bluuebunny/crossref_metadata_2025 huggingface dataset:
Timing of Delivery and Survival Rates for Infants With Prenatal Diagnoses of Congenital Diaphragmatic Hernia
Authors: Stevens Timothy P. , van Wijngaarden Edwin , Ackerman Kate G. , Lally Pamela A. , Lally Kevin P. ,   for the Congenital Diaphragmatic Hernia Study Group
Published: January 2009

OBJECTIVES. The goal of the study was to test the hypothesis that infants with known congenital diaphragmatic hernias born at early term gestation (37–38 weeks) rather than later (39–41 weeks) had greater survival rates and less extracorporeal membrane oxygenation use. Primary outcomes were survival to hospital discharge or transfer and extracorporeal membrane oxygenation use.

METHODS. A retrospective cohort study of term infants with prenatal diagnoses of congenital diaphragmatic hernia was performed with the Congenital Diaphragmatic Hernia Study Group Registry of patients with congenital diaphragmatic hernias who were treated between January 1995 and December 2006.

RESULTS. Among 628 term infants at 37 to 41 weeks of gestation who had prenatal diagnoses of congenital diaphragmatic hernia and were free of major associated anomalies, early term birth (37 vs 39–41 weeks) and greater birth weight were associated independently with survival, whereas black race was related inversely to survival. Infants born at early term with birth weights at or above the group mean (3.1 kg) had the greatest survival rate (80%). Among infants born through elective cesarean delivery, infants born at 37 to 38 weeks of gestation, compared with 39 to 41 weeks, had less use of extracorporeal membrane oxygenation (22.0% vs 35.5%) and a trend toward a greater survival rate (75.0% vs 65.8%).

CONCLUSIONS. The timing of delivery is an independent, potentially important factor in the consideration of elective delivery for infants diagnosed prenatally as having congenital diaphragmatic hernias. Among fetuses with prenatally diagnosed congenital diaphragmatic hernias and without major associated anomalies, early term delivery may confer advantage.
Prolonged Intravenous Therapy Versus Early Transition to Oral Antimicrobial Therapy for Acute Osteomyelitis in Children
Authors: Zaoutis Theoklis , Localio A. Russell , Leckerman Kateri , Saddlemire Stephanie , Bertoch David , Keren Ron
Published: January 2009

OBJECTIVES. Early transition from intravenous to oral antimicrobial therapy for acute osteomyelitis in children has been suggested as a safe and effective alternative to traditional prolonged intravenous therapy via central venous catheter, but no studies have directly compared these 2 treatment modalities. We sought to compare the effectiveness of early transition from intravenous to oral antimicrobial therapy versus prolonged intravenous antimicrobial therapy for the treatment of children with acute osteomyelitis.

METHODS. We conducted a retrospective cohort study of children aged 2 months to 17 years diagnosed with acute osteomyelitis between 2000 and 2005 at 29 freestanding children's hospitals in the United States to confirm the extent of variation in the use of early transition to oral therapy. We used propensity scores to adjust for potential differences between children treated with prolonged intravenous therapy and logistic regression to model the association of outcome (treatment failure rates within 6 months of diagnosis) and difference in the mode of therapy within hospitals and across hospitals.

RESULTS. Of the 1969 children who met inclusion criteria, 1021 received prolonged intravenous therapy and 948 received oral therapy. The use of prolonged intravenous therapy varied significantly across hospitals (10%–95%). The treatment failure rate was 5% (54 of 1021) in the prolonged intravenous therapy group and 4% (38 of 948) in the oral therapy group. There was no significant association between treatment failure and the mode of antimicrobial therapy. Thirty-five (3.4%) children in the prolonged intravenous therapy group were readmitted for a catheter-associated complication.

CONCLUSIONS. Treatment of acute osteomyelitis with early transition to oral therapy is not associated with a higher risk of treatment failures and avoids the risks of prolonged intravenous therapy through central venous catheters.
Mental Health Problems and Overweight in a Nationally Representative Sample of Adolescents: Effects of Race and Ethnicity
Authors: BeLue Rhonda , Francis Lori Ann , Colaco Brendon
Published: January 2009

OBJECTIVES. In this study we examined the relation between mental health problems and weight in a population-based study of youth aged 12 to 17 years and whether the association between mental health problems and weight is moderated by race and ethnicity.

METHODS. We used 2003 National Survey on Children's Health data. Logistic regression was used to arrive at adjusted odds ratios showing the relation between BMI and mental health problems.

RESULTS. Compared with their nonoverweight counterparts, both white and Hispanic youth who were overweight were significantly more likely to report depression or anxiety, feelings of worthlessness or inferiority, behavior problems, and bullying of others. Odds ratios relating mental health problems and BMI in black subjects were not statistically significant except for physician diagnosis of depression.

CONCLUSIONS. Our results suggest that, when addressing youth overweight status, mental health problems also need to be addressed. Given that the relationship between mental health problems and youth overweight differs according to race/ethnic group, public health programs that target overweight youth should be cognizant of potential comorbid mental health problems and that race/ethnicity may play a role in the relationship between mental health and overweight status.
New Opportunity to Improve Pediatric Emergency Preparedness: Pediatric Emergency Assessment, Recognition, and Stabilization Course
Authors: Ralston Mark E. , Zaritsky Arno L.
Published: January 2009

The ideal first response to a life-threatening pediatric emergency includes early recognition of the emergency, activation of the appropriate emergency response system, performance of basic life support (cardiopulmonary resuscitation/automated external defibrillator treatment), and initiation of advanced life support, but the extent of resuscitation training among health care providers likely to be first at the side of a critically ill or injured child is often deficient. In the past, resuscitation courses beyond basic life support focused on training advanced providers. The Pediatric Emergency Assessment, Recognition, and Stabilization course was developed by the American Heart Association to target a broad range of health care providers who are likely to be first at the side of a child requiring resuscitation. It is hoped that training of health care providers through the Pediatric Emergency Assessment, Recognition, and Stabilization course will translate into early recognition of life-threatening pediatric emergencies and greater resuscitation success, but results will depend on the availability of instruction and the maintenance of skills.
Mortality Rates for Extremely Low Birth Weight Infants Born in Japan in 2005
Authors: Itabashi Kazuo , Horiuchi Takeshi , Kusuda Satoshi , Kabe Kazuhiko , Itani Yasufumi , Nakamura Takashi , Fujimura Masanori , Matsuo Masafumi
Published: January 2009

OBJECTIVE. Our goal was to investigate the neonatal mortality rate and the mortality rate during the NICU stay for extremely low birth weight infants born in Japan in 2005.

METHODS. The Committee of Neonatal Medicine of the Japan Pediatric Society retrospectively surveyed the deaths of extremely low birth weight infants born and hospitalized between January 1 and December 31, 2005. From 297 institutions in Japan, data on 3065 extremely low birth weight infants, which represented 98.4% of those reported in the maternal and health statistics of Japan in 2005, were collected.

RESULTS. The neonatal mortality rate and the mortality rate during the NICU stay were 13.0% and 17.0%, respectively, which were lower than 17.7% and 21.5% in the survey in 2000. The neonatal mortality rates and the mortality rates during the NICU stay were 53.3% and 67.7% in the <400-g birth weight group (n = 62), 42.1% and 53.5% in the 400- to 499-g birth weight group (n = 159), 22.2% and 27.7% in the 500- to 599-g birth weight group (n = 387), 16.8% and 22.2% in the 600- to 699-g birth weight group (n = 537), 9.4% and 12.7% in the 700- to 799-g birth weight group (n = 574), 6.3% and 9.1% in the 800- to 899-g birth weight group (n = 649), and 3.9% and 5.3% in the 900- to 999-g birth weight group (n = 697), respectively. The factors involved in the deaths of extremely low birth weight infants included lower gestational age, lower birth weight, male gender, multiple birth, institutions in which <10 extremely low birth weight infants were admitted per year, and no prenatal maternal transfer.

CONCLUSION. The mortality rates of extremely low birth weight infants who were born in 2005 demonstrated definite improvement.
Neuropsychological Performance 10 Years After Immunization in Infancy With Thimerosal-Containing Vaccines
Authors: Tozzi Alberto Eugenio , Bisiacchi Patrizia , Tarantino Vincenza , De Mei Barbara , D'Elia Lidia , Chiarotti Flavia , Salmaso Stefania
Published: January 2009

OBJECTIVE. Thimerosal, a mercury compound used as a preservative in vaccines administered during infancy, has been suspected to affect neuropsychological development. We compared the neuropsychological performance, 10 years after vaccination, of 2 groups of children exposed randomly to different amounts of thimerosal through immunization.

METHODS. Children who were enrolled in an efficacy trial of pertussis vaccines in 1992–1993 were contacted in 2003. Two groups of children were identified, according to thimerosal content in vaccines assigned randomly in the first year of life (cumulative ethylmercury intake of 62.5 or 137.5 μg), and were compared with respect to neuropsychological outcomes. Eleven standardized neuropsychological tests, for a total of 24 outcomes, were administered to children during school hours. Mean scores of neuropsychological tests in the domains of memory and learning, attention, executive functions, visuospatial functions, language, and motor skills were compared according to thimerosal exposure and gender. Standard regression coefficients obtained through multivariate linear regression analyses were used as a measure of effect.

RESULTS. Nearly 70% of the invited subjects participated in the neuropsychological assessment (N = 1403). Among the 24 neuropsychological outcomes that were evaluated, only 2 were significantly associated with thimerosal exposure. Girls with higher thimerosal intake had lower mean scores in the finger-tapping test with the dominant hand and in the Boston Naming Test.

CONCLUSIONS. Given the large number of statistical comparisons performed, the few associations found between thimerosal exposure and neuropsychological development might be attributable to chance. The associations found, although statistically significant, were based on small differences in mean test scores, and their clinical relevance remains to be determined.
Protecting the Public: State Medical Board Licensure Policies for Active and Inactive Physicians
Authors: Freed Gary L. , Dunham Kelly M. , Abraham Leah ,   the Research Advisory Committee of the American Board of Pediatrics
Published: January 2009

OBJECTIVE. The purpose of this research was to explore state physician licensing board policies and regulation of active, inactive, and retired licenses.

METHODS. We conducted structured telephone interviews from January to March 2007 with representatives of all 64 state allopathic and osteopathic medical licensing boards in the United States. All of the licensing boards participated.

RESULTS. Only 34% of state licensing boards query physicians regarding clinical activity at both initial licensure and renewal. The majority of boards allow physicians to hold or renew an unrestricted active license to practice medicine, although they may not have cared for a patient in years. Only 1 board requires a minimum number of patient visits to maintain an active license. Five boards allow physicians with inactive licenses to practice some form of medicine, whereas 7 boards allow physicians with retired licenses to practice. Few states have any mechanism to assess the competency of clinically inactive physicians who return to active practice.

CONCLUSIONS. The number of inactive physicians in the United States is growing. Currently, state medical board policies do not address the issue of continuing competence in license renewal. Greater medical safety concerns on the part of the public will likely lead to calls for greater accountability by state licensing authorities.
Folate, Related B Vitamins, and Homocysteine in Childhood and Adolescence: Potential Implications for Disease Risk in Later Life
Authors: Kerr Maeve A. , Livingstone Barbara , Bates Christopher J. , Bradbury Ian , Scott John M. , Ward Mary , Pentieva Kristina , Mansoor Mohammad Azam , McNulty Helene
Published: January 2009

OBJECTIVES. Folate and the metabolically related B vitamins are an important priority throughout life, but few studies have examined their status through childhood and adolescence. The aims of the current study were to investigate age, gender, and lifestyle factors as determinants of folate, related B-vitamin status, and homocysteine concentrations among British children and adolescents and to propose age-specific reference ranges for these biomarkers, which, at present, are unavailable.

PARTICIPANTS AND METHODS. Data from the National Dietary and Nutritional Survey of 2127 young people aged 4 to 18 years were accessed to provide a representative sample of British children. All of the subjects who provided a blood sample for homocysteine concentrations were included in the current study (n = 840). Of these, laboratory biomarkers of folate (serum and red cell folate: n = 832 and 774, respectively), vitamin B12 (n = 828), vitamin B6 (n = 770), and riboflavin (n = 839) were also examined.

RESULTS. The biomarker status of all 4 of the relevant B vitamins decreased significantly with age. Correspondingly, homocysteine concentrations progressively increased, with median values of 5.6, 6.3, and 7.9 μmol/L for children aged 4 to 10 years, 11 to 14 years, and 15 to 18 years, respectively, and were higher in boys compared with girls (15–18 years only). Independent of age and gender, fortified breakfast cereal intake (consumed by 89% of the sample) was associated with significantly higher B-vitamin status and lower homocysteine concentrations.

CONCLUSIONS. It is not generally appreciated that the well-established progressive increase in homocysteine from 4 to 18 years reflects decreases in the biomarker status of all 4 metabolically related B vitamins. We suggest age-specific laboratory reference ranges for homocysteine and related B-vitamin concentrations for potential use within a pediatric setting.
Persistence of Morbidity and Cost Differences Between Late-Preterm and Term Infants During the First Year of Life
Authors: McLaurin Kimmie K. , Hall Caroline B. , Jackson E. Anne , Owens Oksana V. , Mahadevia Parthiv J.
Published: January 2009

BACKGROUND. Late-preterm infants are known to have greater morbidity and costs compared with term infants during the neonatal period, but less is known about whether these differences continue beyond this period.

OBJECTIVE. The purpose of this study was to examine the most common causes and costs of rehospitalization and other health care use among late-preterm and term infants throughout the first year of life.

METHODS. We conducted a retrospective cohort study of late-preterm (33–36 weeks' gestation) and term infants born in 2004 with ≥1 year of enrollment in a large national US database of commercially insured members. All of the reported health care services and costs were examined from the birth hospitalization through the first year of life.

RESULTS. We evaluated 1683 late-preterm and 33 745 term infants. The average length of stay of the birth hospitalization for term infants was 2.2 days, and the average cost was $2061. Late-preterm infants had a substantially longer average stay of 8.8 days and average cost of $26 054. Total first-year costs after birth discharge were, on average, 3 times as high among late-preterm infants ($12 247) compared with term infants ($4069). Late-preterm infants were rehospitalized more often than term infants (15.2% vs 7.9%). A subset of late-preterm infants that were discharged late from their birth hospitalization had the highest rates of rehospitalization and total health care costs. Higher costs during rehospitalization of late-preterm infants, especially those with a late discharge, indicate their propensity to have more severe illness.

CONCLUSIONS. Late-preterm infants have greater morbidity and total health care costs than term infants, and these differences persist throughout the first year of life. Management strategies and guidelines to reduce morbidity and costs in late-preterm infants should be investigated.
Health of Children 3 to 17 Years of Age With Down Syndrome in the 1997–2005 National Health Interview Survey
Authors: Schieve Laura A. , Boulet Sheree L. , Boyle Coleen , Rasmussen Sonja A. , Schendel Diana
Published: January 2009

OBJECTIVE. This study provides population-based estimates of recent medical conditions, concurrent developmental disorders, and health impact and utilization indicators for US children with and without Down syndrome.

METHODS. The sample included children 3 to 17 years of age in the 1997–2005 National Health Interview Survey Child Sample Core and specifically included 146 children with Down syndrome, 604 children with mental retardation but without Down syndrome, and 95 454 children without either condition reported. Developmental and medical conditions, health status, and service use were reported by parents or other knowledgeable caregivers.

RESULTS. After adjustment for demographic factors, children with Down syndrome had higher odds, compared with children without mental retardation, of recent food/digestive allergy, frequent diarrhea/colitis, ≥3 ear infections in the previous year, very recent head/chest cold, and developmental disabilities other than mental retardation. They had increased odds that approached significance for recent seizures, very recent stomach/intestinal illness, and asthma. They had substantially higher rates (threefold or higher, compared with children without mental retardation) for nearly all health impact and health and special education service use measures. Of note, >25% of children with Down syndrome needed help with personal care, regularly took prescription medications, had recently seen a medical specialist, and received physical therapy or related therapy. The comparison group with mental retardation without Down syndrome represented many children with multiple serious disabilities who also had high rates of medical conditions and high levels of health impact and service use.

CONCLUSION. These findings provide empirical, population-based data to inform guidelines for frequent monitoring and support for children with Down syndrome.
Water-Pipe Tobacco Smoking Among Middle and High School Students in Arizona
Authors: Primack Brian A. , Walsh Michele , Bryce Cindy , Eissenberg Thomas
Published: January 2009

BACKGROUND. Using a water pipe to smoke tobacco is increasing in prevalence among US college students, and it may also be common among younger adolescents. The purpose of this study of Arizona middle and high school students was to examine the prevalence of water-pipe tobacco smoking, compare water-pipe tobacco smoking with other forms of tobacco use, and determine associations between sociodemographic variables and water-pipe tobacco smoking in this population.

METHODS. We added items assessing water-pipe tobacco smoking to Arizona's 2005 Youth Tobacco Survey and used them to estimate statewide water-pipe tobacco smoking prevalence among various demographic groups by using survey weights. We also used multiple logistic regression to determine which demographic characteristics had independent relationships with each of 2 outcomes: ever use of water pipe to smoke tobacco and water-pipe tobacco smoking in the previous 30 days.

RESULTS. Median age of the sample was 14. Accounting for survey weights, among middle school students, 2.1% had ever smoked water-pipe tobacco and 1.4% had done so within the previous 30 days. Among those in high school, 10.3% had ever smoked from a water pipe and 5.4% had done so in the previous 30 days, making water-pipe tobacco smoking more common than use of smokeless tobacco, pipes, bidis, and kreteks (clove cigarettes). In multivariate analyses that controlled for covariates, ever smoking of water-pipe tobacco was associated with older age, Asian race, white race, charter school attendance, and lack of plans to attend college.

CONCLUSIONS. Among Arizona youth, water pipe is the third most common source of tobacco after cigarettes and cigars. Increased national surveillance and additional research will be important for addressing this threat to public health.
The Cost of Preterm Birth Throughout Childhood in England and Wales
Authors: Mangham Lindsay J. , Petrou Stavros , Doyle Lex W. , Draper Elizabeth S. , Marlow Neil
Published: January 2009

BACKGROUND. Infants born preterm are at increased risk of adverse health and developmental outcomes. Mortality and morbidity after preterm birth impose a burden on finite public sector resources. This study considers the economic consequences of preterm birth from birth to adult life and compares the costs accruing to those born preterm with those born at term.

METHODS. A decision-analytic model was constructed to estimate the costs to the public sector over the first 18 years after birth, stratified by week of gestational age at birth. Costs were discounted and reported in UK pounds at 2006 prices. Probabilistic sensitivity analysis was used to examine uncertainty in the model parameters and generate confidence intervals surrounding the cost estimates.

RESULTS. The model estimates the costs associated with a hypothetical cohort of 669601 children and is based on live birth and preterm birth data from England and Wales in 2006. The total cost of preterm birth to the public sector was estimated to be £2.946 billion (US $4.567 billion), and an inverse relationship was identified between gestational age at birth and the average public sector cost per surviving child. The incremental cost per preterm child surviving to 18 years compared with a term survivor was estimated at £22885 (US $35471). The corresponding estimates for a very and extremely preterm child were substantially higher at £61781 (US $95760) and £94740 (US $146847), respectively.

CONCLUSIONS. Despite concerns about ongoing costs after discharge from perinatal services, the largest contribution to the economic implications of preterm birth are hospital inpatient costs after birth, which are responsible for 92.0% of the incremental costs per preterm survivor.
Binge Pattern of Alcohol Consumption During Pregnancy and Childhood Mental Health Outcomes: Longitudinal Population-Based Study
Authors: Sayal Kapil , Heron Jon , Golding Jean , Alati Rosa , Smith George Davey , Gray Ron , Emond Alan
Published: January 2009

OBJECTIVE. Patterns of alcohol consumption during pregnancy such as episodes of binge drinking may be as important as average levels of consumption in conferring risk for later childhood mental health and learning problems. However, it can be difficult to distinguish risk resulting from episodic or regular background levels of drinking. This large study investigates whether patterns of alcohol consumption are independently associated with child mental health and cognitive outcomes, whether there are gender differences in risk, and whether occasional episodes of higher levels of drinking carry any risk in the absence of regular daily drinking during pregnancy.

METHODS. This prospective, population-based study used data from the Avon Longitudinal Study of Parents and Children. We investigated the relationships between a binge pattern of alcohol use (consumption of ≥4 drinks in a day) in the second and third trimesters of pregnancy and childhood mental health problems at 47 and 81 months of age (n = 6355 and 5599, respectively). In a subgroup, we also investigated these relationships with child IQ at 49 months of age (n = 924).

RESULTS. After controlling for a range of prenatal and postnatal factors, any episodes of consuming ≥4 drinks in a day were independently associated with higher risks for mental health problems (especially hyperactivity/inattention) in girls at the age of 47 months and in both genders at 81 months. There was no association with IQ scores at 49 months after adjustment for confounders. The consumption of ≥4 drinks in a day continued to carry risk for mental health problems (especially hyperactivity/inattention) in the absence of regular daily drinking.

CONCLUSIONS. The consumption of ≥4 drinks in a day on an occasional basis during pregnancy may increase risk for child mental health problems in the absence of moderate daily levels of drinking. The main risks seem to relate to hyperactivity and inattention problems.
Parental Smoking and Adolescent Smoking Initiation: An Intergenerational Perspective on Tobacco Control
Authors: Gilman Stephen E. , Rende Richard , Boergers Julie , Abrams David B. , Buka Stephen L. , Clark Melissa A. , Colby Suzanne M. , Hitsman Brian , Kazura Alessandra N. , Lipsitt Lewis P. , Lloyd-Richardson Elizabeth E. , Rogers Michelle L. , Stanton Cassandra A. , Stroud Laura R. , Niaura Raymond S.
Published: January 2009

OBJECTIVE. Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation.

METHODS. We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation.

RESULTS. Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use.

CONCLUSIONS. Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.
Varicella Vaccination and Ischemic Stroke in Children: Is There an Association?
Authors: Donahue James G. , Kieke Burney A. , Yih W. Katherine , Berger Nicholas R. , McCauley Jeremy S. , Baggs James , Zangwill Kenneth M. , Baxter Roger , Eriksen Eileen M. , Glanz Jason M. , Hambidge Simon J. , Klein Nicola P. , Lewis Edwin M. , Marcy S. Michael , Naleway Allison L. , Nordin James D. , Ray Paula , Belongia Edward A. ,   for the Vaccine Safety DataLink Team
Published: January 2009

BACKGROUND. Ischemic stroke is a known complication of varicella disease. Although there have been case reports of ischemic stroke after varicella vaccination, the existence and magnitude of any vaccine-associated risk has not been determined.

OBJECTIVE. The purpose of this work was to determine whether varicella vaccination is associated with an increased risk of ischemic stroke and encephalitis in children within 12 months after vaccination.

PATIENTS AND METHODS. We conducted a retrospective cohort study based on computerized data from children 11 months through 17 years old enrolled for ≥12 months in the Vaccine Safety DataLink from 1991 through 2004. International Classification of Disease codes identified cases of ischemic stroke (433–436, 437.1, 437.4, 437.6, 437.8–437.9) and encephalitis (052.0, 323.5, 323.8–9). Cox regression was used to model the risk in the 12 months after vaccination relative to all other person-time. Covariates included calendar time, gender, and stroke risk factors (eg, sickle cell disease).

RESULTS. Varicella vaccine was administered to 35.3% of the 3.2 million children in the cohort. There were 203 new inpatient ischemic stroke diagnoses, including 8 that occurred within 12 months after vaccination; there was no temporal clustering. The adjusted stroke hazard ratio was not elevated during any of the time periods in the 12 months after vaccination. Stroke was strongly associated with known risk factors such as sickle cell disease and cardiac disease. None of the 243 encephalitis cases occurred during the first 30 days after vaccination, and there was no association between encephalitis and varicella vaccination at any time in the 12 months after vaccination.

CONCLUSION. Our retrospective cohort study of >3 million children found no association between varicella vaccine and ischemic stroke.
Usual Source of Care and Unmet Need Among Vulnerable Children: 1998–2006
Authors: Hoilette Leesha K. , Clark Sarah J. , Gebremariam Achamyeleh , Davis Matthew M.
Published: January 2009

OBJECTIVE. The purpose of this work was to identify the proportions of publicly (Medicaid and State Child Health Insurance Program) insured and uninsured children who did not identify a usual source of care from 1998 to 2006, spanning the State Children's Health Insurance Program (1997 to present) and the President's Health Center Initiative (2002 to present), and to characterize unmet medical need as it relates to insurance and a usual source of care for publicly insured and uninsured children.

METHODS. We conducted a secondary data analysis of multiple years of the National Health Interview Survey. We identified the proportion of publicly insured and uninsured children aged 0 to 17 years who did not identify a usual source of care and stratified according to the site of care. We described the odds of reporting an unmet medical need according to insurance status and usual source of care, compared with privately insured children with a usual source of care. Sample weights were used to derive national estimates.

RESULTS. From 1998 through 2006, there were significant increases in the proportions of children enrolled in Medicaid (16.7%–24.5%) and the State Child Health Insurance Program (2.0%–5.3%). The proportion of uninsured children has remained stable from 2002 to 2006 at ∼10%. However, the proportion of uninsured reporting no usual source of care increased from 17.8% to 23.3%. Hispanic children had significant increases in the proportions of the uninsured and reporting no usual source of care by 2006. Hispanics constituted the largest proportion in both groups. Uninsured children and children without a usual source of care reported the highest odds of unmet need. Among the insured, publicly insured children had twice the odds of reporting an unmet need compared with privately insured children.

CONCLUSIONS. During the State Child Health Insurance Program and the President's Health Center Initiative, growing proportions of uninsured children reported no usual source of care. Unmet medical need was the highest for the uninsured and those without a usual source of care. These findings suggest that initiatives designed to improve access to care must combine broadened insurance coverage with enhanced access to usual sources of care.
Diagnosis and Management of Acute Sinusitis by Pediatricians
Authors: McQuillan Lon , Crane Lori A. , Kempe Allison
Published: January 2009

BACKGROUND. Acute sinusitis is frequently diagnosed in young children, yet little is known regarding pediatrician practices surrounding its diagnosis and management.

OBJECTIVES. The purpose of this work was to describe how pediatricians diagnose and manage nonsevere acute sinusitis in otherwise healthy children ≤6 years of age.

METHODS. We used a mail survey administered from June to August 2007 to a national random sample of 750 general pediatricians from the American Medical Association Master File.

RESULTS. The response rate was 45% (N = 271). Pediatricians reported first considering acute sinusitis at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35 (21%), and ≥36 (20%) months. Symptoms thought to be “very important” in the diagnosis of acute sinusitis included prolonged symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion (43%); 60% reported that symptom duration is more important than symptom combination. Symptom durations expected before considering the diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16 (38%), and ≥17 (6%) days. Fifty-eight percent reported using sinus computed tomography scans “occasionally” or more often in the diagnosis of acute sinusitis. Ninety-six percent reported treating acute sinusitis with an antibiotic “frequently” or “always.” Fifty-three percent reported using contingency antibiotic prescriptions “occasionally” or more often for acute sinusitis. Adjuvants used “frequently” or “always” included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%).

CONCLUSIONS. We found significant variation in the age at which pediatricians begin considering the diagnosis of nonsevere acute sinusitis in children. Most pediatricians consider symptom duration the most important diagnostic factor. The majority of pediatricians use sinus computed tomography imaging at least occasionally in young children with nonsevere symptoms despite its limitations in this clinical setting. Although poorly understood, the use of contingency antibiotic prescriptions is common. Lastly, the use of systemic decongestants and antihistamines in young children is reported, a practice that needs to be reexamined in light of recent Food and Drug Administration warnings regarding their safety.
Policies and Characteristics of the Preschool Environment and Physical Activity of Young Children
Authors: Dowda Marsha , Brown William H. , McIver Kerry L. , Pfeiffer Karin A. , O'Neill Jennifer R. , Addy Cheryl L. , Pate Russell R.
Published: January 2009

OBJECTIVE. The purpose of this study was to examine policies and characteristics of preschools and the extent to which they influence the physical activity of 3- to 5-year-old children during the preschool day.

METHODS. A total of 299 children from 20 preschools wore accelerometers for an average of 8.1 hours/day (SD: 1.5 hours/day), for 5.5 days (SD: 2.1 days). A researcher completed the Early Childhood Environment Rating Scale-Revised for each preschool to assess quality. Classrooms and playgrounds were measured, and the preschool director was interviewed about physical activity policies. For each policy or characteristic, preschools were divided into 2 groups on the basis of whether the characteristic/policy was presumed to promote or not promote physical activity.

RESULTS. Children spent fewer minutes per hour in sedentary activity and more minutes per hour in moderate/vigorous physical activity in preschools that had higher quality scores, less fixed playground equipment, more portable playground equipment, lower use of electronic media, and larger playgrounds. Five preschools had all 5 of these characteristics, and children in those preschools had significantly more moderate/vigorous physical activity minutes per hour and fewer sedentary minutes per hour compared with children in the other preschools.

CONCLUSION. Children in the top 5 physical activity–promoting preschools accumulated >60 minutes of moderate/vigorous physical activity per day, compared with the children in the other preschools, who accumulated <60 minutes of moderate/vigorous physical activity per day.
Neonatal Palliative Care Attitude Scale: Development of an Instrument to Measure the Barriers to and Facilitators of Palliative Care in Neonatal Nursing
Authors: Kain Victoria , Gardner Glenn , Yates Patsy
Published: January 2009

OBJECTIVE. The aim of this research project was to obtain an understanding of the barriers to and facilitators of providing palliative care in neonatal nursing. This article reports the first phase of this research: to develop and administer an instrument to measure the attitudes of neonatal nurses to palliative care.

METHODS. The instrument developed for this research (the Neonatal Palliative Care Attitude Scale) underwent face and content validity testing with an expert panel and was pilot tested to establish temporal stability. It was then administered to a population sample of 1285 neonatal nurses in Australian NICUs, with a response rate of 50% (N = 645). Exploratory factor-analysis techniques were conducted to identify scales and subscales of the instrument.

RESULTS. Data-reduction techniques using principal components analysis were used. Using the criteria of eigenvalues being >1, the items in the Neonatal Palliative Care Attitude Scale extracted 6 factors, which accounted for 48.1% of the variance among the items. By further examining the questions within each factor and the Cronbach's α of items loading on each factor, factors were accepted or rejected. This resulted in acceptance of 3 factors indicating the barriers to and facilitators of palliative care practice. The constructs represented by these factors indicated barriers to and facilitators of palliative care practice relating to (1) the organization in which the nurse practices, (2) the available resources to support a palliative model of care, and (3) the technological imperatives and parental demands.

CONCLUSIONS. The subscales identified by this analysis identified items that measured both barriers to and facilitators of palliative care practice in neonatal nursing. While establishing preliminary reliability of the instrument by using exploratory factor-analysis techniques, further testing of this instrument with different samples of neonatal nurses is necessary using a confirmatory factor-analysis approach.
Using Secondary Data Sources for Pharmacoepidemiology and Outcomes Research
Authors: Harpe Spencer E.
Published: January 2009

The increased availability of electronic medical records and administrative health care databases is adding to the popularity of pharmacoepidemiology and outcomes research studies. Despite their availability, practitioners may be reluctant to use these databases because they lack familiarity with database research in general. The basic principles of research are the same regardless of the data source, but there are a few special considerations. When using secondary data sources for research purposes, special care must be taken to select an appropriate source to ensure that relevant information is available to answer the research question at hand. Special attention must also be paid to selecting the appropriate codes to represent the outcomes and exposures of interest; therefore, a general understanding of coding schemes is necessary. Although time may be saved by not prospectively collecting data, the process of manipulating the data for analysis in secondary databases can be complex. Analysis of data from secondary sources may require special procedures to overcome the lack of randomization. By familiarizing themselves with these special issues, practitioners can use secondary sources to conduct studies that make valuable contributions to the improvement of patient care.
Rate of Suicide in Patients Taking Montelukast
Authors: Jick Hershel , Hagberg Katrina Wilcox , Egger Pascal
Published: January 2009

Study Objective. To estimate the rate of suicide in patients taking montelukast.

Design. Population‐based cohort study.

Data Source. United Kingdom General Practice Research Database.

Patients. A total of 23,500 patients who had received at least one prescription for montelukast in the cumulative data from February 1998‐March 2007.

Measurements and Main Results. Rate of suicide was to be calculated as number of suicides divided by person‐time at risk. Person‐time of montelukast exposure was accrued for each patient as a cumulative duration of all prescriptions. The 23,500 patients had received 252,593 prescriptions for montelukast, representing 21,050 person‐years at risk for suicide. We then sought to identify all cases that had a computer‐recorded diagnosis of suicide; however, no cases of suicide were found in patients exposed to montelukast during our time frame.

Conclusion. The risk of suicide attributable to montelukast, if present at all, is extremely low in users.
Diabetic Retinopathy: Current Management and Experimental Therapeutic Targets
Authors: Ali Tayyeba K. , El‐Remessy Azza B.
Published: January 2009

Diabetic retinopathy, a devastating ocular complication of diabetes mellitus, is the leading cause of blindness among working‐age adults in the United States and is a serious public health problem throughout the world. Standard treatment is retinal laser photocoagulation, which is an invasive procedure with considerable limitations and adverse effects. Understanding the biochemical changes and molecular events that occur with diabetes as well as with retinopathy could lead to new and effective treatments. Research indicates an association between oxidative stress and the development of complications from diabetes, including retinopathy. Thus, many sites and sources of oxidative stress that may be involved in the development of diabetic retinopathy have been studied. However, in clinical trials, classic antioxidants have not been beneficial for patients with diabetes. Additional studies are needed to identify treatments that selectively target oxidative stress‐mediated protein modification and thus prevent or at least delay diabetic retinopathy.
Oxandrolone Treatment in Adults with Severe Thermal Injury
Authors: Miller James T. , Btaiche Imad F.
Published: January 2009

Severe thermal injury is associated with hypermetabolism and hyper‐catabolism, leading to skeletal muscle breakdown, lean body mass loss, weight loss, and negative nitrogen balance. Muscle protein catabolism in patients with severe thermal injury is the result of stress‐induced increased release of cytokines and counterregulatory hormones. Coupled with decreased serum anabolic hormone concentrations such as testosterone and growth hormone along with the presence of insulin resistance, anabolism in patients with severe thermal injury is inefficient or impossible during the acute postburn period. This causes difficulty in restoring lean body mass and regaining lost body weight, as well as poor healing of the burn wound and delayed patient recovery. Oxandrolone, a synthetic derivative of testosterone, has been used in adult patients with severe thermal injury to enhance lean body mass accretion, restore body weight, and accelerate wound healing. In clinical studies, oxandrolone 10 mg orally twice/day improved wound healing, restored lean body mass, and accelerated body weight gain. During the rehabilitation period, oxandrolone therapy with adequate nutrition and exercise improved lean body mass, increased muscle strength, and restored body weight. However, most data on oxandrolone use in adult patients with severe thermal injury are derived from single‐center studies, many of which enrolled a relatively small number of subjects and some of which had a poor design. Multicenter, prospective, randomized studies are needed to better define the optimal oxandrolone dosage and to confirm the efficacy and safety of this drug in adult patients with severe thermal injury.
Daclizumab Treatment for Multiple Sclerosis
Authors: Kim Sylvia E.
Published: January 2009

Multiple sclerosis is a chronic inflammatory and demyelinating disease of the central nervous system and the leading cause of neurologic disability in young adults. Established therapies, such as interferon and glatiramer, have only partial effects, and they offer limited or no effect on the progression of multiple sclerosis. The etiology of multiple sclerosis is unclear; however, the disease is presumed to be a T‐cell‐mediated autoimmune disease influenced by genetic and environmental factors. Therefore, targeting of lymphocytes may be a promising means of therapy for multiple sclerosis. Daclizumab is a humanized monoclonal antibody approved for use in preventing renal allograft rejection. The agent is under investigation in phase II trials for the treatment of multiple sclerosis and has demonstrated positive clinical outcomes, including decreased relapse rates. Adverse events included urinary tract infections, respiratory tract infections, paresthesias, mild leukopenia, transient elevations in liver enzyme and bilirubin levels, rash, postinfusion reactions (fever), lymphadenopathy, transient thrombocytopenia, and nausea. Daclizumab may be an alternative or add‐on therapy when conventional immunomodulators fail or when existing approved therapies cannot be used. Besides ongoing phase II trials, additional phase II or III trials are required to determine the extended benefits of the agent, as well as clinical outcomes.
Influence of salts on strength of cement-treated clays
Authors: Modmoltin C. , Voottipruex P.
Published: January 2009

This paper discusses the influence of salts on cement-treated clays. Three types of soil were studied: Bangkok Clay, bentonite and kaolinite. Two experimental methods were used. In the first method, homoionic clay was made with different concentrations of sodium and calcium to simulate the influence of naturally occurring salts on cement-treated clay. In the second method the clay was mixed with different quantities of sodium chloride (NaCl) and calcium chloride (CaCl2) to evaluate the influence of additional salt on cement-treated clay. All samples were investigated by using unconfined compression tests to determine the strengths of the cement-treated clays. Finally, the samples were evaluated by chemical analysis to study the changes in chemical properties. According to the experimental investigation, the influences of salts on cement-treated Bangkok Clay, bentonite and kaolinite varied as a result of the soil structure and chemical reactions. The mechanisms of the homoionic clay and the clay mixed with salt admixture were different. In the natural clay, the existence of Na+ is beneficial in dissolving the soil silica and alumina, which induces higher strength than that of Ca2+. For practical soil stabilisation, Ca admixture is more beneficial in improving the strength of cement-treated clay than Na admixture because of the high Ca2+ content, which promotes increased cementation.