bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of the Evidence for the Medical Home for Children With Special Health Care Needs
Authors: Homer Charles J. , Klatka Kirsten , Romm Diane , Kuhlthau Karen , Bloom Sheila , Newacheck Paul , Van Cleave Jeanne , Perrin James M.
Published: October 2008

CONTEXT. The receipt of health care in a medical home is increasingly touted as a fundamental basis for improved care for persons with chronic conditions, yet the evidence for this claim has not been systematically assessed.

OBJECTIVE. Our goal was to determine the evidence for the federal Maternal and Child Health Bureau recommendation that children with special health care needs receive ongoing comprehensive care within a medical home.

METHODS. We searched the nursing and medical literature, references of selected articles, and requested expert recommendations. Search terms included children with special health care needs, medical home-related interventions, and health-related outcomes. Articles that met defined criteria (eg, children with special health care needs, United States–based, quantitative) were selected. We extracted data, including design, population characteristics, sample size, intervention, and findings from each article.

RESULTS. We selected 33 articles that reported on 30 distinct studies, 10 of which were comparison-group studies. None of the studies examined the medical home in its entirety. Although tempered by weak designs, inconsistent definitions and extent of medical home attributes, and inconsistent outcome measures, the preponderance of evidence supported a positive relationship between the medical home and desired outcomes, such as better health status, timeliness of care, family centeredness, and improved family functioning.

CONCLUSIONS. The evidence provides moderate support for the hypothesis that medical homes provide improved health-related outcomes for children with special health care needs. Additional studies with comparison groups encompassing all or most of the attributes of the medical home need to be undertaken.
Linking Mother and Child Access to Dental Care
Authors: Grembowski David , Spiekerman Charles , Milgrom Peter
Published: October 2008

OBJECTIVES. Among young children in low-income families covered by Medicaid, we estimated (according to racial/ethnic group) whether children who have mothers with a regular source of dental care at baseline have greater dental use in the subsequent year than children with mothers without a regular source.

METHODS. From a population of 108151 children (aged 3 to 6 years) who were enrolled in Medicaid and their low-income mothers in Washington state, a disproportionate stratified random sample of 11305 children aged 3 to 6 was selected from enrollment records in 4 racial/ethnic groups: black (3791), Hispanic (2806), white (1902), and other racial/ethnic groups (2806). In a prospective cohort design, we conducted a baseline survey of mothers and for respondents collected their children's Medicaid dental claims in the 1-year follow-up period. Mutivariable regression models estimated the associations between the mothers' having a regular source of dental care at baseline and their children's prospective dental use.

RESULTS. Approximately 38% of the mothers had a regular source of dental care. Among children of black and Hispanic mothers, having a mother with a regular source of dental care at baseline was associated with greater odds of receiving any dental care in the subsequent year. For children with dental use, children of black or Hispanic mothers with a regular source of dental care received 1.22 and 1.10 more preventive services, respectively. For children of white mothers, associations were in the same direction but not significant.

CONCLUSIONS. For young children of black and Hispanic mothers, dental care use is higher when their mothers have a regular source of dental care. For low-income young children with Medicaid, increasing the mothers' access to dental care may increase the children's use of dental and preventive services, which, in turn, may reduce racial/ethnic inequalities in oral health.
Cardiovascular Risk Screening Before Starting Stimulant Medications and Prescribing Practices of Canadian Physicians: Impact of the Health Canada Advisory
Authors: Conway Jennifer , Wong Kenny K. , O'Connell Colleen , Warren Andrew E.
Published: October 2008

OBJECTIVE. In May 2006, Health Canada released a statement advising against the use of stimulant medications for patients with cardiac disease after isolated reports of sudden death. The objectives of this study were to determine whether the Health Canada advisory has had an impact on cardiovascular screening of all children with attention-deficit/hyperactivity disorder before stimulants and the medical treatment of children with attention-deficit/hyperactivity disorder and real or potential cardiac problems.

METHODS. Two questionnaires were developed and mailed to a sample of noncardiologist physicians and pediatric cardiologists in Canada. The difference in the proportion of noncardiologist-responders who performed a “full screen” before and after the announcement of the Health Canada advisory was analyzed. Willingness to prescribe stimulant medications to children was assessed by using a series of clinical scenarios.

RESULTS. A total of 2326 questionnaires were distributed, 717 (31%) of which were returned. The proportion who performed a full screen increased for both noncardiologists and cardiologists after the advisory. There was also a dramatic increase in the use of the “modified screen” by the noncardiologist group and the pediatrician subgroup. There was a considerable decrease in the proportion of noncardiologists who were willing to prescribe stimulant medications to children with potential or actual cardiac issues after the advisory.

CONCLUSIONS. The Health Canada advisory has had an impact on clinical practice. It has resulted in an increase in the use of cardiovascular assessment tools before starting stimulants and a decrease in noncardiologists' willingness to prescribe stimulants to those with real or potential cardiac disease. These changes have occurred despite the lack of studies to address the cardiac risks of these medications. Because it will be difficult to assess the true cardiac risks of stimulants, consensus recommendations are needed to determine whether screening is required, what constitutes an appropriate screen, and which children can be treated cautiously with stimulant medications.
A Brief Indicator of Household Energy Security: Associations With Food Security, Child Health, and Child Development in US Infants and Toddlers
Authors: Cook John T. , Frank Deborah A. , Casey Patrick H. , Rose-Jacobs Ruth , Black Maureen M. , Chilton Mariana , deCuba Stephanie Ettinger , Appugliese Danielle , Coleman Sharon , Heeren Timothy , Berkowitz Carol , Cutts Diana B.
Published: October 2008

OBJECTIVE. Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children <36 months of age.

METHODS. A cross-sectional study that used household survey and surveillance data was conducted. Caregivers were interviewed in emergency departments and primary care clinics form January 2001 through December 2006 on demographics, public assistance, food security, experience with heating/cooling and utilities, Parents Evaluation of Developmental Status, and child health. The household energy security indicator includes energy-secure, no energy problems; moderate energy insecurity, utility shutoff threatened in past year; and severe energy insecurity, heated with cooking stove, utility shutoff, or ≥1 day without heat/cooling in past year. The main outcome measures were household and child food security, child reported health status, Parents Evaluation of Developmental Status concerns, and hospitalizations.

RESULTS. Of 9721 children, 11% (n = 1043) and 23% (n = 2293) experienced moderate and severe energy insecurity, respectively. Versus children with energy security, children with moderate energy insecurity had greater odds of household food insecurity, child food insecurity, hospitalization since birth, and caregiver report of child fair/poor health, adjusted for research site and mother, child, and household characteristics. Children with severe energy insecurity had greater adjusted odds of household food insecurity, child food insecurity, caregivers reporting significant developmental concerns on the Parents Evaluation of Developmental Status scale, and report of child fair/poor health. No significant association was found between energy security and child weight for age or weight for length.

CONCLUSIONS. As household energy insecurity increases, infants and toddlers experienced increased odds of household and child food insecurity and of reported poor health, hospitalizations, and developmental risks.
Preauricular Skin Tags and Ear Pits Are Associated With Permanent Hearing Impairment in Newborns
Authors: Roth Daphne Ari-Even , Hildesheimer Minka , Bardenstein Sarit , Goidel Dvora , Reichman Brian , Maayan-Metzger Ayala , Kuint Jacob
Published: October 2008

OBJECTIVES. Our goals were to (1) study the prevalence of hearing impairment in a large cohort of infants with preauricular skin tags or ear pits and compare it with that among all other newborns participating in our universal newborn hearing screening program during the same period and (2) evaluate the effectiveness of transient evoked otoacoustic emissions as a hearing-screening tool in this population.

PATIENTS AND METHODS. During the study period of 7.5 years, 68484 infants were screened for hearing impairment, of whom 637 (0.93%) had preauricular skin tags and/or ear pits. The population was divided into 3 groups: (1) a low-risk group for hearing impairment; (2) a high-risk group for hearing impairment; and (3) a very high-risk group for hearing impairment. The screening results and audiological follow-up for these infants were examined retrospectively.

RESULTS. A significantly higher prevalence of permanent hearing impairment was found among infants with preauricular skin tags or ear pits (8 of 1000), compared with infants without tags or pits (1.5 of 1000). In the low-risk group, the prevalence was 3.4 of 1000, compared with 0.5 of 1000 in infants with and without preauricular tags or pits, respectively. In the high-risk group, the prevalence was 77 of 1000, compared with 20 of 1000 in infants with and without preauricular tags or pits, respectively. The odds ratio for hearing impairment associated with preauricular skin tags and/or ear pits after adjusting for level of risk group was 4.9. All infants diagnosed with permanent hearing impairment, with the exception of 1 with late-onset impairment, were detected by in-hospital transient-evoked otoacoustic emissions screening.

CONCLUSIONS. Infants with preauricular skin tags or ear pits are at increased risk for permanent hearing impairment. Transient-evoked otoacoustic emissions were found to be an effective hearing-screening tool in this population.
Food Insecurity and Compensatory Feeding Practices Among Urban Black Families
Authors: Feinberg Emily , Kavanagh Patricia L. , Young Robin L. , Prudent Nicole
Published: October 2008

OBJECTIVE. In this we study explored the relationship between food insecurity and compensatory maternal feeding practices that may be perceived as buffers against periodic food shortages among urban black families.

METHODS. We interviewed a convenience sample of black mothers of children aged 2 to 13 years. Food-security status (predictor) was determined at the household level. Five maternal feeding practices (outcomes) were assessed. Two were based on Birch's Child Feeding Questionnaire (restricting access to certain foods and pressuring a child to eat), and 3 were derived from investigators' clinical experience (use of high-energy supplements, added sugar in beverages, and perceived appetite stimulants). Anthropometric data were collected from mothers and children.

RESULTS. A total of 278 mother–child dyads were analyzed, and 28% of these mothers reported being food insecure. Use of Child Feeding Questionnaire feeding practices was defined as the top quartile of responses. Use of nutritional supplements, defined as “at least 1 to 2 times monthly,” ranged from 13% to 25%. In logistic regression models adjusted for child age, weight status, and ethnicity and maternal weight status, mothers from food-insecure households were significantly more likely to use high-energy supplements and appetite stimulants. The odds of using the remaining compensatory feeding practices (adding sugars to beverages, pressuring a child to eat, and restricting access to certain foods) were elevated among food-insecure households but did not reach statistical significance.

CONCLUSIONS. Household food insecurity was independently associated with 2 of the 5 maternal compensatory feeding practices studied, and such practices may alter the feeding environment. Longitudinal research is necessary to determine how the relationship between food security and compensatory maternal feeding practices may affect child weight trajectories.
Elevated Blood Pressure in Relation to Overweight and Obesity Among Children in a Rural Canadian Community
Authors: Salvadori Marina , Sontrop Jessica M. , Garg Amit X. , Truong Jennifer , Suri Rita S. , Mahmud Farid H. , Macnab Jennifer J. , Clark William F.
Published: October 2008

OBJECTIVE. Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with prehypertension and hypertension in a well-characterized population of children in rural Canada.

METHODS. The study population for this cross-sectional study was composed of children (aged 4–17 years) who were participants of the Walkerton Health Study (Canada) in 2004. Prehypertension and hypertension were defined on the basis of percentiles from the average of 3 blood pressure measures taken on a single occasion. Percentiles for BMI and blood pressure were calculated by using the 2000 Centers for Disease Control and Prevention growth charts. Multinomial logistic regression was used to evaluate the odds for prehypertension and hypertension resulting from overweight and obesity.

RESULTS. Of 675 children (98.7% white), 122 (18.1%) were overweight and 77 (11.4%) were obese. Prehypertension and hypertension were detected in 51 (7.6%) and 50 (7.4%), respectively. After adjustment for family history of hypertension and kidney disease, obesity was associated with both prehypertension and hypertension. Overweight was associated with hypertension but not prehypertension. These associations were observed across the genders and children aged <13 and ≥13 years, except that overweight was not associated with hypertension among girls.

CONCLUSIONS. In this population of children who lived in a rural community in Canada, overweight and obesity were strongly associated with elevated blood pressure. Whether blood pressure normalizes with improvements in diet, physical activity, and environment is an area for additional study.
Temporary Vaccine Recommendations and Provider Compliance: A Survey of Pediatric Practices During the 2003–2004 Pneumococcal Conjugate Vaccine Shortage
Authors: Groom Holly , Bhatt Achal , Washington Michael L. , Santoli Jeanne
Published: October 2008

OBJECTIVE. Heptavalent pneumococcal conjugate vaccine was in short supply from December 2003 to August 2004. The Centers for Disease Control and Prevention with the American Academy of Pediatrics and the American Academy of Family Physicians made recommendations to providers to withhold third and fourth doses of heptavalent pneumococcal conjugate vaccine to ensure availability for those at highest risk. Previous studies of vaccine shortages have demonstrated that provider compliance with temporary recommendations is low. The objective of this study was to collect timely data about awareness and adherence to temporary recommendations and current supply status of heptavalent pneumococcal conjugate vaccine in pediatric practices.

METHODS. A 2-phase telephone survey of pediatric practices was conducted during a 10-week period during the 2003–2004 heptavalent pneumococcal conjugate vaccine shortage. Immunization nurses at randomly selected sites with physician-members of the American Academy of Pediatrics were asked a series of questions.

RESULTS. In both study phases, >90% of participating practices were aware of the recommendations and reported adhering to the recommendations. In phase 1, practices with insufficient supply were more likely to implement recommendations than practices with sufficient supply. Participants identified health departments and Wyeth Vaccines as the most common sources of information. At least 65% of the practices in each phase reported use of tracking systems for children who missed doses.

CONCLUSIONS. Most pediatric practices surveyed were aware of the shortage and were implementing the heptavalent pneumococcal conjugate vaccine recommendations. Simplified recommendations and collaborative efforts to develop and widely disseminate interim recommendations may result in increased compliance by providers.
Effect of Maternity-Care Practices on Breastfeeding
Authors: DiGirolamo Ann M. , Grummer-Strawn Laurence M. , Fein Sara B.
Published: October 2008

OBJECTIVE. Our goal was to assess the impact of “Baby-Friendly” hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration.

METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for >2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 “Baby-Friendly” practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.

RESULTS. Only 8.1% of the mothers experienced all 6 “Baby-Friendly” practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 “Baby-Friendly” practices, mothers who experienced none were ∼13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.

CONCLUSIONS. Increased “Baby-Friendly” hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the “Baby-Friendly” hospital practices measured in this study.
Characteristics of Breastfeeding Practices Among US Mothers
Authors: Shealy Katherine R. , Scanlon Kelley S. , Labiner-Wolfe Judith , Fein Sara B. , Grummer-Strawn Laurence M.
Published: October 2008

OBJECTIVES. Although much has been published about breastfeeding rates, little is known about how breastfeeding is practiced in the United States. We describe the distributions and characteristics of practices related to common advice about breastfeeding during the infant's first year of life.

PARTICIPANTS AND METHODS. Participants in the 2005–2007 Infant Feeding Practices Study II received monthly questionnaires during their infants’ first year of life. Among breastfeeding respondents, we investigated patterns and trends in types of breastfeeding (supplementing with formula or not, and at the breast or not) and maternal report of infant feeding behaviors corresponding to common breastfeeding advice on frequency, duration, and intervals of feedings.

RESULTS. More than half of the breastfeeding mothers fed their infants nothing other than breast milk until 4 months of age. Formula supplementation declined from 42% at 1 month to 15% at 1 year; adding other foods/liquids increasingly surpassed supplementing with formula beginning at 5 months of age. Six percent of the mothers reported that the only breast milk the infant was fed was expressed, rather than at the breast. Frequency of breast milk feedings per day declined from 8 at 1 month to 3.5 at 1 year. Reported feeding durations of <20 minutes increased from 46% at 1 month to 88% at 1 year. Feeding from both breasts per feeding decreased 15% over the infant's first year (from 69% to 59%). Longest interfeeding intervals more than doubled over the year.

CONCLUSIONS. Exclusive breastfeeding was common up to 4 but not to 6 months of age. Breastfeeding with only expressed milk was rare. Considerable variation existed in maternal report of practices that correspond to common breastfeeding advice. More research is needed to better understand how these variations relate to breastfeeding outcomes and the role of common breastfeeding advice in infant feeding decisions.
Success of Strategies for Combining Employment and Breastfeeding
Authors: Fein Sara B. , Mandal Bidisha , Roe Brian E.
Published: October 2008

OBJECTIVE. Return to work is associated with diminished breastfeeding intensity and duration. Although more mothers breastfeed after returning to work now than earlier, research has not documented the strategies that mothers use for combining paid work and breastfeeding or their effect on breastfeeding outcomes. This study examined which strategies are associated with smaller decrements in breastfeeding intensity and longer durations.

PARTICIPANTS AND METHODS. We analyzed 810 mothers from the Infant Feeding Practices Study II who worked and breastfed. We used regression and censored regression models to analyze 4 strategies that mothers used to combine these 2 activities: (1) feed directly from the breast only; (2) both pump and feed directly; (3) pump only; and (4) neither pump nor breastfeed during the work day. Outcomes were the difference in percentage of milk feeds that were breast milk between the month before and after return to work and duration of breastfeeding after return to work.

RESULTS. Forty-three percent of mothers pumped milk at work only; 32% fed the infant directly from the breast only. These 2 strategies, along with pumping and feeding directly, were statistically similar and superior to neither pumping nor breastfeeding during the work day for the outcome of change in breastfeeding intensity. For the outcome of breastfeeding duration, the 2 strategies that included directly feeding from the breast were associated with longer duration than pumping only, whereas the strategy of neither pumping nor breastfeeding during the work day was associated with the shortest duration.

CONCLUSIONS. Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work. Ways to enable direct feeding include on-site child care, telecommuting, keeping the infant at work, allowing the mother to leave work to go to the infant, and having the infant brought to the work site. Establishing ways for mothers to feed from the breast after return to work is important to meet US breastfeeding goals.
Prevalence of Breast Milk Expression and Associated Factors
Authors: Labiner-Wolfe Judith , Fein Sara B. , Shealy Katherine R. , Wang Cunlin
Published: October 2008

OBJECTIVES. Our goal was to describe the prevalence of any, occasional, and regular breast milk expression, mothers' reasons for expressing their milk, and sociodemographic factors associated with breast milk expression.

PARTICIPANTS AND METHODS. Breastfeeding mothers participating in the 2005–2007 Infant Feeding Practices Study II formed the cohort for these analyses, which were conducted among those with infants in 3 age groups: 1.5 to 4.5 months (n = 1564); >4.5 to 6.5 months (n = 1128); and >6.5 to 9.5 months (n = 914). For the analyses we used frequency and stepwise multiple logistic regression procedures.

RESULTS. Eighty-five percent of breastfeeding mothers of infants in the youngest age group had successfully expressed milk at some time since their infant was born. When asked only about the previous 2-week period, 68% of the breastfeeding mothers of infants in this youngest age group had expressed milk, with 43% having done so occasionally and 25% on a regular schedule. Approximately one quarter of breastfeeding mothers of infants in the 2 older infant age groups also expressed milk on a regular schedule. The percentage of mothers expressing milk decreased with increasing infant age. Mothers expressed milk for various reasons. The most frequently cited reason was to get breast milk for someone else to feed their infant. In all 3 age groups, reporting any breast milk expression, compared with none, was positively associated with maternal employment, higher income, lack of previous breastfeeding experience, and living in the Midwest versus the West. In all 3 age groups, expressing milk on a regular schedule, compared with occasionally, was positively associated with maternal employment and the use of an electric versus manual breast pump.

CONCLUSIONS. Breast milk expression is a very common practice. It is associated most strongly with maternal employment, a recognized barrier to breastfeeding.
Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the First Year
Authors: Li Ruowei , Fein Sara B. , Chen Jian , Grummer-Strawn Laurence M.
Published: October 2008

OBJECTIVES. Our goal was to determine why women stop breastfeeding at various times during their infant's first year.

METHODS. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers ∼2, 3, 4, 5, 6, 7, 9, 10½, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding.

RESULTS. The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%–55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of <350% of the federal poverty level. Mothers' concerns about lactation and nutrition issues were the most frequently cited reasons for stopping breastfeeding during the first 2 months. Starting from the third month, self-weaning reasons were increasingly cited as important, with the statements “My baby began to bite” (31.7%), “My baby lost interest in nursing or began to wean himself or herself” (47.3%), and “Breast milk alone did not satisfy my baby” (43.5%) cited as the top 3 reasons at ≥9 months of age.

CONCLUSIONS. Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.
Association of Breastfeeding Intensity and Bottle-Emptying Behaviors at Early Infancy With Infants' Risk for Excess Weight at Late Infancy
Authors: Li Ruowei , Fein Sara B. , Grummer-Strawn Laurence M.
Published: October 2008

OBJECTIVE. Our goal was to test the hypothesis that infants who were breastfed more intensively during early infancy (≤6 months) will be less likely to have excess weight during late infancy (>6 months) and to examine the independent impact of infant-initiated bottle emptying and mothers' encouragement of bottle emptying on infants' risk for excess weight.

METHOD. The sample consisted of 1896 mothers who participated in postpartum surveys of the Infant Feeding Practice Study II and who provided at least 1 weight measurement of their infants during the second half of infancy. We used multiple logistic regression models to assess the association between infants' risks for excess weight during the second half of infancy and 3 self-reported feeding practices during the first half of infancy after adjusting for a series of sociodemographic characteristics. The early feeding practices examined included the percentage of all milk feedings in which infants consumed breast milk (breastfeeding intensity), the frequency of bottle feedings in which infants initiated bottle emptying, and the frequency of bottle feedings in which mothers encouraged bottle emptying.

RESULTS. Infants fed with low (<20% of milk feeds being breast milk) and medium (20%–80%) breastfeeding intensity in the first half of infancy were at least 2 times more likely to have excess weight during the second half of infancy than those breastfed at high intensity (>80%). Infants who often emptied bottles in early infancy were 69% more likely than those who rarely emptied bottles to have excess weight during late infancy. However, mothers' encouragement of bottle emptying was negatively associated with their infants' risk for excess weight during the second half of infancy.

CONCLUSIONS. Infants’ risk for excess weight during late infancy was negatively associated with breastfeeding intensity but positively associated with infant-initiated bottle emptying during early infancy. These findings not only provide evidence for the potential risk of not breastfeeding or breastfeeding at a low intensity in development of childhood obesity, but they also suggest that infant-initiated bottle emptying may be an independent risk factor as well.
Infant Formula–Handling Education and Safety
Authors: Labiner-Wolfe Judith , Fein Sara B. , Shealy Katherine R.
Published: October 2008

OBJECTIVES. Our goal was to assess the extent to which mothers learn about proper handling of infant formula from health professionals and package labels; mothers' beliefs about the likelihood of germs being in infant formula and the importance of following safe-use directions; whether they take measures while handling infant formula to prevent foodborne illnesses and injury to their infants; and maternal characteristics associated with unsafe infant formula–handling practices.

PARTICIPANTS AND METHODS. The study cohort consisted of mothers participating in the 2005–2007 Infant Feeding Practices Study II who fed their infant formula. We conducted frequency and multiple logistic regression analyses. Sample sizes for the analyses ranged from 860 to 1533.

RESULTS. The majority of formula-feeding mothers did not receive instruction on formula preparation (77%) or storage (73%) from a health professional. Thirty percent did not read some of the safe-use directions on the formula package label; an approximately equal percentage (38%) thought that both powdered (which is not sterile) and ready-to-feed (which is sterile) formula were unlikely to contain germs; and 85% believed that following safe-storage directions was very important. Among the mothers of the youngest infants analyzed, 55% did not always wash their hands with soap before preparing infant formula, 32% did not adequately wash bottle nipples between uses, 35% heated formula bottles in a microwave oven, and 6% did not always discard formula left standing for >2 hours. The prevalence of these unsafe practices was similar among mothers of older infants. No consistent pattern of maternal characteristics was associated with unsafe practices.

CONCLUSIONS. Many mothers do not follow safe practices when preparing infant formula. Additional research is needed to understand why more mothers do not follow safe formula-handling recommendations.
Selected Complementary Feeding Practices and Their Association With Maternal Education
Authors: Fein Sara B. , Labiner-Wolfe Judith , Scanlon Kelley S. , Grummer-Strawn Laurence M.
Published: October 2008

OBJECTIVE. As infants transition from a milk-based diet to one that includes most food groups, the timing of the transition, how infants are fed, and the quality of their diet can have important health implications. Our objective is to describe these factors for US infants.

METHODS. We analyzed data from the Infant Feeding Practices Study II. Sample sizes varied for relevant questions from ∼1600 to ∼2400. We analyzed the prevalence of 14 feeding practices and their association with the mothers' education and also examined participants' use of commercial baby foods.

RESULTS. Approximately 21% of the mothers introduced solid foods before 4 months; 7% introduced solids after 6 months. Twenty-nine percent of the mothers introduced >3 new foods per week to infants aged 5 to 10 months. Approximately 20% of the mothers fed juice before 6 months, fed cow's milk before 12 months, and fed infants <5 times per day after 5 months. Fourteen percent of the mothers chewed food for their infant. Approximately 15% of the mothers fed <1 serving daily of either a fruit or vegetable to infants aged ≥9 months, half added salt to their infant's food, and more than one third who added salt used noniodized salt. Approximately 20% fed reduced-fat cow's milk at 1 year. Almost half of the 10-month-old infants had eaten restaurant food in a restaurant in the previous week, 22% had eaten carry-out food, and 28% had eaten either type of restaurant food ≥2 times. The prevalence of 8 of the 14 unhealthful infant feeding practices we examined was inversely associated with maternal education.

CONCLUSIONS. Nutrition and feeding guidance should be especially targeted to mothers with a high school education or less.
Maternally Reported Food Allergies and Other Food-Related Health Problems in Infants: Characteristics and Associated Factors
Authors: Luccioli Stefano , Ross Marianne , Labiner-Wolfe Judith , Fein Sara B.
Published: October 2008

OBJECTIVE. Our goal was to identify the frequency, demographics, and diagnostic characteristics associated with maternally reported food allergies and other food-related health problems among infants aged ≤1 year.

METHODS. We analyzed data from the 2005–2007 Infant Feeding Practices Study II, a longitudinal survey of 2441 US mothers of healthy singletons from pregnancy through their infant's first year. Doctor diagnosis and symptoms-based criteria were used to identify a probable-food-allergic group from maternal reports of infant health problems with food.

RESULTS. More than one fifth of the 2441 mothers reported that their infant had a food-related problem; 6% (n = 143) had a probable food allergy, and 15% (n = 359) had other food-related problems. Forty percent of the infants with a food-related health problem were evaluated by a doctor. Gastrointestinal symptoms were more commonly reported in early infancy compared with skin-related symptoms, which were reported in later infancy, and 27% received medical treatment for the symptoms. Characteristics associated with increased incidence of probable food allergy included family histories of food allergy and type 1 diabetes, gestational diabetes, living in rural or urban areas, being black, and being male. Among all infants with a food-related health problem, the majority experienced their first problem by 6 months of age. Foods recognized to be major allergens were most commonly reported as the source of an allergy.

CONCLUSIONS. Food-related problems occurred at a high frequency in the first year of life. A better understanding of the demographics, family history, disease manifestations, and diagnoses may provide insight into public health efforts to minimize or prevent food allergies in infancy and to help differentiate food-allergic problems from nonallergic food problems in this age group.
Infant Sleeping Arrangements and Practices During the First Year of Life
Authors: Hauck Fern R. , Signore Caroline , Fein Sara B. , Raju Tonse N.K.
Published: October 2008

OBJECTIVES. Our goal was to examine the sleeping arrangements for infants from birth to 1 year of age and to assess the association between such arrangements and maternal characteristics.

METHODS. Responses to the 3-, 6-, 9-, and 12-month questionnaires from the Infant Feeding Practices Study II were analyzed to assess sleep arrangements, including bed sharing, the latter defined as mother ever (in a given time frame) slept with the infant on the same sleeping surface for nighttime sleep. Women were also asked about the reasons for bed sharing or not bed sharing.

RESULTS. Approximately 2300 women responded at 3 months, and 1800 at 12 months. At 3 months, 85% of the infants slept in the same room as their mother, and at 12 months that rate was 29%. At 3 months, 26% of the mothers did not use the recommended supine position for their infant's nighttime sleep. The rate of noncompliance increased to 29% by 6 months and 36% by 12 months. The bed-sharing rates were 42% at 2 weeks, 34% at 3 months, and 27% at 12 months. Approximately two thirds of those who bed shared with their infant also shared the bed with their husband or partner, and 5% to 15% shared it with other children. The major reasons for bed sharing were to calm a fussy infant, facilitate breastfeeding, and help the infant and/or mother sleep better. The major reasons for not lying down with the infant were safety concerns. Non-Hispanic black mothers were more likely than non-Hispanic white mothers to use nonsupine infant sleep positions and to bed share.

CONCLUSIONS. More than one third of the women in this cohort were noncompliant with safe-sleeping guidelines when their infant was 3 months old. Health care providers need to advise parents of current recommendations and discuss the risks and benefits of their choices for infant sleeping practices.
Exposure to Nontraditional Pets at Home and to Animals in Public Settings: Risks to Children
Authors: Pickering Larry K. , Marano Nina , Bocchini Joseph A. , Angulo Frederick J. ,   and the Committee on Infectious Diseases
Published: October 2008

Exposure to animals can provide many benefits during the growth and development of children. However, there are potential risks associated with animal exposures, including exposure to nontraditional pets in the home and animals in public settings. Educational materials, regulations, and guidelines have been developed to minimize these risks. Pediatricians, veterinarians, and other health care professionals can provide advice on selection of appropriate pets as well as prevention of disease transmission from nontraditional pets and when children contact animals in public settings.
Disaster Planning for Schools
Authors:   Council on School Health
Published: October 2008

This Policy Statement was retired December 2019.

Community awareness of the school district's disaster plan will optimize a community's capacity to maintain the safety of its school-aged population in the event of a school-based or greater community crisis. This statement is intended to stimulate awareness of the disaster-preparedness process in schools as a part of a global, community-wide preparedness plan. Pediatricians, other health care professionals, first responders, public health officials, the media, school nurses, school staff, and parents all need to be unified in their efforts to support schools in the prevention of, preparedness for, response to, and recovery from a disaster.
A política externa do governo FHC: continuidade e renovação
Authors: Lampreia Luiz Felipe
Published: October 2008

O Governo do Presidente Fernando Henrique Cardoso deu seguimento a uma linha de conduta que, ao longo do tempo, tem feito da política externa brasileira um fator de credibilidade para o País. O Presidente agregou, no entanto, a confiabilidade e atratividade que decorrem do êxito do Plano Real, a qualidade de sua liderança e o peso de seu envolvimento pessoal na atividade diplomática, além do compromisso com os valores e ideais - democracia, direitos humanos, justiça social, preservação do meio ambiente - dominantes neste momento da história mundial.
A execução da política externa brasileira: um balanço dos últimos 4 anos
Authors: Barros Sebastião do Rego
Published: October 2008

Artigo de natureza institucional sobre execução da política exterior no primeiro Governo Fernando Henrique Cardoso. Essa política externa, cujos princípios de atuação são claramente definidos, foi marcada por um permanente esforço de intensificar o diálogo com outros setores do Governo e entidades civis (iniciativa privada, organizações sociais e a população em geral) e de aumentar a transparência do processo de decisão. O Itamaraty buscou modernizar-se para fazer frente aos desafios da sociedade globalizada e democratizada, cujo interesse por temas de política externa é crescente. Tais transformações se guiaram pela convicção de que a instituição precisa aperfeiçoar os serviços que presta à sociedade, por meio de ações que favoreçam mais diretamente os cidadãos brasileiros tanto no Brasil quanto no exterior.
Capacidade de atuar e legitimação do Estado democrático de direito na era da globalização
Authors: Pfetsch Frank Richard
Published: October 2008

O texto faz uma reflexão sobre ambas a capacidade de agir e a legitimidade do Estado democrático de direito no mundo contemporâneo. Considera aspectos tais como a globalização, a regionalização e a individualização, levando em conta as funções do Estado, seus instrumentos de operação e suas novas competências.
Idéias e política externa: a atuação brasileira na Liga das Nações e na ONU
Authors: Silva Alexandra de Mello e
Published: October 2008

Esse artigo apresenta uma proposta de análise da influência de idéias sobre a formulação da política externa brasileira contemporânea focalizada em nossa atuação na Liga das Nações e na ONU. Em ambos os organismos, o país desenvolveu aspirações a um papel internacional protagônico, o que acreditamos ser indicador da recorrência, no discurso diplomático, de certas crenças a respeito de quais devam ser o nosso papel, status e pertencimento a nível internacional. Destacamos, ao mesmo tempo, que uma análise desse tipo não pode se limitar a reconstruir o discurso diplomático, mas deve também procurar desvendar os mecanismos causais que explicam o impacto daquelas crenças sobre a formação de políticas. Nesse sentido, a literatura acadêmica internacional já desenvolveu uma série de abordagens que podem se revelar úteis para um estudo da diplomacia brasileira.
Fatores preditores de malignidade em neoplasias de células de Hurthle
Authors: Fischer Carlos Augusto , Graciano Agnaldo José , Ferreira Sérgio José , Daudt Carlos Antônio , Fiorini Cleber Antonio , Silvestri Karina
Published: October 2008

OBJETIVO: neoplasias de células de Hurthle são tumores da glândula tireóide de baixa incidência que apresentam muitas controvérsias quanto à distinção entre carcinomas e adenomas. O objetivo deste estudo foi identificar fatores preditores de malignidade neste tipo específico de neoplasia. MÉTODOS: entre janeiro de 1999 e junho de 2006, 56 casos de neoplasia de células de Hurthle foram diagnosticados em nossa instituição e foram estudados retrospectivamente. RESULTADOS: trinta e sete pacientes apresentaram diagnóstico patológico de adenoma de células de Hurthle (ACH), enquanto 19 casos foram diagnosticados como carcinoma de células de Hurthle (CCH). No grupo de pacientes com adenomas a idade média foi de 47,8 anos, sendo que trinta e cinco (94%) eram do sexo feminino e apenas dois (5,5%) casos do sexo masculino. O tamanho médio dos adenomas foi de 2,1 cm variando de 0,3 a 6,0 cm. Entre os 19 casos de carcinomas a média de idade foi de 51,1 anos, sendo quatorze casos em mulheres (73%) e cinco em homens (26,4%). O tamanho médio dos nódulos neste grupo foi de 3,8 cm, variando de 2,0 cm a 7,5 cm. CONCLUSÃO: Pacientes com neoplasias de células de Hurthle apresentando nódulos maiores que três centímetros, principalmente em homens, apresentam maior risco de malignidade.
Linfadenectomia ampliada (D2) no tratamento do carcinoma gástrico: análise das complicações pós-operatórias
Authors: Toneto Marcelo Garcia , Hoffmann Anselmo , Conte Antonella Furquim , Schambeck João Paulo Leal , Ernani Vinícius , Souza Hamilton Petry de
Published: October 2008

OBJETIVO: Descrever e analisar as principais complicações pós-operatórias e mortalidade dos pacientes submetidos à ressecção gástrica por câncer gástrico com linfadenectomia D2. MÉTODO: Foi realizada uma coorte histórica onde as principais variáveis em estudo foram: idade, localização do tumor, estadiamento, complicações do procedimento cirúrgico, padrão de recidiva tumoral, análise da sobrevida livre de doença e sobrevida total. RESULTADOS: Foram avaliados 35 pacientes submetidos à dissecção linfonodal D2 no período de Janeiro de 2000 a Dezembro de 2004. A média de idade foi 57 anos. Apenas um (2,9%) paciente apresentava tumor precoce e o local mais comum do tumor foi no terço médio do estômago. O número de linfonodos ressecados por paciente variou de 15 a 80 linfonodos (média 28,8). Vinte e seis (74,3%) pacientes apresentaram linfonodos metastáticos, sendo a média de 13,4 (±11,8) linfonodos comprometidos por paciente. Seis (17,1%) pacientes apresentaram complicações no período pós-operatório, sendo duas pneumonias, uma fístula pancreática, uma fístula do coto duodenal e duas deiscências da anastomose esôfago-jejunal. Apenas um (2,86%) paciente morreu devido a complicações operatórias. O tempo de seguimento médio foi de 26 meses. Vinte e dois pacientes apresentavam-se vivos no fechamento do estudo, com uma sobrevida atuarial de 62,9%. CONCLUSÃO: Os resultados deste estudo sugerem que, em centros especializados, a linfadenectomia D2 é um procedimento com nível de complicações aceitável e pode ser realizada sem aumento da mortalidade operatória.