bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional analysis of amino acid residues at the dimerisation interface of KpnI DNA methyltransferase
Authors: Bheemanaik Shivakumara , Bujnicki Janusz M. , Nagaraja Valakunja , Rao Desirazu N.
Published: June 2006

KpnI DNA-(N6-adenine) methyltransferase (M.KpnI) recognises the sequence 5′-GGTACC-3′ and transfers the methyl group fromS-adenosyl-L-methionine (AdoMet) to the N6 position of the adenine residue in each strand. Earlier studies have shown that M.KpnI exists as a dimer in solution, unlike most other MTases. To address the importance of dimerisation for enzyme function, a three-dimensional model of M.KpnI was obtained based on protein fold-recognition analysis, using the crystal structures of M.RsrI and M.MboIIA as templates. Residues I146, I161 and Y167, the side chains of which are present in the putative dimerisation interface in the model, were targeted for site-directed mutagenesis. Methylation andin vitrorestriction assays showed that the mutant MTases are catalytically inactive. Mutation at the I146 position resulted in complete disruption of the dimer. The replacement of I146 led to drastically reduced DNA and cofactor binding. Substitution of I161 resulted in weakening of the interaction between monomers, leading to both monomeric and dimeric species. Steady-state fluorescence measurements showed that the wild-type KpnI MTase induces structural distortion in bound DNA, while the mutant MTases do not. The results establish that monomeric MTase is catalytically inactive and that dimerisation is an essential event for M.KpnI to catalyse the methyl transfer reaction.
Subcellular localisation of human inositol 1,4,5-trisphosphate 3-kinase C: species-specific use of alternative export sites for nucleo-cytoplasmic shuttling indicates divergent roles of the catalytic and N-terminal domains
Authors: Nalaskowski Marcus M. , Windhorst Sabine , Stockebrand Malte C. , Mayr Georg W.
Published: June 2006

The three isoforms of human Ins(1,4,5)P3 3-kinase (IP3K) show remarkable differences in their intracellular targeting. Whereas predominant targeting to the cytoskeleton and endoplasmic reticulum has been shown for IP3K-A and IP3K-B, rat IP3K-C shuttles actively between the nucleus and cytoplasm. In the present study we examined the expression and intracellular localisation of endogenous IP3K-C in different mammalian cell lines using an isoform-specific antibody. In addition, human IP3K-C, showing remarkable differences to its rat homologue in the N-terminal targeting domain, was tagged with EGFP and used to examine active transport mechanisms into and out of the nucleus. We found both a nuclear import activity residing in its N-terminal domain and a nuclear export activity sensitive to treatment with leptomycin B. Different from the rat isoform, an exportin 1-dependent nuclear export site of the human enzyme resides outside the N-terminal targeting domain in the catalytic enzyme domain. A phylogenetic survey of vertebrate IP3K sequences indicates that in each of the three isoforms a nuclear export signal has evolved in the catalytic domain either de novo (IP3K-A) or as a substitute for an earlier evolved corresponding N-terminal signal (IP3K-B and IP3K-C). In higher vertebrates, and in particular in primates, re-export of nuclear IP3K activity may be guaranteed by the mechanism discovered.
Development and Prediction of Hyperactive Symptoms From 2 to 7 Years in a Population-Based Sample
Authors: Romano Elisa , Tremblay Richard E. , Farhat Abdeljelil , Côté Sylvana
Published: June 2006

OBJECTIVES. Children with hyperactive symptoms are often referred to mental health services. Given the frequency and persistent nature of hyperactivity, it is important to better understand its developmental course. This study identified the different developmental trajectories of hyperactive symptoms from 2 to 7 years and tested early predictors of high-level and persistent hyperactivity. These data may lead to earlier detection of at-risk children and to more effective interventions that take into account developmental considerations.

PARTICIPANTS. Four data-collection cycles of a nationwide survey of Canadian children were used to track the early development of hyperactivity. Children were 0 to 23 months at the first cycle in 1994 and 6 to 7 years at the fourth cycle in 2000.

OUTCOME MEASURES. Hyperactivity data were gathered from mothers on a biennial basis beginning when children were 24 months old. Information on potential prenatal and postnatal predictors was gathered from mothers at the first cycle.

DESIGN. Group-based semiparametric mixture modeling was used to estimate developmental trajectories, and logistic-regression analysis identified predictors of hyperactivity.

RESULTS. Four trajectories of hyperactive symptoms were identified: very low, low, moderate, and high. Statistically significant predictors for high and persistent hyperactivity, after controlling for all other factors, were maternal prenatal smoking, child male gender, maternal depression, and hostile parenting.

CONCLUSIONS. For the majority of children, the frequency of hyperactive symptoms decreased or remained low from 2 to 7 years. However, 7 children in 100 were classified as having high initial levels of hyperactive symptoms that persisted over time. Several prenatal and early postnatal risk factors identified these children, although additional variables will need to be identified to accurately predict high and persistent hyperactivity. Findings suggest that preventive interventions could target high-risk families during pregnancy and early childhood.
Symptoms in Children/Young People With Progressive Malignant Disease: United Kingdom Children's Cancer Study Group/Paediatric Oncology Nurses Forum Survey
Authors: Goldman Ann , Hewitt Martin , Collins Gary S. , Childs Margaret , Hain Richard ,   for the United Kingdom Children's Cancer Study Group/Paediatric Oncology Nurses' Forum Palliative Care Working Group
Published: June 2006

AIM. The purpose of this study was to survey symptoms in children/young people with progressive cancer and identify which are the most important and which are the most difficult to treat effectively.

PATIENTS AND METHODS. This was a questionnaire survey of 22 United Kingdom Children's Cancer Study Group centers. Data were collected by clinical nurse specialists in pediatric oncology regarding children/young people between 0 and 20 years of age, using 2 questionnaires. The first collected demographic details and the second data about the occurrence and perceived impact of symptoms.

RESULTS. There were 185 children/young people from 20 centers registered in the study, aged 4 months to 19 years (mean: 8.7 years), who received palliative care for a median of 34 days (range: 0–354 days). Data were analyzed for 164 children/young people who died during the study. Between referral to palliative care and death, there were significant increases in the number of symptoms reported and children/young people experiencing pain (70.6% vs 91.5%). Symptoms included some that often go unrecognized in children/young people, for example, anorexia, weight loss, and weakness. The nature of the underlying malignancy significantly influenced the prevalence of some symptoms. There were significant differences between the symptoms associated with central nervous system tumors and other groups. Pain other than headache occurred more commonly in children with solid tumors (98.4%) than in others (87%). Neurologic symptoms, including headache, were universal among those with central nervous system tumors.

CONCLUSION. This study documents the frequency of symptoms and contrasts the experiences of children/young people with different groups of malignant disease. With access to skilled symptom control, pain can be effectively treated in most children/young people. Some other symptoms often remain intractable. The study highlights the need for further research to establish the effectiveness of therapeutic interventions for symptom control and their impact on the quality of life for children/young people dying from cancer.
Impact of Physician Asthma Care Education on Patient Outcomes
Authors: Cabana Michael D. , Slish Kathryn K. , Evans David , Mellins Robert B. , Brown Randall W. , Lin Xihong , Kaciroti Niko , Clark Noreen M.
Published: June 2006

OBJECTIVE. We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians’ asthma therapeutic and communication skills and patients’ health care utilization for asthma.

METHODS. We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians’ communication, the child’s asthma symptoms, and patients’ asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups.

RESULTS. A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients’ concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year).

CONCLUSIONS. The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician’s participation in the program.
Longitudinal Changes of Brain-Type Natriuretic Peptide in Preterm Neonates
Authors: da Graca Ralph L. , Hassinger Denise C. , Flynn Patrick A. , Sison Cristina P. , Nesin Mirjana , Auld Peter A.M.
Published: June 2006

OBJECTIVE. To determine age-related concentrations of brain-type natriuretic peptide in preterm infants using bedside Triage brain-type natriuretic peptide test and correlate it to the presence or absence of the patent ductus arteriosus and ventilatory support.

METHODS. Serum brain-type natriuretic peptide levels were measured in infants who were born at <32 weeks’ gestation from birth to 2 months of age. Serial echocardiograms were performed, until closure of the patent ductus arteriosus, or until discharge. Brain-type natriuretic peptide levels were correlated to the day of life, gestational age, presence or absence of the patent ductus arteriosus, and the degree of ventilatory support. Nineteen preterm infants (gestational age: 24–31 weeks; birth weight: 645–1670 g) were enrolled prospectively during the first 2 weeks of life. Serum brain-type natriuretic peptide levels (pg/mL) were determined in 177 blood samples, and 87 paired echocardiograms were performed.

RESULTS. Significant negative correlation was found between brain-type natriuretic peptide levels and the day of life and remained significant when the patients were stratified by gestational age (≤28 weeks and >28 weeks). Higher brain-type natriuretic peptide levels correlated with increasing grade of the patent ductus arteriosus. Significant differences in brain-type natriuretic peptide levels were seen with increasing ventilatory support. Comparisons between the size of patent ductus arteriosus and the degree of ventilatory support to brain-type natriuretic peptide levels revealed that the size of the patent ductus arteriosus was the major determinant of both brain-type natriuretic peptide levels and the degree of ventilatory support.

CONCLUSIONS. Similar to term infants, brain-type natriuretic peptide levels of preterm infants are related to the chronological age and decline during the first month of life. Rapid bedside Triage brain-type natriuretic peptide is a potentially valuable and practical assay in determining the hemodynamic changes in preterm infants.
Pharmacologic Management of Insomnia in Children and Adolescents: Consensus Statement
Authors: Mindell Jodi A. , Emslie Graham , Blumer Jeffrey , Genel Myron , Glaze Daniel , Ivanenko Anna , Johnson Kyle , Rosen Carol , Steinberg Frank , Roth Thomas , Banas Bridget
Published: June 2006

OBJECTIVE. The purpose of this work was to develop a consensus statement on the current status and future role for pharmacologic management of insomnia in children and adolescents.

METHOD. The National Sleep Foundation, in collaboration with Best Practice Project Management, Inc, convened expert representatives involved in the study and treatment of pediatric insomnia and conducted a 2-day conference to examine the role of pharmacologic management of pediatric insomnia and to make recommendations regarding the development of clinical trials in this area. After a series of presentations providing background on the current knowledge of pediatric insomnia and its treatment alternatives, workgroups provided recommendations for the evaluation of pharmacologic treatment of insomnia in specific populations of children and adolescents and developed guidelines for the core methodologic issues relevant to the design of clinical trials. The group developed consensus recommendations for clinical trials in this area encompassing: (1) high-priority patient populations for research, (2) inclusion/exclusion criteria, (3) outcome measures, (4) ethical considerations unique to clinical trials involving children and adolescents, and (5) priorities for future research that will enhance the understanding of pediatric insomnia.

RESULTS. Conference participants unanimously agreed that there is a need for pharmacologic management of pediatric insomnia. Furthermore, the widespread use of “hypnotic” and psychotropic medications for children in the absence of safety and efficacy data indicates a knowledge gap about the best pharmacologic practices for management of pediatric insomnia. Attendees reached consensus on methodologic issues in the study of pharmacologic treatment of pediatric insomnia including agreeing on a definition of pediatric insomnia as “repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite age-appropriate time and opportunity for sleep and results in daytime functional impairment for the child and/or family.” It was agreed that priority should be given to insomnia studies in children with attention-deficit/hyperactivity disorder and those with pervasive developmental disorders/autism spectrum disorder. There was also agreement on the need for pharmacokinetic and pharmacodynamic studies to determine appropriate dose levels and to evaluate safety with a wide range of doses.

CONCLUSIONS. The treatment of pediatric insomnia is an unmet medical need. Before appropriate pharmacologic management guidelines can be developed, rigorous, large-scale clinical trials of pediatric insomnia treatment are vitally needed to provide information to the clinician on the safety and efficacy of prescription and over-the-counter agents for the management of pediatric insomnia.
Abnormal Brain Connectivity in Children After Early Severe Socioemotional Deprivation: A Diffusion Tensor Imaging Study
Authors: Eluvathingal Thomas J. , Chugani Harry T. , Behen Michael E. , Juhász Csaba , Muzik Otto , Maqbool Mohsin , Chugani Diane C. , Makki Malek
Published: June 2006

OBJECTIVES. We previously reported that children who were subjected to early socioemotional deprivation in Romanian orphanages showed glucose hypometabolism in limbic and paralimbic structures, including the orbital frontal gyrus, infralimbic prefrontal cortex, hippocampus/amygdala, lateral temporal cortex, and the brainstem. The present study used diffusion tensor imaging tractography to examine the integrity of white matter tracts that connect these brain regions.

METHODS. Fractional anisotropy and apparent diffusion coefficient for uncinate fasciculus, stria terminalis, fornix, and cingulum were measured in 7 right-handed children (5 girls and 2 boys; mean age: 9.7 ± 2.6 years) with a history of early severe socioemotional deprivation in Eastern European orphanages and compared with similar measurements in 7 right-handed normal children (4 girls and 3 boys; mean age: 10.7 ± 2.8 years).

RESULTS. Neuropsychological assessment of the orphans verified the relatively mild specific cognitive impairment and impulsivity consistent with previous studies of children who were adopted from Romanian orphanages. Fractional anisotropy values in the left uncinate fasciculus were decreased significantly in the early deprivation group compared with control subjects. Apparent diffusion coefficient values for the early deprivation group tended to be greater than that in control subjects in all of the tracts measured, without reaching statistical significance.

CONCLUSION. Our study demonstrates in children who experienced socioemotional deprivation a structural change in the left uncinate fasciculus that partly may underlie the cognitive, socioemotional, and behavioral difficulties that commonly are observed in these children.
Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy
Authors: Poole Jill A. , Barriga Kathy , Leung Donald Y.M. , Hoffman Michelle , Eisenbarth George S. , Rewers Marian , Norris Jill M.
Published: June 2006

OBJECTIVE. Early exposure to solid foods in infancy has been associated with the development of allergy. The aim of this study was to examine the association between cereal-grain exposures (wheat, barley, rye, oats) in the infant diet and development of wheat allergy.

METHODS. A total of 1612 children were enrolled at birth and followed to the mean age of 4.7 years. Questionnaire data and dietary exposures were obtained at 3, 6, 9, 15, and 24 months and annually thereafter. The main outcome measure was parent report of wheat allergy. Children with celiac disease autoimmunity detected by tissue transglutaminase autoantibodies were excluded. Wheat-specific immunoglobulin E levels on children reported to have wheat allergy were obtained.

RESULTS. Sixteen children (1%) reported wheat allergy. Children who were first exposed to cereals after 6 months of age had an increased risk of wheat allergy compared with children first exposed to cereals before 6 months of age (after controlling for confounders including a family history of allergic disorders and history of food allergy before 6 months of age). All 4 children with detectable wheat-specific immunoglobulin E were first exposed to cereal grains after 6 months. A first-degree relative with asthma, eczema, or hives was also independently associated with an increased risk of wheat-allergy development.

CONCLUSIONS. Delaying initial exposure to cereal grains until after 6 months may increase the risk of developing wheat allergy. These results do not support delaying introduction of cereal grains for the protection of food allergy.
Thoughts on Health Supervision: Learning-Focused Primary Care
Authors: Needlman Robert
Published: June 2006

Primary care clinicians confront a long list of topics that are supposed to be covered during well-child visits, but evidence for the effectiveness of preventive counseling for most issues is limited, and it is doubtful that covering more topics confers correspondingly enhanced clinical benefits. Amid growing professional interest in rethinking primary care, 3 ideas that would facilitate constructive change are proposed. First, face-to-face time between doctors and parents should be allocated as a scarce resource, with priority given to topics that are both important and uniquely responsive to in-office intervention. Second, to maximize the educational value of anticipatory guidance, visits could focus on experiential, as opposed to merely didactic, learning. Finally, recommendations for primary care should be based on evidence, rather than expert opinion. Competing protocols for preventive care ought to be subjected to large-scale, coordinated research. The unit of analysis should be the visit or series of visits, rather than a single intervention. A crucial first step would be the definition of universal outcome measures.
Orthopedic Complications of Overweight in Children and Adolescents
Authors: Taylor Erica D. , Theim Kelly R. , Mirch Margaret C. , Ghorbani Samareh , Tanofsky-Kraff Marian , Adler-Wailes Diane C. , Brady Sheila , Reynolds James C. , Calis Karim A. , Yanovski Jack A.
Published: June 2006

OBJECTIVE. Few studies have quantified the prevalence of weight-related orthopedic conditions in otherwise healthy overweight children. The goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large pediatric cohort of children that included severely overweight children.

METHODS. Medical charts from 227 overweight and 128 nonoverweight children and adolescents who were enrolled in pediatric clinical studies at the National Institutes of Health from 1996 to 2004 were reviewed to record pertinent orthopedic medical history and musculoskeletal complaints. Questionnaire data from 183 enrollees (146 overweight) documented difficulties with mobility. In 250, lower extremity alignment was determined by bilateral metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements made from whole-body dual-energy x-ray absorptiometry scans.

RESULTS. Compared with nonoverweight children, overweight children reported a greater prevalence of fractures and musculoskeletal discomfort. The most common self-reported joint complaint among those who were questioned directly was knee pain (21.4% overweight vs 16.7% nonoverweight). Overweight children reported greater impairment in mobility than did nonoverweight children (mobility score: 17.0 ± 6.8 vs 11.6 ± 2.8). Both metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements showed greater malalignment in overweight compared with nonoverweight children.

CONCLUSIONS. Reported fractures, musculoskeletal discomfort, impaired mobility, and lower extremity malalignment are more prevalent in overweight than nonoverweight children and adolescents. Because they affect the likelihood that children will engage in physical activity, orthopedic difficulties may be part of the cycle that perpetuates the accumulation of excess weight in children.
Delivery Room Decision-Making for Extremely Preterm Infants in Sweden
Authors: Peerzada Jehanna M. , Schollin Jens , Håkansson Stellan
Published: June 2006

OBJECTIVE. To assess neonatologists' attitudes and practices regarding treatment of extremely preterm infants in the delivery room, particularly in response to parental wishes.

STUDY DESIGN. Cross-sectional survey of all neonatologists in Sweden registered with the Swedish Pediatric Society.

RESULTS. The response rate was 71% (88 of 124 neonatologists). At 24[1/7] to 24[6/7] weeks of gestation, 68% of neonatologists considered treatment clearly beneficial; at 25[1/7] to 25[6/7] weeks of gestation, 93% considered it clearly beneficial. When respondents consider treatment clearly beneficial, 97% reported that they would resuscitate in the delivery room despite parental requests to withhold treatment. At or below 23[0/7] weeks of gestation, 94% of neonatologists considered treatment futile. Nineteen percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, 99% reported that they would resuscitate when parents request it, 99% reported that they would resuscitate when parents are unsure, and 25% reported that they would follow parental requests to withhold treatment.

CONCLUSION. Although neonatologists' attitudes and practices varied, respondents to our survey in general envisioned little parental role in delivery room decision-making for extremely preterm infants.
Social Capital, Family Violence, and Neglect
Authors: Zolotor Adam J. , Runyan Desmond K.
Published: June 2006

BACKGROUND. Social capital includes collective efficacy, psychological sense of community, neighborhood cohesion, and parental investment in the child. It has been shown to be associated with a variety of health and welfare outcomes and may be useful in understanding and preventing parenting behaviors on the continuum of child abuse and neglect.

OBJECTIVE. The purpose of this research was to evaluate low social capital as a risk factor for harsh physical punishment, neglectful parenting, psychologically harsh parenting, and domestic violence.

METHODS. This study is an analysis of cross-sectional telephone survey data of mothers in North and South Carolina (n = 1435). We constructed a 4-point social capital index reflecting survey responses to items ascertaining neighborhood characteristics, willingness to take personal action, the presence of 2 adults in the household, and regular religious service participation. We assessed the relationship of social capital to inventories of self-reported parenting behaviors and in-home violence.

RESULTS. In adjusted analysis, we found that each 1 point increase in a 4-point social capital index was associated with a 30% reduction in the odds of neglectful parenting, psychologically harsh parenting, and domestic violence. There was no relationship between social capital and harsh physical punishment.

CONCLUSIONS. This study demonstrates that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting, and domestic violence but not harsh physical punishment. This supports further investigation into developing social capital as a resource for families.
Can School Income and Racial/Ethnic Composition Explain the Racial/Ethnic Disparity in Adolescent Physical Activity Participation?
Authors: Richmond Tracy K. , Hayward Rodney A. , Gahagan Sheila , Field Alison E. , Heisler Michele
Published: June 2006

OBJECTIVE. Our goal was to determine if racial/ethnic disparities in adolescent boys' and girls' physical activity participation exist and persist once the school attended is considered.

METHODS. We performed a cross-sectional analysis of 17007 teens in the National Longitudinal Study of Adolescent Health. Using multivariate linear regression, we examined the association between adolescent self-reported physical activity and individual race/ethnicity stratified by gender, controlling for a wide range of sociodemographic, attitudinal, behavioral, and health factors. We used multilevel analyses to determine if the relationship between race/ethnicity and physical activity varied by the school attended.

RESULTS. Participants attended racially segregated schools; ∼80% of Hispanic and black adolescent boys and girls attended schools with student populations that were <66% white, whereas nearly 40% of the white adolescents attended schools that were >94% white. Black and Hispanic adolescent girls reported lower levels of physical activity than white adolescent girls. There were more similar levels of physical activity reported in adolescent boys, with black boys reporting slightly more activities. Although black and Hispanic adolescent girls were more likely to attend poorer schools with overall lower levels of physical activity in girls; there was no difference within schools between black, white, and Hispanic adolescent girls' physical activity levels. Within the same schools, both black and Hispanic adolescent boys had higher rates of physical activity when compared with white adolescent boys.

CONCLUSIONS. In this nationally representative sample, lower physical activity levels in Hispanic and black adolescent girls were largely attributable to the schools they attended. In contrast, black and Hispanic males had higher activity levels than white males when attending the same schools. Future research is needed to determine the mechanisms through which school environments contribute to racial/ethnic disparities in adolescent physical activity and will need to consider gender differences in these racial/ethnic disparities.
Pediatric Eye Injury–Related Hospitalizations in the United States
Authors: Brophy Megan , Sinclair Sara A. , Hostetler Sarah Grim , Xiang Huiyun
Published: June 2006

OBJECTIVE. An estimated 2.4 million eye injuries occur in the United States each year, with nearly 35% of injuries among persons aged 17 years or less. Although previous research has identified some of the characteristics of pediatric eye injuries, many studies focused only on a specific patient population or type of eye injury or relied on self-reported data. In addition, little information has been reported on the total charges associated with treating pediatric eye injuries. Using a large national database, our aim was to examine hospitalizations for the treatment of pediatric eye injuries in the United States, including the demographic, medical care, and financial characteristics associated with major categories of eye injury.

METHODS. Cross-sectional data were derived from the 2000 Kids' Inpatient Database of the Healthcare Cost and Utilization Project. Eye injury–related hospitalizations were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes. Discharges were selected if the eye injury was the principal or secondary diagnosis. Guidelines from the Centers for Disease Control and Prevention were used to group external-cause-of-injury codes into broader categories to allow meaningful comparison with previous studies. The reported charges for the treatment of eye injuries and the expected primary payer were determined. Cases were statistically weighted to produce national estimates of hospitalizations for pediatric eye injuries and to determine the characteristics of these injuries.

RESULTS. Data were collected by the Kids' Inpatient Database for 3834 actual eye injury–related hospitalizations. These records represent an estimated 7527 eye injury–related hospitalizations among children aged 20 years or less in the United States during 2000. Inpatient charges for the treatment of these injuries were more than $88 million. The rate of hospitalization for pediatric eye injuries in the United States in 2000 was 8.9 per 100000 persons aged 20 years or less. Young adults aged 18 to 20 years accounted for the highest percentage of hospitalizations (23.7%). Males accounted for 69.7% of hospitalizations. A majority of hospitalizations were for open wounds of the ocular adnexa. Motor vehicle crash was the most common cause of injury, followed by being struck by or against an object and being cut or pierced.

CONCLUSIONS. These findings illustrate the considerable morbidity, financial burden, and proximal causes for pediatric eye injury–related hospitalizations. Our data support the need for eye injury prevention efforts that consider the age, gender, and developmental stage of children. Educating parents and children about the potential for eye injuries at home and during hazardous activities is an important public health goal. In addition, promoting the use of appropriate protective eyewear by children during activities with a high risk of ocular trauma will help prevent future eye injuries.
The Impact of Extremely Low Birth Weight on the Families of School-Aged Children
Authors: Drotar Dennis , Hack Maureen , Taylor Gerry , Schluchter Mark , Andreias Laura , Klein Nancy
Published: June 2006

OBJECTIVE. The purpose of this study was to document the impact and burden of extremely low birth weight (<1000 g) and associated problems on the families of school-aged children in a controlled study. The study was also designed to document the salient predictors of individual differences of family impact within the extremely low birth weight group.

METHODS. A prospective study was completed at 8 years of a cohort of 219 children with extremely low birth weight born 1992–1995 and 176 children with normal birth weight. Measures included the following predictor variables: socioeconomic status and parent risk, birth risk, neonatal risk, neurodevelopmental outcome, impairment in adaptive abilities, and functional impact of chronic conditions. The primary outcome measure was the Impact on Family scale. A measure of family stressors and resources (the Life Stressors and Social Resources Inventory) was also obtained.

RESULTS. The primary finding was that the total family impact was greater in the extremely low birth weight group compared with controls. Moreover, the negative impact on family in specific domains was greater in the extremely low birth weight group in financial impact, caretaker burden, and familial burden. These differences were not attributable to general family stressors, socioeconomic status, child, gender, or race. Higher parent/socioeconomic risk, neurodevelopmental outcomes, and the functional impact of chronic conditions predicted greater family impact within the extremely low birth weight group, whereas birth and neonatal risk scores did not.

CONCLUSIONS. Extremely low birth weight was associated with a negative impact on families. Socioeconomic parental risk, but most especially child-related factors such as neurodevelopmental and the functional impact of chronic conditions, predicted the negative family impact within the extremely low birth weight group. Findings underscore the need to develop and test interventions to provide support for families of extremely low birth weight infants to ameliorate the burden of extremely low birth weight and associated risk factors on families.
Neurodevelopmental and Respiratory Follow-up Results at 7 Years for Children From the United Kingdom and Ireland Enrolled in a Randomized Trial of Early and Late Postnatal Corticosteroid Treatment, Systemic and Inhaled (the Open Study of Early Corticosteroid Treatment)
Authors: Wilson Trevor T. , Waters Lorraine , Patterson Chris C. , McCusker Chris G. , Rooney Nichola M. , Marlow Neil , Halliday Henry L.
Published: June 2006

OBJECTIVES. The goals were to compare early school-age neurodevelopmental and respiratory outcomes for children who were treated with either early (<3 days) or delayed selective (>15 days) postnatal corticosteroid therapy and to compare systemic dexamethasone treatment with inhaled budesonide treatment.

METHODS. One hundred twenty-seven (84%) of 152 survivors from the United Kingdom and Ireland who were recruited to the Open Study of Early Corticosteroid Treatment, a randomized trial of inhaled and systemic corticosteroid therapy to prevent chronic lung disease, were traced and assessed at a median age of 7 years. Outcome measures were level of disability, presence of cerebral palsy, cognitive ability, behavioral difficulties and competencies, growth, and respiratory symptoms. Results were adjusted for potential confounding variables (gestational age, birth weight, gender, prenatal steroid therapy, method of delivery, Apgar score at 5 minutes, and Clinical Risk Index for Babies score).

RESULTS. There were no significant differences among the treatment groups in cognitive ability, behavioral competencies or difficulties, overall disability rates, cerebral palsy, combined outcomes of death or cerebral palsy and death or moderate/severe disability, growth, respiratory morbidity, or diastolic blood pressure. Those assigned to dexamethasone were more likely to have high systolic blood pressure and to have a diagnosis of asthma than were those assigned to budesonide.

CONCLUSIONS. Although postnatal steroid therapy has been associated with poor long-term outcomes, this study failed to show significant differences in cognitive function between dexamethasone- and budesonide-allocated groups. There may be increased systolic blood pressure and a greater likelihood of developing asthma in childhood after postnatal dexamethasone treatment.
Attitudes Predict the Use of Physical Punishment: A Prospective Study of the Emergence of Disciplinary Practices
Authors: Vittrup Brigitte , Holden George W. , Buck Jeanell
Published: June 2006

OBJECTIVE. We sought to track the emergence of discipline techniques by mothers of young children and assess the predictive validity of spanking attitudes with subsequent reports of spanking.

METHODS. One hundred thirty-two mothers were surveyed every 6 months (beginning when their child was 12 months old until they were 4 years old) regarding how they disciplined their children. The discipline behaviors measured included physical punishment, noncoercive methods, and the use of time-outs and withdrawal of privileges. Attitudes toward spanking also were assessed several times.

RESULTS. When their infants were 12 months old, mothers reported using 10 of the 12 discipline techniques assessed, and by the time the children were 24 months old, most mothers reported widespread use of the techniques. The frequency of use increased with age. Although the use of some discipline methods changed as the children got older, the mothers showed significant stability in their overall discipline strategy. Attitudes toward spanking (assessed when their children were 6 months old) were significantly correlated with subsequent spanking behavior, and the mothers’ attitudes showed stability over time as well.

CONCLUSIONS. By the time infants are 12 months old, discipline is a frequent occurrence in many families. A variety of techniques are used, and attitudes toward spanking predict subsequent spanking behavior. This information is useful for pediatricians, because it provides parents with anticipatory guidance about disciplining young children.
Long-term Trends in the Incidence of Headache in Finnish Schoolchildren
Authors: Anttila Pirjo , Metsähonkala Liisa , Sillanpää Matti
Published: June 2006

OBJECTIVE. To study changes over time in the incidence of migraine and frequent headache.

METHODS. A population-based study on migraine and other headaches in Finnish children starting school at age 7 years in the city of Turku was conducted in 1974, 1992, and 2002. The study design used in each study was virtually identical. The study population included 1927 children in 1974, 1436 children in 1992, and 1066 children in 2002. The corresponding response rates were 90%, 96%, and 81%.

RESULTS. An increasing trend in the incidence of migraine was found from 1974 to 2002 in both boys and girls. The incidence rates of migraine with aura increased from 5.2 per 1000 person-years in 1974 to 41.3 per 1000 person-years in 2002. The increase in the rates of migraine without aura was from 14.5 per 1000 person-years in 1974 to 91.9 in 2002. Similarly, a significant increase over time was seen in the incidence of frequent headache from 1974 to 2002 in both boys and girls.

CONCLUSIONS. The incidence of childhood migraine and frequent headache has substantially increased over the last 30 years. The increased incidence is alarming and reflects untoward changes in children's lifestyles. Additional studies are needed on causal associations with life changes.
Expanded Newborn Screening for Biochemical Disorders: The Effect of a False-Positive Result
Authors: Gurian Elizabeth A. , Kinnamon Daniel D. , Henry Judith J. , Waisbren Susan E.
Published: June 2006

BACKGROUND. Newborn screening programs now identify children with >30 biochemical genetic disorders. False-positive identifications may increase as disorders are added to screening panels. Concerns arise regarding the potential impact on parental stress, family relationships, and perceptions of the child's health.

METHODS. Parents of 173 infants with false-positive screening results for a biochemical genetic disorder in the expanded newborn screening panel were compared with parents of 67 children with normal screening results. Parents completed an interview that elicited information about demographic features, child and parental health, and understanding of newborn screening. Parents also completed the parenting stress index.

RESULTS. Parents in the false-positive group attained higher total scores on the PSI than did parents in the normal-screened group, scoring higher on the parent-child dysfunction subscale and the difficult child subscale. Only approximately one third of parents in the false-positive group reported knowing the correct reason for repeat screening. Mothers who reported knowing the correct reason for their child's repeat screening test experienced less total stress than did mothers who were misinformed, were not informed, or did not remember.

CONCLUSIONS. False-positive screening results may affect parental stress and the parent-child relationship. Improved communication with parents regarding the need for repeat screening tests may reduce the negative impact of false-positive results.
Behavioral Outcome at 3 Years of Age in Very Preterm Infants: The EPIPAGE Study
Authors: Delobel-Ayoub Malika , Kaminski Monique , Marret Stéphane , Burguet Antoine , Marchand Laetitia , N′Guyen Sylvie , Matis Jacqueline , Thiriez Gérard , Fresson Jeanne , Arnaud Catherine , Poher Martine , Larroque Béatrice ,   for the EPIPAGE Study Group
Published: June 2006

OBJECTIVES. Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children.

METHODS. We conducted a prospective population-based cohort study: the EPIPAGE (Étude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents.

RESULTS. Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance.

CONCLUSIONS. Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.
Diarrhea- and Rotavirus-Associated Hospitalizations Among Children Less Than 5 Years of Age: United States, 1997 and 2000
Authors: Malek Mark A. , Curns Aaron T. , Holman Robert C. , Fischer Thea K. , Bresee Joseph S. , Glass Roger I. , Steiner Claudia A. , Parashar Umesh D.
Published: June 2006

OBJECTIVE. A new rotavirus vaccine may be licensed in the United States in early 2006. Estimates of the burden of severe rotavirus disease, particularly hospitalizations, will help evaluate the potential benefits of a national rotavirus immunization program.

DESIGN. The Kids' Inpatient Database, a robust sample of 10% of the uncomplicated births and 80% of other pediatric discharges was used to estimate the number and rate of diarrhea- and rotavirus-associated hospitalizations among US children <5 years of age in 1997 and 2000.

RESULTS. In 1997 and 2000, diarrhea was coded in 13% of all childhood hospitalizations, for an estimated cumulative incidence of 1 diarrhea hospitalization per 23 to 27 children by age 5. Most diarrhea-associated hospitalizations (62%) were coded as unspecified etiology, and 35% as viral. Rotavirus was the most common pathogen recorded for 18% and 19% of diarrhea-associated hospitalizations in 1997 and 2000, respectively. Diarrhea-associated hospitalizations coded as unspecified or viral exhibited a marked winter peak similar to that of hospitalizations coded as rotavirus, suggesting that the rotavirus-specific code captures a fraction of all rotavirus hospitalizations. Using indirect methods, we estimated that rotavirus was associated with 51142–60155 and 46839–56820 hospitalizations in 1997 and 2000, respectively. By these estimates, rotavirus is associated with 4% to 5% of all childhood hospitalizations, and 1 in 67 to 1 in 85 children will be hospitalized with rotavirus by 5 years of age.

CONCLUSIONS. Diarrhea is an important cause of hospitalization in US children, and rotavirus is the most important etiology. Disease burden estimates have remained stable during the past decade. An effective rotavirus vaccine will likely reduce substantially the burden of severe rotavirus disease, estimated to account for 4% to 5% of all hospitalizations and ∼30% of hospitalizations for watery diarrhea among children <5 years of age.
Associations Between Childhood Vaccination Coverage, Insurance Type, and Breaks in Health Insurance Coverage
Authors: Smith Philip J. , Stevenson John , Chu Susan Y.
Published: June 2006

OBJECTIVES. This study explored how vaccination coverage is associated with not being insured and with insurance type among children who are insured and to show how these associations are modified by race/ethnicity.

METHODS. We determined whether 8324 children sampled in the National Immunization Survey in 2001 and 2002 were covered by private insurance only, Medicaid/State Children's Health Insurance Program, or another insurance type or were uninsured at the time of the National Immunization Survey interview or were uninsured at some time before the interview. Children were up to date if, by the date of the interview, their vaccination providers had administered ≥4 doses of diphtheria-tetanus toxoids-acellular pertussis vaccine, ≥3 doses of polio vaccine, ≥1 dose of measles-mumps-rubella vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine. To evaluate the association between insurance type and breaks in insurance with timely completion of the recommended vaccination schedule soon after 19 months of age, we restricted our analyses to children 19 to 24 months of age.

RESULTS. Nationally, 12.6 ± 1.6% of all children 19 to 24 months of age were uninsured at some time. Children who were uninsured at the time of the National Immunization Survey interview had significantly lower vaccination coverage than did children with Medicaid/State Children's Health Insurance Program coverage or children with private insurance only (52.6% vs 70.0% and 75.6%). Children who had never been insured and children who were insured but had a break in insurance coverage in the 12 months immediately preceding the National Immunization Survey interview had significantly lower vaccination coverage than did children who had been insured continuously (47.4% and 64.8% vs 73.5%).

CONCLUSIONS. Approximately 1 of 8 children were uninsured at some time, and those children were at greater risk of not being vaccinated on time as recommended.