bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular Risk Screening Before Starting Stimulant Medications and Prescribing Practices of Canadian Physicians: Impact of the Health Canada Advisory
Authors: Conway Jennifer , Wong Kenny K. , O'Connell Colleen , Warren Andrew E. 
Published: October 2008

OBJECTIVE. In May 2006, Health Canada released a statement advising against the use of stimulant medications for patients with cardiac disease after isolated reports of sudden death. The objectives of this study were to determine whether the Health Canada advisory has had an impact on cardiovascular screening of all children with attention-deficit/hyperactivity disorder before stimulants and the medical treatment of children with attention-deficit/hyperactivity disorder and real or potential cardiac problems.
METHODS. Two questionnaires were developed and mailed to a sample of noncardiologist physicians and pediatric cardiologists in Canada. The difference in the proportion of noncardiologist-responders who performed a “full screen” before and after the announcement of the Health Canada advisory was analyzed. Willingness to prescribe stimulant medications to children was assessed by using a series of clinical scenarios.
RESULTS. A total of 2326 questionnaires were distributed, 717 (31%) of which were returned. The proportion who performed a full screen increased for both noncardiologists and cardiologists after the advisory. There was also a dramatic increase in the use of the “modified screen” by the noncardiologist group and the pediatrician subgroup. There was a considerable decrease in the proportion of noncardiologists who were willing to prescribe stimulant medications to children with potential or actual cardiac issues after the advisory.
CONCLUSIONS. The Health Canada advisory has had an impact on clinical practice. It has resulted in an increase in the use of cardiovascular assessment tools before starting stimulants and a decrease in noncardiologists' willingness to prescribe stimulants to those with real or potential cardiac disease. These changes have occurred despite the lack of studies to address the cardiac risks of these medications. Because it will be difficult to assess the true cardiac risks of stimulants, consensus recommendations are needed to determine whether screening is required, what constitutes an appropriate screen, and which children can be treated cautiously with stimulant medications.
A Brief Indicator of Household Energy Security: Associations With Food Security, Child Health, and Child Development in US Infants and Toddlers
Authors: Cook John T. , Frank Deborah A. , Casey Patrick H. , Rose-Jacobs Ruth , Black Maureen M. , Chilton Mariana , deCuba Stephanie Ettinger , Appugliese Danielle , Coleman Sharon , Heeren Timothy , Berkowitz Carol , Cutts Diana B. 
Published: October 2008

OBJECTIVE. Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children &lt;36 months of age.METHODS. A cross-sectional study that used household survey and surveillance data was conducted. Caregivers were interviewed in emergency departments and primary care clinics form January 2001 through December 2006 on demographics, public assistance, food security, experience with heating/cooling and utilities, Parents Evaluation of Developmental Status, and child health. The household energy security indicator includes energy-secure, no energy problems; moderate energy insecurity, utility shutoff threatened in past year; and severe energy insecurity, heated with cooking stove, utility shutoff, or ≥1 day without heat/cooling in past year. The main outcome measures were household and child food security, child reported health status, Parents Evaluation of Developmental Status concerns, and hospitalizations.RESULTS. Of 9721 children, 11% (n = 1043) and 23% (n = 2293) experienced moderate and severe energy insecurity, respectively. Versus children with energy security, children with moderate energy insecurity had greater odds of household food insecurity, child food insecurity, hospitalization since birth, and caregiver report of child fair/poor health, adjusted for research site and mother, child, and household characteristics. Children with severe energy insecurity had greater adjusted odds of household food insecurity, child food insecurity, caregivers reporting significant developmental concerns on the Parents Evaluation of Developmental Status scale, and report of child fair/poor health. No significant association was found between energy security and child weight for age or weight for length.CONCLUSIONS. As household energy insecurity increases, infants and toddlers experienced increased odds of household and child food insecurity and of reported poor health, hospitalizations, and developmental risks.
Preauricular Skin Tags and Ear Pits Are Associated With Permanent Hearing Impairment in Newborns
Authors: Roth Daphne Ari-Even , Hildesheimer Minka , Bardenstein Sarit , Goidel Dvora , Reichman Brian , Maayan-Metzger Ayala , Kuint Jacob 
Published: October 2008

OBJECTIVES. Our goals were to (1) study the prevalence of hearing impairment in a large cohort of infants with preauricular skin tags or ear pits and compare it with that among all other newborns participating in our universal newborn hearing screening program during the same period and (2) evaluate the effectiveness of transient evoked otoacoustic emissions as a hearing-screening tool in this population.PATIENTS AND METHODS. During the study period of 7.5 years, 68484 infants were screened for hearing impairment, of whom 637 (0.93%) had preauricular skin tags and/or ear pits. The population was divided into 3 groups: (1) a low-risk group for hearing impairment; (2) a high-risk group for hearing impairment; and (3) a very high-risk group for hearing impairment. The screening results and audiological follow-up for these infants were examined retrospectively.RESULTS. A significantly higher prevalence of permanent hearing impairment was found among infants with preauricular skin tags or ear pits (8 of 1000), compared with infants without tags or pits (1.5 of 1000). In the low-risk group, the prevalence was 3.4 of 1000, compared with 0.5 of 1000 in infants with and without preauricular tags or pits, respectively. In the high-risk group, the prevalence was 77 of 1000, compared with 20 of 1000 in infants with and without preauricular tags or pits, respectively. The odds ratio for hearing impairment associated with preauricular skin tags and/or ear pits after adjusting for level of risk group was 4.9. All infants diagnosed with permanent hearing impairment, with the exception of 1 with late-onset impairment, were detected by in-hospital transient-evoked otoacoustic emissions screening.CONCLUSIONS. Infants with preauricular skin tags or ear pits are at increased risk for permanent hearing impairment. Transient-evoked otoacoustic emissions were found to be an effective hearing-screening tool in this population.
Food Insecurity and Compensatory Feeding Practices Among Urban Black Families
Authors: Feinberg Emily , Kavanagh Patricia L. , Young Robin L. , Prudent Nicole 
Published: October 2008

OBJECTIVE. In this we study explored the relationship between food insecurity and compensatory maternal feeding practices that may be perceived as buffers against periodic food shortages among urban black families.METHODS. We interviewed a convenience sample of black mothers of children aged 2 to 13 years. Food-security status (predictor) was determined at the household level. Five maternal feeding practices (outcomes) were assessed. Two were based on Birch's Child Feeding Questionnaire (restricting access to certain foods and pressuring a child to eat), and 3 were derived from investigators' clinical experience (use of high-energy supplements, added sugar in beverages, and perceived appetite stimulants). Anthropometric data were collected from mothers and children.RESULTS. A total of 278 mother–child dyads were analyzed, and 28% of these mothers reported being food insecure. Use of Child Feeding Questionnaire feeding practices was defined as the top quartile of responses. Use of nutritional supplements, defined as “at least 1 to 2 times monthly,” ranged from 13% to 25%. In logistic regression models adjusted for child age, weight status, and ethnicity and maternal weight status, mothers from food-insecure households were significantly more likely to use high-energy supplements and appetite stimulants. The odds of using the remaining compensatory feeding practices (adding sugars to beverages, pressuring a child to eat, and restricting access to certain foods) were elevated among food-insecure households but did not reach statistical significance.CONCLUSIONS. Household food insecurity was independently associated with 2 of the 5 maternal compensatory feeding practices studied, and such practices may alter the feeding environment. Longitudinal research is necessary to determine how the relationship between food security and compensatory maternal feeding practices may affect child weight trajectories.
Elevated Blood Pressure in Relation to Overweight and Obesity Among Children in a Rural Canadian Community
Authors: Salvadori Marina , Sontrop Jessica M. , Garg Amit X. , Truong Jennifer , Suri Rita S. , Mahmud Farid H. , Macnab Jennifer J. , Clark William F. 
Published: October 2008

OBJECTIVE. Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with prehypertension and hypertension in a well-characterized population of children in rural Canada.
METHODS. The study population for this cross-sectional study was composed of children (aged 4–17 years) who were participants of the Walkerton Health Study (Canada) in 2004. Prehypertension and hypertension were defined on the basis of percentiles from the average of 3 blood pressure measures taken on a single occasion. Percentiles for BMI and blood pressure were calculated by using the 2000 Centers for Disease Control and Prevention growth charts. Multinomial logistic regression was used to evaluate the odds for prehypertension and hypertension resulting from overweight and obesity.
RESULTS. Of 675 children (98.7% white), 122 (18.1%) were overweight and 77 (11.4%) were obese. Prehypertension and hypertension were detected in 51 (7.6%) and 50 (7.4%), respectively. After adjustment for family history of hypertension and kidney disease, obesity was associated with both prehypertension and hypertension. Overweight was associated with hypertension but not prehypertension. These associations were observed across the genders and children aged &lt;13 and ≥13 years, except that overweight was not associated with hypertension among girls.
CONCLUSIONS. In this population of children who lived in a rural community in Canada, overweight and obesity were strongly associated with elevated blood pressure. Whether blood pressure normalizes with improvements in diet, physical activity, and environment is an area for additional study.
Temporary Vaccine Recommendations and Provider Compliance: A Survey of Pediatric Practices During the 2003–2004 Pneumococcal Conjugate Vaccine Shortage
Authors: Groom Holly , Bhatt Achal , Washington Michael L. , Santoli Jeanne 
Published: October 2008

OBJECTIVE. Heptavalent pneumococcal conjugate vaccine was in short supply from December 2003 to August 2004. The Centers for Disease Control and Prevention with the American Academy of Pediatrics and the American Academy of Family Physicians made recommendations to providers to withhold third and fourth doses of heptavalent pneumococcal conjugate vaccine to ensure availability for those at highest risk. Previous studies of vaccine shortages have demonstrated that provider compliance with temporary recommendations is low. The objective of this study was to collect timely data about awareness and adherence to temporary recommendations and current supply status of heptavalent pneumococcal conjugate vaccine in pediatric practices.
METHODS. A 2-phase telephone survey of pediatric practices was conducted during a 10-week period during the 2003–2004 heptavalent pneumococcal conjugate vaccine shortage. Immunization nurses at randomly selected sites with physician-members of the American Academy of Pediatrics were asked a series of questions.
RESULTS. In both study phases, &gt;90% of participating practices were aware of the recommendations and reported adhering to the recommendations. In phase 1, practices with insufficient supply were more likely to implement recommendations than practices with sufficient supply. Participants identified health departments and Wyeth Vaccines as the most common sources of information. At least 65% of the practices in each phase reported use of tracking systems for children who missed doses.
CONCLUSIONS. Most pediatric practices surveyed were aware of the shortage and were implementing the heptavalent pneumococcal conjugate vaccine recommendations. Simplified recommendations and collaborative efforts to develop and widely disseminate interim recommendations may result in increased compliance by providers.
Effect of Maternity-Care Practices on Breastfeeding
Authors: DiGirolamo Ann M. , Grummer-Strawn Laurence M. , Fein Sara B. 
Published: October 2008

OBJECTIVE. Our goal was to assess the impact of “Baby-Friendly” hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration.
METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for &gt;2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 “Baby-Friendly” practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.
RESULTS. Only 8.1% of the mothers experienced all 6 “Baby-Friendly” practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 “Baby-Friendly” practices, mothers who experienced none were ∼13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.
CONCLUSIONS. Increased “Baby-Friendly” hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the “Baby-Friendly” hospital practices measured in this study.
Characteristics of Breastfeeding Practices Among US Mothers
Authors: Shealy Katherine R. , Scanlon Kelley S. , Labiner-Wolfe Judith , Fein Sara B. , Grummer-Strawn Laurence M. 
Published: October 2008

OBJECTIVES. Although much has been published about breastfeeding rates, little is known about how breastfeeding is practiced in the United States. We describe the distributions and characteristics of practices related to common advice about breastfeeding during the infant's first year of life.
PARTICIPANTS AND METHODS. Participants in the 2005–2007 Infant Feeding Practices Study II received monthly questionnaires during their infants’ first year of life. Among breastfeeding respondents, we investigated patterns and trends in types of breastfeeding (supplementing with formula or not, and at the breast or not) and maternal report of infant feeding behaviors corresponding to common breastfeeding advice on frequency, duration, and intervals of feedings.
RESULTS. More than half of the breastfeeding mothers fed their infants nothing other than breast milk until 4 months of age. Formula supplementation declined from 42% at 1 month to 15% at 1 year; adding other foods/liquids increasingly surpassed supplementing with formula beginning at 5 months of age. Six percent of the mothers reported that the only breast milk the infant was fed was expressed, rather than at the breast. Frequency of breast milk feedings per day declined from 8 at 1 month to 3.5 at 1 year. Reported feeding durations of &lt;20 minutes increased from 46% at 1 month to 88% at 1 year. Feeding from both breasts per feeding decreased 15% over the infant's first year (from 69% to 59%). Longest interfeeding intervals more than doubled over the year.
CONCLUSIONS. Exclusive breastfeeding was common up to 4 but not to 6 months of age. Breastfeeding with only expressed milk was rare. Considerable variation existed in maternal report of practices that correspond to common breastfeeding advice. More research is needed to better understand how these variations relate to breastfeeding outcomes and the role of common breastfeeding advice in infant feeding decisions.
Success of Strategies for Combining Employment and Breastfeeding
Authors: Fein Sara B. , Mandal Bidisha , Roe Brian E. 
Published: October 2008

OBJECTIVE. Return to work is associated with diminished breastfeeding intensity and duration. Although more mothers breastfeed after returning to work now than earlier, research has not documented the strategies that mothers use for combining paid work and breastfeeding or their effect on breastfeeding outcomes. This study examined which strategies are associated with smaller decrements in breastfeeding intensity and longer durations.PARTICIPANTS AND METHODS. We analyzed 810 mothers from the Infant Feeding Practices Study II who worked and breastfed. We used regression and censored regression models to analyze 4 strategies that mothers used to combine these 2 activities: (1) feed directly from the breast only; (2) both pump and feed directly; (3) pump only; and (4) neither pump nor breastfeed during the work day. Outcomes were the difference in percentage of milk feeds that were breast milk between the month before and after return to work and duration of breastfeeding after return to work.RESULTS. Forty-three percent of mothers pumped milk at work only; 32% fed the infant directly from the breast only. These 2 strategies, along with pumping and feeding directly, were statistically similar and superior to neither pumping nor breastfeeding during the work day for the outcome of change in breastfeeding intensity. For the outcome of breastfeeding duration, the 2 strategies that included directly feeding from the breast were associated with longer duration than pumping only, whereas the strategy of neither pumping nor breastfeeding during the work day was associated with the shortest duration.CONCLUSIONS. Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work. Ways to enable direct feeding include on-site child care, telecommuting, keeping the infant at work, allowing the mother to leave work to go to the infant, and having the infant brought to the work site. Establishing ways for mothers to feed from the breast after return to work is important to meet US breastfeeding goals.
Prevalence of Breast Milk Expression and Associated Factors
Authors: Labiner-Wolfe Judith , Fein Sara B. , Shealy Katherine R. , Wang Cunlin 
Published: October 2008

OBJECTIVES. Our goal was to describe the prevalence of any, occasional, and regular breast milk expression, mothers' reasons for expressing their milk, and sociodemographic factors associated with breast milk expression.
PARTICIPANTS AND METHODS. Breastfeeding mothers participating in the 2005–2007 Infant Feeding Practices Study II formed the cohort for these analyses, which were conducted among those with infants in 3 age groups: 1.5 to 4.5 months (n = 1564); &gt;4.5 to 6.5 months (n = 1128); and &gt;6.5 to 9.5 months (n = 914). For the analyses we used frequency and stepwise multiple logistic regression procedures.
RESULTS. Eighty-five percent of breastfeeding mothers of infants in the youngest age group had successfully expressed milk at some time since their infant was born. When asked only about the previous 2-week period, 68% of the breastfeeding mothers of infants in this youngest age group had expressed milk, with 43% having done so occasionally and 25% on a regular schedule. Approximately one quarter of breastfeeding mothers of infants in the 2 older infant age groups also expressed milk on a regular schedule. The percentage of mothers expressing milk decreased with increasing infant age. Mothers expressed milk for various reasons. The most frequently cited reason was to get breast milk for someone else to feed their infant. In all 3 age groups, reporting any breast milk expression, compared with none, was positively associated with maternal employment, higher income, lack of previous breastfeeding experience, and living in the Midwest versus the West. In all 3 age groups, expressing milk on a regular schedule, compared with occasionally, was positively associated with maternal employment and the use of an electric versus manual breast pump.
CONCLUSIONS. Breast milk expression is a very common practice. It is associated most strongly with maternal employment, a recognized barrier to breastfeeding.
Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the First Year
Authors: Li Ruowei , Fein Sara B. , Chen Jian , Grummer-Strawn Laurence M. 
Published: October 2008

OBJECTIVES. Our goal was to determine why women stop breastfeeding at various times during their infant's first year.
METHODS. We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers ∼2, 3, 4, 5, 6, 7, 9, 10½, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding.
RESULTS. The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%–55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of &lt;350% of the federal poverty level. Mothers' concerns about lactation and nutrition issues were the most frequently cited reasons for stopping breastfeeding during the first 2 months. Starting from the third month, self-weaning reasons were increasingly cited as important, with the statements “My baby began to bite” (31.7%), “My baby lost interest in nursing or began to wean himself or herself” (47.3%), and “Breast milk alone did not satisfy my baby” (43.5%) cited as the top 3 reasons at ≥9 months of age.
CONCLUSIONS. Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.