bluuebunny/crossref_metadata_2025 huggingface dataset:
Efectos de la presencia de la banca extranjera en la banca nacional del Perú: un estudio comparativo 1995-2007 (avances)
Authors: Cortez Cortez Gaby
Published: January 2018

La presencia de bancos extranjeros en la economía peruana no es un fenómeno nuevo. Sin embargo, su importancia se pone de manifiesto en las últimas décadas con la apertura de la economía y la liberalización del mercado bancario. El propósito del presente trabajo es evaluar los efectos del ingreso de bancos extranjeros en el comportamiento de los bancos en el Perú en relación a la competencia, eficiencia, márgenes de interés, y la ganancia. Se puede plantear la hipótesis de que el ingreso de los bancos extranjeros en el Perú, contribuye a estimular a los bancos nacionales a través de una mayor competencia, menores márgenes, disminución de costos, al aumento de la eficiencia y a la mayor diversidad de productos y servicios financieros.
The Paradigm of Cyberporn On Legal Culture and Religion Perspective
Authors: Angkupi Prima
Published: January 2018

Indonesia as the largest Muslim country should ideally have a society with good legal culture. Criminal offense or a violation related to cyberporn, does not need to happen. Cyberporn crime is not only a legal issue, but it is more complex. The weakness of the legislation, as well as the technological advances that are supported by the low legal awareness of society, it will difficult to tackle the cyberporn crime. The role of religion is needed as ethical teachings. Indonesia, which recognizes the principle of the Deity as its first principle, mean idealizing the condition of religious society. Awareness of the law will also be easily formed in communities that implement the teachings of their religion well, including public awareness for not accessing the cyberporn. : Indonesia sebagai Negara umat muslim terbesar idealnya memiliki masyarakat dengan budaya hukum yang baik. Tindak pidana atau bentuk pelanggaran yang berkaitan dengan cyberporn tidak perlu terjadi. Kejahatan cyberporn tidak hanya merupakan permasalahan hukum, tetapi lebih kompleks. Kelemahan peraturan perundang-undangan serta kemajuan teknologi yang didukung dengan kesadaran hukum masyarakat yang sangat rendah mengakibatkan akan sulit menanggulangi kejahatan cyberporn. Peran agama dibutuhkan sebagai sebuah ajaran etika. Indonesia yang mengakui sila Ketuhanan sebagai sila pertamanya, berarti mengidealkan kondisi masyarakat Indonesia yang religius. Kesadaran terhadap hukum pun juga akan mudah dibentuk dalam masyarakat yang mengamalkan ajaran agamanya dengan baik, termasuk kesadaran masyarakat untuk tidak mengakses cyberporn.    DOI: 10.15408/jch.v5i1.3509
Existence of Clemency as President Prerogative Right (Comparison Study of Indonesia with Countries of the World)
Authors: . Fathudin , Kharlie Ahmad Tholabi
Published: January 2018

The debate about the existence of clemency as a prerogative of the president stems from the understanding that the rights is coming independently from the authority and without any branches of power. In this context, the comparative study of the constitutional norms in some countries in the world related to the norm of clemency is important to read the tendency of other countries about clemency rules. This study shows that the constitutional norm of countries in the world basically has the same tendency in the application of clemency by the president; there is involvement of other branches of power. Some constitutions of the world call the recommendation, hearing, information, consultation, advice, in accord, concurrence (approval) and others. The involvement of other branches of power in the grant of pardon does not mean reducing the authority of the president (prerogative), but it has become a tendency in almost all modern states to embrace the system of government power within the framework of public accountability. The term prerogative of the president (absolute) in practice is no longer absolute and independent. Perdebatan sepuar eksistensi grasi sebagai hak prerogatif presiden berpangkal pada pemahaman yang menyebut bahwa suatu hak disebut sebagai hak prerogatif presiden jika kewenangan yang lahir dari hak tersebut bersifat khusus dan  mandiri tanpa adanya keterlibatan cabang kekuasaan lain. Dalam konteks ini, kajian perbandingan terutama terhadap norma konstitusi di beberapa negara di dunia terkait dengan norma tentang grasi menjadi penting untuk memotret kecenderungan yang dimiliki negara-negara lain dalam hal pengaturan tentang grasi. Kajian ini menunjukan bahwa norma konstitusi negara-negara di dunia pada dasarnya memiliki kecenderungan yang sama dalam penerapan pemberian grasi oleh presiden, yakni ada keterlibatan cabang kekuasaan lain. Beberapa konstitusi negara-negara di dunia menyebut keterlibatan tersebut dengan menggunakan ragam istilah seperti recomandation, hearing, inform, consultation, advice, in accordance, conccurance (persetujuan) dan lain-lain. Adanya keterlibatan cabang kekuasaan lain dalam mekanisme pemberian grasi bukan berarti mereduksi kewenangan presiden (hak prerogatif), tetapi memang menjadi kecenderungan hampir di semua negara-negara modern untuk menganut sistem pemerintahan yang berusaha menempatkan segala model kekuasaannya dalam kerangka pertanggungjawaban publik, sehingga istilah hak prerogatif presiden (sacara mutlak) dalam prakteknya tidak lagi bersifat mutlak dan mandiri. DOI: 10.15408/jch.v5i1.6574
Integration of Mobile Devices to Facilitate Patient Care and Teaching During Family-Centered Rounds
Authors: Byrd Angela S. , McMahon Pamela M. , Vath Richard J. , Bolton Michael , Roy Melissa
Published: January 2018

OBJECTIVES:

The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching.

METHODS:

We designed a mixed-methods study involving pre- and post-implementation surveys to residents, families, and faculty as well as direct observations of family-centered rounds. We conducted rapid cycles of continual quality improvement by using the Plan-Do-Study-Act framework involving 3 interventions.

RESULTS:

Pre-intervention, the mobile computing cart was used for resident education on average 3.3 times per rounding session. After cycle 3, teaching through the use of mobile devices increased by ∼79% to 5.9 times per rounding session. On the basis of survey data, we determined there was a statistically significant increase in residents’ perception of feeling prepared for rounds, receiving teaching on clinical care, and ability to teach families. Additionally, average time spent per patient on rounds decreased after implementation of mobile devices.

CONCLUSIONS:

Integration of mobile devices into a pediatric hospital medicine teaching service can facilitate patient care and perception of resident teaching by extending the utility of electronic medical records in care decisions and by improving access to knowledge resources.
Variation in Care and Clinical Outcomes in Children Hospitalized With Orbital Cellulitis
Authors: Markham Jessica L. , Hall Matthew , Bettenhausen Jessica L. , Myers Angela L. , Puls Henry T. , McCulloh Russell J.
Published: January 2018

OBJECTIVES:

To describe variation in the care of children hospitalized with orbital cellulitis and to determine associations with length of stay (LOS), emergency department (ED) revisits, and hospital readmissions.

METHODS:

By using the Pediatric Health Information System, we performed a multicenter, retrospective study of children aged 2 months to 18 years with a primary International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for orbital cellulitis from 2007 to 2014. We assessed hospital-level variation in the use of diagnostic tests, corticosteroids, and antibiotics individually and in aggregate for association with outcomes (LOS, ED revisits, readmissions) after risk-adjusting for important clinical and demographic factors.

RESULTS:

A total of 1828 children met inclusion criteria. Complete blood cell counts (median [interquartile range]: 81.8% [66.7–89.6]), C-reactive protein levels (57.1% [22.2–84.0]), blood cultures (57.9% [48.9–63.6]), and computed tomography imaging (74.7% [66.7–81.0]) were the most frequently performed diagnostic tests, with significant variation observed across hospitals (all P < .001). Corticosteroids were used in 29.2% of children (interquartile range: 18.4–37.5). There was significant variation in antibiotic exposure across hospitals (P < .001). Increased total diagnostic test usage was associated with increased LOS (P = .044), but not with 30-day ED revisits (P = .176) or readmissions (P = .403).

CONCLUSIONS:

Children hospitalized with orbital cellulitis experience wide variation in clinical management. Increased hospital-level usage is associated with increased LOS. Our findings highlight a critical need to identify treatment strategies that optimize resource use and outcomes for children hospitalized with orbital cellulitis.
Variation in Pediatric Procedural Sedations Across Children’s Hospital Emergency Departments
Authors: Miller Andrew F. , Monuteaux Michael C. , Bourgeois Florence T. , Fleegler Eric W.
Published: January 2018

OBJECTIVES:

Describe the trends in pediatric sedation use over time and determine variation in use of procedural sedation across children’s hospital emergency departments (EDs).

METHODS:

We analyzed ED data from 35 hospitals within the Pediatric Health Information System for patients <19 years old who received sedation medications and were discharged from 2009 to 2014. Patients with chronic comorbidities or undergoing intubation were excluded. We determined frequency and trends in use of sedation and compared these between EDs. Descriptive statistics with appropriate weighting were used.

RESULTS:

Of the 1 448 011 patients potentially requiring sedation who presented to the ED, 99 951 (7.9%) underwent procedural sedation. Medication usage in 2014 included ketamine (73.7%), fentanyl and midazolam (15.9%), ketofol (7.3%), and propofol (2.7%). Use of fentanyl and midazolam increased, whereas use of ketamine, pentobarbital, etomidate, chloral hydrate, and methohexital decreased over time. Significant variation exists in the use of sedation across hospitals; in 2014, the sedation rate ranged 0.2% to 32.0%, with a median of 8.0%. The diagnosis with the largest variation in procedural sedation use was dislocation, with sedation rates ranging from 2% to 35%.

CONCLUSIONS:

There is significant variability across pediatric EDs in the use of procedural sedation, suggesting sedations may be performed too often or too little in some hospitals.
Hospital Variation in Neonatal Abstinence Syndrome Incidence, Treatment Modalities, Resource Use, and Costs Across Pediatric Hospitals in the United States, 2013 to 2016
Authors: Milliren Carly E. , Gupta Munish , Graham Dionne A. , Melvin Patrice , Jorina Maria , Ozonoff Al
Published: January 2018

BACKGROUND:

The national incidence of neonatal abstinence syndrome (NAS) has increased with the opioid epidemic in the United States. The impact of pharmacologic treatment on hospital use is not well established. We examined the recent population of neonates with NAS admitted to pediatric hospitals, hospital variation in pharmacologic treatment, and the effect of treatment on resource use during neonatal hospitalization, including length of stay (LOS), readmission, and cost-of-living adjusted hospital costs.

METHODS:

We included inpatients discharged between January 2013 and March 2016 from hospitals in the Pediatric Health Information System. We compared neonates with NAS to those without on demographic, socioeconomic, clinical characteristics and hospital resource use. We also compared neonates with NAS on these characteristics by pharmacologic treatment.

RESULTS:

This analysis included 136 762 neonatal encounters from 23 hospitals. Of these, 2% had a diagnosis of NAS. Compared with other neonates, neonates with NAS had a longer LOS (18.7 vs 2.9 days; P = .004). Average costs per admission were 10 times higher for neonates with NAS ($37 584 vs $3536; P = .003). Of neonates with NAS, 70% were treated pharmacologically with wide variation in hospital rates of pharmacotherapy (range: 13%–90%). Pharmacologically-treated neonates with NAS experienced a longer LOS (22.0 vs 10.9 days; P = .004) than other neonates with NAS. Total costs for pharmacologically-treated neonates with NAS were over 2 times higher ($44 720 vs $20 708; P = .002) than neonates with NAS treated without pharmacotherapy.

CONCLUSIONS:

Neonates with NAS, particularly those treated pharmacologically, have lengthier, more expensive hospital stays. Significant variation in pharmacologic treatment reflects opportunities for practice standardization and substantial reductions in resource use.
Physician Preferences Surrounding Urinary Tract Infection Management in Neonates
Authors: Joshi Neha S. , Lucas Brian P. , Schroeder Alan R.
Published: January 2018

OBJECTIVES:

Variability exists in the treatment of neonates with urinary tract infection (UTI), potentially reflecting an overuse of resources. A cross-sectional vignette survey was designed to examine variability in physician preferences for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource use.

METHODS:

The survey was administered to a random sample of pediatricians through the American Medical Association’s Physician Masterfile. Respondents were provided with a case vignette of a 2-week-old neonate with a febrile UTI and asked to indicate preferences for IV antibiotic duration and rank drivers of this decision. Respondents were also asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, randomly presented with a normal result or bilateral grade II vesicoureteral reflux. The survey was delivered electronically to facilitate skip logic and randomization.

RESULTS:

A total of 279 surveys were completed. Preference for total IV antibiotic duration differed significantly (P < .001) across specialty, with a median duration of 2 days for general pediatricians/hospitalists, 7 days for neonatologists, and 5 days for infectious disease pediatricians. For the 47% (n = 131) who did not want a VCUG, 24/61 (39%) wanted prophylactic antibiotics when presented with grade II vesicoureteral reflux (P < .001).

CONCLUSIONS:

Subspecialty status appeared to be the most influential driver of IV antibiotic duration in the treatment of UTI. A substantial proportion of pediatricians who initially expressed a preference against ordering a VCUG wished to prescribe prophylactic antibiotics when results were abnormal, which suggests that even unwanted diagnostic test results drive treatment decisions.
Randomized Clinical Trial of Standard- Versus High-Calorie Formula for Methadone-Exposed Infants: A Feasibility Study
Authors: Bogen Debra L. , Hanusa Barbara H. , Baker Robyn , Medoff-Cooper Barbara , Cohlan Barbara
Published: January 2018

BACKGROUND:

Newborns who are prenatally exposed to methadone are at risk for neonatal abstinence syndrome and the associated excess weight loss and poor weight gain. This pilot feasibility study aimed to evaluate early caloric enhancement on weight patterns among infants born to women receiving methadone maintenance therapy while pregnant.

METHODS:

In this double-blind pilot feasibility study, we randomly assigned infants with fetal methadone exposure to 24 or 20 kcal/oz formula from days 3 to 21. Randomization was stratified by any breastfeeding, sex of the infant, and gestational age. Eligible infants were ≥35 weeks’ gestation and weighed ≥2200 g. Outcomes were days to weight nadir, maximum percent weight loss, days to birth weight, percentage weight change per day, and feasibility.

RESULTS:

A total of 49 infants were randomly assigned (22 to standard- and 27 to high-calorie formula); groups had comparable demographic characteristics. Main outcomes comparing standard- to high-calorie formula groups were not significant (days to weight nadir, 5.0 vs 4.4 days; P = .20; maximum percent weight loss, −9.4% vs −8.6%; P = .15; days to birth weight, 14.7 vs 13.6 days; P = .07); however, in longitudinal analyses (days 4 to 21), the high-calorie group had a higher percent weight gained per day compared with the standard-calorie group (P <.001). There were high levels of protocol adherence, and no adverse effects were observed.

CONCLUSIONS:

Study findings suggest that early initiation of high-calorie formula for infants with prenatal methadone exposure may be beneficial for weight gain; evaluation in a larger study is warranted.
A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome
Authors: Grossman Matthew R. , Lipshaw Matthew J. , Osborn Rachel R. , Berkwitt Adam K.
Published: January 2018

OBJECTIVES:

Neonatal abstinence syndrome (NAS) is a growing problem and poses a significant burden on the health care system. The traditional Finnegan Neonatal Abstinence Scoring System (FNASS) assessment approach may lead to unnecessary opioid treatment of infants with NAS. We developed a novel assessment approach and describe its effect on the management of infants with NAS.

METHODS:

We retrospectively compared treatment decisions of 50 consecutive opioid-exposed infants managed on the inpatient unit at the Yale New Haven Children’s Hospital. All infants had FNASS scores recorded every 2 to 6 hours but were managed by using the Eat, Sleep, Console (ESC) assessment approach. Actual treatment decisions made by using the ESC approach were compared with predicted treatment decisions based on recorded FNASS scores. The primary outcome was postnatal treatment with morphine.

RESULTS:

By using the ESC approach, 6 infants (12%) were treated with morphine compared with 31 infants (62%) predicted to be treated with morphine by using the FNASS approach (P < .001). The ESC approach started or increased morphine on 8 days (2.7%) compared with 76 days (25.7%) predicted by using the FNASS approach (P < .001). There were no readmissions or adverse events reported.

CONCLUSIONS:

Infants managed by using the ESC approach were treated with morphine significantly less frequently than they would have been by using the FNASS approach. The ESC approach is an effective method for the management of infants with NAS that limits pharmacologic treatment and may lead to substantial reductions in length of stay.
Placental Transfusion: Current Practices and Future Directions
Authors: DuPont Tara L. , Ohls Robin K.
Published: January 2018

Over the past decade, the benefits of placental transfusion have been established in neonates. The evidence for this practice in various groups of newborns is reviewed. In addition, multiple professional organizations have recently issued guidelines for delayed cord clamping and cord milking. These recommendations are discussed.
Coagulation Disorders in the Newborn
Authors: Davila Jennifer
Published: January 2018

Coagulation disorders in the newborn are a challenge to caregivers. Abnormalities of the immature, complex coagulation system of the newborn can have life-threatening consequences. This review provides a summary of the most common newborn bleeding abnormalities faced by clinicians, as well as an approach to the diagnosis and management of these disorders.
Neonatal Neutropenia
Authors: Moerdler Scott , LaTuga M. Susan
Published: January 2018

Neonatal neutropenia is a common laboratory finding noted on the complete blood cell count of neonates in the intensive care unit. Neonatal neutropenia has various causes, ranging from maternal conditions to congenital syndromes to immune-mediated processes. However, not all neonatal neutropenia is clinically relevant; it often does not increase the risk of infection. In this review, we will discuss neutrophil function and development, review the causes of neonatal neutropenia, and describe their clinical relevance, evaluation, and management options.
Hematologic Changes in Newborns with Neonatal Encephalopathy
Authors: Dina Pele , Muraskas Jonathan K.
Published: January 2018

Neonatal encephalopathy is a disorder frequently observed by clinicians caring for sick neonates. One of the causes of this disorder is intrapartum hypoxia-ischemia. Caregivers are frequently called on to determine the etiology of neonatal encephalopathy, manage the disorder, and estimate the timing of any associated brain injury. Components of a complete blood cell count may be useful in assessing infants with neonatal encephalopathy. In this review, we discuss the usefulness of these parameters.
Thrombocytopenia in the Newborn
Authors: Morrone Kerry
Published: January 2018

Neonates develop thrombocytopenia from a multitude of causes, including immune-mediated conditions, infections, inherited disorders, and acquired conditions such as thrombosis. This can make it challenging to diagnose an underlying cause and the evaluation can be extensive. This article will provide strategies to facilitate the evaluation of thrombocytopenia in the newborn and provide a background for the underlying pathophysiology of this condition and its various causes.
The Role of Secondhand Smoke Research in Protecting Nonsmokers
Authors: Gorzkowski Julie A. , Klein Jonathan D.
Published: January 2018

In this commentary, we explore the role of tobacco and SHS research in protecting children and families from tobacco use and exposure.
Correlates of Allowing Alternative Tobacco Product or Marijuana Use in the Homes of Young Adults
Authors: Berg Carla J. , Haardörfer Regine , Wagener Theodore L. , Kegler Michelle C. , Windle Michael
Published: January 2018

BACKGROUND:

Given the increases in alternative tobacco product (ATP) and marijuana use, we examined self-reported likelihood of allowing ATP and marijuana use in the home among young adults.

METHODS:

We analyzed data from a study of students aged 18 to 25 years (n = 2865) at 7 Georgia colleges and universities. Variables included: personal, household members’, and friends’ tobacco (cigarettes, little cigars and cigarillos [LCCs], e-cigarettes, hookah) and marijuana use and the perceived harm to health, harm of byproducts, addictiveness, and social acceptability of each. Regression models were specified to examine correlates of the likelihood of allowing use of each product in the home.

RESULTS:

Personal use prevalence ranged from 5.5% for e-cigarettes to 12.5% for marijuana. E-cigarettes were most likely to be allowed in the home; cigarettes were least. Regression indicated that others’ use and the perceived social acceptability of using each product was correlated with greater likelihood of allowing the use of a product. A greater likelihood of allowing cigarette and LCC use in the home was only associated with cigarette or LCC use, respectively; a greater likelihood of allowing e-cigarette use was associated with current e-cigarette use; greater likelihood of allowing hookah use was associated with using any product except e-cigarettes; and greater likelihood of allowing marijuana use was associated with LCC and marijuana use. Perceived harm to health, byproduct harms, and addictiveness were differentially related to the likelihood of allowing use of different products.

CONCLUSIONS:

ATPs and marijuana may undermine efforts to protect against environmental toxins in the home, thus warranting interventions targeting young adults.
Adult Attitudes and Practices Regarding Smoking Restrictions and Child Tobacco Smoke Exposure: 2000 to 2015
Authors: McMillen Robert , Wilson Karen , Tanski Susanne , Klein Jonathan D. , Winickoff Jonathan P.
Published: January 2018

BACKGROUND AND OBJECTIVES:

Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure.

METHODS:

Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed.

RESULTS:

The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P < .05). Car smoking prohibitions increased from 68.3% to 81.8% (P < .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues.

CONCLUSIONS:

Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.
Referral Strategies to a Tobacco Quitline and Racial and/or Ethnic Differences in Participation
Authors: Russo Elizabeth T. , Reid Margaret , Taher Rashida , Sharifi Mona , Shah Snehal N.
Published: January 2018

BACKGROUND:

Tobacco use inflicts a disproportionate burden of disease on people of color. We evaluated the reach among African American and Hispanic smokers in Boston of 2 referral strategies to the Massachusetts quitline: (1) a provider-referred strategy based in pediatric and dental clinics and (2) a targeted media campaign to promote self-referral to the quitline.

METHODS:

Selected demographic characteristics of Boston quitline participants during the study period (2010–2012) were compared between strategies. Self-referred smoker characteristics were also compared in the years before and after the media campaign. Finally, the characteristics of quitline participants were compared with smokers in the 2010 Boston Behavioral Risk Factor Surveillance Survey.

RESULTS:

During the study period, 4066 smokers received cessation services from the quitline; 3722 (91.5%) were self-referred, and 344 (8.5%) were referred by pediatric and dental providers. The proportion of black (31.6%) and Hispanic (20.3%) participants referred by providers was higher than among self-referred participants (18.3% and 7.8%, respectively; P <.001). Overall, provider-referred participants were less likely to be white (17.9%) than to be people of color. Self-referred smokers were more likely to be white (68.0%) than the estimated population of Boston smokers overall (62.9%; P <.001).

CONCLUSIONS:

The large-scale media campaign, which promoted self-referral, was associated with higher quitline participation overall, but the provider-referred strategy based in community health centers yielded participation from a greater proportion of smokers of color. The 2 strategies reached different subpopulations of smokers, and their combined reach enhanced access to cessation services among smokers from different racial and ethnic backgrounds.
Smoke-Free Car Legislation and Student Exposure to Smoking
Authors: Patel Minal , Thai Chan L. , Meng Ying-Ying , Kuo Tony , Zheng Hong , Dietsch Barbara , McCarthy William J.
Published: January 2018

BACKGROUND:

Policies protecting children from exposure to secondhand smoke (SHS) may help prevent SHS-related negative health outcomes in children and discourage them from intending to smoke in the future. In this study, we assess the impact of California’s 2007 smoke-free vehicle law on changes in middle and high school students’ reported exposure to smoking in cars. Secondary aims included assessing the association of student-reported exposure to smoking in vehicles and lifetime asthma diagnosis and future intentions to smoke.

METHODS:

Population-weighted data from the California Student Tobacco Survey and the National Youth Tobacco Survey were used to evaluate California and national trends, respectively. Weighted logistic regression models using California Student Tobacco Survey 2011 data assessed the association between the number of days of exposure to smoking in cars and student-reported lifetime asthma diagnosis as well as intention to smoke in the future.

RESULTS:

The proportion of California students reporting exposure to smoking in cars in the last 7 days declined <1% annually from 2001 through 2005, but declined 12% annually from 2007 to 2011. National trends did not show comparable declines after 2006. Students reporting exposure to smoking in vehicles were more likely to report having ever been diagnosed with asthma and intending to smoke in the future than students who were not exposed to SHS.

CONCLUSIONS:

These findings support the legislative intent that public policies that are designed to protect children from exposure to smoking in vehicles will yield better adolescent health outcomes and a lower risk of future adolescent cigarette smoking.
Implementing Tobacco Control Assistance in Pediatric Departments of Chinese Hospitals: A Feasibility Study
Authors: Abdullah Abu S. , Guangmin Nong , Kaiyong Huang , Jing Liao , Yang Li , Zhang Zhiyong , Winickoff Jonathan P.
Published: January 2018

BACKGROUND AND OBJECTIVES:

Evidence-based tobacco control strategies delivered through pediatric settings could encourage parental smoking cessation and reduce children’s exposure to second hand smoke (SHS) in the United States. The extent to which these tobacco control strategies could be routinely implemented in the pediatric setting of a developing country is not known. We tested the feasibility and efficacy of implementing an evidence-based intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE), in a Chinese hospital to address the second hand smoke exposure of children in the home and car and to address parental smoking.

METHODS:

We conducted a quasi-experimental trial of CEASE implementation in the pediatric inpatient departments of 2 Chinese hospitals, 1 assigned as the intervention hospital and another assigned as the control hospital. Data were collected through pre- and postsurveys of parents and clinicians, implementation process surveys, and chart review.

RESULTS:

In the intervention hospital, pediatricians’ rates of delivering different types of tobacco control assistance to smoking parents were all significantly (P < .0001) higher during the post-CEASE implementation period than in the pre-CEASE implementation period. During the post-CEASE implementation period, pediatricians’ rates of delivery for all aspects of tobacco control assistance were significantly higher (all P < .0001) in the intervention hospital than in the control hospital, whereas there was no difference during the pre-CEASE period.

CONCLUSIONS:

The findings of this study suggest that it is feasible to implement a system-level intervention of CEASE in the pediatric inpatient department of a major hospital in southern China. A large-scale trial incorporating measures to increase quit rates and including a long-term follow-up is needed to examine the effectiveness of CEASE implementation in China.
Airborne Nicotine, Secondhand Smoke, and Precursors to Adolescent Smoking
Authors: McGrath Jennifer J. , Racicot Simon , Okoli Chizimuzo T.C. , Hammond S. Katharine , O’Loughlin Jennifer
Published: January 2018

BACKGROUND AND OBJECTIVES:

Secondhand smoke (SHS) directly increases exposure to airborne nicotine, tobacco’s main psychoactive substance. When exposed to SHS, nonsmokers inhale 60% to 80% of airborne nicotine, absorb concentrations similar to those absorbed by smokers, and display high levels of nicotine biomarkers. Social modeling, or observing other smokers, is a well-established predictor of smoking during adolescence. Observing smokers also leads to increased pharmacological exposure to airborne nicotine via SHS. The objective of this study is to investigate whether greater exposure to airborne nicotine via SHS increases the risk for smoking initiation precursors among never-smoking adolescents.

METHODS:

Secondary students (N = 406; never-smokers: n = 338, 53% girls, mean age = 12.9, SD = 0.4) participated in the AdoQuest II longitudinal cohort. They answered questionnaires about social exposure to smoking (parents, siblings, peers) and known smoking precursors (eg, expected benefits and/or costs, SHS aversion, smoking susceptibility, and nicotine dependence symptoms). Saliva and hair samples were collected to derive biomarkers of cotinine and nicotine. Adolescents wore a passive monitor for 1 week to measure airborne nicotine.

RESULTS:

Higher airborne nicotine was significantly associated with greater expected benefits (R2 = 0.024) and lower expected costs (R2 = 0.014). Higher social exposure was significantly associated with more temptation to try smoking (R2 = 0.025), lower aversion to SHS (R2 = 0.038), and greater smoking susceptibility (R2 = 0.071). Greater social exposure was significantly associated with more nicotine dependence symptoms; this relation worsened with higher nicotine exposure (cotinine R2 = 0.096; airborne nicotine R2 = 0.088).

CONCLUSIONS:

Airborne nicotine exposure via SHS is a plausible risk factor for smoking initiation during adolescence. Public health implications include limiting airborne nicotine through smoking bans in homes and cars, in addition to stringent restrictions for e-cigarettes.
An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial
Authors: Collins Bradley N. , Lepore Stephen J. , Winickoff Jonathan P. , Nair Uma S. , Moughan Beth , Bryant-Stephens Tyra , Davey Adam , Taylor Daniel , Fleece David , Godfrey Melissa
Published: January 2018

BACKGROUND:

Provider adherence to best practice guidelines (ask, advise, refer [AAR]) for addressing child tobacco smoke exposure (TSE) motivates parents to reduce TSE. However, high-risk, vulnerable populations of smokers may require more intensive treatment. We hypothesized that a pragmatic, multilevel treatment model including AAR coupled with individualized, telephone-based behavioral counseling promoting child TSE reduction would demonstrate greater child TSE reduction than would standard AAR.

METHODS:

In this 2-arm randomized controlled trial, we trained pediatric providers in systems serving low-income communities to improve AAR adherence by using decision aid prompts embedded in routine electronic health record assessments. Providers faxed referrals to the study and received ongoing AAR adherence feedback. Referred participants were eligible if they were daily smokers, >17 years old, and spoke English. Participants were randomly assigned to telephone-based behavioral counseling (AAR and counseling) or nutrition education (AAR and attention control). Participants completed prerandomization and 3-month follow-up assessments.

RESULTS:

Of providers, >80% (n = 334) adhered to AAR procedures and faxed 2949 referrals. Participants (n = 327) were 83% women, 83% African American, and 79% low income (below poverty level). Intention-to-treat logistic regression showed robust, positive treatment effects: more parents in AAR and counseling than in AAR and attention control eliminated all sources of TSE (45.8% vs 29.9%; odds ratio 1.99 [95% confidence interval 1.44–2.74]) and quit smoking (28.2% vs 8.2%; odds ratio 3.78 [95% confidence interval 1.51–9.52]).

CONCLUSIONS:

The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.
Neighborhood Factors and Urinary Metabolites of Nicotine, Phthalates, and Dichlorobenzene
Authors: Galvez Maida P. , McGovern Kathleen , Teitelbaum Susan L. , Windham Gayle , Wolff Mary S.
Published: January 2018

BACKGROUND AND OBJECTIVES:

Exposures to environmental chemicals are ubiquitous in the US. Little is known about how neighborhood factors contribute to exposures.

METHODS:

Growing Up Healthy is a prospective cohort study of environmental exposures and growth and development among Hispanic and African American children (n = 506) in New York City. We sought to determine associations between neighborhood-level factors (eg, housing type, school, time spent indoors versus outdoors) and urinary biomarkers of chemical exposures suspected to be associated with these characteristics (cotinine, 2,5-dichlorophenol, and phthalate metabolites) adjusted by age, sex, race, and caregiver education and language.

RESULTS:

Urinary cotinine concentrations revealed a prevalent exposure to secondhand smoke; children living in public housing had higher concentrations than those in private housing. In homes with 1 smoker versus none, we found significant differences in urinary cotinine concentrations by housing, although not in homes with 2 or more smokers. Children in charter or public schools had higher urinary cotinine concentrations than those in private schools. School type was associated with exposures to both low- and high-molecular-weight phthalates, and concentrations of both exposure biomarkers were higher for children attending public versus private school. 2,5-Dichlorophenol concentrations declined from 2004 to 2007 (P = .038) and were higher among charter school children.

CONCLUSIONS:

Housing and school type are associated with chemical exposures in this minority, inner city population. Understanding the role of neighborhood on environmental exposures can lead to targeted community-level interventions, with the goal of reducing environmental chemical exposures disproportionately seen in urban minority communities.
Parental Smoking Cessation: Impacting Children’s Tobacco Smoke Exposure in the Home
Authors: Caldwell Alice Little , Tingen Martha S. , Nguyen Joshua T. , Andrews Jeannette O. , Heath Janie , Waller Jennifer L. , Treiber Frank A.
Published: January 2018

OBJECTIVES:

There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention.

METHODS:

Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned <$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up.

RESULTS:

Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039).

CONCLUSIONS:

This study provides evidence that tailored cessation offered to Ps/Cs in their children’s schools during their children’s enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.
Protecting Young Children From Tobacco Smoke Exposure: A Pilot Study of Project Zero Exposure
Authors: Rosen Laura , Guttman Nurit , Myers Vicki , Brown Nili , Ram Amit , Hovell Mel , Breysse Patrick , Rule Ana , Berkovitch Mati , Zucker David
Published: January 2018

BACKGROUND:

Tobacco smoke exposure (TSE) harms children, who are often “captive smokers” in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014.

METHODS:

The intervention consisted of motivational interviews, child biomarker and home air quality feedback, a Web site, a video, and self-help materials. The primary outcome was child TSE as measured by hair nicotine. Secondary outcome measures were air nicotine and particulate matter, parental reports of TSE, parental smoking behavior, and TSE child protection. A single-group pre- and posttest design was used.

RESULTS:

Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine.

CONCLUSIONS:

A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions.
Secondhand Smoke Exposure and Validity of Self-Report in Low-Income Women and Children in India
Authors: Elf Jessica L. , Kinikar Aarti , Khadse Sandhya , Mave Vidya , Gupte Nikhil , Kulkarni Vaishali , Patekar Sunita , Raichur Priyanka , Cohen Joanna , Breysse Patrick N. , Gupta Amita , Golub Jonathan E.
Published: January 2018

BACKGROUND:

There is limited validation of self-reported measures for secondhand smoke (SHS) exposure in low- and middle-income countries. We evaluated the validity of standard self-reported measures among women and children in urban India.

METHODS:

Structured questionnaires were administered, and household air and hair samples were analyzed for nicotine concentration.

RESULTS:

In total, 141 households of 70 child and 71 adult participants were included. Air nicotine was detected in 72 (51%) homes, and 35 (75%) child and 12 (56%) adult participants had detectable hair nicotine. Correlation between air and hair nicotine was significant in children (r = 0.5; P = .0002) but not in adults (r = −0.1; P = .57). Poor correlation was found between self-reported measures of exposure and both air and hair nicotine. No questions were significantly correlated with hair nicotine, and the highest-magnitude correlation with air nicotine was for how often someone smoked inside for adults (r = 0.4; P = .10) and for home preparation of mishri (a smokeless tobacco product prepared for consumption by roasting) for children (r = 0.4; P = .39). The highest value for sensitivity by using air nicotine as the gold standard was for whether people smelled other families preparing mishri (47%; 95% confidence interval: 31–62) and prepared mishri in their own homes (50%; 95% confidence interval: 19–81).

CONCLUSIONS:

These results raise caution in using or evaluating self-reported SHS exposure in these communities. More appropriate questions for this population are needed, including mishri preparation as a source of SHS exposure.
Tobacco Control Laws and Pediatric Asthma
Authors: Hatoun Jonathan , Davis-Plourde Kendra , Penti Brian , Cabral Howard , Kazis Lewis
Published: January 2018

BACKGROUND:

Exposure to environmental tobacco smoke increases pediatric asthma severity. Strict, state-level tobacco control reduces smoking. The Child Asthma Call-Back Survey (Child ACBS) is a nationally representative survey of the guardians of children with asthma. The American Lung Association’s annual State of Tobacco Control report grades tobacco control laws in each state including a tax grade (cigarette excise tax relative to the national mean), and a smoke-free air grade (number of locations where smoking is prohibited).

METHODS:

We joined Child ACBS data from 2006 to 2010 with corresponding state and year tobacco grades. In the primary analysis, we investigated the effect of state tax grades on a child’s asthma severity by using a logistic regression model adjusting for year. A secondary analysis assessed the impact of smoke-free air grades on in-home smoking.

RESULTS:

Our analysis included 12 860 Child ACBS interviews from 35 states over 5 years, representing over 24 million individuals. We merged 112 unique State of Tobacco Control grades with patient data by state and year. A higher tax grade was associated with reduced severity (adjusted odds ratio = 1.40; P = .007, 95% confidence interval: 1.10–1.80). A better smoke-free air grade was not associated with decreased in-home smoking after adjusting for confounding by income and type of residence.

CONCLUSIONS:

A stronger tobacco tax is associated with reduced asthma severity. Further study is needed to determine the effect of smoke-free air laws on in-home environmental. This work supports ongoing efforts to strengthen tobacco control through federal and state regulations.
Prediction of shear strength of FRP-reinforced concrete members using a rule-based method
Authors: Abbasloo Asad-Allah , Shayanfar Mohsen Ali , Pahlavan Hossein , Barkhordari Mohammad Ali , Hamze-Ziabari Seyed Mahmood
Published: January 2018

Due to sudden and brittle shear failure of concrete members reinforced with fibre-reinforced polymer (FRP), shear design of these members is necessary. Various design equations have been developed to determine the shear strength with and without stirrup members. However, there is still no clear expression to predict the shear strength of FRP-reinforced concrete and the available design formulas have limited accuracy. Recently, soft computing methods such as artificial neural networks have been used for predicting the shear strength of FRP-reinforced concrete elements. However, these methods do not give enough insight into the generated models and are not as easy to use as the empirical formulas. In this study, new formulas based on M5′ and multivariate adaptive regression splines (MARS) model tree approaches for the prediction of shear strength are presented. In order to develop new models, a comprehensive database containing 176 and 112 test data for members with and without stirrups, respectively, is used. It is shown that the proposed models are compact, simple and physically sound. The most important parameters are specified based on sensitivity analysis, which is calculated using the MARS algorithm. Comparison between the developed and shear design formulas showed that the developed models are more accurate than existing equations.