bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severity of Respiratory Syncytial Virus Bronchiolitis Is Affected by Cigarette Smoke Exposure and Atopy
Authors: Bradley Joseph P. , Bacharier Leonard B. , Bonfiglio JoAnn , Schechtman Kenneth B. , Strunk Robert , Storch Gregory , Castro Mario 
Published: January 2017

Objective. Respiratory syncytial virus (RSV) bronchiolitis is a common cause of hospitalizations in children and has been increasingly identified as a risk factor in the development of asthma. Little is known about what determines the severity of RSV bronchiolitis, which may be helpful in the initial assessment of these children.
Design. We evaluated a variety of environmental and host factors that may contribute to the severity of RSV bronchiolitis in the RSV Bronchiolitis in Early Life prospective cohort study. Severity of bronchiolitis was based on the quantization of lowest O2 saturation and the length of stay. These factors included the child's and family's demographics, presence of household allergens (dust mite, cat, dog, and cockroach), peripheral blood eosinophil count, immunoglobulin E level, infant feeding, prior illnesses, exposure to intrauterine and postnatal cigarette smoke, and family history of atopy.
Patients. We prospectively enrolled 206 hospitalized infants, all under 12 months old (4.0 ± 3.3 months old), with their first episode of severe RSV bronchiolitis (mean O2 saturation: 91.6 ± 7.3%; length of stay: 2.5 ± 2.5 days; presence of radiographic opacities: 75%). Patients were excluded for a variety of reasons including previous wheezing, regular use of bronchodilator or antiinflammatory medications, any preexisting lung disease including asthma, chronic lung disease of prematurity/bronchopulmonary dysplasia, or cystic fibrosis; gastroesophageal reflux disease on medical therapy; or congenital anomalies of the chest or lung.
Results. Age was found to be a significant factor in the severity of infection. The younger an infant was, the more severe the infection tended to be as measured by the lowest oxygen (O2) saturation. We also found that infants exposed to postnatal cigarette smoke from the mother had a lower O2 saturation than those not exposed. However, there was no significant difference in RSV bronchiolitis severity between infants exposed only to intrauterine smoke and those infants never exposed to cigarette smoke. Infants with a family history of atopy, especially a maternal history of asthma or hay fever, had a higher O2 saturation. Although a history of maternal atopy seemed to be protective, there was no association between allergens and bronchiolitis severity, although 25% of households had elevated allergen levels. Black infants demonstrated less severe RSV bronchiolitis than their white counterparts. Multivariate analysis revealed age, race, maternal atopy, and smoking to be associated with severity of RSV bronchiolitis.
Conclusion. The severity of RSV bronchiolitis early in life seems modified by postnatal maternal cigarette smoke exposure and atopy and age of the infant, not by levels of allergens in the home environment.
Helicobacter pyloriInfection Is Not Associated With Specific Symptoms in Nonulcer-Dyspeptic Children
Authors: Kalach Nicolas , Mention Karine , Guimber Dominique , Michaud Laurent , Spyckerelle Claire , Gottrand Fréderic 
Published: January 2017

Objectives. To assess symptoms associated with Helicobacter pylori infection in children presenting with nonulcer dyspepsia (NUD).Study Design. A prospective double-blind study was conducted between March 2001 and April 2002 in children at least 6 years old with NUD who had been referred for upper gastrointestinal endoscopy for epigastric pain. A standardized questionnaire was administered blindly by a pediatric gastroenterologist. This questionnaire characterized epigastric pain and associated factors. Infection was confirmed by positive culture and histologic examination of the gastric mucosa.Results. From 100 children enrolled, 26 proved infected (12 female, 14 male; mean age: 11.4 ± 2.6 years), and 74 were noninfected (44 female, 30 male; mean age: 10.4 ± 3.1 years). There were no differences in age or symptom characteristics between groups except for epigastric pain during meals that was more frequent in noninfected than in infected children (25.6% vs 3.8%).Conclusion. There were no specific characteristics of symptoms in nonulcer-dyspeptic H pylori–infected children as compared with noninfected children.
Kitchen Scalds and Thermal Burns in Children Five Years and Younger
Authors: Drago Dorothy A. 
Published: January 2017

Objective. The current study was undertaken to describe patterns of kitchen burns and scalds to young children to understand better why such injuries continue to occur despite intervention efforts.
Methods. Emergency department–treated thermal burns and scalds associated with nonelectric cookware were examined from a national sample, collected by the US Consumer Product Safety Commission's injury surveillance system over a 6-year period, 1997–2002. Data extracted from the cases included age, gender, body part, disposition, case weight, causal substance, and injury pattern. Data were analyzed using Epi Info 2002, with significance assessed by χ2 test.
Results. Scalds were approximately twice as common as were thermal burns. Hot water was the chief causal agent for scalds. The 2 most common scald injury patterns were (1) the child reached up and pulled a pot of hot water off the stove or other elevated surface and (2) the child grabbed, overturned, or spilled a container of hot water onto him- or herself. One-year-olds were at highest risk for scalds and thermal burns. Scalds resulted in significantly more hospitalizations than did thermal burns. In nearly all injury patterns, more boys than girls were injured, but the ratio varied depending on the injury pattern.
Conclusions. Although the kitchen is recognized as a room that is hazardous for young children, parents seem not to recognize or anticipate the risk for burns and scalds. The ability of children, especially toddlers, to reach containers of hot liquids on elevated surfaces is reflected in the injury data and is explained by anthropometry data, yet there is an apparent failure on the part of parents to recognize children's ability to gain access to the hazard and a failure to recognize the potential severity of resulting injury. These failures might explain why behavioral interventions (eg, place pots on back burners of stove) have been nonmotivating and ineffective. A multifaceted spectrum of prevention that has individual, community, and organizational components may prove to be more useful.
A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria
Authors: Hoyme H. Eugene , May Philip A. , Kalberg Wendy O. , Kodituwakku Piyadasa , Gossage J. Phillip , Trujillo Phyllis M. , Buckley David G. , Miller Joseph H. , Aragon Alfredo S. , Khaole Nathaniel , Viljoen Denis L. , Jones Kenneth Lyons , Robinson Luther K. 
Published: January 2017

Background. The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice.Objective. The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice.Methods. A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results.Results. The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint.Conclusions. The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.
Deaths of Pediatric Patients: Relevance to Their Medical Home, an Urban Primary Care Clinic
Authors: Serwint Janet R. , Nellis Marianne E. 
Published: January 2017

Background. The Institute of Medicine’s report When Children Die emphasizes the importance of the medical home in end-of-life care, but no research has been conducted from this perspective. Identifying types and locations of patient deaths from the perspective of the medical home is important for developing the needed psychosocial support and addressing the longitudinal needs of bereaved families and staff members.Objectives. The objectives of this study were to quantify and to characterize the deaths of pediatric patients who received their primary care from an urban, hospital-based, resident continuity clinic, to determine the mechanisms of communication about these deaths, and to compare the characteristics of deaths that were sudden, unexpected, or anticipated.Methods. Patient deaths were identified through a pediatric department-wide tracking system for institutional deaths and a clinic-initiated tracking system for deaths that occurred outside the institution. Patient medical records were reviewed for patient demographic characteristics, preexisting medical conditions, setting and cause of death, and whether an autopsy was performed.Results. Thirty-six patient deaths were identified between July 1, 1998, and June 31, 2002, within a clinic population of 7000 patients (average annual mortality rate: 0.13%). Seventeen patient deaths (48%) were identified through the institutional tracking system, and 19 (52%) were identified through the clinic-initiated tracking system for deaths that occurred outside the institution. Only 1 anticipated death occurred in the patient's home. Sixty-six percent of patients had underlying medical conditions, with neuromuscular diseases being the most common (28%). The causes of death differed from national data in the Institute of Medicine report and included specific organ failure (58%), probable sudden infant death syndrome (16%), accidental trauma (6%), intentional trauma (6%), and unspecified causes (14%). Twelve deaths (33%) were classified as sudden, 16 (44%) as unexpected, and 8 (22%) as anticipated. Autopsy was performed for 69% of the patients.Conclusions. The wide diversity of patient ages and types and causes of deaths suggests that medical home sites need end-of-life services that are flexible enough to meet the individual needs of bereaved families and staff members. The greater relative mortality rate and higher proportion of patients with underlying medical conditions, compared with national data, suggest a greater burden of disease in this continuity setting. Medical home sites should consider tracking systems to identify patients who have died. Future research needs to identify the barriers to patients dying at home and to study the impact of patient deaths on medical home staff members.
Community and Hospital-Based Physicians' Attitudes Regarding Pediatric Hospitalist Systems
Authors: Srivastava Rajendu , Norlin Chuck , James Brent C. , Muret-Wagstaff Sharon , Young Paul C. , Auerbach Andrew 
Published: January 2017

Objective. Pediatric hospitalist systems are being implemented widely. Their implementation may be influenced by physician attitudes, which may vary according to practice type (eg, community or hospital-based practice) and personal characteristics (eg, age and practice location). Little evidence exists to describe factors relevant to pediatric systems. The objective of this study was to determine physicians' attitudes regarding hospitalists and associated physician and practice characteristics.Methods. We used a cross-sectional survey of all physicians with admitting privileges at a tertiary-care, pediatric, teaching hospital in the Intermountain West in April 2002. Outcomes included survey responses indicating attitudes toward the effects of the hospitalist system on quality of care, patient satisfaction, and teaching.Results. A total of 313 of 368 physicians (85%) responded, 191 of whom (61%) were community physicians; 224 respondents (72%) spent the majority of their time in outpatient care. Community physicians more often characterized inpatient care as an inefficient use of time (45% vs 25%) but were less likely to think that hospitalists would improve the quality of care (49% vs 68%) or increase patient satisfaction (10% vs 30%). In multivariate models examining predictors of overall attitudes toward hospitalists, being a community physician (6.4 points more negative) and admitting patients at &gt;1 hospital (3.3 points more negative) were associated with less favorable attitudes. Being &lt;40 years of age (4.5 points more positive) and practicing &gt;13 miles from the hospital (4.3 points more positive) were associated with more positive attitudes.Conclusions. Attitudes regarding hospitalist systems differ between physician groups and are influenced by practice characteristics. Understanding these differences and tailoring hospitalist systems to address them will be important as pediatric hospitalist systems are implemented nationwide.
Medical Homes for At-Risk Children: Parental Reports of Clinician-Parent Relationships, Anticipatory Guidance, and Behavior Changes
Authors: Nelson Catherine S. , Higman Susan M. , Sia Calvin , McFarlane Elizabeth , Fuddy Loretta , Duggan Anne K. 
Published: January 2017

Background. Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice.Objectives. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes.Methods. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded.Results. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 ± 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (β = .026, SE = .004), compassion (β = .019, SE = .005), and trust (β = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (β = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of ≥5 well-child visits, and baseline attributes.Conclusions. Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.
Status of Newborn Screening Programs in the United States
Authors: Therrell Bradford L. , Johnson Alissa , Williams Donna 
Published: January 2017

BACKGROUND. Newborn screening programs have expanded over the years; currently, many programs screen for dozens of congenital conditions that, if not detected and treated early, could result in catastrophic health consequences, including death. Some programs, however, still require universal newborn screening for only a few conditions. Although all 51 US programs (all states and the District of Columbia) have statutory screening requirements and similarities exist in many parts of the different screening systems, the enabling statutes, rules, regulations, protocols, and financing strategies vary dramatically. Consequently, there is a significant lack of equity in newborn screening services across the country.METHODS. We investigated program variations existing in and around January 2005 and provide baseline information with which future program comparisons can be made. We used program surveys, electronic searches of legislation, and individual input (validation) from program decision-makers to create a reservoir of program information.RESULTS. Included is a compilation of pertinent newborn screening statutes, information from genetic privacy statutes that potentially affects newborn screening programs, and a review of state laws that affect specimen and information retention. In addition, program policies related to the use of residual newborn screening blood spots are reviewed, along with the developmental processes affecting program informational brochures, including the information contained and the strategies for brochure dissemination.CONCLUSIONS. Building on a progressive and successful history, newborn screening continues as an example of an essential population genetic screening program. As the intricacies of screening systems have increased in complexity, so have the policy issues that shape program successes and failures. The summary information in this article provides a basis for national and individual program evaluation. Indeed, some of the information reported here has already been useful for program refinements reported elsewhere in this supplement.
Recommendations for Effective Newborn Screening Communication: Results of Focus Groups With Parents, Providers, and Experts
Authors: Davis Terry C. , Humiston Sharon G. , Arnold Connie L. , Bocchini Joseph A. , Bass Pat F. , Kennen Estela M. , Bocchini Anna , Williams Donna , Kyler Penny , Lloyd-Puryear Michele 
Published: January 2017

OBJECTIVES. The aims of this study were to determine parent and provider knowledge and awareness of newborn screening; to gather opinions from parents, providers, and newborn screening professionals about the content and timing of newborn screening education; and to use consensus data to formulate recommendations and to develop educational materials for parents and providers.METHODS. We conducted 22 focus groups and 3 individual interviews between October 2003 and May 2004, with English- and Spanish-speaking parents of infants &lt;1 year of age who had experience with initial testing, retesting, or false-positive screenings; health professionals who provide prenatal care or health care for newborns; and state newborn screening program health professionals.RESULTS. Parents and providers had limited knowledge and awareness about newborn screening practices. Parents wanted brief to-the-point information on newborn screening and its benefits, including the possible need for retesting and the importance of returning promptly for retesting if initial results are abnormal. Parents wanted the information orally from the primary care provider. Parents, providers, and newborn screening professionals all thought that an accompanying concise, easy-to-read brochure with contact information would be helpful. All focus group participants thought that parents should receive this information before the birth of the infant, preferably in the third trimester of pregnancy. Providers wanted a brief checklist of information and resources to prepare them to educate parents effectively.CONCLUSIONS. We recommend prenatal and primary care providers be more involved in educating parents about newborn screening. Professional societies and state health officials should work together to encourage parent and provider education. User-friendly patient and provider education materials, such as those we developed, could form the basis for this educational approach.
Psychiatric Disorders and General Functioning in Low Birth Weight Adults: A Longitudinal Study
Authors: Lærum Astrid M. W. , Reitan Solveig Klæbo , Evensen Kari Anne I. , Lydersen Stian , Brubakk Ann-Mari , Skranes Jon , Indredavik Marit S. 
Published: January 2017

OBJECTIVE:
To examine psychiatric morbidity and overall functioning in adults born with low birth weight compared with normal birth weight controls at age 26 years and to study longitudinal trajectories of psychiatric morbidity from early adolescence to adulthood.

METHODS:
Prospective cohort study wherein 44 preterm very low birth weight (≤1500 g), 64 term small for gestational age (SGA; &lt;10th percentile), and 81 control adults were examined using the MINI-International Neuropsychiatric Interview: M.I.N.I. Plus, Norwegian version, the Global Assessment of Functioning, and questions on daily occupation and level of education. Prevalence of psychiatric disorders from previous follow-ups at age 14 and 19 years were included for longitudinal analysis.

RESULTS:
From adolescence to adulthood, the term SGA group had a marked increase in the estimated probability of psychiatric disorders from 9% (95% confidence interval, 4–19) to 39% (95% confidence interval, 28–51). At 26 years, psychiatric diagnoses were significantly more prevalent in the preterm very low birth weight group (n = 16, 36%; P = .003) and the term SGA group (n = 24, 38%; P = .019) compared with the control group (n = 11, 14%). Both low birth weight groups had lower educational level and functioning scores than controls and a higher frequency of unemployment and disability benefit.

CONCLUSIONS:
Low birth weight was a substantial risk factor for adult psychiatric morbidity and lowered overall functioning. The results underscore the need for long-term follow-up of low birth weight survivors through adolescence and adulthood, focusing on mental health. The longitudinal increase in psychiatric morbidity in the term SGA group calls for additional investigation.