bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tuberculosis Screening in Internationally Adopted Children: The Need for Initial and Repeat Testing
Authors: Trehan Indi , Meinzen-Derr Jareen K. , Jamison Linda , Staat Mary Allen 
Published: July 2008

OBJECTIVE. Because most internationally adopted children come from areas of high tuberculosis prevalence, an initial tuberculin skin test is recommended after arrival to the United States. We evaluated whether repeat testing of children ≥3 months after arrival to the United States would identify additional children with latent tuberculosis infection.METHODS. Internationally adopted children who were seen at our International Adoption Center and had a tuberculin skin test within 2 months of arrival to the United States were eligible for the study. Children not diagnosed with tuberculosis with initial testing were retested at least 3 months later. The prevalence of tuberculosis on arrival and after repeat testing was determined, and potential risk factors for infection were examined.RESULTS. Of the 527 internationally adopted children with an initial tuberculin skin test completed, 111 (21%) had evidence of latent tuberculosis infection. Repeat tuberculosis testing was complete for 191 internationally adopted children (46.9% of those who had an initially negative tuberculin skin test). Latent tuberculosis infection was found in 20% of those who were retested. No children were found to have active tuberculosis disease. Children with an initially positive tuberculin skin test result had slightly higher weight-for-age z scores at their initial clinic visit, whereas those whose tuberculin skin test result was positive after repeat testing had slightly lower weight-for-age z scores. A strong correlation between BCG immunization and tuberculin skin test result was observed.CONCLUSIONS. Latent tuberculosis infection is common in internationally adopted children. A high proportion of internationally adopted children had an initially false-negative tuberculin skin test. Repeat tuberculosis testing of all internationally adopted children with an initially negative tuberculin skin test should be the standard of care for identifying tuberculosis infection and preventing tuberculosis disease in this high-risk population.
What's in a Smile? Maternal Brain Responses to Infant Facial Cues
Authors: Strathearn Lane , Li Jian , Fonagy Peter , Montague P. Read 
Published: July 2008

OBJECTIVES. Our goal was to determine how a mother's brain responds to her own infant's facial expressions, comparing happy, neutral, and sad face affect.
METHODS. In an event-related functional MRI study, 28 first-time mothers were shown novel face images of their own 5- to 10-month-old infant and a matched unknown infant. Sixty unique stimuli from 6 categories (own-happy, own-neutral, own-sad, unknown-happy, unknown-neutral, and unknown-sad) were presented randomly for 2 seconds each, with a variable 2- to 6-second interstimulus interval.
RESULTS. Key dopamine-associated reward-processing regions of the brain were activated when mothers viewed their own infant's face compared with an unknown infant's face. These included the ventral tegmental area/substantia nigra regions, the striatum, and frontal lobe regions involved in (1) emotion processing (medial prefrontal, anterior cingulate, and insula cortex), (2) cognition (dorsolateral prefrontal cortex), and (3) motor/behavioral outputs (primary motor area). Happy, but not neutral or sad own-infant faces, activated nigrostriatal brain regions interconnected by dopaminergic neurons, including the substantia nigra and dorsal putamen. A region-of-interest analysis revealed that activation in these regions was related to positive infant affect (happy &gt; neutral &gt; sad) for each own–unknown infant-face contrast.
CONCLUSIONS. When first-time mothers see their own infant's face, an extensive brain network seems to be activated, wherein affective and cognitive information may be integrated and directed toward motor/behavioral outputs. Dopaminergic reward-related brain regions are activated specifically in response to happy, but not sad, infant faces. Understanding how a mother responds uniquely to her own infant, when smiling or crying, may be the first step in understanding the neural basis of mother–infant attachment.
Overweight in Children and Adolescents in Relation to Attention-Deficit/Hyperactivity Disorder: Results From a National Sample
Authors: Waring Molly E. , Lapane Kate L. 
Published: July 2008

OBJECTIVE. As the prevalence of childhood obesity increases, identifying groups of children who are at increased risk of overweight is important. The current study estimated the prevalence of overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder and medication use.PATIENTS AND METHODS. This study was a cross-sectional analysis of 62 887 children and adolescents aged 5 to 17 years from the 2003–2004 National Survey of Children's Health, a nationally representative sample of children and adolescents in the United States. Attention-deficit disorder/attention-deficit/hyperactivity disorder was determined by response to the question “Has a doctor or health professional ever told you that your child has attention-deficit disorder or attention-deficit/hyperactive disorder, that is, ADD or ADHD?” Children and adolescents were classified as underweight, normal weight, at risk of overweight, or overweight according to BMI for age and gender.RESULTS. After adjustment for age, gender, race/ethnicity, socioeconomic status, and depression/anxiety, children and adolescents with attention-deficit disorder/attention-deficit/hyperactivity disorder not currently using medication had ∼1.5 times the odds of being overweight, and children and adolescents currently medicated for attention-deficit disorder/attention-deficit/hyperactivity disorder had ∼1.6 times the odds of being underweight compared with children and adolescents without either diagnosis.CONCLUSIONS. This study provides heightened awareness for pediatric providers about the relationship between attention-deficit disorder/attention-deficit/hyperactivity disorder, medication use, and weight status. Future work is needed to better understand the longitudinal and pharmacologic factors that influence the relationship between attention-deficit disorder/attention-deficit/hyperactivity disorder and weight status in children and adolescents.
Universal Screening for Hearing Loss in Newborns: US Preventive Services Task Force Recommendation Statement
Authors:   US Preventive Services Task Force
Published: July 2008

DESCRIPTION. This is the 2008 update of the 2001 US Preventive Services Task Force recommendation on universal newborn hearing screening.
METHODS. The US Preventive Services Task Force weighed the benefits and harms of universal newborn hearing screening, incorporating new evidence addressing gaps identified in the 2001 US Preventive Services Task Force recommendation statement. Published literature on this topic was identified (by using Medline and Cochrane databases) and systematically reviewed.
RECOMMENDATION. Screen for hearing loss in all newborn infants (B recommendation).
Care Coordination for Children and Youth With Special Health Care Needs: A Descriptive, Multisite Study of Activities, Personnel Costs, and Outcomes
Authors: Antonelli Richard C. , Stille Christopher J. , Antonelli Donna M. 
Published: July 2008

OBJECTIVES. Objectives included testing use of the care-coordination measurement tool in pediatric primary care practices; describing care-coordination activities for children and youth that occur in primary care practices; assessing the relationship of care-coordination activities in the medical home with outcomes related to resource use; and measuring the direct personnel costs of care-coordination activities.
METHODS. Six general pediatric practices were selected, representing a diverse range of sizes, locations, patient demographics, and care-coordination activity model types. The care-coordination measurement tool was used over a period of 8 months in 2003 to record all of the nonreimbursable care-coordination activity encounters performed by any office-based personnel. The tool enabled recording of activities, resources-use outcomes, and time. Cost of personnel performing care-coordination activities was derived by extrapolation from the time spent.
RESULTS. Care-coordination activity services were used by patients of all complexity levels. Children and youth with special health care needs with acute-onset, family-based psychosocial problems experienced 14% of the care-coordination activity encounters and used 21% of the care-coordination activities minutes. Children and youth without special health care needs, without complicating family psychosocial problems, received 50% of the encounters and used 36% of the care-coordination activity minutes. The average cost per care-coordination activity encounter varied from $4.39 to $12.86, with an overall mean of $7.78. A principal cost driver seemed to be the percentage of care-coordination activities performed by physicians. Office-based nurses prevented a large majority of emergency department visits and episodic office visits.
CONCLUSIONS. Care-coordination activity was assessed at the practice level, and the care-coordination measurement tool was used successfully during the operations of typical, pediatric, primary care settings. The presence of acute, family-based social stressors was a significant driver of need for care-coordination activities. A high proportion of dependence on care-coordination performed by physicians led to increased costs. Office-based nurses providing care coordination were responsible for a significant number of episodes of avoidance of higher cost use outcomes.
Patient Factors Used by Pediatricians to Assign Asthma Treatment
Authors: Okelo Sande O. , Patino Cecilia M. , Riekert Kristin A. , Merriman Barry , Bilderback Andrew , Hansel Nadia N. , Thompson Kathy , Thompson Jennifer , Quartey Ruth , Rand Cynthia S. , Diette Gregory B. 
Published: July 2008

OBJECTIVE. Although asthma is often inappropriately treated in children, little is known about what information pediatricians use to adjust asthma therapy. The purpose of this work was to assess the importance of various dimensions of patient asthma status as the basis of pediatrician treatment decisions.PATIENTS AND METHODS. We conducted a cross-sectional, random-sample survey, between November 2005 and May 2006, of 500 members of the American Academy of Pediatrics using standardized case vignettes. Vignettes varied in regard to (1) acute health care use (hospitalized 6 months ago), (2) bother (parent bothered by the child's asthma status), (3) control (frequency of symptoms and albuterol use), (4) direction (qualitative change in symptoms), and (5) wheezing during physical examination. Our primary outcome was the proportion of pediatricians who would adjust treatment in the presence or absence of these 5 factors.RESULTS. Physicians used multiple dimensions of asthma status other than symptoms to determine treatment. Pediatricians were significantly more likely to increase treatment for a recently hospitalized patient (45% vs 18%), a bothered parent (67% vs 18%), poorly controlled symptoms (4–5 times per week; 100% vs 18%), or if there was wheezing on examination (45% vs 18%) compared with patients who only had well-controlled symptoms. Pediatricians were significantly less likely to decrease treatment for a child with well-controlled symptoms and recent hospitalization (28%), parents who reported being bothered (43%), or a child whose symptoms had worsened since the last doctor visit (10%) compared with children with well-controlled symptoms alone.CONCLUSIONS. Pediatricians treat asthma on the basis of multiple dimensions of asthma status, including hospitalization, bother, symptom frequency, direction, and wheezing but use these factors differently to increase and decrease treatment. Tools that systematically assess multiple dimensions of asthma may be useful to help further improve pediatric asthma care.
Implementation of Rotavirus Immunization in Philadelphia, Pennsylvania: High Levels of Vaccine Ineligibility and Off-Label Use
Authors: Daskalaki Irini , Spain C. Victor , Long Sarah S. , Watson Barbara 
Published: July 2008

OBJECTIVE. Our goal was to predict, using delayed diphtheria-tetanus-acellular pertussis vaccination as an indicator, whether the current narrowly defined age limits for pentavalent rotavirus vaccine exclude a substantial proportion of children from complete immunization against rotavirus and to assess adherence of providers to recommended age limits by examining the first 6 months of use of pentavalent rotavirus vaccine in Philadelphia, Pennsylvania.
PATIENTS AND METHODS. Data from a computerized children's immunization registry in Philadelphia were analyzed. Demographics and age at immunization with first 3 diphtheria-tetanus-acellular pertussis doses were examined from 2001 to 2005. Similar characteristics were evaluated for children who received pentavalent rotavirus vaccine doses during the first 6 months of its availability (August 2006 through January 2007).
RESULTS. During the 5-year period, 24 403 of 103 967 recipients of first diphtheria-tetanus-acellular pertussis vaccine were &gt;12 weeks of age; only 56 411 of 79 564 first diphtheria-tetanus-acellular pertussis recipients ≤12 weeks of age received the first 3 doses at ages that they could have completed the pentavalent rotavirus vaccine series if vaccines were given at the same visit. Children using public providers were more likely to have delayed immunization. During the first 6 months of pentavalent rotavirus vaccine implementation, 5566 pentavalent rotavirus vaccine doses were recorded in the Kids Immunization Database/Tracking System: 3912 first doses, 1419 second doses, and 235 third doses. Of 3912 first-dose pentavalent rotavirus vaccine recipients, 770 were &gt;12 weeks of age. Hospital-based providers were less likely to administer pentavalent rotavirus vaccine off-label.
CONCLUSIONS. With the current level of vaccine implementation and current pentavalent rotavirus vaccine recommendations for series initiation, a substantial proportion of children are expected to be excluded from receiving any pentavalent rotavirus vaccine or completing the series. In the first 6 months of availability, pentavalent rotavirus vaccine frequently was used off-label for age, underscoring the importance of education of immunization providers. Current outreach programs for finding 10-month-old toddlers delinquent for immunizations will not improve the possibility of protection against rotavirus.
Is Office-Based Counseling About Media Use, Timeouts, and Firearm Storage Effective? Results From a Cluster-Randomized, Controlled Trial
Authors: Barkin Shari L. , Finch Stacia A. , Ip Edward H. , Scheindlin Benjamin , Craig Joseph A. , Steffes Jennifer , Weiley Victoria , Slora Eric , Altman David , Wasserman Richard C. 
Published: July 2008

OBJECTIVE. The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use of a violence-prevention clinical intervention during the routine well-child examination.METHODS. In this cluster-randomized, controlled trial (2002–2006), 137 Pediatric Research in Office Settings practices were randomly assigned and initiated patient recruitment for either an office-based violence-prevention intervention or a control group (educational handout on literacy promotion provided). Primary caregivers of children who were aged 2 to 11 years and presented for a well-child visit were surveyed at baseline and 1 and 6 months. Practitioners were trained to (1) review a parent previsit summary regarding patient-family behavior and parental concern about media use, discipline strategies, and children's exposure to firearms, (2) counsel using brief principles of motivational interviewing, (3) identify and provide local agency resources for anger and behavior management when indicated, and (4) instruct patient-families on use of tangible tools (minute timers to monitor media time/timeouts and firearm cable locks to store firearms more safely where children live or play). Main outcomes were change over time in self-reported media use &lt;120 minutes per day, use of timeouts, and use of firearm cable locks.RESULTS. Generalized estimating equation analysis revealed a significant effect at 6 months for decreased media use and safer firearm storage. The intervention group compared with the control group showed an increase in limiting media use to &lt;120 minutes per day. There was no significant effect for timeout use. There was a substantial increase in storing firearms with cable locks for the intervention group versus a decrease for the control group.CONCLUSIONS. This randomized, controlled trial demonstrated decreased media exposure and increased safe firearm storage as a result of a brief office-based violence-prevention approach.
Community-wide Intervention to Improve the Attention-Deficit/Hyperactivity Disorder Assessment and Treatment Practices of Community Physicians
Authors: Epstein Jeffery N. , Langberg Joshua M. , Lichtenstein Philip K. , Mainwaring Beth A. , Luzader Carolyn P. , Stark Lori J. 
Published: July 2008

OBJECTIVES. The goals were to implement and to test a quality-improvement intervention aimed at improving community-based primary care providers’ adherence to the American Academy of Pediatrics, evidence-based diagnostic and treatment guidelines for attention-deficit/hyperactivity disorder.
METHODS. Nineteen practices (with 84 primary care providers) from a large urban community were trained by using quality-improvement methods with some academic detailing. Pretraining and posttraining adherence to evidence-based practices was assessed through review of patient charts.
RESULTS. Preintervention rates of guideline usage were uniformly low. After the intervention, primary care providers showed substantial improvement in their use of the guidelines for the assessment and treatment of elementary school-aged patients with newly diagnosed attention-deficit/hyperactivity disorder. Use of parent and teacher assessment rating scales increased from levels of 52% to 55% to levels of nearly 100%. Systematic monitoring of responses to medication improved from a baseline level of 9% to 40%.
CONCLUSIONS. Quality-improvement interventions such as the one used in this study seem quite effective in improving primary care providers’ practices at offices that express interest in improving the quality of care for attention-deficit/hyperactivity disorder. The design of the intervention, problems associated with improving and sustaining treatment monitoring, and issues related to generalizability of the intervention model are discussed.
Common Metabolic Profile in Infants Indicating Impaired Cobalamin Status Responds to Cobalamin Supplementation
Authors: Bjørke-Monsen Anne-Lise , Torsvik Ingrid , Sætran Hege , Markestad Trond , Ueland Per Magne 
Published: July 2008

OBJECTIVE. A metabolic profile consistent with impaired cobalamin status is prevalent in breastfed infants. We investigated whether this profile reflects immature organ systems or impaired cobalamin status.
METHODS. In a single-center, randomized, placebo-controlled trial, we studied 107 six-week-old infants. The infants were randomly assigned to receive either an intramuscular injection of 400 μg of cobalamin or no intervention. Concentrations of cobalamin and folate in serum and total homocysteine, methylmalonic acid, and cystathionine in plasma were determined at enrollment and at the age of 4 months.
RESULTS. There were no significant differences between the intervention group (n = 54) and the control group (n = 53) in the concentrations of any vitamin marker at baseline (6 weeks). At 4 months, the supplement-treated infants had a 75% higher median serum cobalamin level and remarkable reductions in median plasma total homocysteine (from 7.46 to 4.57 μmol/L) and methylmalonic acid (from 0.58 to 0.20 μmol/L) levels, whereas levels of both metabolites were essentially unchanged during the follow-up period in the control group.
CONCLUSIONS. Cobalamin supplementation changed all markers of impaired cobalamin status (low cobalamin, high total homocysteine, and high methylmalonic acid levels) toward a profile observed in cobalamin-replete older children and adults. Therefore, the high total homocysteine and methylmalonic acid levels reported for a large fraction of infants reflect not immature metabolism but rather insufficient cobalamin levels to fully sustain cobalamin-dependent reactions fully.
School Food Environments and Policies in US Public Schools
Authors: Finkelstein Daniel M. , Hill Elaine L. , Whitaker Robert C. 
Published: July 2008

OBJECTIVE. The purpose of this study was to describe school food environments and policies in US public schools and how they vary according to school characteristics.
METHODS. We analyzed cross-sectional data from the third School Nutrition and Dietary Assessment study by using a nationally representative sample of 395 US public schools in 129 school districts in 38 states. These 2005 data included school reports of foods and beverages offered in the National School Lunch Program and on-site observations, in a subsample of schools, of competitive foods and beverages (those sold in vending machines and a la carte and that are not part of the National School Lunch Program). Seventeen factors were used to characterize school lunches, competitive foods, and other food-related policies and practices. These factors were used to compute the food environment summary score (0 [least healthy] to 17 [most healthy]) of each school.
RESULTS. There were vending machines in 17%, 82%, and 97% of elementary, middle, and high schools, respectively, and a la carte items were sold in 71%, 92%, and 93% of schools, respectively. Among secondary schools with vending and a la carte sales, these sources were free of low-nutrient energy-dense foods or beverages in 15% and 21% of middle and high schools, respectively. The food environment summary score was significantly higher (healthier) in the lower grade levels. The summary score was not associated with the percentage of students that was certified for free or reduced-price lunches or the percentage of students that was a racial/ethnic minority.
CONCLUSIONS. As children move to higher grade levels, their school food environments become less healthy. The great majority of US secondary schools sell items a la carte in the cafeteria and through vending machines, and these 2 sources often contain low-nutrient, energy-dense foods and beverages, commonly referred to as junk food.