bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Pediatric Holiday-Related Injuries Presenting to US Emergency Departments
Authors: D'Ippolito Anthony , Collins Christy L. , Comstock R. Dawn 
Published: April 2010

OBJECTIVE:
The objective of this study was to calculate injury rates and describe the epidemiology of holiday-related injuries among children who were aged ≤19 years and presented to US emergency departments (EDs) from 1997 through 2006.

METHODS:
Data on holiday-related injuries obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System were analyzed.

RESULTS:
From 1997 through 2006, an estimated 5710999 holiday-related injuries sustained by children who were aged ≤19 years presented to US EDs. The greatest number of injuries occurred on Labor Day followed by Memorial Day, Fourth of July, and Halloween. Children who were younger than 5 years sustained a greater proportion of injuries than other age groups. The face, finger/hand, and head were the most commonly injured body parts. Lacerations, contusion/abrasions, fractures, and sprain/strains were the most common diagnoses. Overall, the majority of injuries that occurred on holidays were classified as sports and recreation–related. In addition, home structure–related and home furnishing–related injuries were prevalent. Injuries that were associated with fireworks were more likely to occur on the Fourth of July than any other holiday, yet fireworks accounted for only a small proportion of Fourth of July injuries.

CONCLUSIONS:
Most injuries that were sustained on holidays and required ED treatment were not holiday-specific but were associated with more general activities. Parents should be aware that holidays present a risk not only for holiday-specific injuries but also for more general, “everyday” injuries.
Reduction of Severe Hyperbilirubinemia After Institution of Predischarge Bilirubin Screening
Authors: Mah Michael P. , Clark Steven L. , Akhigbe Efe , Englebright Jane , Frye Donna K. , Meyers Janet A. , Perlin Jonathan B. , Rodriguez Mitch , Shepard Arthur 
Published: April 2010

OBJECTIVE:The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population.METHODS:This was a 5-year prospective study directed at neonates who were aged ≤28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of ≥20.0 mg/dL. This time frame includes periods before, during, and after the initiation of systemwide institution of a program of universal predischarge neonatal bilirubin screening. The primary outcome measures were serum bilirubin 25.0 to 29.9 and ≥30.0 mg/dL. Neonatal phototherapy use during these years was also analyzed.RESULTS:Of the 1028817 infants who were born in 116 hospitals between May 1, 2004, and December 31, 2008, 129345 were delivered before implementation and 899472 infants were delivered after implementation of this screening program in their individual hospitals. With a program of universal screening, the incidence of infants with total bilirubin 25.0 to 29.9 mg/dL declined from 43 per 100000 to 27 per 100000, and the incidence of infants with total bilirubin of ≥30.0 mg/dL dropped from 9 per 100000 to 3 per 100000 (P = .0019 and P = .0051, respectively). This change was associated with a small but statistically significant increase in phototherapy use.CONCLUSIONS:A comprehensive program of prevention, including universal predischarge neonatal bilirubin screening, significantly reduces the subsequent development of bilirubin levels that are known to place newborns at risk for bilirubin encephalopathy.
Glomerular Filtration Rate Reference Values in Very Preterm Infants
Authors: Vieux Rachel , Hascoet Jean-Michel , Merdariu Dana , Fresson Jeanne , Guillemin Francis 
Published: April 2010

OBJECTIVE:In very preterm infants, there is a high risk for impaired kidney function; therefore, access to normal ranges of glomerular filtration rate (GFR) for age and definition of a reliable normal range of glomerular clearance is essential. Despite this, updated GFR reference values for use in clinical practice are not available. The objective of this study was to determine GFR reference values in very preterm infants aged 27 to 31 weeks' gestation.METHODS:This was a multicenter, prospective cohort study. Infants were recruited to the study before 48 hours of life. Glomerular clearance was measured at inclusion, then weekly for the first month. Reference values were determined by measurement of 12-hour urine specimens and generation of a linear regression model with repeated measures after removal of risk factor components. Validation was checked with a bootstrap technique for infants who were not exposed to significant risk factors.RESULTS:This study included 275 infants. Median GFR reference values (mL/min per 1.73 m2) in infants aged 27 to 31 weeks' gestation ranged from 7.9 to 30.3 on day 7, 10.7 to 33.1 on day 14, 12.5 to 34.9 on day 21, and 15.5 to 37.9 on day 28.CONCLUSIONS:The GFR reference values, presented in this article as 3rd, 10th, 50th, 90th, and 97th percentiles, should be useful in NICUs for adaptation of drug doses to glomerular clearance and in defining infants who present with altered GFR and who need additional investigation and close follow-up to adjust fluid intake and drug dosage.
Glycemic Control in Pediatric Type 1 Diabetes: Role of Caregiver Literacy
Authors: Hassan Krishnavathana , Heptulla Rubina A. 
Published: April 2010

OBJECTIVE:
Poorly controlled diabetes may occur because caregivers of children with type 1 diabetes fail to comprehend provided diabetes education. We hypothesized that poorly controlled diabetes is associated with lower literacy/numerical skills of caregivers of children with type 1 diabetes.

METHODS:
Primary caregivers were evaluated by using Newest Vital Sign (NVS) and a sociodemographic questionnaire. The NVS identifies individuals who are at risk for low health literacy by measuring general literacy/numeracy skills and yields an overall estimate of health literacy. The NVS scores are interpreted to suggest inadequate, limited, or adequate literacy.

RESULTS:
Two hundred caregivers of children who had type 1 diabetes with mean hemoglobin A1c (HbA1c) of 8.8 ± 1.9%, age of 11.8 ± 3.7 years, duration of disease of 4.8 ± 3.3 years, and BMI of 20.8 ± 4.4 kg/m2 participated. HbA1c in those of inadequate literacy (10.4 ± 2.2%) was significantly higher than in those of adequate literacy (8.6 ± 1.7%; P &lt; .001). HbA1c in those whose caregivers had limited literacy (9.5 ± 2.2%) did not differ significantly from the other 2 groups. On adjusting for independent covariates, we found that children whose caregivers had at least 50% correct math answers had better glycemic control (8.5 ± 1.7%) than those who failed (9.8 ± 2.1%; P &lt; .0005).

CONCLUSIONS:
Literacy and numerical skills of caregivers significantly influence glycemic control of their children with type 1 diabetes. Assessing literacy/numeracy skills of caregivers and addressing these deficiencies may be crucial in optimizing glycemic control.
The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis
Authors: Bartick Melissa , Reinhold Arnold 
Published: April 2010

BACKGROUND AND OBJECTIVE:
A 2001 study revealed that $3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality.

STUDY DESIGN:
Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars.

RESULTS:
If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).

CONCLUSIONS:
Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.
Dextranomer/Hyaluronic Acid for Pediatric Vesicoureteral Reflux: Systematic Review
Authors: Routh Jonathan C. , Inman Brant A. , Reinberg Yuri 
Published: April 2010

OBJECTIVE:
Published success rates of dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates.

METHODS:
We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors.

RESULTS:
We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall.

CONCLUSIONS:
The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.
Safety of Influenza Vaccine Administration in Egg-Allergic Patients
Authors: Chung Erica Y. , Huang Lin , Schneider Lynda 
Published: April 2010

OBJECTIVE:
Current guidelines recommend that egg-allergic patients receive an influenza vaccine skin test before the influenza vaccine. This study evaluated the safety of bypassing the skin test and administering graded doses of influenza vaccine to egg-allergic children.

METHODS:
We conducted a retrospective chart-review study of egg-allergic patients aged 6 months to 18 years who received the vaccine skin test and/or a 2-dose graded influenza vaccine. Between influenza seasons 2002–2003 and 2006–2007, egg-allergic patients underwent a vaccine skin test before influenza vaccine administration. Starting in 2006–2007, the skin test was removed from our protocol and egg-allergic patients received the influenza vaccine in 2 graded doses. All vaccinated patients were observed for adverse reactions.

RESULTS:
Two hundred sixty-one egg-allergic patients were evaluated for influenza vaccine administration, and 171 went on to receive the vaccine. Of the 56 patients who received the skin test before the influenza vaccine, 95% (exact 95% confidence interval [CI]: 85.1–98.9) tolerated the vaccine without a serious adverse reaction. This rate was unchanged after the vaccine skin test was removed from the protocol. Of the 115 patients who received the vaccine without a preceding skin test, 97% (exact 95% CI: 91.3–99.0) tolerated the vaccine without serious adverse reaction. The tolerance rate ratio was 1.01 (95% CI: 0.97–1.06).

CONCLUSION:
The results of our study suggest that egg-allergic patients without anaphylaxis to egg may safely receive the influenza vaccine in a 2-dose, graded fashion without a vaccine skin test.
Accuracy of Computer-Generated, Spanish-Language Medicine Labels
Authors: Sharif Iman , Tse Julia 
Published: April 2010

OBJECTIVE:
We evaluated the accuracy of translated, Spanish-language medicine labels among pharmacies in a borough with a large Spanish-speaking population.

METHODS:
A cross-sectional, telephone survey of all pharmacies in the Bronx, New York, was performed. Selected pharmacies were visited to learn about the computer software being used to generate Spanish medicine labels. Outcomes included the proportion of pharmacies providing Spanish medicine labels, frequency of computerized translation, and description of Spanish medicine labels produced.

RESULTS:
Of 316 pharmacies, 286 (91%) participated. Overall, 209 (73%) provided medicine labels in Spanish. Independent pharmacies were significantly more likely to provide Spanish labels than were hospital or chain pharmacies (88% vs 57% vs 32%; P &lt; .0001). Pharmacies that provided Spanish labels mostly commonly (86%) used computer programs to do so; 11% used lay staff members, and 3% used a professional interpreter. We identified 14 different computer programs used to generate Spanish labels, with 70% of pharmacies using 1 of 3 major programs. We evaluated 76 medicine labels generated by 13 different computer programs. Overall, 32 Spanish labels (43%) included incomplete translations (a mixture of English and Spanish), and 6 additional labels contained misspellings or grammar errors, which resulted in an overall error rate of 50%.

CONCLUSIONS:
Although pharmacies were likely to provide medicine labels translated into Spanish, the quality of the translations was inconsistent and potentially hazardous. Unless regulations and funding support the technological advances needed to ensure the safety of such labeling, we risk perpetuating health disparities for populations with limited English proficiency.
Blood Lead Levels and Delayed Onset of Puberty in a Longitudinal Study of Russian Boys
Authors: Williams Paige L. , Sergeyev Oleg , Lee Mary M. , Korrick Susan A. , Burns Jane S. , Humblet Olivier , DelPrato Julie , Revich Boris , Hauser Russ 
Published: April 2010

OBJECTIVE:We evaluated the association of blood lead levels (BLLs) with pubertal onset in a longitudinal cohort of Russian boys.METHODS:A total of 489 Russian boys were enrolled in 2003–2005, at 8 to 9 years of age, and were monitored annually through May 2008. Cox proportional-hazards models were used to evaluate the association of BLLs at enrollment with time to pubertal onset during follow-up monitoring.RESULTS:A total of 481 boys had BLLs, with a median of 3 μg/dL and 28% with values of ≥5 μg/dL. The proportion of pubertal boys increased with age, from 12% at age 8 to 83% at age 12 for testicular volume of &gt;3 mL, from 22% to 90% for genitalia stage 2 or higher, and from 4% to 40% for pubic hair stage 2 or higher. After adjustment for potential confounders including BMI and height, boys with high BLLs (≥5 μg/dL) had 24% to 31% reduced risk of pubertal onset, on the basis of testicular volume of &gt;3 mL (hazard ratio [HR]: 0.73 [95% confidence interval [CI]: 0.55–0.97]; P = .03), genitalia staging (HR: 0.76 [95% CI: 0.59–0.98]; P = .04), and pubic hair staging (HR: 0.69 [95% CI: 0.44–1.07]; P = .10), compared with those with lower BLLs. Pubertal onset occurred 6 to 8 months later, on average, for boys with high BLLs, compared with those with BLLs of &lt;5 μg/dL.CONCLUSION:Higher BLLs were associated with later pubertal onset in this prospective study of peripubertal Russian boys.
Symptoms or Symptom-Based Scores Cannot Predict Acute Otitis Media at Otitis-Prone Age
Authors: Laine Miia K. , Tähtinen Paula A. , Ruuskanen Olli , Huovinen Pentti , Ruohola Aino 
Published: April 2010

OBJECTIVE:Acute symptoms are used to diagnose and manage acute otitis media (AOM). We studied whether AOM could be predicted by the reason for parental suspicion of AOM or by the occurrence, duration, and/or severity of symptoms. We also compared scores including or excluding tympanic-membrane examination of children with and without AOM.PATIENTS AND METHODS:Children aged 6 to 35 months with parental suspicion of AOM were eligible. Before tympanic-membrane examination, we registered on a structured questionnaire the reason for parental suspicion of AOM, symptoms, and score components.RESULTS:Of 469 children studied, 237 had AOM and 232 had respiratory tract infection without AOM. The most common reason for parental suspicion of AOM, restless sleep, was not predictive for AOM (RR: 1.0 [95% CI: 0.8–1.2]), nor was ear-rubbing (relative risk [RR]: 0.7 [95% confidence interval (CI): 0.5–1.0]). Neither the occurrence of fever (RR: 1.2 [95% CI: 1.0–1.4]) nor the highest mean temperature within 24 hours predicted AOM, nor did the occurrences of ear-related, nonspecific, respiratory, or gastrointestinal symptoms. The duration and severity of symptoms were not predictive for AOM, although rhinitis lasted longer and conjunctivitis was more severe in children with AOM. The clinical/otologic score (median: 4.0 vs 2.0; P = .000) and the AOM total-severity index (11.0 vs 6.0; P = .000), both including symptoms and tympanic-membrane examination, were higher in those with AOM. The AOM severity-of-symptom scale, based solely on symptoms, was equal in children with and without AOM (6.0 vs 6.0; P = .917).CONCLUSIONS:AOM cannot be predicted by the occurrence, duration, or severity of symptoms at otitis-prone age. Likewise, solely symptom-based scores do not differentiate between respiratory tract infections with or without AOM. Thus, tympanic-membrane examination is crucial in the diagnosis and severity classification of AOM in clinical practice and research settings.
Evaluation of the PHQ-2 as a Brief Screen for Detecting Major Depression Among Adolescents
Authors: Richardson Laura P. , Rockhill Carol , Russo Joan E. , Grossman David C. , Richards Julie , McCarty Carolyn , McCauley Elizabeth , Katon Wayne 
Published: April 2010

OBJECTIVE:
To examine the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents.

METHODS:
After completing a brief depression screen, 499 youth (aged 13–17 years) who were enrolled in an integrated health care system were invited to participate in a full assessment, including a longer depression-screening scale (Patient Health Questionnaire 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children). Eighty-nine percent (n = 444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment.

RESULTS:
A PHQ-2 score of ≥3 had a sensitivity of 74% and specificity of 75% for detecting youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the Diagnostic Interview Schedule for Children and a sensitivity of 96% and specificity of 82% for detecting youth who met criteria for probable major depression on the Patient Health Questionnaire 9-item depression screen. On receiver operating characteristic analysis, the PHQ-2 had an area under the curve of 0.84 (95% confidence interval: 0.75–0.92), and a cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 score of ≥3 had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores of &lt;3.

CONCLUSIONS:
The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care.
The Pediatric Obesity Epidemic Continues Unabated in Bogalusa, Louisiana
Authors: Broyles Stephanie , Katzmarzyk Peter T. , Srinivasan Sathanur R. , Chen Wei , Bouchard Claude , Freedman David S. , Berenson Gerald S. 
Published: April 2010

OBJECTIVES:
To examine 35-year trends in the prevalence of overweight and obesity among children and adolescents from Bogalusa, Louisiana.

PATIENTS AND METHODS:
Height and weight were measured for 11653 children and adolescents between 5 and 17 years of age in 8 cross-sectional surveys. The Bogalusa Heart Study contributed data from 1973–1994, and routine school screening provided 2008–2009 data. Trends in mean BMI, mean gender-specific BMI-for-age z scores, prevalence of overweight/obesity (BMI ≥ 85th percentile), and prevalence of obesity (BMI ≥ 95th percentile) according to age, race, and gender were examined.

RESULTS:
Since 1973–1974, the proportion of children and adolescents aged 5 to 17 years who are overweight (overweight plus obese) has more than tripled, from 14.2% to 48.4% in 2008–2009. Similarly, the proportion of obese children and adolescents has increased more than fivefold from 5.6% in 1973–1974 to 30.8% in 2008–2009. The prevalence of overweight or obesity, and secular changes, were similar among black and white boys and girls.

CONCLUSIONS:
In semirural Bogalusa, the childhood obesity epidemic has not plateaued, and nearly half of the children are now overweight or obese.
Impact of Very Preterm Birth on Health Care Costs at Five Years of Age
Authors: Korvenranta Emmi , Lehtonen Liisa , Rautava Liisi , Häkkinen Unto , Andersson Sture , Gissler Mika , Hallman Mikko , Leipälä Jaana , Peltola Mikko , Tammela Outi , Linna Miika ,   for the PERFECT Preterm Infant Study Group
Published: April 2010

OBJECTIVE:
We assessed the effects of very preterm birth (gestational age &lt;32 weeks or birth weight &lt;1501 g) and prematurity-related morbidities on health care costs during the fifth year of life.

METHODS:
The study population consisted of 588 very preterm children and 176 term control subjects born in 2001–2002. Costs of hospitalizations, visits to health care professionals and therapists, and the use of other social welfare services were assessed during the fifth year of life. Hospital visits were derived from register data and other health care contacts, and the use of social welfare services were derived from parental reports. The effects of 6 prematurity-related morbidities (cerebral palsy [CP], seizure disorder, obstructive airway disease, hearing loss, visual disturbances or blindness, and other ophthalmologic problems) on the costs of health care were studied.

RESULTS:
The average health care costs during the fifth year of life were 749€ in the term control subjects, 1023€ in the very preterm children without morbidities, and 3265€ in those with morbidities. The costs of social welfare services and therapies exceeded the hospitalization costs in all groups. Among children who were born preterm, CP was associated with 5125€ higher costs, whereas later obstructive airway diseases increased the costs by 819€ compared with individuals without these morbidities.

CONCLUSIONS:
The health care costs during the fifth year of life in very preterm children with morbidities were 4.4-fold and in those without morbidities 1.4-fold compared with those of term control subjects. This emphasizes the importance of prevention of morbidities, especially CP, to reduce the long-term costs of prematurity.