bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aripiprazole in the Treatment of Irritability in Children and Adolescents With Autistic Disorder
Authors: Owen Randall , Sikich Linmarie , Marcus Ronald N. , Corey-Lisle Patricia , Manos George , McQuade Robert D. , Carson William H. , Findling Robert L. 
Published: November 2009

OBJECTIVE: The objective of this study was to evaluate short-term efficacy and safety of aripiprazole in the treatment of irritability in children and adolescents with autistic disorder who were manifesting behaviors such as tantrums, aggression, self-injurious behavior, or a combination of these.
METHODS: This 8-week, double-blind, randomized, placebo-controlled, parallel-group study was conducted of children and adolescents (aged 6–17 years) with autistic disorder. Patients were randomly assigned (1:1) to flexibly dosed aripiprazole (target dosage: 5, 10, or 15 mg/day) or placebo. Efficacy outcome measures included the Aberrant Behavior Checklist irritability subscale and the Clinical Global Impression–Improvement score (CGI-I). Safety and tolerability were also assessed.
RESULTS: Ninety-eight patients were randomly assigned to receive placebo (n = 51) or aripiprazole (n = 47). Mean improvement in Aberrant Behavior Checklist irritability subscale score was significantly greater with aripiprazole than with placebo from week 1 through week 8. Aripiprazole demonstrated significantly greater global improvements than placebo, as assessed by the mean CGI-I score from week 1 through week 8; however, clinically significant residual symptoms may still persist for some patients. Discontinuation rates as a result of adverse events (AEs) were 10.6% for aripiprazole and 5.9% for placebo. Extrapyramidal symptom-related AE rates were 14.9% for aripiprazole and 8.0% for placebo. No serious AEs were reported. Mean weight gain was 2.0 kg on aripiprazole and 0.8 kg on placebo at week 8.
CONCLUSIONS: Aripiprazole was efficacious in children and adolescents with irritability associated with autistic disorder and was generally safe and well tolerated.
Decreased Regional Brain Volume and Cognitive Impairment in Preterm Children at Low Risk
Authors: Soria-Pastor Sara , Padilla Nelly , Zubiaurre-Elorza Leire , Ibarretxe-Bilbao Naroa , Botet Francesc , Costas-Moragas Carme , Falcon Carles , Bargallo Nuria , Mercader Josep Maria , Junqué Carme 
Published: November 2009

OBJECTIVE: To investigate whether preterm children with low risk for neurodevelopmental deficits show long-term changes in gray matter (GM) and white matter (WM) volumes compared with term children and to relate these changes to cognitive outcome.
METHODS: MRI was used to evaluate 20 preterm children who were determined to be at low risk for neurodevelopmental deficits and were born between 30 and 34 weeks’ gestational age without major neonatal morbidity or cerebral pathology in the neonatal period and 22 matched, term control subjects. Volumetric images were analyzed by means of voxel-based morphometry to identify regional cerebral alterations. Children also underwent cognitive and behavioral/emotional assessments.
RESULTS: Preterm children showed global and regional GM volume reductions in several brain areas, including temporal and parietal lobes and concomitant WM volume reductions in the same areas, although only the left temporal regions achieved statistical significance. Global intellectual performance in the preterm group was significantly decreased compared with control subjects. Neither behavioral nor emotional problems were found in the preterm group. In the whole sample, we found a positive correlation between GM volume bilaterally in the middle temporal and in the postcentral gyri with IQ. Positive correlations were observed between GM and gestational age at birth in parietal and temporal cerebral regions and with WM in parietal regions.
CONCLUSION: Preterm birth has an important impact on the neurodevelopmental and cognitive outcome of children at 9 years of age, being a risk factor for decreased regional cortical GM and WM even in preterm children with low risk for neurodevelopmental deficits.
Continuous Monitoring of Cerebrovascular Pressure Reactivity After Traumatic Brain Injury in Children
Authors: Brady Ken M. , Shaffner Donald H. , Lee Jennifer K. , Easley R. Blaine , Smielewski Peter , Czosnyka Marek , Jallo George I. , Guerguerian Anne-Marie 
Published: November 2009

OBJECTIVE: We hypothesized that pressure reactivity index (PRx) values indicating preserved cerebrovascular pressure autoregulation would be associated with survival in children with traumatic brain injury (TBI). This hypothesis was tested in a prospective, blinded, observational, pilot study.
METHODS: Twenty-one children admitted between May 2006 and September 2008 with severe TBI necessitating invasive intracranial pressure monitoring were enrolled in this study. The PRx was continuously monitored as a moving, linear correlation coefficient between low-frequency waves of intracranial and arterial blood pressures. Positive values of PRx approaching 1 indicate impaired cerebrovascular pressure reactivity, whereas negative PRx values or values close to 0 indicate preserved cerebrovascular pressure reactivity. Survival was the primary outcome and was compared with the average PRx value obtained during the intracranial pressure-monitoring period.
RESULTS: PRx was associated with survival in this cohort; survivors (N = 15) had a mean PRx ± SD of 0.08 ± 0.19, and nonsurvivors (N = 6) had a mean PRx of 0.69 ± 0.21 (P = .0009). In this sample, continuous PRx monitoring suggested impaired cerebrovascular pressure reactivity at low levels of cerebral perfusion pressure (CPP) and intact cerebrovascular pressure reactivity at higher levels of CPP.
CONCLUSIONS: Intact cerebrovascular pressure reactivity quantified with the PRx is associated with survival after severe head trauma in children. The PRx is CPP dependent in children. The PRx may be useful for defining age-specific and possibly patient-specific optimal targets for CPP after TBI.
Attitudes of Adolescent Cancer Survivors Toward End-of-Life Decisions for Minors
Authors: Pousset Geert , Bilsen Johan , De Wilde Joke , Benoit Yves , Verlooy Joris , Bomans An , Deliens Luc , Mortier Freddy 
Published: November 2009

OBJECTIVES: The present study aimed to investigate the attitudes of adolescent cancer survivors toward end-of-life decisions with life-shortening effects, including nontreatment decisions (NTDs), intensified alleviation of pain and symptoms (APS), and euthanasia, and the influence of illness experience on these attitudes.
METHODS: Adolescent cancer survivors were interviewed with a structured questionnaire using hypothetical case descriptions. The results were compared with a study of 1769 adolescents without experience of chronic illness.
RESULTS: Eighty-three adolescents, 11 to 18 years of age, were interviewed. In terminal situations, 70% to 90% found requests for NTDs acceptable, 84% requests for APS, and 57% to 64% requests for euthanasia. Requests for end-of-life decisions were less acceptable in nonterminal situations, where 28% found requests for NTDs acceptable, 39% to 47% requests for APS, and 11% to 21% requests for euthanasia. Frequently cited reasons for holding back physicians from administering a lethal drug to a child were the child not being well informed about his or her condition (92%) and the parents' opinion not being asked (92%). Compared with adolescents without experience with chronic illness, cancer survivors were more accepting toward requests for NTDs and APS in terminal situations.
CONCLUSIONS: Adolescent cancer survivors, like other adolescents, want to be involved in medical decision-making at the end of life. They value autonomous decision-making, without excluding parents from the process. The experience of living through a life-threatening illness can alter adolescents' attitudes toward requests for NTDs and APS.
Depressive Symptoms in Nonresident African American Fathers and Involvement With Their Sons
Authors: Davis R. Neal , Caldwell Cleopatra Howard , Clark Sarah J. , Davis Matthew M. 
Published: November 2009

OBJECTIVE: Our objective was to determine whether paternal depressive symptoms were associated with less father involvement among African American fathers not living with their children (ie, nonresident fathers).
METHODS: We analyzed survey data for 345 fathers enrolled in a program for nonresident African American fathers and their preteen sons. Father involvement included measures of contact, closeness, monitoring, communication, and conflict. We used bivariate analyses and multivariate logistic regression analysis to examine associations between father involvement and depressive symptoms.
RESULTS: Thirty-six percent of fathers reported moderate depressive symptoms, and 11% reported severe depressive symptoms. In bivariate analyses, depressive symptoms were associated with less contact, less closeness, low monitoring, and increased conflict. In multivariate analyses controlling for basic demographic features, fathers with moderate depressive symptoms were more likely to have less contact (adjusted odds ratio: 1.7 [95% confidence interval: 1.1–2.8]), less closeness (adjusted odds ratio: 2.1 [95% confidence interval: 1.3–3.5]), low monitoring (adjusted odds ratio: 2.7 [95% confidence interval: 1.4–5.2]), and high conflict (adjusted odds ratio: 2.1 [95% confidence interval: 1.2–3.6]). Fathers with severe depressive symptoms also were more likely to have less contact (adjusted odds ratio: 3.1 [95% confidence interval: 1.4–7.2]), less closeness (adjusted odds ratio: 2.6 [95% confidence interval: 1.2–5.7]), low monitoring (adjusted odds ratio: 2.8 [95% confidence interval: 1.1–7.1]), and high conflict (adjusted odds ratio: 2.6 [95% confidence interval: 1.1–5.9]).
CONCLUSION: Paternal depressive symptoms may be an important, but modifiable, barrier for nonresident African American fathers willing to be more involved with their children.
Unmet Health Care Needs Among CSHCN With Neurologic Conditions
Authors: Bitsko Rebecca H. , Visser Susanna N. , Schieve Laura A. , Ross Danielle S. , Thurman David J. , Perou Ruth 
Published: November 2009

OBJECTIVE
Children with neurologic conditions require a variety of services. With this study we examined health care needs and unmet needs among children with neurologic conditions.

METHODS
Cross-sectional data reported by parents of 3-to 17-year-olds in the 2005–2006 National Survey of Children With Special Health Care Needs were analyzed. Demographic characteristics, health care needs, and unmet needs of children with special health care needs (CSHCN) and neurologic conditions were descriptively compared with an independent referent group of children without special health care needs; statistical contrasts were performed as a function of the type (conditions included in the Diagnostic and Statistical Manual of Mental Disorders [DSM] or not) and number of reported neurologic conditions.

RESULTS
Compared with the parents of children without special health care needs, parents of CSHCN with neurologic conditions were more likely to report unmet health care needs for their child. After adjustment for demographic factors and severity of functional limitation, CSHCN with at least 2 conditions had more visits to a health care provider, needed more services, and reported more unmet needs than CSHCN with a single DSM condition. The magnitude of need among CSHCN was greatest among those with at least 1 of each type of neurologic condition.

CONCLUSIONS
Unmet health care needs exist among CSHCN with neurologic conditions and are particularly pronounced among children with a combination of both DSM and non-DSM disorders. The health care needs among CSHCN with multiple neurologic conditions may be better served by targeted efforts to improve care coordination.
Geographic Disparities in Access to the Medical Home Among US CSHCN
Authors: Singh Gopal K. , Strickland Bonnie B. , Ghandour Reem M. , van Dyck Peter C. 
Published: November 2009

OBJECTIVES: In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years.
METHODS: The 2005–2006 National Survey of Children With Special Health Care Needs was used to estimate prevalence and odds of not having a medical home and 5 component outcomes according to state. Logistic regression was used to examine individual-level and state-level determinants of access.
RESULTS: Medical home access varied substantially across geographic areas. CSHCN in Alaska, Arizona, Washington, DC, Florida, Illinois, Massachusetts, New Jersey, Nevada, and Virginia had at least 50% higher adjusted odds of not having a medical home than CSHCN in Iowa. The adjusted prevalence of CSHCN lacking a medical home varied from a low of 46% in Iowa and Ohio to a high of 59% in Alaska and 61% in New Jersey. CSHCN in several western and southwestern states experienced greater problems with access to a personal doctor/nurse, a usual source of care, specialty care referrals, care coordination, and family-centered care. Adjustment for age, gender, race/ethnicity, household socioeconomic status, language use, insurance coverage, and functional limitation reduced state disparities in access. CSHCN in states with higher immigrant and non–English-speaking populations had significantly lower medical home access. Increases in state health care expenditure and infrastructure and Medicaid/State Children's Health Insurance Program eligibility were associated with increased access to a personal doctor/nurse.
CONCLUSIONS: Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.
The Well-Being of the Health Care Environment for CSHCN and Their Families: A Latent Variable Approach
Authors: Blumberg Stephen J. , Carle Adam C. 
Published: November 2009

OBJECTIVE: Using structural equation modeling, we sought to assess the system of services for children with special health care needs (CSHCN) and their families by using 14 key indicators of functional abilities of CSHCN, health insurance coverage, access to care, and the impact of their conditions on their families.
METHODS: With data from the 2001 and 2005–2006 National Surveys of Children With Special Health Care Needs, we used confirmatory factor analysis for ordered-categorical measures to model the relationship between an indirectly observed (ie, latent) variable and the key indicators and evaluate changes in this relationship over time.
RESULTS: For both survey periods, a single-factor model fit well. The latent construct was defined as the well-being of the health care environment for CSHCN and their families. Family financial problems caused by the child's condition, unmet needs for family support services, and negative impact on employment were most strongly related to the latent well-being construct. The lowest levels of the well-being construct were associated with families that had unmet needs for support services, CSHCN who lacked a usual place for care, and families that spent ≥11 hours/week providing or coordinating care. CSHCN and their families with family-centered care and with adequate health insurance were likely to have average or better levels of the well-being construct. Mean levels of the well-being construct were unchanged over time.
CONCLUSIONS: The 14 key indicators can be used to reliably assess a single latent construct. The relative ordering of the indicators' thresholds (a model parameter) may be useful for guiding pediatricians' evaluations of the health care environment for CSHCN and their families. Researchers may use the scores available from the latent-variable model to assess outcomes related to the health care environment and the system of services for CSHCN and their families.
Oral Health Care in CSHCN: State Medicaid Policy Considerations
Authors: Kenney Mary Kay 
Published: November 2009

OBJECTIVE: Low dental care service utilization among Medicaid-enrolled children has often been attributed to low Medicaid reimbursement levels. The purpose of this study was to provide estimates of preventive dental care utilization by Medicaid-enrolled children with special health care needs (CSHCN) and investigate the association of Medicaid preventive dental care reimbursement levels with the receipt of preventive dental care.METHODS: We analyzed data for 40256 CSHCN (1–17 years of age). Unadjusted estimates of not needing, needing and receiving, and needing but not receiving preventive dental care are presented. Multilevel logistic regression models were fitted to examine associations between state Medicaid dental-procedure reimbursement and receipt of preventive dental care.RESULTS: Some significant associations were found between state-level Medicaid dental-procedure reimbursements and receipt of preventive dental care. The strongest individual-level factor associated with not receiving needed preventive dental care was not receiving needed preventive medical care. Parents of Medicaid-enrolled CSHCN were less likely to report receiving needed preventive dental care and more likely to report not needing or not receiving preventive dental care than non–Medicaid-enrolled CSHCN.CONCLUSIONS: Medicaid-enrolled CSHCN received less needed preventive dental care than non–Medicaid-enrolled CSHCN. An important link to receiving appropriate dental care may be the primary care provider. Raising the level of preventive dental care reimbursement along with other policy changes should increase the frequency of CSHCN receiving preventive dental services. State Medicaid agencies must develop models of medical-dental care management for CSHCN in their programs to ensure the most appropriate care.
Does Private Insurance Adequately Protect Families of Children With Mental Health Disorders?
Authors: Busch Susan H. , Barry Colleen L. 
Published: November 2009

OBJECTIVE: Although private insurance typically covers many health care costs, the challenges faced by families who care for a sick child are substantial. These challenges may be more severe for children with special health care needs (CSHCN) with mental illnesses than for other CSHCN. Our objective was to determine if families of privately insured children who need mental health care face different burdens than other families in caring for their children.
PATIENTS AND METHODS: We used the 2005–2006 National Survey of Children With Special Health Care Needs (NS-CSHCN) to study privately insured children aged 6 to 17 years. We compared CSHCN with mental health care needs (N = 4918) to 3 groups: children with no special health care needs (n = 2346); CSHCN with no mental health care needs (n = 16250); and CSHCN with no mental health care need but a need for other specialty services (n = 7902). The latter group was a subset of CSHCN with no mental health care need. We used weighted logistic regression and study outcomes across 4 domains: financial burden; health plan experiences; labor-market and time effects; and parent experience with services.
RESULTS: We found that families of children with mental health care needs face significantly greater financial barriers, have more negative health plan experiences, and are more likely to reduce their labor-market participation to care for their child than other families.
CONCLUSIONS: Families of privately insured CSHCN who need mental health care face a higher burden than other families in caring for their children. Policies are needed to help these families obtain affordable, high-quality care for their children.
Access to and Satisfaction With School and Community Health Services for US Children With ASD
Authors: Montes Guillermo , Halterman Jill S. , Magyar Caroline I. 
Published: November 2009

OBJECTIVE: Our objective was to compare access to and satisfaction with school and community health resources among families with a child with an autism spectrum disorder (ASD) and families of other children with special health care needs (CSHCN).
METHODS: Parents of 40256 children aged 0 to 17 were surveyed by the 2005–2006 National Survey of Children With Special Health Care Needs. Autism was defined by the question, “To the best of your knowledge, does (child) currently have autism or autism spectrum disorder, that is, ASD?” We used χ2 and multivariate regression analyses to compare access to and satisfaction with services for parents of children with ASDs and parents of other CSHCN.
RESULTS: Children with ASDs (n = 2123) comprise 5.4% of the CSHCN. More parents of children with ASDs reported difficulty using school and community services (27.6% vs 9.7%) and dissatisfaction (19.8% vs 7.9%) than parents of other CSHCN. Multivariate models determined that parents of children with ASDs were 3.39 times more likely to experience difficulty in obtaining services and 2.65 times more likely to be dissatisfied with services received than parents of other CSHCN, after controlling for household demographics and insurance status. Parents of children with ASDs reported a lack of available services and skilled providers.
CONCLUSIONS: Parents of children with ASDs reported less access to and more dissatisfaction with school and community health services than parents of other CSHCN. An increased supply of appropriate services with qualified providers for children with ASDs is needed in the United States.
The Impact of Insurance on Satisfaction and Family-Centered Care for CSHCN
Authors: Thompson Lindsay A. , Knapp Caprice A. , Saliba Heidi , Giunta Nancy , Shenkman Elizabeth A. , Nackashi John 
Published: November 2009

BACKGROUND: Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown.OBJECTIVES: To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies.METHODS: We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N = 40723). Additional state data included Medicaid and State Children's Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Florida's SCHIP comprehensive care program (CMS-Duval [“Ped-I-Care”]) for CSHCN (N = 300).RESULTS: Nationally, 59.8% of parents were satisfied with their child's health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas family-centered care reflects more on provider encounters.CONCLUSIONS: Insurance type affects both satisfaction and family-centered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care.