, primary language, and average daily sleep duration, we found that each additional hour of television viewing in infancy was not associated with Peabody Picture Vocabulary Test III or total standardized Wide-Range Assessment of Visual Motor Abilities scores at age 3.

CONCLUSION. Television viewing in infancy does not seem to be associated with language or visual motor skills at 3 years of age.
Long-term Follow-up Care for Pediatric Cancer Survivors
Authors:   AMERICAN ACADEMY OF PEDIATRICS Section on Hematology/Oncology CHILDREN'S ONCOLOGY GROUP
Published: March 2009

This Clinical Report was revised. See https://doi.org/10.1542/peds.2021-053127.

Progress in therapy has made survival into adulthood a reality for most children, adolescents, and young adults diagnosed with cancer today. Notably, this growing population remains vulnerable to a variety of long-term therapy-related sequelae. Systematic ongoing follow-up of these patients, therefore, is important for providing for early detection of and intervention for potentially serious late-onset complications. In addition, health counseling and promotion of healthy lifestyles are important aspects of long-term follow-up care to promote risk reduction for health problems that commonly present during adulthood. Both general and subspecialty pediatric health care providers are playing an increasingly important role in the ongoing care of childhood cancer survivors, beyond the routine preventive care, health supervision, and anticipatory guidance provided to all patients. This report is based on the guidelines that have been developed by the Children's Oncology Group to facilitate comprehensive long-term follow-up of childhood cancer survivors (www.survivorshipguidelines.org).
A enfermagem e o cuidar na área de saúde mental
Authors: Villela Sueli de Carvalho , Scatena Maria Cecília Moraes
Published: March 2009

Este trabalho descreve os aspectos político-sociais que envolveram a reforma da assistência psiquiátrica, enfocando o processo de desinstitucionalização e a importância da enfermagem além de constituinte da equipe interdisciplinar. Objetiva analisar o processo de assistência de enfermagem ao doente mental em serviços externos ao hospital. Constitui-se de revisão bibliográfica em periódicos nacionais no período de 1999 a 2001. As autoras discutem sobre o comprometimento dos trabalhadores na área de saúde mental, com a "desconstrução"/construção a cerca do cuidado, fazendo-se necessária uma abordagem humanizada por meio do relacionamento interpessoal de pacientes, enfermeiros e as equipes responsáveis pela assistência ao doente mental.
A importância do aspecto (psico)motor na avaliação e tratamento das dificuldades sociais infantis
Authors: Prebianchi Helena Bazanelli
Published: March 2009

O presente trabalho pretende discutir, brevemente, a importância das habilidades motoras nas interações sociais de crianças, sem handicaps físicos ou intelectuais, em idade escolar. A partir do reconhecimento de que as habilidades sociais se desenvolvem continuamente ao longo da vida dos indivíduos e de que são fatores de ajustamento e qualidade de vida, enfatiza-se a importância do relacionamento da criança com o grupo de companheiros. Propõe-se que, numa perspectiva Comportamental, a avaliação e o tratamento das dificuldades sociais infantis têm negligenciado o aspecto motor, a despeito de as habilidades motoras serem requisitos fundamentais à participação nas atividades com o grupo de iguais. Um exemplo clínico é apresentado, de forma a ilustrar a necessidade de os processos de avaliação e intervenção psicoterápico não se restringirem ao desenvolvimento de habilidades sociais verbais, uma vez que, as mesmas, isoladamente, não garantem a manutenção da criança no grupo de companheiros e a formação de amizades. Conclui-se que, ao terapeuta comportamental infantil é indispensável o conhecimento de técnicas de avaliação e intervenção psicomotoras.
Disposição dos consumidores porto-alegrenses à compra de carne bovina com certificação
Authors: Velho João Pedro , Barcellos Júlio Otávio Jardim , Lengler Letícia , Elias Sandro Al-Alam , Oliveira Tamara Esteves de
Published: March 2009

Analisou-se o perfil de consumidores de carne bovina e determinou-se o consumo de carne com certificação visando obter dados sobre a importância e o valor da certificação da carne na hora da compra. Avaliou-se ainda o conhecimento do consumidor de carne bovina quanto à certificação da carne e quanto esse consumidor paga por este processo. A pesquisa foi realizada em uma rede de supermercados, mediante a aplicação de questionários dirigidos às pessoas próximas aos balcões com carne, independentemente da espécie animal. Os consumidores exigem alimentos com qualidade e certificados confiáveis que demonstrem e garantam a qualidade dos alimentos, porém, estão dispostos a pagar somente um pouco a mais pela certificação, em comparação ao valor atual de mercado, provavelmente pelo fato de sua renda mensal não permitir maior valorização desse atributo.
Clinical Applications of Orthodontic Microimplant Anchorage in Craniofacial Patients
Authors: Vachiramon Amornpong , Urata Mark , Kyung Hee Moon , Yamashita Dennis-Duke , Yen Stephen L-K.
Published: March 2009

Microimplant anchors, also known as temporary anchorage devices, mini- and micro-screws, have been used to enhance orthodontic anchorage for difficult tooth movements. Here, the authors describe how microimplants can be used to help treat craniofacial patients by supporting distraction osteogenesis procedures, maxillary protraction procedures, cleft segment expansion and stabilization, and tooth movement into narrow alveolar cleft sites. While most craniofacial patients are treated without microimplants, it would be worthwhile to identify which cases could benefit from microimplant anchorage. As an adjunct to orthodontic treatment, the microimplant offers a potential method for solving troublesome orthodontic and surgical problems such as guiding distraction procedures with orthodontics when primary teeth are exfoliating, addressing residual maxillary cants after vertical distraction osteogenesis of a ramus, stabilizing an edentulous premaxilla, and moving teeth into atrophic alveolar ridges. These cases are presented to open a dialogue on their possible uses in craniofacial patients.
Assessment of the Cleft Nasal Deformity Using a Regression Equation
Authors: Kim Soo Chan , Nam Ki Chang , Rah Dong Kyun , Cha Eun Jong , Kim Deok Won
Published: March 2009

Objective:

The purpose of this study is to propose an objective and simple method for assessing surgical outcomes of cleft nasal deformity using two-dimensional digital images.

Design:

Five plastic surgeons evaluated slides of 20 normal and 65 repaired cleft nasal deformities using the full range of values from 0 to 100 with 10-point intervals. Five laypersons rated 12 parameters per image from the same data set using the developed assessment tool. Correlation coefficients between the parameter values and the surgeons’ grades were obtained to find the best matches, and a regression equation was formulated using those. The reproducibility of the proposed method used by the laypersons was compared with that of the subjective grades made by the surgeons.

Results:

The mean correlation coefficient among the evaluated grades by the five laypersons using the proposed method was higher (.90) than that for the subjectively determined grades from the five plastic surgeons (.80). The grade reproducibility of the patients by the laypersons (9.6%) was also better than that by the surgeons (14.6%).

Conclusions:

The proposed assessment tool, including the regression equation, allows laypersons as well as surgeons to perform simple, reproducible, quantitative, and objective assessments of the surgical outcomes for cleft nasal deformity using two-dimensional photographs.
Screening for Obstructive Sleep Apnea in Preschool Children with Cleft Palate
Authors: MacLean J. E. , Waters K. , Fitzsimons D. , Hayward P. , Fitzgerald D. A.
Published: March 2009

Objective:

The objective of this study was to explore the prevalence, range of reported symptoms, and clinical risk factors of obstructive sleep apnea in preschool children with cleft lip and/or palate.

Design:

Questionnaires were distributed to parents/guardians of all children from birth to 5 years of age who were followed by the cleft clinic.

Results:

Questionnaire data and cleft classification were available for 248 children, with a mean age of 33.4 months. Obstructive sleep apnea was identified in 31.4% of the children. Only 29.5% of children with obstructive sleep apnea had undergone an investigation of these symptoms. The three most common symptoms reported in children with a questionnaire diagnosis of obstructive sleep apnea were (1) “heavy or loud breathing,” (2) “easily distracted,” and (3) “on the go” or “driven by a motor.” The only clinical risk factor associated with a questionnaire diagnosis of obstructive sleep apnea was the presence of a syndrome (χ2  =  3.5, p  =  .05). There were no significant differences in risk of obstructive sleep apnea by age, cleft classification, and surgical status.

Conclusion:

Preschool children with cleft lip and/or palate have a risk of obstructive sleep apnea that is as much as five times that of children without cleft. Obstructive sleep apnea appears to be underrecognized in this group of children. Further research is needed to investigate important risk factors for obstructive sleep apnea in children with cleft lip and/or palate.
Fluctuating Asymmetry and Developmental Instability in Sagittal Craniosynostosis
Authors: DeLeon Valerie Burke , Richtsmeier Joan T.
Published: March 2009

Objective:

To determine whether premature sagittal craniosynostosis is associated with developmental instability in the skull by analyzing fluctuating asymmetry in skull shape.

Design:

Cranial shape was quantified by collecting coordinate data from landmarks located on three-dimensional reconstructions of preoperative computed tomography (CT) images of 22 children with sagittal craniosynostosis and 22 age-matched controls. A fluctuating asymmetry application of Euclidean distance matrix analysis (EDMA) was used to quantify and compare asymmetry in cranial shape using these landmark data.

Results:

In contrast to expectations, the sagittal craniosynostosis group did not show a statistically significant increase in the overall level of fluctuating asymmetry relative to the control group. However, we discerned statistically significant localized increases in fluctuating asymmetry in the sagittal craniosynostosis group at pterion and the anterior clinoid processes (α  =  .05). We also determined a significant correlation of fluctuating asymmetry values between the two groups (r  =  .71).

Conclusions:

We conclude that there is no evidence of a role for system-wide developmental instability in the etiology of nonsyndromic sagittal craniosynostosis. However, the localized evidence of asymmetry at the anterior clinoid processes in the sagittal synostosis group suggests an association with the tracts of dura mater that attach there.
BASELINE MEASUREMENT OF RUNNING AWAY AMONG YOUTH IN FOSTER CARE
Authors: Witherup Luanne R. , Vollmer Timothy R. , Camp Carole M. Van , Goh Han‐Leong , Borrero John C. , Mayfield Kristin
Published: March 2009

The current study evaluated the use of various behavioral measures of running away with regard to (a) the differential utility of interval‐versus event‐based measures, (b) the differential utility of rate versus duration measures, (c) the utility of correcting for occurrence opportunity, and (d) the influence of unit of analysis (i.e., single‐subject vs. grouped data). Seven different baseline measures were calculated for 84 runaways, and a unit‐size analysis was conducted by constructing groups of various sizes from the original sample. An expert panel evaluated the suitability of the baseline measures for treatment evaluation. Results demonstrate the utility of evaluating duration‐based measures and correcting for occurrence opportunity. Results also indicate that single‐subject baselines may often be unacceptable for treatment evaluations, regardless of the type of measure selected for use.
THE ROLE OF OVERT AND COVERT SELF‐RULES IN ESTABLISHING A DAILY LIVING SKILL IN ADULTS WITH MILD DEVELOPMENTAL DISABILITIES
Authors: Faloon Bridget J. , Rehfeldt Ruth Anne
Published: March 2009

The purpose of the current study was to explore the use of overt and covert self‐rules in the acquisition, maintenance, and generalization of a chained task by adults with mild developmental disabilities. This research differed from previous research in that the experimenter did not deliver reinforcement for correct responses during training, and we examined the correspondence between each self‐rule statement and each subsequent response on each trial. Results showed that the self‐rules participated in control over participants' responding, in that the skill was acquired and shown to generalize in the absence of experimenter‐delivered reinforcement. Moreover, performance was shown to deteriorate when the emission of overt, but not covert, self‐rules was blocked.
A SOCIAL STORIES™ INTERVENTION PACKAGE FOR STUDENTS WITH AUTISM IN INCLUSIVE CLASSROOM SETTINGS
Authors: Chan Jeffrey M. , O'Reilly Mark F.
Published: March 2009

A Social Stories™ intervention package was used to teach 2 students with autism to read Social Stories, answer comprehension questions, and engage in role plays. Appropriate social behaviors increased and inappropriate behaviors decreased for both participants, and the effects were maintained for up to 10 months. This intervention package appears to be useful in inclusive classroom environments and does not require intensive supervision of the child's behavior.
DECREASING PROBLEM BEHAVIOR ASSOCIATED WITH A WALKING PROGRAM FOR AN INDIVIDUAL WITH DEVELOPMENTAL AND PHYSICAL DISABILITIES
Authors: Roane Henry S. , Kelley Michael E.
Published: March 2009

In the current investigation, a functional analysis suggested that positive reinforcement in the form of physical contact maintained the self‐injurious behavior of a girl with developmental and physical disabilities. We used the information obtained from the functional analysis to develop a treatment for noncompliance with walking in which a therapist removed physical interaction following inappropriate behavior during walks.
SOME EFFECTS OF NONCONTINGENT POSITIVE REINFORCEMENT ON MULTIPLY CONTROLLED PROBLEM BEHAVIOR AND COMPLIANCE IN A DEMAND CONTEXT
Authors: Ingvarsson Einar T. , Kahng SungWoo , Hausman Nicole L.
Published: March 2009

Functional analysis suggested that the problem behavior of an 8‐year‐old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.
A PRELIMINARY COMPARISON OF FUNCTIONAL ANALYSIS RESULTS WHEN CONDUCTED IN CONTRIVED VERSUS NATURAL SETTINGS
Authors: Lang Russell , O'Reilly Mark , Machalicek Wendy , Lancioni Giulio , Rispoli Mandy , Chan Jeffrey M.
Published: March 2009

A preliminary evaluation of the correspondence between functional analysis outcomes across settings was conducted with 2 children who had been diagnosed with autism and who engaged in challenging behavior. Differences across settings (a therapy room and a classroom) were demonstrated in ABAB reversal designs. Three potential patterns of results that may occur when comparing functional analyses across environments are described, and one possible explanation for the occurrence of discrepancies between environments (differing learning histories within separate environments) is offered.
CAREGIVER‐CONDUCTED EXPERIMENTAL FUNCTIONAL ANALYSES OF INAPPROPRIATE MEALTIME BEHAVIOR
Authors: Najdowski Adel C. , Wallace Michele D. , Penrod Becky , Tarbox Jonathan , Reagon Kara , Higbee Thomas S.
Published: March 2009

The purpose of the current study was to replicate the use of parents as therapists for experimental functional analyses of inappropriate mealtime behavior with multiple participants while measuring procedural integrity. Clear functions were identified, and high percentages of procedural integrity were obtained.
CONTEXTUAL CONTROL OF SLOT‐MACHINE GAMBLING: REPLICATION AND EXTENSION
Authors: Hoon Alice , Dymond Simon , Jackson James W. , Dixon Mark R.
Published: March 2009

Participants were trained and tested to select stimuli of differing physical quantities in the presence of 2 color contextual cues for more than and less than. Following more than and less than relational training, participants allocated the majority of their responses to the slot machine that shared formal properties of color with the contextual cue for more than, despite the identical payout probabilities of the slot machines.
Periodontal Conditions of Individuals With Sjögren's Syndrome
Authors: Antoniazzi Raquel Pippi , Miranda Letícia Algarves , Zanatta Fabricio Batistin , Islabão Alexandre Garcia , Gustafsson Anders , Chiapinotto Geraldo Augusto , Oppermann Rui Vicente
Published: March 2009

Background: Sjögren's syndrome (SjS) is a systemic autoimmune disease that might lead to hyposalivation and negatively affect the oral environment. The evidence with regard to the periodontal conditions in this group of subjects is still controversial. This study aimed to evaluate the periodontal clinical conditions and inflammatory markers in gingival crevicular fluid (GCF) from patients with primary Sjögren's syndrome (SjS [P]) or secondary Sjögren's syndrome (SjS [S]) compared to a control group.

Methods: Nineteen individuals with SjS (11 SjS [P] and eight SjS [S]) and 19 controls, matched for gender, age, and tobacco exposure, were selected from two private clinics and a hospital. The groups were compared for stimulated whole saliva (SWS) flow rate, plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), and total amount of interleukin (IL)‐1β and total elastase activity in the GCF. Generalized estimating equations were used for data analysis.

Results: Individuals with SjS had a significantly lower SWS flow rate and higher mean PI, GI, PD, CAL, and BOP than controls. After adjustment for plaque, GI remained significantly higher in patients with SjS. Patients with SjS (S) had significantly higher mean CAL and PD than patients with SjS (P), and CAL and BOP remained significantly higher in this subgroup after adjustment. No differences were observed with regard to the GCF inflammatory markers. After adjusting for PD, subjects with SjS (P) showed lower levels of IL‐1β compared to controls.

Conclusion: SjS seemed to negatively affect the periodontal condition because gingival inflammation was more evident in the individuals with SjS, particularly those with SjS (S).
Sinus Floor Elevation From a Maxillary Molar Tooth Extraction Socket in a Patient With Chronic Inflammation
Authors: Tözüm Tolga F. , Dursun Erhan , Tulunoglu Ibrahim
Published: March 2009

Background: The compromised nature of the residual interradicular bone after extraction of periodontally hopeless maxillary molars often requires a sinus elevation procedure to ideally place the implants to accept future prosthesis. Maxillary sinus elevation surgery is a procedure used to increase the volume of bone mass so that dental implants can be placed. This article documents a sinus floor elevation technique through an extraction socket in a 65‐year‐old white male with chronic inflammation to increase the bone mass after the extraction of a periodontally involved maxillary molar tooth.

Methods: Computerized tomography revealed an increased thickness of the sinus membrane, which was attributed to possible chronic sinus inflammation and periodontal inflammation. After consultation with the Department of Otolaryngology, it was diagnosed as chronic inflammation without any contraindication for sinus elevation surgery or implant placement. One month after the extraction, the sinus floor elevation surgery was performed through the extraction socket, and implants were placed 4 months later.

Results: An uneventful healing was noted after 6 months of osseointegration; two porcelain‐fused‐to‐metal crowns were fabricated. Clinical follow‐up took place every 3 months for 3 years, and successful healing was achieved. The patient was satisfied with the esthetic and functional results of the oral rehabilitation.

Conclusion: Sinus floor elevation through an extraction socket without any residual bone, followed by dental implant placement, provided successful functional results and acceptable stability.
Investigating the Relationship Among Self‐Reported Oral Health Status, Oral Health–Related Behaviors, and Self‐Consciousness in Romanian Dental Patients
Authors: Dumitrescu A.L. , Kawamura M. , Zetu L. , Teslaru S.
Published: March 2009

Background: The purpose of this study was to investigate whether self‐consciousness, self‐reported oral health status, and oral health–related behaviors were associated in a Romanian population.

Methods: A cross‐sectional study design was used. Data were collected between January and March 2008. The sample consisted of 180 Romanian adults (mean age: 35.8 years; 72.6% women; 57% married) who were a random population drawn consecutively from the registry file of a private dental practice in the Iasi area. The questionnaire included information about demographic, psychologic, self‐reported oral health, and oral health–related behavior items. The self‐consciousness (SC) scale with three subscales (public SC, private SC, and social anxiety) was applied.

Results: Significant differences were found on the public SC scale in relation to denture/removable false teeth and on the total SC scale in relation to periodontal problems. When oral health behaviors were analyzed, private SC was associated with oral health behaviors (flossing, use of mouthrinse, and dental visit frequency). There was no association between toothbrushing frequency and the self‐consciousness subscales.

Conclusion: The moderating effects of self‐consciousness should be considered when evaluating risk‐reduction interventions and tailoring intervention efforts to oral health promotion.
Cardiovascular Disease Parameters in Periodontitis
Authors: Monteiro Andréa M. , Jardini Maria A.N. , Alves Sarah , Giampaoli Viviana , Aubin Elisete C.Q. , Figueiredo Neto Antônio M. , Gidlund Magnus
Published: March 2009

Background: Recently, there has been an increasing in the impact of oral health on atherosclerosis and subsequent cardiovascular disease. The aim of this study is to investigate the association between chronic periodontitis and cardiovascular risk markers.

Methods: Forty patients with periodontitis and 40 healthy gender‐, body mass index–, and age‐matched individuals were compared by measuring total cholesterol, high‐density lipoprotein, low‐density lipoprotein, triglycerides, levels of cytokines, antibodies against oxidized low‐density lipoprotein, thiobarbituric acid reactive substances, total and differential white blood cell counts, and the non‐linear index of refraction.

Results: The levels of triglycerides and high‐density lipoprotein in periodontitis patients were significantly higher and lower, respectively (P = 0.002 and P = 0.0126), compared to controls. Total cholesterol, low‐density lipoprotein, and lipid peroxide levels were the same in both groups (P = 0.2943, P = 0.1284, and P = 0.067, respectively). Interleukin (IL)‐6 and −8, antibodies against oxidized low‐density lipoprotein, and leukocyte and neutrophil counts were significantly higher in periodontitis patients (P <0.05). The value of the non‐linear index of refraction of low‐density lipoprotein solutions was higher in the controls (P = 0.015) compared to individuals with periodontitis.

Conclusion: Our results confirmed and further strengthened the suggested association between coronary artery disease and periodontitis.