bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Underinsurance and Access to Care Among Children With Special Health Care Needs in the United States
Authors: Kogan Michael D. , Newacheck Paul W. , Honberg Lynda , Strickland Bonnie 
Published: November 2005

Objective. To examine the impact of underinsurance on access to care among children with special health care needs (CSHCN) in the United States.Methods. Interviews were conducted by telephone with the families of 38866 CSHCN who were younger than 18 years using the 2001 National Survey of Children With Special Health Care Needs. The prevalence of underinsurance and its relationship to access to care and family financial problems was examined in this cross-sectional analysis. CSHCN were classified as underinsured when coverage was deemed inadequate to meet the child's needs.Results. An estimated 12.8% of US children experienced a special health care need in 2001. Although 95% of CSHCN had some type of insurance coverage at the time of the interview, 32% were classified as underinsured. Underinsured CSHCN were disproportionately represented in low-income families and were significantly more likely than fully insured children to have unmet health needs, and their families were more likely to report difficulty in obtaining specialty referrals, experience financial problems, and report that the child's condition caused family members to reduce or stop work. Underinsured CSHCN seemed to be somewhat better off than CSHCN with no insurance coverage on these measures.Conclusions. Underinsured CSHCN represent an important and largely hidden underserved population.
Salivary Cortisol and Mood and Pain Profiles During Skin-to-Skin Care for an Unselected Group of Mothers and Infants in Neonatal Intensive Care
Authors: Mörelius Evalotte , Theodorsson Elvar , Nelson Nina 
Published: November 2005

Objectives. Mother-infant separation after birth is a well-known source of stress. Parents and preterm infants in neonatal intensive care are separated immediately after birth. Skin-to-skin care is 1 possible method to reduce the separation-dependent stress. The aim of the present study was to investigate how skin-to-skin care influences stress for the mother and the infant in neonatal intensive care.Methods. Seventeen mother-infant pairs were included at their first and fourth skin-to-skin care. The infants were 25 to 33 weeks' gestational age, with birth weights ranging from 495 to 2590 g. In mothers, salivary cortisol, heart rate, mood scale, and stress measured on a visual analog scale (VAS) were analyzed. In infants, salivary cortisol and heart rate were analyzed, and because pain is one facet of stress, 2 different pain scales were used.Results. In mothers, the skin-to-skin care decreased salivary cortisol (32%), heart rate (7%), and VAS (89%), whereas mood increased (6%). Before the fourth skin-to-skin care, mothers rated less stress on VAS, and salivary cortisol and heart rate improved faster. The infants' cortisol either increased or decreased. Their heart rates and pain scores decreased during skin-to-skin care.Conclusions. Our results lend additional support to the value of skin-to-skin care in neonatal intensive care. Variable stress responses in preterm infants favor the need for individualized care. The mothers' need for support seem to be more pronounced in the first skin-to-skin session as our results show a higher degree of stress as compared with later skin-to-skin care.
Heart Rate Characteristics: Novel Physiomarkers to Predict Neonatal Infection and Death
Authors: Griffin M. Pamela , Lake Douglas E. , Bissonette Eric A. , Harrell Frank E. , O'Shea T. Michael , Moorman J. Randall 
Published: November 2005

Objective. Monitoring of regulated physiologic processes using physiomarkers such as heart rate variability may be important in the early diagnosis of subacute, potentially catastrophic illness. Early in the course of neonatal sepsis, there are physiomarkers of reduced heart rate variability and transient decelerations similar to fetal distress. The goal of this study was to determine the degree of increased risk for sepsis, urinary tract infection (UTI), and death when these abnormal heart rate characteristics (HRC) were observed.
Methods. We monitored 1022 infants at 2 tertiary care NICUs, 458 of whom were very low birth weight. We calculated an HRC index from validated regression models relating mathematical features of heart rate time series and histograms to episodes of illness. We calculated the risks for adverse events of sepsis, UTI, and death for infants stratified by HRC measurements.
Results. Compared with infants with low-risk HRC measurements, infants with high-risk HRC measurements had 5- to 6-fold increased risk for an adverse event in the next day and 3-fold increased risk in the next week. Laboratory tests that were relevant to infection added information to HRC measurements. Infants with both high-risk HRC and abnormal laboratory tests had 6- to 7-fold increased risk for an adverse event in the next day compared with infants who had neither.
Conclusion. HRC are noninvasively monitored physiomarkers that identify infants in the NICU who are at high risk for sepsis, UTI, and death.
Medicaid Acceptance and Availability of Timely Follow-up for Newborns With Medicaid
Authors: Galbraith Alison A. , Grossman David C. , Koepsell Thomas D. , Heagerty Patrick J. , Christakis Dimitri A. 
Published: November 2005

Objective. Decreased physician participation in Medicaid has been shown to affect adversely timeliness of adult acute care and pediatric specialty care, but it is not clear whether this is the case for newborn follow-up. The objectives of this study were to determine whether there is a difference within clinics in the timeliness of follow-up appointments that are given to newborns with Medicaid compared with newborns with private insurance and to determine whether there is a difference between clinics that do and do not accept Medicaid in the timeliness of appointments that are given for newborn follow-up.Methods. A randomized crossover study was conducted among general pediatric clinics and practices that were identified from the yellow pages and Internet searches of hospitals and health departments in 8 metropolitan areas from September 2003 to March 2004. A simulated parent telephoned clinics to find the earliest available appointment for a 1-day-old infant who needed routine follow-up after discharge that day. Clinics were randomly assigned to receive a first call from a patient with either Medicaid or private insurance; each clinic received the same call at least 3 weeks later with the patient's insurance status reversed. The main outcome measure was whether the appointment was timely (≤2 days from the day of the call).Results. Of 401 participating clinics, 22% did not accept Medicaid. Among clinics that accepted Medicaid, availability of a timely appointment for a newborn with Medicaid was similar to that for a newborn with private insurance (87% vs 90%, respectively). Appointments that were provided to privately insured newborns were as likely to be timely in clinics that accept Medicaid as in clinics that do not accept Medicaid (89.5% vs 93.4%, respectively). However, providing timely appointments was significantly less likely in clinics that were in high-poverty locations compared with clinics that were not (86.1% vs 92.7%, respectively).Conclusions. Although newborns with Medicaid did not have access to &gt;20% of clinics because of their insurance, among clinics that did accept Medicaid, timeliness of available follow-up was similar for newborns with Medicaid compared with newborns with private insurance and similar between clinics that did and did not accept Medicaid. However, to the extent that care for newborns with Medicaid is concentrated in clinics in high-poverty areas, some newborns with Medicaid may not be able to receive timely appointments.
Using the Internet to Provide Information Prescriptions
Authors: Ritterband Lee M. , Borowitz Stephen , Cox Daniel J. , Kovatchev Boris , Walker Lynn S. , Lucas Vanessa , Sutphen James 
Published: November 2005

Introduction. An information prescription is the provision of specific information to a patient on how to help manage a health problem. The Internet is being used increasingly as a source for information prescriptions, with clinicians directing patients to specific Web sites. As with any health care intervention, patients' lack of compliance is a barrier to the effectiveness of Web-based information prescriptions (WebIPs). WebIPs cannot be helpful if patients do not review the information prescribed for them.
Objective. The main objective of this study was to quantify the percentage of families who visit a Web site that was specifically prescribed by their physician. In addition, the use of an e-mail reminder was used to determine if it increases the likelihood that families will visit the prescribed Web site. Finally, barriers to accessing the prescribed Web site were identified.
Methods. Children were eligible if they presented to the pediatric gastroenterology clinic with chronic constipation and/or encopresis and their family had an active e-mail account and access to the Internet in their home. During their clinic visit, physicians instructed families to visit a Web site that provided educational information pertinent to their child's problem. Families were given a form with the Web-site address and a log-in identification number. Two days after their clinic visit, half of the families received an e-mail reminding them to visit the Web site. Families were contacted 1 week after their clinic visit to identify barriers to accessing the Web site.
Results. Eighty-three families participated in the study. Of the 83 families, 54 (65%) visited the prescribed Web site within 1 week of their clinic visit. Families who received e-mail reminders were significantly more likely to visit the Web site than families who did not receive an e-mail reminder (77% vs 53%). This difference could not be explained by the type or speed of Internet connection or how frequently they accessed the Internet or e-mail. The most common reasons that families cited for not accessing the Web site were “I forgot” and “I didn't have time.” Few families cited technical reasons for not accessing the Web site.
Conclusions. Almost two thirds of the families given a WebIP logged on to the prescribed Web site. The probability that families would access the site was increased by 45% with an e-mail reminder. Clearly, e-mail prompts improve compliance to WebIPs. As content and treatment programs continue to proliferate on the Web, it is important to identify barriers and solutions to them to improve overall compliance.
Nonresponse Bias in a Follow-up Study of 19-Year-Old Adolescents Born as Preterm Infants
Authors: Hille E.T.M. , Elbertse L. , Gravenhorst J. Bennebroek , Brand R. , Verloove-Vanhorick S.P. ,   on behalf of the Dutch POPS-19 Collaborative Study Group
Published: November 2005

Objective. To assess the effect of demographic and neonatal risk factors and outcome at the last available assessment on the probability of full responders, postal responders (those who only responded to the mailed questionnaire), or nonresponders in a follow-up study of 19-year-old adolescents who were born as preterm infants.
Design. The 19-year follow-up program was part of a large ongoing collaborative study in the Netherlands on the long-term effect of prematurity and dysmaturity on various medical, psychological, and social parameters. In the original cohort, 1338 infants (94%) with a gestational age of &lt;32 weeks and/or a birth weight of &lt;1500 g were enrolled. Neonatal mortality was 23% (n = 312), and another 67 children had died between the ages of 28 days and 19 years, leaving 959 survivors (72% of the original cohort) for follow-up at the present assessment. To study the effect of nonresponse, we divided the 959 survivors into 3 groups: full responders (596 [62.1%]), postal responders (109 [11.4%]), and nonresponders (254 [26.5%]). In the 3 groups we compared demographic and neonatal data, as well as outcome at the last available assessment.
Results. The odds ratios (ORs) for male versus female for the probabilities of nonresponse and postal response were statistically significant: 2.7 (95% CI: 1.9–3.9) and 1.6 (95% CI: 1.0–2.5), respectively. The same holds for the ORs for non-Dutch versus Dutch and low versus high maternal education for nonresponse: 2.0 (95% CI: 1.3–3.2) and 3.7 (95% CI: 2.0–6.7), respectively. Special education and severe handicap showed a statistically significant influence on nonresponse (OR: 1.6; 95% CI: 1.1–2.4 and OR: 2.6; 95% CI: 1.3–5.2) and postal response (OR: 2.0; 95% CI: 1.2–3.3 and OR: 4.4; 95% CI: 2.0–9.9), respectively. At the age of 19 years, primary school and special education were found significantly more frequent in the postal responders than in the full-response group (20% and 21% vs 6% and 12%). The full responders, on the other hand, were higher educated than were the postal responders.
Conclusions. In this follow-up study at the age of 19 years, boys, non-Dutch adolescents, and low maternal education were overrepresented in the nonresponse and postal-response groups. Nonresponse decreased the proportion of infants with adverse outcome in assessed children. To be able to present reliable results for the total group of survivors in long-term follow-up studies, the nonresponse bias needs to be quantified. Therefore, it is evident that more research using statistical methods such as imputation of missing data is needed.
Exposure to Movie Smoking: Its Relation to Smoking Initiation Among US Adolescents
Authors: Sargent James D. , Beach Michael L. , Adachi-Mejia Anna M. , Gibson Jennifer J. , Titus-Ernstoff Linda T. , Carusi Charles P. , Swain Susan D. , Heatherton Todd F. , Dalton Madeline A. 
Published: November 2005

Objective. Regional studies have linked exposure to movie smoking with adolescent smoking. We examined this association in a representative US sample.
Design/Methods. We conducted a random-digit-dial survey of 6522 US adolescents aged 10 to 14 years. Using previously validated methods, we estimated exposure to movie smoking, in 532 recent box-office hits, and examined its relation with adolescents having ever tried smoking a cigarette.
Results. The distributions of demographics and census region in the unweighted sample were almost identical to 2000 US Census estimates, confirming representativeness. Overall, 10% of the population had tried smoking. Quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.02 of adolescents in Q1 had tried smoking; 0.06 in Q2; 0.11 in Q3; and 0.22 in Q4. This association did not differ significantly by race/ethnicity or census region. After controlling for sociodemographics, friend/sibling/parent smoking, school performance, personality characteristics, and parenting style, the adjusted odds ratio for having tried smoking were 1.7 (95% confidence interval [CI]: 1.1, 2.7) for Q2, 1.8 (95% CI: 1.2, 2.9) for Q3, and 2.6 (95% CI: 1.7, 4.1) for Q4 compared with adolescents in Q1. The covariate-adjusted attributable fraction was 0.38 (95% CI: 0.20, 0.56), suggesting that exposure to movie smoking is the primary independent risk factor for smoking initiation in US adolescents in this age group.
Conclusions. Smoking in movies is a risk factor for smoking initiation among US adolescents. Limiting exposure of young adolescents to movie smoking could have important public health implications.
All-Terrain Vehicle–Related Nonfatal Injuries Among Young Riders: United States, 2001–2003
Authors: Shults Ruth A. , Wiles Stacey D. , Vajani Madhavi , Helmkamp James C. 
Published: November 2005

Background. All-terrain vehicles (ATVs) have gained in popularity in recent years, and this rise in use has been accompanied by increases in the number of ATV-related injuries. Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate ATVs properly, their risk for injury is greater. Furthermore, most children ride adult-sized ATVs.
Objectives. To estimate the numbers and rates of ATV-related nonfatal injuries to riders aged ≤15 years who were treated in hospital emergency departments (EDs) in the United States from 2001 through 2003.
Methods. Estimates of ATV-related injuries were obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System-All Injury Program. The database is a nationally representative, stratified probability sample of 66 US hospitals with ≥6 beds and a 24-hour ED. ATV-related nonfatal injuries to riders aged ≤15 years who were treated in hospital EDs were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status.
Results. From 2001 through 2003, an estimated 108724 children aged ≤15 years were treated in hospital EDs for nonfatal injuries sustained while riding ATVs. The number of ATV-related injuries increased by 25% over the 3-year period. Males aged 11 to 15 years accounted for 52% of all ATV-related ED visits and hospitalizations among young riders. Children aged 0 to 5 years were more likely than the older children to have facial injuries, whereas the older children were more likely to sustain lower trunk and leg or foot injuries. Fractures were the most common diagnosis, accounting for 27% of ED visits and 45% of hospitalizations.
Conclusions. Current legal and regulatory standards have been ineffective in reducing injuries among young ATV riders. Renewed efforts by health care providers to counsel parents about the injury risk to children who ride ATVs and advocate for more stringent state-level minimum age requirements may help reduce the escalating rates of ATV-related injuries among young riders.
Thioridazine Induces Immediate and Delayed Erythema in Photopatch Test
Authors: Takiwaki Hirotsugu , Tsuchiya Koichiro , Fujita Mayumi , Miyaoka Yuki 
Published: November 2005

ABSTRACTThioridazine is a phenothiazine derivative that has been used as an antipsychotic; it rarely causes photosensitization. However, we noticed that this drug induced an erythematous reaction in a photopatch test. Six volunteers were patch tested with various concentrations of thioridazine and irradiated with a range of UVA doses, and the time courses of the color of and blood flow to the test sites were monitored. The free‐radical metabolites of thioridazine generated under UVA irradiation and its effects on ascorbate radical formation were examined with an electron paramagnetic resonance (EPR) spectrometer in vitro. As a result, immediate erythema developed during UVA irradiation in most subjects when 1% thioridazine was applied for 48 h and irradiation doses were higher than 4 J cm‐2. Another peak of erythematous reaction was observed 8–12 h after irradiation. The in vitro examination detected an apparent EPR signal, which appeared when 2 mM thioridazine in air‐saturated phosphate buffer was irradiated with UVA, whereas this reaction was attenuated under anaerobic conditions. The EPR signal of the ascorbate radical was augmented under both aerobic and anaerobic conditions. Thioridazine‐derived oxidants and/or thioridazine radicals generated during UVA irradiation seem to play an important role in this unique phototoxic reaction.
Radiation Sources Providing Increased UVNUVB Ratios Induce Photoprotection Dependent on the UVA Dose in Hairless Mice
Authors: Reeve Vivienne E. , Domanski Diane , Slater Michael 
Published: November 2005

ABSTRACTIn studies involving mice in which doses of UVA (320–400 nm) and UVB (290–320 nm) radiation were administered alone or combined sequentially, we observed a protective effect of UVA against UVB‐induced erythemdedema and systemic suppression of contact hypersensitivity. The UVA immunoprotection was mediated by the induction of the stress enzyme heme oxygenase‐1 (HO‐1) in the skin, protection of the cutaneous Th1 cytokines interferon‐gM (IFN‐γ) and IL‐12 and inhibition of the UVB‐induced expression of the Th2 cytokine IL‐10. In this study, we seek evidence for an immunological waveband interaction when UVA and UVB are administered concurrently to hairless mice as occurs during sunlight exposure in humans. A series of spectra providing varying ratios of UVA/UVB were developed, with the UVA ratio increased to approximately 3.5 times the UVA component in solar simulated UV (SSUV). We report that progressively increasing the UVA component of the radiation while maintaining a constant UVB dose resulted in a reduction of both the erythemdedema reaction and the degree of systemic immunosuppression, as measured as contact hypersensitivity. The UVA‐enhanced immunoprotection was abrogated in mice treated with a specific HO enzyme inhibitor. UVA‐enhanced radiation also upregulated the expression of cutaneous IFN‐γ and IL‐12 and inhibited expression of both IL‐6 and IL‐10, compared with the activity of SSUV. The results were consistent with the previously characterized mechanisms of photoprotection by the UVA waveband alone and suggest that the UVA component of solar UV may have beneficial properties for humans.
Renal Safety of Ibandronate
Authors: Jackson Graham H. 
Published: November 2005

Abstract
Despite their efficacy in treating complications associated with metastatic bone disease, there are concerns about the potential nephrotoxicity of certain i.v. bisphosphonates for the long-term management of cancer patients. Clinical data suggest, however, that i.v. ibandronate (Bondronat®; F. Hoffman-La Roche Ltd., Basel, Switzerland, http://www.roche.com), unlike other bisphosphonates, has a renal safety profile comparable with that of placebo. In a 2-year, phase III study of patients with breast cancer metastatic to bone, the incidence of adverse renal events in patients treated with 6 mg i.v. ibandronate was low and comparable with that of placebo (4% versus 4.5% with placebo). Two-year assessments of time to serum creatinine increase also demonstrated renal safety comparable with that of placebo (patients with creatinine increase: 6% versus 12% with placebo). Long-term (4-year) renal safety of ibandronate was demonstrated in a 2-year extension of the trial. Phase II, open-label studies show that intensive ibandronate dosing does not compromise renal safety in patients with metastatic bone pain from a variety of tumor types. In addition, i.v. ibandronate is well tolerated, with no evidence of renal toxicity in multiple myeloma and urologic cancer patients with existing renal impairment. The potential nephrotoxicity of some bisphosphonates has prompted additional renal safety precautions in product labeling for these agents. The precautions are not, however, contained in the label for ibandronate, which may thus simplify patient management.