bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxygen Delivery Through Nasal Cannulae to Preterm Infants: Can Practice Be Improved?
Authors: Walsh Michele , Engle William , Laptook Abbot , Kazzi S. Nadya J. , Buchter Susie , Rasmussen Maynard , Yao Qing ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: September 2005

Objective. Oxygen delivery through nasal cannulae to convalescent preterm infants is a common but largely unstudied practice. To learn more about current nasal cannula oxygen delivery practices, we examined the variations in oxygen delivery through nasal cannulae among the centers of the Neonatal Research Network, the frequency of prescription of low levels of oxygen, and the success of weaning to room air. We hypothesized that some infants treated with oxygen through nasal cannulae were receiving oxygen levels equivalent to those of room air.

Methods. This was a descriptive, nested, cohort study of nasal cannula oxygen prescription among 187 infants with birth weights of <1250 g. All infants were studied at a postmenstrual age of 36 weeks, with a timed oxygen reduction challenge to establish their ability to be weaned to room air. The results of this challenge were compared with the fraction of inspired oxygen (Fio2) delivered, calculated as effective Fio2. Infants who maintained oxygen saturation values of ≥90% during oxygen weaning and during a 30-minute period in room air were defined as passing the challenge.

Results. Fifty-two infants (27.8%) were receiving oxygen concentrations and flow rates through nasal cannulae that delivered an effective Fio2 of <0.23, of whom 16 were receiving oxygen concentrations and flow rates that delivered an effective Fio2 of 0.21. In addition, 22 infants (11.8%) were prescribed room air through nasal cannulae intentionally. Seventy-two percent of those prescribed an effective Fio2 of <0.23 passed the room air challenge.

Conclusions. Prescription of oxygen with combinations of flow rates and oxygen concentrations that delivered a low effective Fio2 was common. We speculate that some of this, including the inadvertent prescription of an effective Fio2 equivalent to that of room air, is related to lack of knowledge of the effective Fio2. Routine calculation of effective Fio2 values may prompt earlier trials of room air and thus reduce unnecessary days of oxygen therapy.
The Changing Composition of the Pediatric Medical Subspecialty Workforce
Authors: Mayer Michelle L. , Preisser John S.
Published: September 2005

Objectives. To characterize the composition of the pediatric subspecialty workforce in terms of the distribution of women and international medical graduates (IMGs) across pediatric medical subspecialties and to determine whether the proportions of board-certified pediatric subspecialists who are women or IMGs differ between graduation cohorts.

Study Design. We used board certification data from the American Board of Pediatrics. Within each pediatric subspecialty, we classified physicians into 2 groups, ie, recent graduates, defined as those who completed medical school after January 1, 1987, and nonrecent graduates, who completed medical school before that date. We calculated the percentage of female physicians for each subspecialty and computed 95% confidence intervals around those estimates to identify male-dominated subspecialties. Using Pearson χ2 tests, we compared the percentages of women between the 2 graduation cohorts for each subspecialty. Similar calculations were performed for the percentage of IMGs in each subspecialty. Sensitivity analyses were performed with data from the 2002 American Medical Association Physician Masterfile.

Results. For 9 of 16 pediatric medical subspecialties studied, the percentages of board-certified women were significantly greater in the recent cohort than in the nonrecent cohort. Subspecialties that remain predominantly male in the recent graduation cohort include cardiology, critical care medicine, gastroenterology, pulmonology, and sports medicine. In contrast, the percentages of board-certified IMGs were significantly lower for 6 of the 16 specialties studied; endocrinology and gastroenterology remain relatively reliant on IMGs.

Conclusions. For the majority of pediatric medical subspecialties, concerns that the predominance of women in pediatric training may negatively affect the supply of subspecialists are likely unfounded; however, a small number of procedure-based specialties, as well as sports medicine, continue to rely disproportionately on men. There do not seem to be consistent differences in the role of IMGs across the pediatric medical subspecialties between recent and nonrecent graduates, which may reflect differing tendencies to become certified.
Comparison of the Cariogenicity of Cola, Honey, Cow Milk, Human Milk, and Sucrose
Authors: Bowen William H. , Lawrence Ruth A.
Published: September 2005

Objective. The purpose of this study was to determine and compare the cariogenicity of various fluids that are frequently fed to infants and toddlers. We chose to examine sucrose, cola drink, honey, human milk, cow milk, and water because some of these have been associated with development of early childhood caries, although direct experimental evidence is lacking.

Methods. We used our desalivated rat model because the approach mimics the situation found in infants, whereby the flow of saliva is interrupted through mechanical effects of a nipple. The animals received basic nutrition by gavage, and the fluids being tested were available ad libitum. Thus, the only substances that came in contact with teeth were the test fluids. The investigation continued for 14 days.

Results. Cola, sucrose, and honey were by far the most cariogenic. In addition, cola and honey induced considerable erosion. Human milk was significantly more cariogenic than cow milk probably because of its lower mineral content and higher level of lactose.

Conclusions. Our data show that the use of honey, cola, and sucrose water in nursing bottles should be discouraged. Although human milk is more cariogenic than cow milk, it is no more cariogenic than are common infant formulas. Protracted exposure to human milk or formula through allowing an infant to sleep on the nipple should be discouraged, and the need for oral hygiene after tooth eruption should be emphasized.
Bone Area and Bone Mineral Content Deficits in Children With Sickle Cell Disease
Authors: Buison Anne M. , Kawchak Deborah A. , Schall Joan I. , Ohene-Frempong Kwaku , Stallings Virginia A. , Leonard Mary B. , Zemel Babette S.
Published: September 2005

Objective. Children with sickle cell disease (SCD) experience poor growth, altered body composition, and delayed maturation. Deficits in bone mineral content (BMC) and bone area (BA) have not been well characterized. The objectives of this study were to assess whole-body BMC (WBBMC) and WBBA in children with SCD, type SS (SCD-SS), compared with healthy control subjects, adjusted for growth and body composition, and to determine the relationships of WBBMC and WBBA to bone age and hematologic parameters in children with SCD-SS.

Methods. WBBMC, WBBA, and lean mass were measured by dual-energy x-ray absorptiometry in children who were aged 4 to 19 years. Growth, sexual development, and bone age were assessed. Gender-specific z scores for WBBMC relative to age and height were generated from control data.

Results. Ninety children with SCD-SS and 198 healthy control subjects were evaluated. SCD-SS was associated with poor growth. WBBMC was significantly decreased in SCD-SS compared with control subjects, adjusted for age, height, pubertal status, and lean mass. WBBMC relative to age and WBBMC relative to height z scores were −0.95 ± 0.99 and −0.54 ± 0.97, respectively, and were associated with hemoglobin and hematocrit levels and history of delayed bone age.

Conclusions. Children with SCD-SS have significant deficits in WBBMC that persist despite adjustment for poor growth and decreased lean mass. These children may be at increased risk for fragility fractures and suboptimal peak bone mass.
Recent Steroid Therapy Increases Severity of Varicella Infections in Children With Acute Lymphoblastic Leukemia
Authors: Hill Garick , Chauvenet Allen R. , Lovato James , McLean Thomas W.
Published: September 2005

Objective. The varicella-zoster virus (VZV) continues to be a dangerous pathogen to immunocompromised children. Children with acute lymphoblastic leukemia (ALL) are treated with intermittent steroid therapy. This study was undertaken to examine the relationship between steroid therapy for ALL and severity of varicella infection.

Methods. We performed a retrospective review of patients who were on Pediatric Oncology Group Protocol 9201 and had a history of varicella infection. Pediatric Oncology Group 9201 is a phase III study for the treatment of children with lesser risk ALL diagnosed between 1992 and 1999. Cases of varicella were coded 1 to 5 on the basis of severity: grade 1 caused minimal to no symptoms, grade 2 caused mild to moderate symptoms that did not require hospitalization, grade 3 caused symptoms severe enough to require hospitalization and intravenous acyclovir, grade 4 caused severe disease that had complications or that required intensive care, and grade 5 resulted in death.

Results. Of 697 enrolled patients, 110 (15.8%) developed primary varicella; 59% of these were male. For analysis, disease grade was dichotomized into nonsevere (grades 1 and 2) and severe (grades 3, 4, and 5). Of the 110 patients, 56 had nonsevere disease; 54 had severe disease, including 2 deaths. Of the patients whose varicella was diagnosed within 3 weeks of receipt of prednisone, 70% had severe infection, whereas only 44% of those who had not received prednisone within 3 weeks had severe infection. The odds ratio for having a severe infection within 3 weeks of prednisone versus >3 weeks is 2.9 (95% confidence interval: 1.1–7.9). By multivariate analysis, older age at ALL diagnosis, years from ALL diagnosis to VZV diagnosis, and VZV diagnosis within the 4-week period of interest (during or within 3 weeks of prednisone therapy) all were independently associated with an increased risk for severe infection.

Conclusions. This study represents the largest study to date of varicella in children with ALL and provides convincing evidence that prednisone therapy during the VZV incubation period significantly increases the risk for developing severe varicella infection. In addition, older age is associated with more severe infection. Despite the varicella vaccine and a dropping incidence of primary infections, VZV remains a dangerous pathogen for pediatric patients with ALL. With the possible exception of induction therapy, patients who are on ALL therapy and are exposed to varicella should have steroid therapy delayed until after the VZV incubation period. These findings may have implications for other diseases that are treated with corticosteroids.
Cochlear Implantation in Children Younger Than 12 Months
Authors: Waltzman Susan B. , Roland J. Thomas
Published: September 2005

Objectives. As a result of universal newborn hearing screening and improved evaluation tools, many children with severe to profound hearing loss are being diagnosed as infants. This affords the opportunity to provide these children access to cochlear implantation, although medical and audiologic challenges must be addressed. The purpose of this study was to investigate the safety and efficacy of cochlear implantation in children who are younger than 1 year.

Methods. A prospective study was conducted of 18 children who had confirmed severe to profound sensorineural hearing loss and received cochlear implants at our medical center before 12 months of age. The length of device usage ranged from 6 months to 4 years, 5 months. The main outcomes measured were perioperative and postoperative surgical/medical aspects, the Infant-Toddler Meaningful Auditory Integration Scale and age-appropriate phoneme, and word and sentence recognition tests, when appropriate.

Results. All children had full insertions of the electrode array without surgical complications and are developing age-appropriate auditory perception and oral language skills.

Conclusions. Early implantation is feasible and beneficial in some children who are younger than 12 months and should be considered with attention to variables involved in the decision-making process, including possible increased surgical risk, skull size and scalp thickness, and mastoid development.
Changing Parental Opinions About Teen Privacy Through Education
Authors: Hutchinson Jeffrey W. , Stafford Elisabeth M.
Published: September 2005

Objective. Confidentiality for adolescent patients is the standard of care. However, some parents object to this practice. We determined the prevalence of parents who have negative opinions regarding adolescent privacy policies and education's effect on that prevalence.

Methods. All parents who sought care for their teen at 2 adolescent medicine clinics were asked to complete a computer survey about teen privacy and risk-taking behavior. Parents who did not know the clinic's privacy policy or had never been to the clinic were asked to participate in an educational study. Study participants were randomly selected to receive education by a handout or a scripted face-to-face encounter. They were surveyed again the same day. For evaluating long-term retention, a follow-up survey was conducted at least 30 days after the education.

Results. A total of 563 parents were surveyed. Of 281 eligible parents, 130 (46%) completed the postintervention survey and 52 (19%) completed the follow-up survey. Repeated measures analysis of variance showed that both education types were equally effective in teaching parents chosen privacy facts. The average number of correct test questions increased from 58.6% to 89.1%. More than 30 days later, the parents' score was 86.9%. Before education, 35% disagreed or strongly disagreed with teens' having private information, compared with 13.8% immediately after education and 15.4% at follow-up. The percentage of parents who disagreed or strongly disagreed with providers' seeing the patient alone was 30.5%, which decreased to 14.5% after education and 17.3% with the follow-up survey. χ2 tests showed no statistically significant differences between face-to-face and written education in changing parental opinions regarding privacy. When an adolescent wanted to speak with a provider alone, 93% of the parents agreed with that choice, regardless of intervention.

Conclusions. This study identifies that almost one third of the parents who presented to these adolescent medicine clinics had negative opinions about some privacy practices. The 2 main issues were teens' seeing a provider alone and providers' keeping information confidential. Education was effective in teaching parents about privacy issues and produced a significant improvement in parental opinion about confidentiality. Simultaneously, an overwhelming majority of parents support the idea that teens should speak with a provider alone if the teen so desires, suggesting that parents acknowledge a need for independence. Providing confidential services is an essential part of adolescent health care that works best with the alliance of parents. This study supports the continued need to assess parental attitudes about privacy issues and to provide parents with education.
Poor Formulation Information in Published Pediatric Drug Trials
Authors: Standing Joseph F. , Khaki Zahra F. , Wong Ian C. K.
Published: September 2005

Objective. The International Conference on Harmonisation Steering Committee recommends that appropriate formulations be used in pediatric drug trials. However, a lack of formulation research and/or economic constraints means that appropriate formulations are not always used. It is important for investigators who report the results of pediatric drug trials to provide sufficient information on the formulation and method of administration to ensure that the results can be reproduced in other clinical studies (reliability) and, more important, implemented in clinical practice (validity). The objective of this study was to evaluate whether pediatric formulation information was adequately reported in recent published trials of oral medicines that included children who were younger than 12 years.

Methods. Studies that were published between July 2002 and June 2004 in 10 highly cited journals (5 pediatric and 5 general medicine) were hand-searched and data were extracted independently by 2 reviewers according to a protocol. Papers that reported oral medication studies that included children who were younger than 12 years were classified as containing adequate, some, or no information on drug formulation.

Results. Of 3992 papers reviewed, 76 fulfilled the inclusion criteria. Only 28 (37%) gave adequate information for the study to be reproduced accurately, and 20 (26%) did not state the formulation used. When the formulation was reported, only 37 (49%) studies used a pediatric formulation (liquid, chewable tablet, granules). No significant differences between pediatric and general medical journals were seen, and no single journal consistently met the criteria for adequate information.

Conclusion. Highly cited journals seem to permit inadequate formulation information in pediatric drug trials that they publish, impairing their validity and reliability. Authors should provide full formulation information in all pediatric clinical trial reports.
Mild Hypothermia and the Distribution of Cerebral Lesions in Neonates With Hypoxic-Ischemic Encephalopathy
Authors: Rutherford Mary A. , Azzopardi Denis , Whitelaw Andrew , Cowan Frances , Renowden S. , Edwards A. David , Thoresen Marianne
Published: September 2005

Hypothermia induced by whole-body cooling (WBC) and selective head cooling (SHC) both reduce brain injury after hypoxia-ischemia in newborn animals, but it is not known how these treatments affect the incidence or pattern of brain injury in human newborns. To assess this, 14 term infants with hypoxic-ischemic encephalopathy (HIE) treated with SHC, 20 infants with HIE treated with WBC, and 52 noncooled infants with HIE of similar severity were studied with magnetic resonance imaging in the neonatal period. Infants fulfilling strict criteria for HIE were recruited into the study after assessment of an amplitude-integrated electroencephalography (aEEG). Cooling was commenced within 6 hours of birth and continued for 48 to 72 hours. Hypothermia was not associated with unexpected or unusual lesions, and the prevalence of intracranial hemorrhage was similar in all 3 groups. Both modes of hypothermia were associated with a decrease in basal ganglia and thalamic lesions, which are predictive of abnormal outcome. This decrease was significant in infants with a moderate aEEG finding but not in those with a severe aEEG finding. A decrease in the incidence of severe cortical lesions was seen in the infants treated with SHC.
Opportunities for Health Promotion Education in Child Care
Authors: Gupta Ruchi S. , Shuman Steve , Taveras Elsie M. , Kulldorff Martin , Finkelstein Jonathan A.
Published: September 2005

Objectives. Comprehensive health promotion education is not feasible through pediatric office visits alone. Opportunities may exist for enhanced health promotion in child care settings. The objectives of this study were to understand the attitudes toward, barriers to, and strategies for incorporating health promotion activities in child care settings as well as topics that are deemed most useful from the perspectives of parents, child care directors, and health consultants. We also sought to understand the health consultants' (health professionals serving as consultants to child care centers) current and desired roles in leading health promotion activities in child care settings.

Methods. We conducted simultaneous surveys of all licensed child care center directors and their health consultants in Boston. A total of 240 parents in 16 randomly selected centers were also surveyed.

Results. A total of 97 (65%) directors in the 150 child care centers identified responded. A total of 71% (56 of 79) of consultants and 58% (138 of 240) of parents responded. Parents (89%), child care directors (88%), and health consultants (80%) believe that health promotion activities through child care centers would improve the health knowledge and behaviors of preschool children. A total of 45% of parents reported already receiving useful health information from child care staff and materials distributed in child care. Most topic areas that were suggested to parents were considered useful, with the greatest utility in the areas of behavior/discipline, child development, and emergency management. No significant barriers were identified by health professionals. Lack of funds (63%) and lack of someone to provide information (59%) were the top barriers identified by directors. An educational session on health topics by health care professionals was believed to be the best strategy to improve health promotion education for families. Among the health consultants, 83% of nurses or nurse practitioners said that they would be able to provide health education in child care compared with 53% of physicians.

Conclusion. Parents, child care center directors, and health professionals believe that enhancing health promotion education in child care could improve child health. Collaboration between pediatricians and early care and education professionals has the potential to improve the breadth and effectiveness of health promotion education. Effective strategies are necessary to optimize access to health professionals by early educators, and effectively utilize the unique skills and preferences of physicians and nurses to promote health education in child care.
A Controlled Trial of the Father's Role in Breastfeeding Promotion
Authors: Pisacane Alfredo , Continisio Grazia Isabella , Aldinucci Maria , D'Amora Stefania , Continisio Paola
Published: September 2005

Objective. To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding.

Methods. A controlled trial, in which the participating fathers were allocated in 2-month blocks to a child care training session, was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples, Italy. Support and advice about breastfeeding was provided to all of the mothers. Among the fathers of the intervention group, the training session included the management of breastfeeding; among those of the control group, it did not. Primary outcome was the prevalence of full breastfeeding at 6 months. Secondary outcomes were the proportion of women who perceived their milk to be insufficient, who stopped breastfeeding because of problems, and who reported to have received help in breastfeeding management by their partners.

Results The prevalence of full breastfeeding at 6 months was 25% (35 of 140) in the intervention group and 15% (21 of 140) in the control group and that of any breastfeeding at 12 months was 19% (27) and 11% (16), respectively. Perceived milk insufficiency was significantly more frequent among the mothers of the control group (38 [27%] of 140 vs 12 [8.6%] of 140), as well as breastfeeding interruption because of problems with lactation (25 [18%] of 140 vs 6 [4%] of 140). Moreover, significantly more women in the intervention group reported receiving support and relevant help with infant feeding management from their partners (128 [91%] of 140 vs 48 [34%] of 140). Among the women who had reported difficulties with lactation in the intervention and control groups (96 [69%] and 89 [64%], respectively), the prevalence of full breastfeeding at 6 months was 24% and 4.5%, respectively.

Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months.
Pediatric Use of Complementary Therapies: Ethical and Policy Choices
Authors: Cohen Michael H. , Kemper Kathi J. , Stevens Laura , Hashimoto Dean , Gilmour Joan
Published: September 2005

Objective. Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children.

Methods. We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases.

Results. Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies.

Conclusions. Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.
Peer and Adult Companion Helmet Use Is Associated With Bicycle Helmet Use by Children
Authors: Khambalia Amina , MacArthur Colin , Parkin Patricia C.
Published: September 2005

Objective. To examine whether the helmet status of riding companions (child or adult) influences helmet use by children (5–14 years).

Methods. This study is part of a larger prospective observational survey that was conducted in a defined urban region of Toronto, Canada (1990–1997, 1999, and 2001). Trained observers collected data on children who were riding bicycles in April through October each year. Observation sites included school yards, parks, major intersections, and residential streets.

Results. Of the 2094 children who were observed riding a bicycle, 50% were riding alone, 36% were riding with at least 1 child companion, and 14% were riding with at least 1 adult companion. Compared with riding alone, children were less likely to wear a helmet when riding with nonhelmeted child companions (relative risk [RR]: 0.29; 95% confidence interval [CI]: 0.22–0.38) and were more than twice as likely to wear a helmet when riding with either helmeted child (RR: 2.18; 95% CI: 1.97–2.42) or adult companions (RR: 2.67; 95% CI: 2.44–2.93). Compared with children who were riding with nonhelmeted child companions, children were more likely to wear a helmet when riding with nonhelmeted adults (RR: 3.93; 95% CI: 2.86–5.40), helmeted adults (RR: 9.18; 95% CI: 7.04–11.98), or helmeted children (RR: 7.49; 95% CI: 5.72–9.82). Adjusted analyses showed no difference between companion helmet status and helmet use by children before and after legislation.

Conclusions. Helmeted and nonhelmeted adult riding companions were positively associated with child helmet use. The association between child riding companions and child helmet use was positive for helmeted child riding companions and negative for nonhelmeted child riding companions. Efforts need to be made toward improving adult helmet use and children's perceptions and attitudes toward helmet use.
Intentional Injury Management and Prevention in Pediatric Practice: Results From 1998 and 2003 American Academy of Pediatrics Periodic Surveys
Authors: Trowbridge Matthew J. , Sege Robert D. , Olson Lynn , O’Connor Karen , Flaherty Emalee , Spivak Howard
Published: September 2005

Objective. Intentional injuries are significant causes of pediatric morbidity and mortality in the United States. A 1998 American Academy of Pediatrics (AAP) survey identified child abuse, domestic violence, and community violence as concerns for pediatricians, although the majority of pediatricians also reported feeling unprepared to manage these issues. A second AAP survey in 2003 analyzed trends in pediatrician experience and attitudes related to these issues.

Methods. Surveys were sent to national random samples of AAP members in 1998 (n = 1629) and 2003 (n = 1603); response rates were 62% and 53%, respectively. Surveys measured pediatrician experience in the past 12 months in managing injuries caused by child abuse, domestic violence, and community violence. Attitudes regarding available resources and adequacy of training about intentional injury management were also collected. Trends between surveys were analyzed using χ2 analysis.

Results. The proportion of pediatricians who reported treatment of intentional injuries increased between surveys. The percentage of pediatricians who indicated that screening for domestic violence and community violence risk should be included in routine health visits increased from 66% to 72% and 71% to 77%, respectively. Confidence in ability to identify and manage injuries that were caused by domestic violence and community violence increased but remained low, whereas the proportion of pediatricians who expressed confidence in ability to identify child abuse decreased (65% vs 60%).

Conclusions. Despite overall improvement in acceptance of intentional injury prevention in routine care as well as confidence in intentional injury management, pediatrician confidence to identify and manage intentional injuries remains low.
Anogenital and Respiratory Tract Human Papillomavirus Infections Among Children: Age, Gender, and Potential Transmission Through Sexual Abuse
Authors: Sinclair Kelly A. , Woods Charles R. , Kirse Daniel J. , Sinal Sara H.
Published: September 2005

Objectives. To evaluate human papillomavirus (HPV) presentation among children <13 years of age and its association with suspected child sexual abuse (CSA), and to assess sexual abuse consideration among different clinical services treating these children.

Methods. Records of children <13 years of age from 1985 to 2003 were selected for review if the children had a HPV-related International Classification of Diseases, Ninth Revision, code or had been examined in the CSA clinic. Abstracted data included demographic features, clinical findings, clinical services involved, age at diagnosis, age when care was first sought, and age when symptoms were first noted.

Results. HPV was identified by clinical examination and/or biopsy for 124 children, 40 with laryngeal lesions, 67 with anogenital lesions, 10 with oral lesions, and 7 with both anogenital and oral lesions. The mean age at HPV diagnosis was 4.0 ± 2.9 years, compared with 6.4 ± 3.0 years for 1565 HPV-negative children. Among 108 HPV cases with data for age when symptoms were first noted, the mean age was 3.3 ± 2.9 years (median: 2.2 years) for children with anogenital and oral HPV and 2.4 ± 2.3 years (median: 1.9 years) for children with laryngeal HPV. Among HPV-positive patients, 56% were female, compared with 82% of HPV-negative children. Fifty-five (73%) of 75 children with anogenital HPV infections were referred to the CSA clinic for evaluation, compared with none of 49 children with laryngeal or oral HPV infections treated by the otolaryngology service. Laryngeal cases presented earlier than anogenital and oral lesions. Abuse was considered at least possible for 17 of 55 children with any CSA evaluation. The mean age of likely abused, HPV-positive children was 6.5 ± 3.8 years (median: 5.3 years), compared with 3.6 ± 2.3 years (median: 2.6 years) for likely not abused, HPV-positive children. The likelihood of possible abuse as a source of HPV infection increased with age. The positive predictive value of HPV for possible sexual abuse was 36% (95% confidence interval: 13–65%) for children 4 to 8 years of age and 70% (95% confidence interval: 35–93%) for children >8 years of age.

Conclusions. The data from this epidemiologic study of HPV suggest that many anogenital and laryngeal HPV infections among preadolescent children are a result of nonsexual horizontal transmission, acquired either perinatally or postnatally. It seems that many children >2 years of age acquire HPV infection from nonsexual contact. Different subspecialties vary greatly in their suspicion and evaluation of CSA. At this time, there remains no clear age below which sexual abuse is never a concern for children with anogenital HPV infections. Every case needs a medical evaluation to determine whether enough concern for abuse exists to pursue additional investigations.
Keeping Children With Asthma Out of Hospitals: Parents' and Physicians' Perspectives on How Pediatric Asthma Hospitalizations Can Be Prevented
Authors: Flores Glenn , Abreu Milagros , Tomany-Korman Sandra , Meurer John
Published: September 2005

Background. A total of 196000 hospitalizations occur each year among the 9 million US children who have been diagnosed with asthma. Not enough is known about how to prevent pediatric asthma hospitalizations.

Objectives. To identify the proportion of preventable pediatric asthma hospitalizations and how such hospitalizations might be prevented, according to parents and physicians of hospitalized children with asthma.

Methods. A cross-sectional survey was conducted of parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) of a consecutive series of all children who were admitted for asthma to an urban hospital in a 14-month period.

Results. The 230 hospitalized children had a median age of 5 years; most were poor (median annual family income: $13356), were nonwhite (93%), and had public (74%) or no (14%) health insurance. Compared with children who were hospitalized for other ambulatory care–sensitive conditions, hospitalized children with asthma were significantly more likely to be African American (70% vs 57%), to be older, and not to have made a physician visit or telephone contact before admission (52% vs 41%). Only 26% of parents said that their child's admission was preventable, compared with 38% of PCPs and 43% of IAPs. The proportion of asthma hospitalizations that were assessed as preventable varied according to the source or combination of sources, from 15% for agreement among all 3 sources to 54% as identified by any 1 of the 3 sources. PCPs (83%) and IAPs (67%) significantly more often than parents (44%) cited parent/patient-related reasons for how hospitalizations could have been prevented, including adhering to and refilling medications, better outpatient follow-up, and avoiding known disease triggers. Parents (27%) and IAPs (26%) significantly more often than PCPs (11%) cited physician-related reasons for how hospitalizations could have been avoided, including better education by physicians about the child's condition, and better quality of care. Multivariate analyses revealed that an age ≥11 years and no physician contact before the hospitalization were associated with ∼2 times the odds of a preventable asthma hospitalization.

Conclusions. The proportion of asthma hospitalizations assessed as preventable varies from 15% to 54%, depending on the source. Adolescents and families who fail to contact physicians before hospitalization are at greatest risk for preventable hospitalizations. Many pediatric asthma hospitalizations might be prevented if parents and children were better educated about the child's condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers.
Successful Hematopoietic Stem Cell Transplantation for Niemann-Pick Disease Type B
Authors: Shah Ami J. , Kapoor Neena , Crooks Gay M. , Parkman Robertson , Weinberg Kenneth I. , Wilson Kathy , Kohn Donald B.
Published: September 2005

Histocompatible hematopoietic stem cell transplantation (HSCT) was conducted on a 4.5-year-old girl with Niemann-Pick disease type B. The donor was her unaffected brother. At the time of transplantation, she had severe pulmonary disease. After her first HSCT, she developed graft failure. Five years after her second HSCT, her sphingomyelinase levels are within normal levels, she has no pulmonary symptoms, and aside from persistent graft versus host disease, she is doing well.
Stable Prevalence but Changing Risk Factors for Sudden Infant Death Syndrome in Child Care Settings in 2001
Authors: Moon Rachel Y. , Sprague Bruce M. , Patel Kantilal M.
Published: September 2005

Objective. A total of 20% of sudden infant death syndrome (SIDS) cases in the 1990s occurred in child care settings. This is much higher than the 8% expected from Census Bureau data. Factors that were associated with child care SIDS included older age; white race; older, more educated mothers; and unaccustomed prone position. Since these findings, much emphasis has been placed on promoting a safe sleep environment in child care. The objectives of this study were to determine the proportion of SIDS occurring in child care in 2001 and to assess risk factors for SIDS in child care.

Methods. We conducted a retrospective review of all SIDS deaths that occurred in 2001 in 13 US states. Information regarding demographics, SIDS risk factors, and child care arrangements were collected and analyzed. Deaths that occurred in child care were compared with deaths that occurred during parental care.

Results. Of 480 deaths, 79 (16.5%) occurred in child care settings. Of these child care deaths, 36.7% occurred in family child care homes, 17.7% occurred in child care centers, 21.3% occurred in relative care, and 17.7% occurred with a nanny/babysitter at home. Infants in child care were more likely to be older and to die between the hours of 8 am and 4 pm and less likely to be exposed to secondhand smoke. There was no difference in usual, found, or placed sleep position between child care and home deaths. Approximately one half of the infants who died of SIDS in both settings were found prone, and 20% of deaths in both settings were among infants who were unaccustomed to prone sleep.

Conclusions. The proportion of SIDS deaths in child care has declined slightly but still remains high at 16.5%. Infants in child care are no more likely to be placed or found prone and no more likely to be on an unsafe sleep surface. Educational efforts with child care providers have been effective and should be expanded to unregulated child care providers. In addition, there may be other, yet-unidentified factors in child care that place infants in those settings at higher risk for SIDS.
Reducing Low Birthweight by Resolving Risks: Results from Colorado’s Prenatal Plus Program
Authors: Ricketts Sue Austin , Murray Erin K. , Schwalberg Renee
Published: September 2005

Objectives. We examined low-birthweight (LBW) rates among participants in Colorado’s Prenatal Plus program by prenatal risk factors (smoking, inadequate weight gain during pregnancy, and psychosocial problems) and the effect of successful resolution of these risks during pregnancy.

Methods. Data for 3569 Medicaid-eligible women who received care coordination, nutritional counseling, or psychosocial counseling through the Prenatal Plus Program in 2002 were analyzed to determine the prevalence of specific risks, the proportion of women who resolved each specific risk, and the low birthweight rates for births to women who did and did not resolve risk. LBW rates were analyzed with χ2 tests of significance.

Results. Women who quit smoking had an LBW rate of 8.5%, compared with an LBW rate of 13.7% among women who did not. Women with adequate weight gain had an LBW rate of 6.7%, compared with 17.2% among women with inadequate weight gain. Women who resolved all of their risks had a low-birthweight rate of 7.0%, compared with a rate of 13.2% among women who resolved no risks. Women who had at least 10 Prenatal Plus visits were more likely to resolve their risks than were women who had fewer visits.

Conclusions. Multidisciplinary prenatal interventions targeted toward specific risks demonstrate success at significantly improving infant birthweight.
Establishing Priorities for Reducing Suicide and Its Antecedents in the United States
Authors: Knox Kerry L. , Caine Eric D.
Published: September 2005

There is now a substantial literature on risk factors for suicide across the life course. Therefore, it is essential to extend this knowledge by considering more fully which age- and gender-specific groups bear the greatest public health burden owing to suicide and its antecedents. With this in mind, suicide mortality rates alone may not sufficiently inform U.S. policy makers who must distribute scarce suicide prevention resources.

We compared age- and gender-specific mortality rates, age- and gender-specific estimates of years of potential life lost, and age- and gender-specific present value of lost earnings that individuals would have contributed to society had they lived to their full life expectancies.

Men in the middle years of life contribute disproportionately to the public health burden because of completed suicide. The substantial burden evident in this group has not translated into a public health priority.
Use of Discretionary Protective Equipment in High School Athletes: Prevalence and Determinants
Authors: Yang Jingzhen , Bowling J. Michael , Lewis Megan A. , Marshall Stephen W. , Runyan Carol W. , Mueller Frederick O.
Published: September 2005

Objectives. We sought to describe the use of discretionary protective equipment among high school athletes and to examine social and behavioral determinants contributing to equipment usage.

Methods. We analyzed data from a 3-year (1996–1999), stratified, 2-stage cluster sample of athletes engaged in 12 organized sports in 100 North Carolina high schools (n=19728 athlete-seasons) (an athlete-season represents an individual student who participates in a particular sport in a particular season). We used generalized logistic regression to model the association of social and behavioral determinants and demographic variables with discretionary protective equipment use.

Results. About one third of high school athletes self-reported using lower extremity discretionary protective equipment. Girls, seniors, those who played limited-contact sports, and those who played multiple sports reported higher usage. Small school size, low player/coach ratio, high proportion of team usage, and history of previous lower extremity injury were important predictors of usage. Coaches’ experience, qualifications, and training, however, were not predictive of usage.

Conclusions. Intervention efforts to promote use of discretionary protective equipment need to target school-level factors and should consider both team requirements and the role of peers in setting and reinforcing norms.
The Contribution of Self-Rated Health and Depressive Symptoms to Disability Severity as a Predictor of 10-Year Mortality in European Elderly Men
Authors: van den Brink Carolien L. , Tijhuis Marja , van den Bos Geertrudis A.M. , Giampaoli Simona , Nissinen Aulikki , Kromhout Daan
Published: September 2005

Objectives. To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality.

Methods. Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks.

Results. Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms.

Conclusions. For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account.
A Model for a Regional System of Care to Promote the Health and Well-Being of People with Rare Chronic Genetic Disorders.
Authors: Baker Judith R. , Crudder Sally O. , Riske Brenda , Bias Val , Forsberg Ann
Published: September 2005

People with rare, inherited chronic health conditions, such as hemophilia, face added physical, social, emotional, and fiscal challenges beyond those that are common to more prevalent chronic conditions. In 1975, a partnership among clinicians, consumers, and government agencies created a nationwide regional health delivery system that increased access to clinical care, prevention, and research, thereby improving health outcomes for people with hemophilia in the United States.

Today, more than 130 Comprehensive Hemophilia Diagnostic and Treatment Centers in 12 regions serve 70%–80% of the nation’s hemophilia patients. Health care leaders and advocates for other rare, expensive, chronic disorders may find that regionalization improves survival and reduces disability among affected populations. However, diverse and stable resources are needed to sustain such a model in our profit-oriented US health care arena.
The Role of the Built Environment in the Disablement Process
Authors: Clarke Philippa , George Linda K.
Published: September 2005

The Disablement Process model explicates the transition from health conditions to disability and specifically emphasizes the role of intervening factors that speed up or slow down the pathway between pathology and disability.

We used hierarchical Poisson regression analyses with data on older adults from central North Carolina to examine the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. We found that, despite declining physical function, older adults report greater independence in instrumental activities when they live in environments with more land-use diversity.

Independence in self-care activities is modified by housing density, in part through the effect of substandard and inadequate housing.
The Contribution of Specific Diseases to Educational Disparities in Disability-Free Life Expectancy
Authors: Nusselder Wilma J. , Looman Caspar W.N. , Mackenbach Johan P. , Huisman Martijn , van Oyen Herman , Deboosere Patrick , Gadeyne Sylvie , Kunst Anton E.
Published: September 2005

Objectives. We examined the contribution that specific diseases, as causes of both death and disability, make to educational disparities in disability-free life expectancy (DFLE).

Methods. We used disability data from the Belgian Health Interview Survey (1997) and mortality data from the National Mortality Follow-Up Study (1991–1996) to assess education-related disparities in DFLE and to partition these differences into additive contributions of specific diseases.

Results. The DFLE advantage of higher-educated compared with lower-educated persons was 8.0 years for men and 5.9 years for women. Arthritis (men, 1.3 years; women, 2.2 years), back complaints (men, 2.1 years), heart disease/stroke (men, 1.5 years; women, 1.6 years), asthma/chronic obstructive pulmonary disease (COPD) (men, 1.2 years; women, 1.5 years), and “other diseases” (men, 2.4 years) contributed the most to this difference.

Conclusions. Disabling diseases, such as arthritis, back complaints, and asthma/COPD, contribute substantially to differences in DFLE by education. Public health policy aiming to reduce existing disparities in the DFLE and to improve population health should not only focus on fatal diseases but also on these nonfatal diseases.