bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Individualized Developmental Care in a Randomized Trial of Preterm Infants &lt;32 Weeks
Authors: Maguire Celeste M. , Walther Frans J. , Sprij Arwen J. , Le Cessie Saskia , Wit Jan M. , Veen Sylvia ,   for the Leiden Developmental Care Project
Published: September 2009

OBJECTIVE: The goal was to investigate the effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on days of respiratory support and intensive care, growth, and neuromotor development at term age for infants born at &lt;32 weeks.METHODS: Infants were assigned randomly, within 48 hours after birth, to a NIDCAP group or basic developmental care (control) group. The NIDCAP intervention consisted of weekly formal behavioral observations of the infants and caregiving recommendations and support for staff members and parents, as well as incubator covers and positioning aids. The control group infants were given basic developmental care, which consisted of only incubator covers and positioning aids. Outcome measures were respiratory support, intensive care, and weight of &lt;1000 g. Growth parameters were measured weekly or biweekly and at term age. Neuromotor development was assessed at term age.RESULTS: A total of 164 infants met the inclusion criteria (NIDCAP: N = 81; control: N = 83). In-hospital mortality rates were 8 (9.9%) of 81 infants in the NIDCAP group and 3 (3.6%) of 83 infants in the control group. No differences in mean days of respiratory support (NIDCAP: 13.9 days; control: 16.3 days) or mean days of intensive care (NIDCAP: 15.2 days; control: 17.0 days) were found. Short-term growth and neuromotor development at term age showed no differences, even with correction for the duration of the intervention.CONCLUSIONS: NIDCAP developmental care had no effect on respiratory support, days of intensive care, growth, or neuromotor development at term age.
Transcutaneous Bilirubin Nomogram for Prediction of Significant Neonatal Hyperbilirubinemia
Authors: Varvarigou Anastasia , Fouzas Sotirios , Skylogianni Eleni , Mantagou Lito , Bougioukou Dorothea , Mantagos Stefanos 
Published: September 2009

OBJECTIVE: The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates.
METHODS: A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of ≥35 weeks and birth weight of ≥2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram.
RESULTS: Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be &gt;35% for values in the high-risk zone and &lt;0.5% for values in the low-risk zone of the nomogram.
CONCLUSIONS: We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.
An Analysis of the Association Between Parental Acculturation and Children's Medication Use
Authors: Foster Byron Alexander , Read Debra , Bethell Christina 
Published: September 2009

OBJECTIVES: We examined how Hispanic children, with stratification according to language to approximate acculturation, differed with respect to sociodemographic characteristics and medication use. We also examined how different factors were associated with the use of different classes of prescription medications.METHODS: We used data from the 2004 Medical Expenditure Panel Survey linked to the National Health Interview Survey. Independent variables were grouped as predisposing characteristics, enabling factors, perceived need, and evaluated need. Multivariate logistic regression was used to assess the impact of independent variables on the outcomes of overall and specific types of medication use.RESULTS: Hispanic, Spanish-interviewed children were less likely to have a usual source of care than were Hispanic, English-interviewed subjects. Both groups had lower odds of using any prescription medication, compared with white children, which was explained largely by having a usual source of care. The lower use of psychiatric medications in the Spanish-interviewed group was not explained by the independent variables, whereas the difference in the use of antibiotics was.CONCLUSIONS: There are differences between Hispanic children according to acculturation, and acculturation affects prescription medication use. These findings may be used to address more specifically the needs of Hispanic children, particularly mental health needs.
Mastering Diagnostic Skills: Enhancing Proficiency in Otitis Media, a Model for Diagnostic Skills Training
Authors: Kaleida Phillip H. , Ploof Dianna L. , Kurs-Lasky Marcia , Shaikh Nader , Colborn D. Kathleen , Haralam Mary Ann , Ray Sean , Kearney Diana , Paradise Jack L. , Hoberman Alejandro 
Published: September 2009

OBJECTIVE: We developed a program for training in the diagnosis of otitis media that included images illustrating various otoscopic findings, mnemonic guides to recollection, and discrimination sessions that included feedback and assessments of diagnostic skills.
METHODS: We prepared a computerized, interactive curriculum, Enhancing Proficiency in Otitis Media (ePROM), that was centered around assemblages of clinically diverse, still and video images of tympanic membranes (TMs). To assess curriculum effectiveness, we constructed a test, the Diagnostic Ear Assessment Resource, that consisted of 50 video TM images. We administered the test to 84 residents in pediatrics or family practice who had not been exposed to ePROM and, varying the order in which the images were presented, to another group of 102 residents in the same programs both before and after exposure to ePROM.
RESULTS:o Mean proportions of correct diagnoses in the Diagnostic Ear Assessment Resource were larger among residents who had been exposed to ePROM than among residents at comparable levels of training who had not been exposed (67% vs 62%; P = .007). Among residents exposed to ePROM, mean proportions of correct diagnoses were larger after exposure than before (67% vs 55%; P &lt; .001).
CONCLUSION: A structured, computerized curriculum to supplement standard clinical training can enhance residents' abilities to interpret still and video images of TMs and may improve their skills in diagnosing otitis media.
Impact of Universal Bilirubin Screening on Severe Hyperbilirubinemia and Phototherapy Use
Authors: Kuzniewicz Michael W. , Escobar Gabriel J. , Newman Thomas B. 
Published: September 2009

OBJECTIVE: The goal was to assess the impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use.
METHODS: In this retrospective cohort study of 358086 infants of ≥35 weeks and ≥2000 g born between January 1, 1995, and June 30, 2007, we obtained demographic data, bilirubin levels, and codes for inpatient phototherapy from existing databases. We compared the incidence of high total serum bilirubin (TSB) levels and phototherapy before and after implementation of universal screening and examined risk factors for high TSB levels.
RESULTS: A total of 38182 infants (10.6%) were born at facilities that had implemented universal bilirubin screening. Compared with infants born at facilities that were not screening, these infants had a 62% lower incidence of TSB levels exceeding the American Academy of Pediatrics exchange guideline (0.17% vs 0.45%; P &lt; .001), received twice the inpatient phototherapy (9.1% vs 4.2%; P &lt; .001), and had slightly longer birth hospitalization lengths of stay (50.9 vs 48.7 hours; P &lt; .001). Of those receiving phototherapy, 56% after initiation of universal screening had TSB levels at which phototherapy was recommended by the guideline, compared with 70% before screening. The adjusted odds ratio for developing TSB levels exceeding the guideline value was 0.28 (95% confidence interval: 0.20–0.40) for those born at a facility using TSB screening and 0.28 (95% confidence interval: 0.19–0.42) for those born at a facility using transcutaneous bilirubin screening.
CONCLUSIONS: Universal bilirubin screening was associated with a significantly lower incidence of severe hyperbilirubinemia but also with increased phototherapy use.
Primary Access to Vehicles Increases Risky Teen Driving Behaviors and Crashes: National Perspective
Authors: García-España J. Felipe , Ginsburg Kenneth R. , Durbin Dennis R. , Elliott Michael R. , Winston Flaura K. 
Published: September 2009

OBJECTIVE: The goal was to explore teen driver vehicle access and its association with risky driving behaviors and crashes.
METHODS: A nationally representative, school-based survey of 2167 ninth-, 10th-, and 11th-graders examined patterns of vehicle access (primary access [ie, the teen is the main driver of the vehicle] versus shared access) and associated driving exposure, risky driving behaviors, and sociodemographic factors.
RESULTS: Seventy percent of drivers reported having primary access to vehicles. They were more likely to be white, to be in 11th grade, to attend schools with higher socioeconomic levels, to have mostly A/B grades, to have a job, to drive a pickup truck, and to drive more hours per week but were not more or less likely to consume alcohol or to wear seat belts while driving. Compared with drivers with shared access, drivers with primary access reported more than twice the crash risk (risk ratio [RR]: 2.05 [95% confidence interval [CI]: 1.41–2.99]) and higher likelihoods of using cellular telephones while driving (RR: 1.23 [95% CI: 1.12–1.35]) and speeding ≥10 mph above the posted limit (RR: 1.24 [95% CI: 1.11–1.40]).
CONCLUSIONS: Primary access of novice teen drivers to vehicles is highly prevalent in the United States. This practice is a dangerous norm, because primary access is associated with risky driving behaviors. Healthcare providers and schools should consider counseling parents to discourage giving novice teen drivers primary access to vehicles. In communities where teens require primary access (eg, due to limited public transportation options), greater efforts should be made to promote safe behaviors.
The “Fear Factor” for Surgical Masks and Face Shields, as Perceived by Children and Their Parents
Authors: Forgie Sarah E. , Reitsma Jeff , Spady Don , Wright Bruce , Stobart Kent 
Published: September 2009

Objective: The goal was to determine whether young children and their parents prefer physicians wearing clear face shields or surgical masks.
Methods: Eighty children (4–10 years of age) and their guardians were recruited from a pediatric emergency department. A survey and color photographs of the same male and female physicians wearing face shields and surgical masks were distributed. The parents were asked to decide which set of physicians they would prefer to care for their children and with which set of physicians they thought their children would be most comfortable. The children then were asked to decide which set of physicians they would prefer to take care of them and why. The children also were asked whether they found any of the physicians frightening and, if so, why.
Results: Fifty-one percent of parents preferred the pictures of physicians wearing face shields, and 62% thought that their children would choose the physicians in the face shields because their faces were visible and therefore less frightening. However, 59% of children stated that either set of physicians would be fine and neither was frightening; if given a choice, 49% would choose physicians in face shields.
Conclusions: Physicians and parents have a perception that surgical masks are frightening to all children. Our study has shown that this perception is not completely true. Face shields may be a better choice, however, because both parents and children would prefer this option.
Improvement of Short- and Long-Term Outcomes for Very Low Birth Weight Infants: Edmonton NIDCAP Trial
Authors: Peters Kathrine Leigh , Rosychuk Rhonda Jean , Hendson Leonora , Coté Judith Jean , McPherson Catherine , Tyebkhan Juzer Mohamed 
Published: September 2009

OBJECTIVE: Our objective was to determine the impact of Newborn Individualized Developmental Care and Assessment Program (NIDCAP)-based care on length of stay of very low birth weight (VLBW) infants. Secondary outcome measures were days of ventilation, incidence of chronic lung disease, and 18-month neurodevelopmental outcomes.METHODS: This cluster-randomized, controlled trial took place in a large NICU in Canada, with follow-up evaluation at 18 months of age, from September 1999 to September 2004. One hundred VLBW singleton infants and 10 VLBW twin sets were assigned randomly to NIDCAP-based or control care, and 90% participated in follow-up assessments. The intervention was NIDCAP-based care (N = 56), that is, care by NIDCAP-educated staff members and behavioral observations. The control group (N = 55) received standard NICU care. Statistical analyses were adjusted for cluster randomization. Although the intervention was not blinded, the pediatricians making the decisions to discharge the infants were not involved in the study, and the follow-up staff members were blinded with respect to group.RESULTS: NIDCAP group infants had reduced length of stay (median: NIDCAP: 74 days; control: 84 days; P = .003) and incidence of chronic lung disease (NIDCAP: 29%; control: 49%; odds ratio: 0.42 [95% confidence interval: 0.18–0.95]; P = .035). At 18 months of adjusted age, NIDCAP group infants had less disability, specifically mental delay (NIDCAP: 10%; control: 30%; odds ratio: 0.25 [95% confidence interval: 0.08–0.82]; P = .017).CONCLUSION: NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.
Predictors of Early Adult Outcomes in Pediatric-Onset Obsessive-Compulsive Disorder
Authors: Bloch Michael H. , Craiglow Brittany G. , Landeros-Weisenberger Angeli , Dombrowski Philip A. , Panza Kaitlyn E. , Peterson Bradley S. , Leckman James F. 
Published: September 2009

OBJECTIVE: The aim of this study was to determine the childhood clinical predictors of early adult outcomes in pediatric-onset obsessive-compulsive disorder (OCD) and to assess whether dimensional subtypes of OCD and the presence of comorbid tic symptoms influence long-term outcomes.METHODS: We conducted a longitudinal cohort study in which 45 of 62 eligible children with OCD were reassessed an average of 9 years later, in early adulthood. Main outcome measures included expert-rated, obsessive-compulsive (OC) symptom severity and time to remission of OC symptoms. Baseline clinical characteristics were evaluated in terms of their influence on OCD severity in adulthood and time to remission of OC symptoms.RESULTS: Forty-four percent of subjects were determined to have subclinical OC symptoms at the follow-up evaluation. The absence of a comorbid tic disorder and the presence of prominent hoarding symptoms were associated with the persistence of OCD symptoms. Female gender, earlier age at childhood assessment, later age of OCD onset, more-severe childhood OCD symptoms, and comorbid oppositional defiant disorder also were associated with persistence of OCD symptoms into adulthood.CONCLUSIONS: These results confirm that a significant proportion of treated children with OCD experience remission by adulthood. The presence of comorbid tics heralds a positive outcome, whereas primary hoarding symptoms are associated with persistent OCD.
Differentiating PFAPA Syndrome From Monogenic Periodic Fevers
Authors: Gattorno Marco , Caorsi Roberta , Meini Antonella , Cattalini Marco , Federici Silvia , Zulian Francesco , Cortis Elisabetta , Calcagno Giuseppina , Tommasini Alberto , Consolini Rita , Simonini Gabriele , Pelagatti Maria Antonietta , Baldi Maurizia , Ceccherini Isabella , Plebani Alessandro , Frenkel Joost , Sormani Maria Pia , Martini Alberto 
Published: September 2009

OBJECTIVES: To analyze whether there were clinical differences between genetically positive and negative patients fulfilling periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome criteria and to test the accuracy of the Gaslini diagnostic score for identifying patients with PFAPA syndrome with higher probabilities of carrying relevant mutations in genes associated with periodic fevers.METHODS: Complete clinical and genetic information was available for 393 children with periodic fever; 82 had positive genetic test results, 75 had incomplete genetic test results, and 236 had negative results for MVK, TNFRSF1A, and MEFV mutations. Current diagnostic criteria for PFAPA syndrome were applied.RESULTS: Of 393 children, 210 satisfied PFAPA syndrome criteria; 43 carried diagnostic mutations (mevalonate kinase deficiency: n = 33; tumor necrosis factor receptor-associated periodic syndrome: n = 3; familial Mediterranean fever: n = 7), 37 displayed low-penetrance mutations or incomplete genotypes, and 130 demonstrated negative genetic testing results. Genetically positive patients had higher frequencies of abdominal pain and diarrhea (P &lt; .001), vomiting (P = .006), and cutaneous rash and arthralgia (P = .01). Genetically negative patients had a higher frequency of exudative pharyngitis (P = .010). Genetically undetermined patients showed the same pattern of symptom frequency as genetically negative patients. The Gaslini diagnostic score was able to identify 91% of genetically positive patients correctly, with a global accuracy of 66%.CONCLUSION: The Gaslini diagnostic score represents a useful tool to identify patients meeting PFAPA syndrome criteria and at low risk of carrying relevant mutations in genes associated with periodic fevers.
Disparities in Access to Pediatric Neurooncological Surgery in the United States
Authors: Mukherjee Debraj , Kosztowski Thomas , Zaidi Hasan A. , Jallo George , Carson Benjamin S. , Chang David C. , Quiñones-Hinojosa Alfredo 
Published: September 2009

OBJECTIVE: The objective of this study was to investigate whether disparities in access to high-volume centers for neurooncological care existed in the United States in 1988–2005.METHODS: A retrospective analysis of the Nationwide Inpatient Sample (1988–2005) was performed, with additional factors incorporated from the Area Resource File (2006). International Classification of Diseases, Ninth Revision, diagnosis/procedure coding was used to identify patients. High-volume centers were defined as those with ≥50 neurosurgical cases per year. Patients &gt;18 years of age were excluded. Covariates included age, gender, race, Charlson Index score, insurance, and county-level characteristics (including median home value, proportion of foreign born residents, and county neurosurgeon density). Multivariate analysis was performed by using multiple logistic regression models. P values of &lt;.05 were considered statistically significant.RESULTS: A total of 4421 patients were identified; 1651 (37.34%) were admitted to high-volume centers. Overall access to high-volume centers improved slightly over the 18-year period (odds ratio [OR]: 1.04). Factors associated with greater access to high-volume centers included greater county neurosurgeon density (OR: 1.72) and greater county home value (OR: 1.66). Factors associated with worse access included Hispanic ethnicity (OR: 0.68) and each 1% increase in foreign residents per county (OR: 0.59). All reported P values were &lt;.05.CONCLUSION: This study demonstrates that racial and socioeconomic disparities in access to high-volume neurooncological care exist for the pediatric population. We also identify numerous prehospital factors that potentially contribute to persistent disparities and may be amenable to change through national health policy interventions.
Mental Health Context of Food Insecurity: a Representative Cohort of Families With Young Children
Authors: Melchior Maria , Caspi Avshalom , Howard Louise M. , Ambler Antony P. , Bolton Heather , Mountain Nicky , Moffitt Terrie E. 
Published: September 2009

OBJECTIVE: Children from food-insecure families (ie, families that lack access to sufficient, safe, and nutritious food) are at risk for developmental problems. Food insecurity disproportionately occurs among low–socioeconomic status (SES) and low-income families; however, interventions that supplement families' income or diet have not eradicated food insecurity. This may be because food insecurity is also related to nonfinancial factors such as the presence of maternal mental health problems. To clarify whether addressing mothers' mental health problems may be a promising strategy for reducing the burden of food insecurity, we tested the hypothesis that low-SES families are especially vulnerable to food insecurity when the mother experiences depression, alcohol or drug abuse, psychosis spectrum disorder, or domestic violence.METHODS: We used data from a nationally representative cohort of 1116 British families (the Environmental Risk Longitudinal Study). Food insecurity, family SES, maternal mental health and exposure to domestic violence, and children's behavioral outcomes were measured by using validated methods.RESULTS: Overall, 9.7% of study families were food-insecure. Among low-SES families, controlling for income variation, food insecurity co-occurred with maternal depression (odds ratio [OR]: 2.82 [95% confidence interval (CI): 1.62–4.93]), psychosis spectrum disorder (OR: 4.01 [95% CI: 2.03–7.94]), and domestic violence (OR: 2.36 [95% CI: 1.18–4.73]). In addition, food insecurity predicted elevated rates of children's behavior problems.CONCLUSIONS: Among families with young children, food insecurity is frequent, particularly when the mother experiences mental health problems. This suggests that interventions that improve women's mental health may also contribute to decreasing the burden of food insecurity and its impact on the next generation.