bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attention-Deficit/Hyperactivity Disorder: How Much Responsibility Are Pediatricians Taking?
Authors: Stein Ruth E.K. , Horwitz Sarah McCue , Storfer-Isser Amy , Heneghan Amy M. , Hoagwood Kimberly Eaton , Kelleher Kelly J. , O'Connor Karen G. , Olson Lynn 
Published: December 2008

BACKGROUND. Attention-deficit/hyperactivity disorder, the most common childhood behavioral condition, is one that pediatricians think they should identify and treat/manage.
OBJECTIVE. Our goals were to explore the relationships between pediatricians' self-reports of their practice behaviors concerning usually inquiring about and treating/managing attention-deficit/hyperactivity disorder and (1) attitudes regarding perceived responsibility for attention-deficit/hyperactivity disorder and (2) personal and practice characteristics.
METHODS. We analyzed data from the 59th Periodic Survey of the American Academy of Pediatrics for the 447 respondents who practice exclusively in general pediatrics. Bivariate and logistic regression analyses were used to identify attitudes and personal and practice characteristics associated with usually identifying and treating/managing attention-deficit/hyperactivity disorder.
RESULTS. A total of 67% reported that they usually inquire about and 65% reported that they usually treat/manage attention-deficit/hyperactivity disorder. Factors positively associated with usually inquiring about attention-deficit/hyperactivity disorder in adjusted multivariable analyses include perceived high prevalence among current patients, attendance at a lecture/conference on child mental health in the past 2 years, having patients who are assigned or can select a specific pediatrician, practicing in suburban communities, practicing for ≥10 years, and being female. Pediatricians' attitudes about responsibility for identification of attention-deficit/hyperactivity disorder were not associated with usually inquiring about attention-deficit/hyperactivity disorder in either unadjusted or adjusted analyses. Attitudes about treating/managing attention-deficit/hyperactivity disorder were significantly associated with usually treating/managing attention-deficit/hyperactivity disorder in unadjusted and adjusted analyses. Those who perceived that pediatricians should be responsible for treating/managing had almost 12 times the odds of reporting treating/managing attention-deficit/hyperactivity disorder, whereas those who believe physicians should refer had threefold decreased odds of treating/managing. Other physician/practice characteristics significantly associated with the odds of usually treating/managing attention-deficit/hyperactivity disorder include belief that attention-deficit/hyperactivity disorder is very prevalent among current patients, seeing patients who are assigned or can select a specific pediatrician, and practice location.
CONCLUSIONS. Taking responsibility for treating attention-deficit/hyperactivity disorder and practice characteristics seem to be important correlates of pediatrician self-reported behavior toward caring for children with attention-deficit/hyperactivity disorder.
Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants
Authors: Cotten C. Michael , Taylor Sarah , Stoll Barbara , Goldberg Ronald N. , Hansen Nellie I. , Sánchez Pablo J. , Ambalavanan Namasivayam , Benjamin Daniel K. ,   for the NICHD Neonatal Research Network
Published: December 2008

OBJECTIVES. Our objectives were to identify factors associated with the duration of the first antibiotic course initiated in the first 3 postnatal days and to assess associations between the duration of the initial antibiotic course and subsequent necrotizing enterocolitis or death in extremely low birth weight infants with sterile initial postnatal culture results.
METHODS. We conducted a retrospective cohort analysis of extremely low birth weight infants admitted to tertiary centers in 1998–2001. We defined initial empirical antibiotic treatment duration as continuous days of antibiotic therapy started in the first 3 postnatal days with sterile culture results. We used descriptive statistics to characterize center practice, bivariate analyses to identify factors associated with prolonged empirical antibiotic therapy (≥5 days), and multivariate analyses to evaluate associations between therapy duration, prolonged empirical therapy, and subsequent necrotizing enterocolitis or death.
RESULTS. Of 5693 extremely low birth weight infants admitted to 19 centers, 4039 (71%) survived &gt;5 days, received initial empirical antibiotic treatment, and had sterile initial culture results through the first 3 postnatal days. The median therapy duration was 5 days (range: 1–36 days); 2147 infants (53%) received prolonged empirical therapy (center range: 27%–85%). Infants who received prolonged therapy were less mature, had lower Apgar scores, and were more likely to be black. In multivariate analyses adjusted for these factors and center, prolonged therapy was associated with increased odds of necrotizing enterocolitis or death and of death. Each empirical treatment day was associated with increased odds of death, necrotizing enterocolitis, and the composite measure of necrotizing enterocolitis or death.
CONCLUSION. Prolonged initial empirical antibiotic therapy may be associated with increased risk of necrotizing enterocolitis or death and should be used with caution.
Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults
Authors: Ryan Caitlin , Huebner David , Diaz Rafael M. , Sanchez Jorge 
Published: December 2008

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults.METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys.RESULTS. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents
Authors: Arpadi Stephen M. , McMahon Donald , Abrams Elaine J. , Bamji Marukh , Purswani Murli , Engelson Ellen S. , Horlick Mary , Shane Elizabeth 
Published: December 2008

OBJECTIVE. Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period.
METHODS. HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly.
RESULTS. No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration &lt;20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of ≥30 ng/mL compared with 3 (11.1%) in the placebo group.
CONCLUSIONS. Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.
Prevalence and Time Course of Acute Mountain Sickness in Older Children and Adolescents After Rapid Ascent to 3450 Meters
Authors: Bloch Jonathan , Duplain Hervé , Rimoldi Stefano F. , Stuber Thomas , Kriemler Susi , Allemann Yves , Sartori Claudio , Scherrer Urs 
Published: December 2008

OBJECTIVE. Acute mountain sickness is a frequent and debilitating complication of high-altitude exposure, but there is little information on the prevalence and time course of acute mountain sickness in children and adolescents after rapid ascent by mechanical transportation to 3500 m, an altitude at which major tourist destinations are located throughout the world.
METHODS. We performed serial assessments of acute mountain sickness (Lake Louise scores) in 48 healthy nonacclimatized children and adolescents (mean ± SD age: 13.7 ± 0.3 years; 20 girls and 28 boys), with no previous high-altitude experience, 6, 18, and 42 hours after arrival at the Jungfraujoch high-altitude research station (3450 m), which was reached through a 2.5-hour train ascent.
RESULTS. We found that the overall prevalence of acute mountain sickness during the first 3 days at high altitude was 37.5%. Rates were similar for the 2 genders and decreased progressively during the stay (25% at 6 hours, 21% at 18 hours, and 8% at 42 hours). None of the subjects needed to be evacuated to lower altitude. Five subjects needed symptomatic treatment and responded well.
CONCLUSION. After rapid ascent to high altitude, the prevalence of acute mountain sickness in children and adolescents was relatively low; the clinical manifestations were benign and resolved rapidly. These findings suggest that, for the majority of healthy nonacclimatized children and adolescents, travel to 3500 m is safe and pharmacologic prophylaxis for acute mountain sickness is not needed.
Neurodevelopmental Outcome of Extremely Low Birth Weight Infants Randomly Assigned to Restrictive or Liberal Hemoglobin Thresholds for Blood Transfusion
Authors: Whyte Robin K. , Kirpalani Haresh , Asztalos Elizabeth V. , Andersen Chad , Blajchman Morris , Heddle Nancy , LaCorte Meena , Robertson Charlene M. T. , Clarke Maxine C. , Vincer Michael J. , Doyle Lex W. , Roberts Robin S. ,   for the PINTOS Study Group
Published: December 2008

BACKGROUND AND OBJECTIVE. Extremely low birth weight infants frequently receive red cell transfusions. We sought to determine whether a restrictive versus liberal hemoglobin transfusion threshold results in differences in death or adverse neurodevelopmental outcomes of extremely low birth weight infants.
PATIENTS AND METHODS. Extremely low birth weight infants previously enrolled in the Preterm Infants in Need of Transfusion Trial, a randomized, controlled trial of low versus high hemoglobin transfusion thresholds, were followed up at 18 to 21 months’ corrected age. Erythrocyte transfusion was determined by an algorithm of low (restrictive) or high (liberal) hemoglobin transfusion thresholds, differing by 10 to 20 g/L and maintained until first hospital discharge. The primary composite outcome was death or the presence of cerebral palsy, cognitive delay, or severe visual or hearing impairment.
RESULTS. Of 451 enrolled infants, the primary outcome was available in 430. There was no statistically significant difference in the primary outcome, found in 94 (45%) of 208 in the restrictive group and 82 (38%) of 213 in the liberal group. There were no statistically significant differences in preplanned secondary outcomes. However, the difference in cognitive delay (Mental Development Index score &lt; 70) approached statistical significance. A posthoc analysis with cognitive delay redefined (Mental Development Index score &lt; 85) showed a significant difference favoring the liberal threshold group.
CONCLUSIONS. Maintaining the hemoglobin of extremely low birth weight infants at these restrictive rather than liberal transfusion thresholds did not result in a statistically significant difference in combined death or severe adverse neurodevelopmental outcome.
Using a Count of Neonatal Morbidities to Predict Poor Outcome in Extremely Low Birth Weight Infants: Added Role of Neonatal Infection
Authors: Bassler Dirk , Stoll Barbara J. , Schmidt Barbara , Asztalos Elizabeth V. , Roberts Robin S. , Robertson Charlene M. T. , Sauve Reg S. ,   for the Trial of Indomethacin Prophylaxis in Preterms Investigators
Published: December 2008

OBJECTIVE. A count of 3 neonatal morbidities (bronchopulmonary dysplasia, brain injury, and severe retinopathy of prematurity) strongly predict the risk of death or neurosensory impairment in extremely low birth weight infants who survive to 36 weeks' postmenstrual age. Neonatal infection has also been linked with later impairment. We examined whether the addition of infection to the count of 3 neonatal morbidities further improves the prediction of poor outcome.
METHODS. We studied 944 infants who participated in the Trial of Indomethacin Prophylaxis in Preterms and survived to 36 weeks' postmenstrual age. Culture-proven sepsis, meningitis, and stage II or III necrotizing enterocolitis were recorded prospectively. We investigated the incremental prognostic importance of neonatal infection by adding terms for the different types of infection to a logistic model that already contained terms for the count of bronchopulmonary dysplasia, brain injury, and severe retinopathy. Poor outcome at 18 months of age was death or survival with 1 or more of the following: cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.
RESULTS. There were 414 (44%) infants with at least 1 episode of infection or necrotizing enterocolitis. Meningitis and the presence of any type of infection added independent prognostic information to the morbidity-count model. The odds ratio associated with infection or necrotizing enterocolitis in this model was 50% smaller than the odds ratio associated with each count of the other 3 neonatal morbidities. Meningitis was rare and occurred in 22 (2.3%) of 944 infants.
CONCLUSIONS. In this cohort of extremely low birth weight infants who survived to 36 weeks' postmenstrual age, neonatal infection increased the risk of a late death or survival with neurosensory impairment. However, infection was a weaker predictor of poor outcome than bronchopulmonary dysplasia, brain injury, and severe retinopathy.
Family Burden After Traumatic Brain Injury in Children
Authors: Aitken Mary E. , McCarthy Melissa L. , Slomine Beth S. , Ding Ru , Durbin Dennis R. , Jaffe Kenneth M. , Paidas Charles N. , Dorsch Andrea M. , Christensen James R. , MacKenzie Ellen J. ,   and the CHAT Study Group
Published: December 2008

OBJECTIVE. Traumatic brain injury has a substantial impact on caregivers. This study describes the burden experienced by caregivers of children with traumatic brain injury and examines the relationship between child functioning and family burden during the first year after injury.PATIENTS AND METHODS. Children aged 5 to 15 years hospitalized for traumatic brain injury at 4 participating trauma centers were eligible. Caregivers completed baseline and 3- and 12-month telephone interviews measuring the child's health-related quality of life using the Pediatric Quality of Life Inventory. The emotional impact scale of the Child Health Questionnaire was used to identify caregivers with substantial distress, including general worry or interference with family routine. Caregiver perceptions of whether health care needs were met or unmet and days missed from work were also measured.RESULTS. A total of 330 subjects enrolled; follow-up was conducted with 312 at 3 months and 288 at 12 months. Most subjects were white (68%) and male (69%). Abnormal Pediatric Quality of Life Inventory subscores were related to substantial caregiver burden (either general worry or interference in routine). These abnormalities were reported by &gt;75% of patients at 3 months and persisted to 1 year in some patients. Parental perception of unmet health care needs was strongly related to family burden outcomes, with up to 69% of this subset of parents reporting substantial worry, and nearly one quarter reporting interference with daily routine/concentration 1 year after injury. Child dysfunction predicted parental burden at 3 and 12 months. Burden was greater when health care need was unmet. Abnormalities on the Pediatric Quality of Life Inventory predicted the amount of work missed by parents, especially in the presence of unmet needs.CONCLUSIONS. Caregivers are more likely to report family burden problems when child functioning is poorer and health care needs are unmet. Improved identification and provision of services is a potentially modifiable factor that may decrease family burden after pediatric traumatic brain injury.
Pedometer Accuracy for Children: Can We Recommend Them for Our Obese Population?
Authors: Mitre Naim , Lanningham-Foster Lorraine , Foster Randal , Levine James A. 
Published: December 2008

OBJECTIVE. In this study, we investigated the accuracy of measuring walking steps with commercially available pedometers and an accelerometer-based step-counter in normal and overweight children. Our primary hypothesis was that commercially available pedometers are not an accurate measure of walking steps in normal and overweight children while walking. Our secondary hypothesis was that the accelerometer-based step-counter provides an accurate measure of walking steps in normal and overweight children.
METHODS. Thirteen boys (11 ± 1 years) and 14 girls (11 ± 1 years) who ranged in BMI from 15 to 27 kg/m2 (16 normal and 11 overweight or obese) were recruited. Each child wore 4 pedometers at the waist and 1 accelerometer-based step-counter on each ankle. Steps were manually counted and energy expenditure was measured while the child walked on the treadmill at 0.5, 1.0, 1.5, and 2.0 mph, each for 5 minutes. The step-counting devices were also validated while children walked on level ground at a self-selected pace.
RESULTS. For the commercially available pedometers at the lowest speed of 0.5 mph, the percentage error approximated 100% for both of the pedometers. At the fastest speed of 2.0 mph, the percentage error approximated 60%. Conversely the accelerometer-based step-counter showed a percentage error of 24% ± 22% (mean ± SD) at 0.5 mph; however, as walking speed increased, the error declined to 5% ± 8% at 1.0 mph, 4% ± 5% at 1.5 mph, and 2% ± 2% at 2.0 mph. The relationship between steps counted and walking energy expenditure showed good linear correlation.
CONCLUSIONS. Commercially available pedometers are less accurate for measuring walking and require discretion in their use for children. The accuracy of the accelerometer-based step-counter enables it to be used as a tool to assess and potentially promote physical activity in normal and overweight children.
Failure of Ductus Arteriosus Closure Is Associated With Increased Mortality in Preterm Infants
Authors: Noori Shahab , McCoy Michael , Friedlich Philippe , Bright Brianna , Gottipati Venugopal , Seri Istvan , Sekar Kris 
Published: December 2008

OBJECTIVE. Because the standard of care has been to attempt to close the patent ductus arteriosus in preterm neonates, there is a paucity of information on the outcome of patients with a persistent patent ductus arteriosus. Our objective was to compare the mortality of preterm infants with and without a persistent patent ductus arteriosus.
METHODS. This was a single-center, retrospective study. Very preterm infants (birth weight ≤ 1500 g and gestational age ≤ 29 weeks) who survived beyond the first 3 postnatal days and did not undergo surgical ligation were included in the primary analysis. Mortality of neonates with a persistent and a closed patent ductus arteriosus was compared during the initial hospitalization by using the χ2 test. Cox proportional hazard regression and logistic regression were used to take into account the time until death and assess the independent effect of each risk factor on mortality. We also performed 3 secondary analyses by excluding patients who died during the first 7 and 14 postnatal days and including patients who underwent surgical ligation by using different group assignments. A persistent patent ductus arteriosus was defined as a failure of either spontaneous or pharmacologic ductal closure during the initial hospitalization.
RESULTS. Patients with a persistent patent ductus arteriosus (n = 41) had lower birth weight and were less mature than those with a closed ductus (n = 260). Unadjusted mortality rate was higher in patients with a persistent (70.7%) than with a closed (11.2%) ductus. After adjustment for perinatal factors, level of maturity, disease severity, and morbid pathologies, the hazard for death in neonates with a persistent ductus was eightfold higher than in those with a closed ductus. Exclusion of patients who died during the first 2 weeks or inclusion of those who underwent ductal ligation did not change the findings.
CONCLUSION. Failure of ductal closure is associated with an increase in mortality in very preterm infants.