bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences on Children's Oral Health: A Conceptual Model
Authors: Fisher-Owens Susan A. , Gansky Stuart A. , Platt Larry J. , Weintraub Jane A. , Soobader Mah-J , Bramlett Matthew D. , Newacheck Paul W.
Published: August 2007

OBJECTIVES. Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

METHODS. The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.

RESULTS. A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.

CONCLUSIONS. This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.
Clinical Manifestations and Predictors of Severe Malaria in Indian Children
Authors: Tripathy Radha , Parida Sailajanandan , Das Leena , Mishra Debi Prasad , Tripathy Diptimayee , Das Mangala Charan , Chen Hegang , Maguire James H. , Panigrahi Pinaki
Published: August 2007

OBJECTIVE. Although the greatest morbidity and mortality attributable to malaria occurs among children in Africa, up to one third of the world's malaria burden is borne by non-African countries, where levels of endemicity are lower. Because there are few published criteria for managing life-threatening malaria in children in these countries, we conducted a study of major syndromes and predictors of death among critically ill Indian children to identify factors that could be used to improve the approach to their treatment.

METHODS. A prospective study was conducted at the pediatric ward of SCB Medical College in eastern India (Orissa). Baseline demographic data were collected on all of the patients with confirmed slide-positive falciparum malaria. Patients satisfying any 1 of the 2000 World Health Organization criteria for severe malaria were included in the analysis. Prevalence of and mortality as a result of major symptoms were calculated followed by multiple regression modeling to identify major predictors of death.

RESULTS. Of 1682 confirmed cases of malaria during a 32-month period, 374 subjects met the World Health Organization criteria for severe malaria. The case fatality rate was 12% in this series. Multiple regression analysis identified respiratory distress, coma, multiple organ dysfunctions, and hyperparasitemia as major predictors of death. Anemia and jaundice did not emerge as important markers of mortality. Many patients presented with multiple major complications, and the mortality rate was consistently high when >1 major predictor was present in a patient.

CONCLUSIONS. Clinical features in Indian children differed from those reported in most studies that involved an African population. Multiple organ dysfunctions emerged as an important presenting feature and a new predictor of death in childhood malaria.
Group B Streptococcal Infections in a Northern Region of Italy
Authors: Berardi Alberto , Lugli Licia , Baronciani Dante , Creti Roberta , Rossi Katia , Ciccia Matilde , Gambini Lucia , Mariani Sabrina , Papa Irene , Serra Laura , Tridapalli Elisabetta , Ferrari Fabrizio ,   for the GBS Prevention Working Group of Emilia-Romagna
Published: August 2007

BACKGROUND. Group B streptococcus is a leading cause of neonatal bacterial infections. Despite adoption of preventive strategies, cases of infection continue to occur and there is concern that widespread antimicrobial prophylaxis might delay rather than prevent disease onset, increasing the rates of late-onset diseases.

OBJECTIVES. The purpose of this study was to determine the incidence and clinical features of early- and late-onset group B streptococcus disease in a northern region of Italy where a screening-based approach had been proposed.

METHODS. A population-based study was prospectively conducted in Emilia-Romagna, Italy. Infections that occurred during 2003–2005 in infants aged <3 months were analyzed.

RESULTS. Among 112933 live births, 56 cases of invasive disease (30 early- and 26 late-onset disease) were observed, giving an annual group B streptococcus disease incidence of 0.50 per 1000 live births. Eleven infants with early-onset disease showed no signs of illness or were mildly ill, whereas 19 had moderate-to-severe symptoms, and culture-proven meningitis was found in 2. Risk factors were detected in 12 women. Twenty-two mothers had antenatal screening; 5 were group B streptococcus colonized, but 17 were culture-negative. Prophylaxis was administered in 3 women. Three infants with late-onset diseases were mildly ill, whereas 23 had moderate-to-severe symptoms. Risk factors were found in 7 mothers. Late-onset diseases were clinically more severe than early-onset diseases; meningitis was diagnosed in 12 infants, and 4 of 26 died.

CONCLUSIONS. The incidence of early-onset disease was low. Some early infections were still observed because of negative screening results or missed opportunity for prevention. Late-onset diseases accounted for most meningitis cases and deaths. Strict adherence to protocols and adoption of optimal culture methods would further improve prevention of early-onset disease, but the aim of future strategies should be the prevention of all invasive diseases.
Attenuation of the September Epidemic of Asthma Exacerbations in Children: A Randomized, Controlled Trial of Montelukast Added to Usual Therapy
Authors: Johnston Neil W. , Mandhane Piush J. , Dai Jennifer , Duncan Joanne M. , Greene Justina M. , Lambert Kim , Sears Malcolm R.
Published: August 2007

BACKGROUND. A recurring epidemic of asthma exacerbations in children occurs annually in September in North America when school resumes after summer vacation.

OBJECTIVE. Our goal was to determine whether montelukast, added to usual asthma therapy, would reduce days with worse asthma symptoms and unscheduled physician visits of children during the September epidemic.

PATIENTS AND METHODS. A total of 194 asthmatic children aged 2 to 14 years, stratified according to age group (2–5, 6–9, and 10–14 years) and gender, participated in a double-blind, randomized, placebo-controlled trial of the addition of montelukast to usual asthma therapy between September 1 and October 15, 2005.

RESULTS. Children randomly assigned to receive montelukast experienced a 53% reduction in days with worse asthma symptoms compared with placebo (3.9% vs 8.3%) and a 78% reduction in unscheduled physician visits for asthma (4 [montelukast] vs 18 [placebo] visits). The benefit of montelukast was seen both in those using and not using regular inhaled corticosteroids and among those reporting and not reporting colds during the trial. There were differences in efficacy according to age and gender. Boys aged 2 to 5 years showed greater benefit from montelukast (0.4% vs 8.8% days with worse asthma symptoms) than did older boys, whereas among girls the treatment effect was most evident in 10- to 14-year-olds (4.6% [montelukast] vs 17.0% [placebo]), with nonsignificant effects in younger girls.

CONCLUSIONS. Montelukast added to usual treatment reduced the risk of worsened asthma symptoms and unscheduled physician visits during the predictable annual September asthma epidemic. Treatment-effect differences observed between age and gender groups require additional investigation.
Children of HIV-Infected Parents: Custody Status in a Nationally Representative Sample
Authors: Cowgill Burton O. , Beckett Megan K. , Corona Rosalie , Elliott Marc N. , Zhou Annie J. , Schuster Mark A.
Published: August 2007

OBJECTIVE. The purpose of this work was to determine the rates and predictors of custody status for children of HIV-infected parents.

PARTICIPANTS AND METHODS. Data came from interviews of 538 parents with 1017 children (0–17 years old) from a nationally representative sample of HIV-infected adults receiving health care in the United States. Outcomes were collected at 2 survey waves and included child custody status and who, other than the HIV-infected parent, had custody of the child. Child custody status was categorized as (1) in custody of HIV-infected parent at both survey waves, (2) infected parent had custody at first survey wave but not second survey wave, (3) not in custody of infected parent at either survey wave, and (4) infected parent gained custody between survey waves. Potential custodians included (1) other biological parent, (2) state, foster, or adoptive parent, (3) grandparent, and (4) relative, friend, nonbiological parent, or other. Multinomial logistic regression modeled both outcomes.

RESULTS. Forty-seven percent of the children were in the custody of their HIV-infected parent at both survey waves, 4% were in the parent's custody at the first but not second survey wave, 42% were not in custody at either survey wave, and the parent of 7% gained custody between survey waves. Parents cited drug use (62%) and financial hardship (27%) as reasons for losing custody. Children of HIV-infected fathers, older parents, parents living without other adults, parents with low CD4 counts, drug-using parents, and parents with ≥1 hospital stay were less likely to be in their parent's custody at either survey wave.

CONCLUSIONS. More than half of the children were not in custody of their HIV-infected parent at some time during the study period. Pediatricians and others taking care of children with HIV-infected parents may be able to offer counseling or referrals to assist parents with child custody issues.
Characteristics of Children Discharged From Hospitals in the United States in 2000 With the Diagnosis of Acute Rheumatic Fever
Authors: Miyake Christina Y. , Gauvreau Kimberlee , Tani Lloyd Y. , Sundel Robert P. , Newburger Jane W.
Published: August 2007

OBJECTIVE. The goal was to describe characteristics of children discharged from hospitals in the United States in 2000 with the diagnosis of acute rheumatic fever.

METHODS. We explored characteristics of children <21 years of age who were hospitalized with a diagnosis of acute rheumatic fever by using the 2000 Kids' Inpatient Database, weighted to estimate the number and rate of acute rheumatic fever–associated hospitalizations in the United States.

RESULTS. In 2000, an estimated 503 acute rheumatic fever hospitalizations occurred among children <21 years of age, at a rate of 14.8 cases per 100000 hospitalized children, with a mean age of 10 years. In comparison with all Kids' Inpatient Database admissions, acute rheumatic fever hospitalizations were more common in the age group of 6 to 11 years and among male patients. Chorea was more common in female patients (61.7%). White patients were significantly underrepresented, whereas Asian/Pacific Islander patients and patients of other races were overrepresented. Hospitalizations of patients with acute rheumatic fever were significantly more common in the Northeast and less common in the South. The highest rates of acute rheumatic fever hospitalizations occurred in Utah, Hawaii, Pennsylvania, and New York. Significantly more acute rheumatic fever admissions occurred in March. The expected payor was more likely to be private insurance and less likely to be Medicaid. Acute rheumatic fever hospitalizations were more likely to occur in teaching hospitals, freestanding children's hospitals, and children's units in general hospitals and in urban locations. The median length of stay for acute rheumatic fever hospitalizations was 3 days, and the median total charges were $6349. The in-hospital mortality rate was 0.6%.

CONCLUSIONS. In 2000, we found that hospitalizations for acute rheumatic fever were infrequent and varied according to race, season, location, and type of hospital.
Administration of Inactivated Trivalent Influenza Vaccine to Parents of High-Risk Infants in the Neonatal Intensive Care Unit
Authors: Shah Shetal I. , Caprio Martha , Hendricks-Munoz Karen
Published: August 2007

OBJECTIVE. Infants who are younger than 6 months and have influenza demonstrate significant morbidity and mortality. Trivalent inactivated influenza vaccine is indicated for parents and household contacts of these infants; however, the influenza vaccination rate in this population is estimated at 30%. The objective of this study was to determine the feasibility of trivalent inactivated influenza vaccine administration to parents in a tertiary-care, level III NICU and measure the effect of this program on vaccination rates among parents of this high-risk population.

METHODS. For a 4-month period during influenza season, all parents of admitted patients were informed of the risks and benefits of trivalent inactivated influenza vaccine by placing an information letter at their infant's bedside. All staff were educated about the dangers of influenza and instructed to reinforce the need to obtain vaccination. Parents were screened, provided medical consent, and, when eligible, were immunized at their infant's bedside.

RESULTS. During the study period, 158 children (273 parents) were admitted to the NICU with gestational ages ranging from 24 to 41 weeks; 220 parents (130 infants) were offered the vaccine, and 40 parents received the vaccine from their obstetrician. Overall vaccination rate was 95% (209 parents). A total of 23% of the parent population had never received trivalent inactivated influenza vaccine, despite having previous indications for immunization (smoking, asthma, or other children younger than 23 months, the indicated age for parental vaccination at the time of this study); 75% of the population received trivalent inactivated influenza vaccine for the first time. The 28 infants whose parents were not offered vaccine spent <72 hours in the NICU.

CONCLUSIONS. Administration of trivalent inactivated influenza vaccine in the NICU is an effective means of increasing vaccination rates in parents of this population. In addition, the improved access and convenience allow for an increase in first-time vaccination of parents who were previously eligible to receive trivalent inactivated influenza vaccine but were never immunized.
Additional Health Care Visits Needed Among Adolescents for Human Papillomavirus Vaccine Delivery Within Medical Homes: A National Study
Authors: Rand Cynthia M. , Szilagyi Peter G. , Albertin Christina , Auinger Peggy
Published: August 2007

OBJECTIVE. We estimated the additional number of primary care visits needed to deliver 3 doses of human papillomavirus vaccine to all US adolescents in medical homes. We determined adolescent and family factors associated with needing the greatest number of additional visits for full human papillomavirus vaccination.

METHODS. We performed a cross-sectional analysis of adolescents 11 to 21 years of age included in the 2002 and 2003 Medical Expenditure Panel Surveys (n = 2900) to measure existing primary care visits to pediatricians, family physicians, obstetrician/gynecologists, and internists. We then estimated additional visits needed for human papillomavirus vaccination. We determined the number of additional visits needed within a 6-, 12-, 18-, or 24-month vaccination window.

RESULTS. Within a 12-month period, 72% of female adolescents would need 3 visits for human papillomavirus vaccination if the vaccine was introduced at a preventive visit; 9% and 16% would need 1 and 2 more visits, respectively. Similarly, 79% of male patients would need 3 visits; 7% and 12% would need 1 and 2 more visits, respectively. If all opportunities to vaccinate were used, then 41% of female patients and 52% of male patients would need 3 additional visits within 12 months. With expansion of the window to 24 months and vaccination at every possible visit, 23% of female patients and 37% of male patients would need 3 additional visits. Factors that predicted needing more visits (2 or 3 vs 0 or 1 in 24 months) included being older, male, black, Hispanic, uninsured, and near-poor.

CONCLUSIONS. Most adolescents would require 2 or 3 additional primary care visits to receive 3 vaccines for human papillomavirus in the medical home. Strategies to minimize additional visits include vaccinating patients at all primary care visits and encouraging annual preventive visits.
Three-Year Surveillance of Intussusception in Children in Switzerland
Authors: Buettcher Michael , Baer Gurli , Bonhoeffer Jan , Schaad Urs B. , Heininger Ulrich
Published: August 2007

OBJECTIVE. We attempted to obtain baseline data on the incidence of intussusception and its association with gastroenteritis in a cross-sectional observational study in children.

METHODS. Admissions to all 38 pediatric units in Switzerland because of intussusception were reported to the Swiss Pediatric Surveillance Unit from April 2003 to March 2006. Patient and disease characteristics were assessed prospectively with the use of a standardized questionnaire based on the case definition for intussusception developed by the Brighton Collaboration. Completeness of reporting was verified through capture-recapture analysis.

RESULTS. There were 294 patients with reported intussusception; 35 cases were excluded for various reasons, and 29 additional patients were identified through International Classification of Diseases, 10th Revision, codes. After capture-recapture analysis, we estimated underreporting to the Swiss Pediatric Surveillance Unit to be 32% and we calculated a true number of 381 intussusception episodes. The highest level of diagnostic certainty was reached by 248 patients, and 20 fulfilled level 2 criteria; for the remaining 20 patients, available information was insufficient. The mean age of the patients was 2.7 years. The yearly mean incidence of intussusception was 38, 31, and 26 cases per 100000 live births in the first, second, and third year of life, respectively, with no apparent seasonality. Seventy patients had a history of coinciding gastroenteritis, and 5 of 61 tested positive for rotavirus. Spontaneous devagination was observed for 38 patients; enemas reduced intussusception successfully in 183 cases, whereas surgical treatment was required in 67. All patients recovered without sequelae.

CONCLUSIONS. This is the first prospective nationwide surveillance of intussusception in childhood using a standardized case definition. Most cases occurred beyond infancy, and association with rotavirus gastroenteritis was rare.
Diagnosis of Pediatric Cholesteatoma
Authors: Isaacson Glenn
Published: August 2007

Cholesteatomas are abnormal collections of squamous epithelium and keratin debris that usually involve the middle ear and mastoid. Although histologically benign, they have the ability to expand and destroy bone. Cholesteatomas are treated surgically. The success of such surgery is highly dependent on the extent of the lesion. This article presents information and images to aid the general pediatrician in the early recognition of cholesteatomas, both congenital and acquired, in hopes of improving the outcome for children with this treatable disorder.
Fetal Alcohol Exposure, Iron-Deficiency Anemia, and Infant Growth
Authors: Carter R. Colin , Jacobson Sandra W. , Molteno Christopher D. , Jacobson Joseph L.
Published: August 2007

OBJECTIVES. Our goals were to determine whether prenatal alcohol exposure is associated with an increased incidence of iron-deficiency anemia in infancy and to compare effects of fetal alcohol exposure and iron-deficiency anemia on infant growth. We also tested whether effects of fetal alcohol exposure on growth are mediated or moderated by iron-deficiency anemia.

METHODS. A total of 96 infants born to mothers from the Coloured (mixed ancestry) community in Cape Town, South Africa, were recruited prenatally; 42 mothers drank heavily during pregnancy, and 54 abstained or drank small amounts of alcohol. Growth was assessed at birth and 6.5 and 12 months, and iron-deficiency anemia was assessed at 6.5 or 12 months.

RESULTS. Infants whose mothers binge drank during pregnancy (≥4 drinks per occasion) were 3.6 times more likely to be diagnosed with iron-deficiency anemia at 12 months than were infants whose mothers did not binge drink. Prenatal alcohol exposure was associated with reduced weight at birth, 6.5 months, and 12 months and with shorter length at 6.5 and 12 months. Iron-deficiency anemia was related to reduced 12-month weight and head circumference and to slower growth velocity between 6 and 12 months. The effects of prenatal alcohol on weight were not mediated by iron-deficiency anemia; however, they were seen primarily in infants with iron-deficiency anemia.

CONCLUSIONS. The association of maternal binge drinking with an increased incidence of iron-deficiency anemia may reflect disruption of accumulation of fetal iron stores or postnatal deficiencies in iron uptake, absorption, or intake. Moreover, iron deficiency seems to exacerbate the prenatal alcohol effects on growth.
Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project
Authors: Mercier Charles E. , Barry Sara E. , Paul Kimberley , Delaney Thomas V. , Horbar Jeffrey D. , Wasserman Richard C. , Berry Patricia , Shaw Judith S.
Published: August 2007

OBJECTIVE. The goal was to test the effectiveness of a statewide, collaborative, hospital-based quality-improvement project targeting preventive services delivered to healthy newborns during the birth hospitalization.

METHODS. All Vermont hospitals with obstetric services participated. The quality-improvement collaborative (intervention) was based on the Breakthrough Series Collaborative model. Targeted preventive services included hepatitis B immunization; assessment of breastfeeding; assessment of risk of hyperbilirubinemia; performance of metabolic and hearing screens; assessment of and counseling on tobacco smoke exposure, infant sleep position, car safety seat fit, and exposure to domestic violence; and planning for outpatient follow-up care. The effect of the intervention was assessed at the end of an 18-month period. Preintervention and postintervention chart audits were conducted by using a random sample of 30 newborn medical charts per audit for each participating hospital.

RESULTS. Documented rates of assessment improved for breastfeeding adequacy (49% vs 81%), risk for hyperbilirubinemia (14% vs 23%), infant sleep position (13% vs 56%), and car safety seat fit (42% vs 71%). Documented rates of counseling improved for tobacco smoke exposure (23% vs 53%) and car safety seat fit (38% vs 75%). Performance of hearing screens also improved (74% vs 97%). No significant changes were noted in performance of hepatitis B immunization (45% vs 30%) or metabolic screens (98% vs 98%), assessment of tobacco smoke exposure (53% vs 67%), counseling on sleep position (46% vs 68%), assessment of exposure to domestic violence (27% vs 36%), or planning for outpatient follow-up care (80% vs 71%). All hospitals demonstrated preintervention versus postintervention improvement of ≥20% in ≥1 newborn preventive service.

CONCLUSIONS. A statewide, hospital-based quality-improvement project targeting hospital staff members and community physicians was effective in improving documented newborn preventive services during the birth hospitalization.
Routine Cerebrospinal Fluid Enterovirus Polymerase Chain Reaction Testing Reduces Hospitalization and Antibiotic Use for Infants 90 Days of Age or Younger
Authors: King Rebecca L. , Lorch Scott A. , Cohen Daniela M. , Hodinka Richard L. , Cohn Keri A. , Shah Samir S.
Published: August 2007

OBJECTIVE. The goal was to evaluate the impact of cerebrospinal fluid enterovirus polymerase chain reaction testing on the length of hospitalization and the duration of antibiotic use for infants ≤90 days of age with suspected aseptic meningitis.

METHODS. This retrospective cohort study was conducted at an urban, tertiary-care children's hospital. Data were collected for 478 patients ≤90 days of age for whom cerebrospinal fluid enterovirus polymerase chain reaction testing was performed during the enteroviral seasons of 2000 to 2006. The length of hospitalization and the duration of antibiotic use were assessed.

RESULTS. Cerebrospinal fluid enterovirus polymerase chain reaction test results were positive for 154 patients (34.8%). The mean length of stay was 3.65 days. The median polymerase chain reaction turnaround time was 23 hours. In multivariate analysis, having a positive cerebrospinal fluid enterovirus polymerase chain reaction result was associated with a 1.54-day decrease in the length of stay and a 33.7% shorter duration of antibiotic use. When patients were stratified according to the presence or absence of pleocytosis, both groups demonstrated significant reductions in the length of stay with positive cerebrospinal fluid enterovirus polymerase chain reaction results (1.32 and 1.38 days, respectively). Furthermore, increasing the polymerase chain reaction turnaround time by 24 hours increased the length of stay by 13.6% for patients with positive cerebrospinal fluid enterovirus polymerase chain reaction results.

CONCLUSIONS. Having positive cerebrospinal fluid enterovirus polymerase chain reaction results decreases the length of hospitalization and the duration of antibiotic use for young infants. These results support the routine use of this test during periods of peak enterovirus prevalence.
Atopic Dermatitis in Children in the United States, 1997–2004: Visit Trends, Patient and Provider Characteristics, and Prescribing Patterns
Authors: Horii Kimberly A. , Simon Stephen D. , Liu Deede Y. , Sharma Vidya
Published: August 2007

OBJECTIVE. Atopic dermatitis is the most common chronic inflammatory skin disease of childhood and is increasing in prevalence throughout the world. Morbidity and resource use for atopic dermatitis are comparable to other chronic diseases. Topical corticosteroids are first-line therapeutic agents for atopic dermatitis; topical calcineurin inhibitors are considered second-line agents for patients who are older than 2 years. The aims of this study were to examine trends in visits for atopic dermatitis in children in the United States between 1997 and 2004, identify factors that were associated with a pediatric visit for atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time.

METHODS. Visits for atopic dermatitis by children (0–18 years) to office-based physicians and hospital outpatient departments using 1997–2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey databases were analyzed. Medication prescribing rates during 2 time periods (1997–2000 and 2001–2004) were also analyzed.

RESULTS. There were an estimated 7.4 million visits for atopic dermatitis. Statistically significant differences in patients with atopic dermatitis included age 2 to 5 years, black race, Asian race, and specialist or hospital outpatient clinic evaluation. The increase in atopic dermatitis visits per year was statistically significant. No statistical differences in prescribing rates were identified between the 2 time periods. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin inhibitors were prescribed in 22% of visits.

CONCLUSIONS. Visits for atopic dermatitis in children are increasing. A recommended first-line treatment was prescribed in a minority of the visits.
Ischemic Perinatal Stroke: Summary of a Workshop Sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke
Authors: Raju Tonse N.K. , Nelson Karin B. , Ferriero Donna , Lynch John Kylan ,   and the NICHD-NINDS Perinatal Stroke Workshop Participants
Published: August 2007

Ischemic perinatal stroke is a disorder associated with significant long-term neurologic morbidity. With an estimated incidence of 1 in 2300 to 5000 births, stroke is more likely to occur in the perinatal period than at any time in childhood. The incidence of ischemic perinatal stroke ranks second only to that of strokes in the elderly population. Although ischemic perinatal stroke is a well-recognized disorder, many aspects remain to be studied. There is no consensus on its terminology, definition, or classification. Several risk factors have been identified, but their precise roles in causing stroke are not well understood. There are no reliable predictors of ischemic perinatal stroke on which to base prevention or treatment strategies. To review these important issues and propose a research agenda, the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke convened a workshop in August 2006. This article provides a summary of the workshop.
Neonatologists' Practices and Experiences in Arranging Retinopathy of Prematurity Screening Services
Authors: Kemper Alex R. , Wallace David K.
Published: August 2007

BACKGROUND. Neonatologists play a central role in identifying infants who require screening for retinopathy of prematurity and in coordinating screening and treatment when necessary. No previous study has evaluated neonatologists' practices or experiences related to these activities.

METHODS. A national mail survey of a random sample of 300 neonatologists was conducted from September to November 2006.

RESULTS. The response rate was 62%. Nearly all (98%) of the respondents considered gestational age to identify infants for retinopathy of prematurity screening. However, only 19% used the currently recommended gestational age criterion of 30 weeks; instead, 6% used a lower, more-restrictive criterion, and 74% used a higher, more-inclusive criterion. Fewer respondents (77%) considered birth weight to identify infants for retinopathy of prematurity screening, most of whom (86%) used the current criterion of ≤1500 g. Although more than one half (67%) of the respondents reported that pediatric ophthalmologists usually screen infants for retinopathy of prematurity in their NICU, nearly one half (46%) reported that retinal specialists provide treatment. Some (36%) reported that they have been unable to transfer a child to a NICU of lower acuity or closer to the child's home because there are no specialists available there for retinopathy of prematurity screening. Some (34%) also reported that they have needed to delay discharge because outpatient follow-up for either screening or treatment of retinopathy of prematurity is not available near the family's home.

CONCLUSIONS. We found variations in how children are identified for retinopathy of prematurity screening and how screening and treatment are provided. Future research is needed to understand how these variations affect visual outcomes and costs of care. Such work must also consider the impact of regional pediatric eye care workforce shortages on retinopathy of prematurity screening and treatment strategies.
Improving the Management of Family Psychosocial Problems at Low-Income Children's Well-Child Care Visits: The WE CARE Project
Authors: Garg Arvin , Butz Arlene M. , Dworkin Paul H. , Lewis Rooti A. , Thompson Richard E. , Serwint Janet R.
Published: August 2007

OBJECTIVE. Our goal was to evaluate the feasibility and impact of an intervention on the management of family psychosocial topics at well-child care visits at a medical home for low-income children.

PATIENTS AND METHODS. A randomized, controlled trial of a 10-item self-report psychosocial screening instrument was conducted at an urban hospital-based pediatric clinic. Pediatric residents and parents were randomly assigned to either the intervention or control group. During a 12-week period, parents of children aged 2 months to 10 years presenting for a well-child care visit were enrolled. The intervention components included provider training, administration of the family psychosocial screening tool to parents before the visit, and provider access to a resource book that contained community resources. Parent outcomes were obtained from postvisit and 1-month interviews, and from medical chart review. Provider outcomes were obtained from a self-administered questionnaire collected after the study.

RESULTS. Two hundred parents and 45 residents were enrolled. Compared with the control group, parents in the intervention group discussed a significantly greater number of family psychosocial topics (2.9 vs 1.8) with their resident provider and had fewer unmet desires for discussion (0.46 vs 1.41). More parents in the intervention group received at least 1 referral (51.0% vs 11.6%), most often for employment (21.9%), graduate equivalent degree programs (15.3%), and smoking-cessation classes (14.6%). After controlling for child age, Medicaid status, race, educational status, and food stamps, intervention parents at 1 month had greater odds of having contacted a community resource. The majority of residents in the intervention group reported that the survey instrument did not slow the visit; 54% reported that it added <2 minutes to the visit.

CONCLUSIONS. Brief family psychosocial screening is feasible in pediatric practice. Screening and provider training may lead to greater discussion of topics and contact of community family support resources by parents.
Follow-up of a Randomized, Placebo-Controlled Trial of Dexamethasone to Decrease the Duration of Ventilator Dependency in Very Low Birth Weight Infants: Neurodevelopmental Outcomes at 4 to 11 Years of Age
Authors: O'Shea T. Michael , Washburn Lisa K. , Nixon Patricia A. , Goldstein Donald J.
Published: August 2007

OBJECTIVE. High doses of dexamethasone reduce the risk of chronic lung disease among premature infants but may increase the risk of developmental impairments. The objective of this study was to compare developmental outcomes beyond infancy for children who, as neonates, participated in a randomized trial of dexamethasone.

PATIENTS AND METHODS. One hundred eighteen children with birth weights <1500 g were randomly assigned at 15 to 25 days of life to a 42-day tapering course of dexamethasone or placebo. All 95 survivors were assessed by using standardized measures of developmental outcome at least once at or beyond 1 year of age, and 84 were examined at 4 to 11 years. For this follow-up study, the outcome of primary interest was death or major neurodevelopmental impairment, which was defined as cerebral palsy, cognitive impairment, or blindness.

RESULTS. On the basis of each child's most recent follow-up, the rates of major neurodevelopmental impairments were 40% for the dexamethasone group and 20% for the placebo group. The higher impairment rate for the dexamethasone group was mainly attributed to a higher prevalence of cerebral palsy. Rates of the composite outcome of death or major neurodevelopmental impairment were 47% and 41%, respectively.

CONCLUSION. A 42-day tapering course of dexamethasone, which was shown previously to decrease the risk of chronic lung disease in very low birth weight infants, does not increase the risk of the composite outcome of death or major neurodevelopmental impairment.
Iron Deficiency in Early Childhood in the United States: Risk Factors and Racial/Ethnic Disparities
Authors: Brotanek Jane M. , Gosz Jacqueline , Weitzman Michael , Flores Glenn
Published: August 2007

BACKGROUND. Iron deficiency affects 2.4 million US children, and childhood iron-deficiency anemia is associated with behavioral and cognitive delays. Given the detrimental long-term effects and high prevalence of iron deficiency, its prevention in early childhood is an important public health issue.

OBJECTIVES. The study objectives were to (1) identify risk factors for iron deficiency in US children 1 to 3 years old, using data from the most recent waves of the National Health and Nutrition Examination Survey IV (1999–2002) and (2) examine risk factors for iron deficiency among Hispanic toddlers, the largest minority group of US children.

PATIENTS AND METHODS. Analyses of the National Health and Nutrition Examination Survey IV were performed for a nationally representative sample of US children 1 to 3 years old. Iron-status measures were transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin. Bivariate and multivariable analyses were performed to identify factors associated with iron deficiency.

RESULTS. Among 1641 toddlers, 42% were Hispanic, 28% were white, and 25% were black. The iron deficiency prevalence was 12% among Hispanics versus 6% in whites and 6% in blacks. Iron deficiency prevalence was 20% among those with overweight, 8% for those at risk for overweight, and 7% for normal-weight toddlers. Fourteen percent of toddlers with parents interviewed in a non–English language had iron deficiency versus 7% of toddlers with parents interviewed in English. Five percent of toddlers in day care and 10% of the toddlers not in day care had iron deficiency. Hispanic toddlers were significantly more likely than white and black toddlers to be overweight (16% vs 5% vs 4%) and not in day care (70% vs 50% vs 43%). In multivariable analyses, overweight toddlers and those not in day care had higher odds of iron deficiency.

CONCLUSIONS. Toddlers who are overweight and not in day care are at high risk for iron deficiency. Hispanic toddlers are more likely than white and black toddlers to be overweight and not in day care. The higher prevalence of these risk factors among Hispanic toddlers may account for their increased prevalence of iron deficiency.
Prevention of Human Papillomavirus Infection: Provisional Recommendations for Immunization of Girls and Women With Quadrivalent Human Papillomavirus Vaccine
Authors:   Committee on Infectious Diseases
Published: August 2007

This Policy Statement was retired July 2010.

This policy statement contains provisional recommendations for use of the quadrivalent human papillomavirus vaccine in girls and women. A full policy statement from the American Academy of Pediatrics is forthcoming.
Suicide and Suicide Attempts in Adolescents
Authors: Shain Benjamin N. ,   and the Committee on Adolescence
Published: August 2007

This Clinical Report was revised. See https://doi.org/10.1542/peds.2023-064800.

Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.
Radiation Risk to Children From Computed Tomography
Authors: Brody Alan S. , Frush Donald P. , Huda Walter , Brent Robert L. ,   and the Section on Radiology
Published: August 2007

Imaging studies that use ionizing radiation are an essential tool for the evaluation of many disorders of childhood. Ionizing radiation is used in radiography, fluoroscopy, angiography, and computed tomography scanning. Computed tomography is of particular interest because of its relatively high radiation dose and wide use. Consensus statements on radiation risk suggest that it is reasonable to act on the assumption that low-level radiation may have a small risk of causing cancer. The medical community should seek ways to decrease radiation exposure by using radiation doses as low as reasonably achievable and by performing these studies only when necessary. There is wide agreement that the benefits of an indicated computed tomography scan far outweigh the risks. Pediatric health care professionals’ roles in the use of computed tomography on children include deciding when a computed tomography scan is necessary and discussing the risk with patients and families. Radiologists should be a source of consultation when forming imaging strategies and should create specific protocols with scanning techniques optimized for pediatric patients. Families and patients should be encouraged to ask questions about the risks and benefits of computed tomography scanning. The information in this report is provided to aid in decision-making and discussions with the health care team, patients, and families.
A correction to the nanoindentation technique for ultrashallow indenting depths
Authors: Yeo Chang-Dong , Polycarpou Andreas A.
Published: August 2007

A correction to the nanoindentation technique taking into account the elastic recovery at extremely shallow contact depths was proposed. Using a high-sensitivity nanoindentation system with a sharp indenting tip, the magnitude of the elastic recovery could be obtained directly from very low-force load–unload curves, which was then used to correct the contact area used for hardness measurements. Nanoindentation experiments were performed on a standard fused quartz sample and, compared to standard nanoindentation techniques, the proposed method was found to be more accurate at ultrashallow indenting depths of <3 nm.
Preparation, ion-exchange, and electrochemical behavior of Cs-type manganese oxides with a novel hexagonal-like morphology
Authors: Liu Zong-Huai , Kang Liping , Zhao Mingzhu , Ooi Kenta
Published: August 2007

Cs-type layered manganese oxide with a novel hexagonal-like morphology (Cs–BirMO) was prepared by a solid-state reaction procedure. The Cs+ extraction and alkali–metal ion insertion reactions were investigated by chemical analyses, x-ray analyses, scanning electron microscopy observation, Fourier transform-infrared spectroscopy, thermogravimetric differential thermal analyses, pH titration, and distribution coefficient (Kd) measurements. A considerable percentage (88%) of Cs+ ions in the interlayer sites were topotactically extracted by acid treatment, accompanied by a slight change of the lattice parameters. Alkali–metal ions could be inserted into the interlayer of the acid-treated sample (H–BirMO), mainly by an ion-exchange mechanism. The pH titration curve of the H–BirMO sample showed a simple monobasic acid toward Li+, Rb+, and Cs+ ions, and dibasic acid behavior toward Na+ and K+ ions. The order of the apparent capacity was K+ > Li+ ≈ Na+ ≈ Rb+ ≈ Cs+ at pH < 6. The Kd study showed the selectivity sequence of K+ > Rb+ > Na+ > Li+ for alkali–metal ions at the range of pH <5; H–BirMO sample showed markedly high selectivity for the adsorption of K+ ions. Preliminary investigations of the electrochemical properties of the Li+-inserted sample Li–BirMO(1M, 6d) showed that the obtained samples had a relatively high discharge capacity of 115 mAh g−1 and excellent layered stability.
Fabrication of porous/hollow tin (IV) oxide skeletons from polypeptide mediated self-assembly
Authors: Zhu Jie , Zhang T.S. , Ma J. , Tay B.Y.
Published: August 2007

We demonstrate the aqueous self-assembly of ligand-assisted SnO2 sol precursors onto preformed poly-l-lysine templates through interfacial electrostatic forces (COO−/NH3+). On the removal of organics, two unique coral-like and sea worm-like textures consisting of hierarchical pores (macropores and mesopores) and nanocrystalline SnO2 frameworks are synthesized, mainly depending on the chelator/Sn molar ratio. Structural formation is discussed based on acid-base interaction and interfacial charge density matching. For the first time, metal oxide structures mediated by polypeptides are reported. More importantly, the method described here might open a generally attractive route for synthesizing complex nanostructures of other oxides (e.g., ZnO, TiO2, and ZrO2).
Nanostructure evolution and properties of two-phase nc-Ti(C, N)/a-(C, CNx) nanocomposites by high-resolution transmission electron microscopy, x-ray photoelectron spectroscopy, and Raman spectroscopy
Authors: Lu Y.H. , Shen Y.G.
Published: August 2007

High-resolution transmission electron microscopy, x-ray photoelectron spectroscopy (XPS), and Raman spectroscopy were used to study phase configuration and nanostructure evolutions of Ti–Cx–Ny thin films with different amounts of C incorporation. It was found that the atomic ratio of (C + N)/Ti played a crucial role in phase configuration and nanostructure evolutions as well as mechanical behaviors. When the ratio was less than one unit, a nanocrystalline (nc-) Ti(C, N) solid solution was formed by way of dissolution of C into TiN lattice. When this dissolution reached saturation, precipitation of a small amount of amorphous (a-) C phase along nc-Ti(C, N) grains was followed with more C incorporation. Further increase of C content (up to ∼19 at.% C) made the amorphous phase fully wet nanocrystallites, which resulted in the formation of two-phase nanocomposite thin films with microstructures comprising of ∼5 nm nc-Ti(C,N) crystallites separated by ∼0.5 nm a-(C, CNx) phase. Thicker amorphous walls and smaller sized grains were followed when the C content was further increased, accompanying with the formation of some disorders and defects in nc-grains and amorphous matrices. When the C content was increased to ∼48 at.%, 1–3 nm nanocrystallites with an average size of ∼2 nm were embedded into amorphous matrices. Both microhardness and residual compressive stress values were increased with increase of the atomic ratio in solid solution thin films when the atomic ratio value was less than one unit. Their maximums were obtained at stiochiometry nc-Ti(C,N) solid solution. Enhancement of hardness values was attributed to solid solution effect.
Damage behavior of Cu–Ta bilayered films under cyclic loading
Authors: Zhu X.F. , Zhang G.P. , Tan J. , Liu Y. , Zhu S.J.
Published: August 2007

Damage behavior of Cu–Ta bilayered films bonded to polyimide (PI) substrates has been investigated by cyclic loading tests. Experimental results show that fatigue cracks preferentially initiated in the Ta layer close to the Ta–PI interface and propagated into the Cu layer perpendicular to the interface. The alignment of nanometer-sized Cu grains resulted from the potential GB sliding combined with a small amount of grain rotation was found in the damage zone ahead of the crack tip, and that is suggested to be a likely damage mechanism to accommodate cyclic plastic strain ahead of the fatigue crack tip of the submicrometer-thick Cu layer.