bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Constraint-Induced Movement Therapy on Involved Upper-Extremity Use in Children With Hemiplegic Cerebral Palsy Is Not Age-Dependent
Authors: Gordon Andrew M. , Charles Jeanne , Wolf Steven L. 
Published: March 2006

OBJECTIVES. Constraint-induced (CI) movement therapy has been shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). Because little is known about patient characteristics predicting treatment efficacy, not all children may benefit from this intervention. Here we examine the relationship between efficacy of a child-friendly form of CI therapy and age on involved upper-extremity function.
DESIGN. Twenty children with hemiplegic CP age 4 to 13 years received CI therapy and completed evaluations. Based on established functional and neuromaturational changes in hand skill development, the children were divided into a “younger group” (age 4–8 years, n = 12) and “older group” (age 9–13 years, n = 8). Children wore a sling on their noninvolved upper extremity for 6 hours per day for 10 of 12 consecutive days, during which time they were engaged in play and functional activities. Each child was evaluated by trained evaluators who were blinded to the fact that the children received treatment. The evaluations took place once before the intervention and at 1 week, 1 month, and 6 months after the intervention. Efficacy was examined at the movement efficiency (Jebsen-Taylor Test of Hand Function, subtest 8 of the Bruininks-Oseretsky Test of Motor Proficiency), environmental (caregiver frequency and quality of involved upper-limb use), and impairment (strength, tactile sensitivity, and muscle tone) levels.
RESULTS. Children in both age groups had significant improvements in involved hand-movement efficiency and environmental functional limitations, which were retained through the 6-month posttest. However, there were no differences in efficacy between younger and older children. Both hand severity and the children's behavior during testing (number of redirections), with the latter serving as a reasonable correlate for attention during the intervention, were related to changes in performance in the younger group but not in the older group.
CONCLUSIONS. The results suggest that the intensive practice associated with CI therapy can improve movement efficiency and environmental functional limitations among a carefully selected subgroup of children with hemiplegic CP of varying ages and that this efficacy is not age-dependent.
Efficacy of Iron and/or Zinc Supplementation on Cognitive Performance of Lead-Exposed Mexican Schoolchildren: A Randomized, Placebo-Controlled Trial
Authors: Rico Javier Alatorre , Kordas Katarzyna , López Patricia , Rosado Jorge L. , Vargas Gonzalo García , Ronquillo Dolores , Stoltzfus Rebecca J. 
Published: March 2006

OBJECTIVE. Lead exposure in children has been associated with both global and specific cognitive deficits. Although chelation therapy is advised for children with blood lead concentrations of &gt;44 μg/dL, treatment options for children with lower blood lead values are limited. Because lead absorption is related to children's nutritional status, micronutrient supplements may be 1 strategy for combating low-level, chronic lead exposure. This study was designed to test the efficacy of iron and zinc supplementation for lowering blood lead concentrations and improving cognitive performance in schoolchildren who live in a lead-contaminated city.METHODS. This randomized, double-blind, placebo-controlled field trial was conducted in public elementary schools in Torreón, an industrialized city in northern Mexico. A metal foundry, located close to the city center and within 3.5 km of 9 schools, was the main source of lead exposure. A total of 602 children who were aged 6 to 8 years and regularly attending first grade in the study schools were enrolled. Children were given 30 mg of iron, 30 mg of zinc, both, or a placebo daily for 6 months. A total of 527 completed the treatment, and 515 were available for long-term follow-up, after another 6 months without supplementation. Eleven cognitive tests of memory, attention, visual-spatial abilities, and learning were administered at baseline and each follow-up.RESULTS. There were no consistent or lasting differences in cognitive performance among treatment groups.CONCLUSIONS. Daily supplementation with iron and/or zinc may be of limited usefulness for improving cognition in lead-exposed schoolchildren. However, these treatments may be effective in settings with higher prevalence of nutritional deficiencies or in younger children.
Clinical Significance of Primary Vesicoureteral Reflux and Urinary Antibiotic Prophylaxis After Acute Pyelonephritis: A Multicenter, Randomized, Controlled Study
Authors: Garin Eduardo H. , Olavarria Fernando , Nieto Victor Garcia , Valenciano Blanca , Campos Alfonso , Young Linda 
Published: March 2006

OBJECTIVES. To evaluate the role of primary vesicoureteral reflux (VUR) in increasing the frequency and severity of urinary tract infections (UTIs) and renal parenchymal damage among patients with acute pyelonephritis and to determine whether urinary antibiotic prophylaxis reduces the frequency and/or severity of UTIs and/or prevents renal parenchymal damage among patients with mild/moderate VUR.METHODS. Patients 3 months to 18 years of age with acute pyelonephritis, with or without VUR, were assigned randomly to receive urinary antibiotic prophylaxis or not. Patients were monitored every 3 months for 1 year. Dimercaptosuccinic acid renal scans were repeated at 6 months or if there was a recurrence of febrile UTI. Urinalysis and urine culture were performed at each clinic visit. Renal ultrasound scans and voiding cystourethrograms were repeated at the end of 1 year of follow-up monitoring.RESULTS. Of the 236 patients enrolled in the study, 218 completed the 1-year follow-up monitoring. Groups were similar with respect to age, gender, and reflux grade distribution for those with VUR. No statistically significant differences were found among the groups with respect to rate of recurrent UTI, type of recurrence, rate of subsequent pyelonephritis, and development of renal parenchymal scars.CONCLUSIONS. After 1 year of follow-up monitoring, mild/moderate VUR does not increase the incidence of UTI, pyelonephritis, or renal scarring after acute pyelonephritis. Moreover, a role for urinary antibiotic prophylaxis in preventing the recurrence of infection and the development of renal scars is not supported by this study.
Assessment of Pediatricians by a Regulatory Authority
Authors: Violato Claudio , Lockyer Jocelyn M. , Fidler Herta 
Published: March 2006

OBJECTIVE. To determine whether it is possible to develop feasible, valid, and reliable multisource feedback data for pediatricians.
METHODS. Surveys with 40, 22, 38, and 37 items were developed for assessment of pediatricians by patients, co-workers, medical colleagues, and themselves, respectively, using 5-point scales with an “unable to assess” category. Items addressed key competencies related to communication skills, professionalism, collegiality, continuing professional development, and collaboration. Each pediatrician was assessed by 25 patients, 8 medical colleagues, and 8 co-workers. Feasibility was assessed with response rates for each instrument. Validity was assessed with rating profiles, the percentage of participants unable to assess the physician for each item, and exploratory factor analyses to determine which items grouped together into scales. Cronbach's α and generalizability coefficient analyses assessed reliability.
RESULTS. One hundred pediatricians participated. The mean number of respondents per physician was 23.4 (93.6%) for patients, 7.6 (94.8%) for co-workers, and 7.6 (95.5%) for medical colleagues. The mean ratings ranged from 4 to 5 for each item on each scale. Few items had high percentages of “unable to assess” responses. The factor analyses revealed a 4-factor solution for the patient survey, a 3-factor solution for the co-worker survey, and a 4-factor solution for the medical colleague survey, accounting for at least 64% of the variance. All instruments had high internal consistency. The generalizability coefficients were .85 for patients, .87 for co-workers, and .78 for medical colleagues.
CONCLUSION. Surveys can be developed to provide feedback data on key competencies.
Analysis of Dog Bites in Children Who Are Younger Than 17 Years
Authors: Schalamon Johannes , Ainoedhofer Herwig , Singer Georg , Petnehazy Thomas , Mayr Johannes , Kiss Katalin , Höllwarth Michael E. 
Published: March 2006

OBJECTIVES. This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites.METHODS. In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed.RESULTS. A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was ∼5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients.CONCLUSIONS. Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.
Randomized Trial of the Early Start Program of Home Visitation: Parent and Family Outcomes
Authors: Fergusson David M. , Grant Hildegard , Horwood L. John , Ridder Elizabeth M. 
Published: March 2006

OBJECTIVE. To examine the extent to which the Early Start program of home visitation had beneficial consequences in the areas of maternal health, family functioning, family economic circumstances, and exposure to stress and adversity.
METHODS. The study used a randomized, controlled trial design in which 220 families receiving the Early Start program were contrasted with a control series of 223 families not receiving the program. Families were enrolled in the program after population screening conducted by community health nurses. Families were enrolled in the program for up to 36 months. Outcomes were assessed at 6, 12, 24, and 36 months after trial entry.
RESULTS. There was a consistent lack of association between maternal and family outcomes and group membership. There were no significant differences between the Early Start and control series in any comparisons.
CONCLUSIONS. This evaluation suggested that the Early Start program failed to lead to parent- and family-related benefits. This absence of benefit for parent/family outcomes is contrasted with the benefits found previously for child-related outcomes, including child health, preschool education, child abuse and neglect, parenting, and behavioral adjustment. This comparison suggests that home visitation programs may provide benefits for child-related outcomes in the absence of parent- or family-related outcomes.
Dietary Energy Intake at the Age of 4 Months Predicts Postnatal Weight Gain and Childhood Body Mass Index
Authors: Ong Ken K. , Emmett Pauline M. , Noble Sian , Ness Andy , Dunger David B. ,   and the ALSPAC Study Team
Published: March 2006

OBJECTIVE. Rapid infant weight gain has been shown to predict later obesity risk; however, it is unclear which factors influence infant diet and weight gain. The objective of this study was to determine whether different feeding patterns and energy intakes that are provided to infants affect body weight and BMI later in childhood.
METHODS. This representative birth cohort study was conducted in the United Kingdom. Energy intake at age 4 months was estimated from 1-day unweighed dietary records in 881 infants and related to their childhood weight gain and BMI.
RESULTS. Among formula- or mixed-fed infants (N = 582), energy intake was higher in first-born infants (mean ± SE: 2730 ± 29.4 kJ/day; n = 263) than in subsequent-born infants (2620.8 ± 25.2 kJ/day; n = 296). Energy intake at 4 months was also higher in infants who were given solid foods earlier (1–2 months: 2805.6 ± 50.4 kJ/day, n = 89; 2–3 months: 2658.6 ± 25.2 kJ/day, n = 339; 4+ months: 2587.2 ± 46.2 kJ/day, n = 111). Higher energy intake at 4 months predicted greater weight gain between birth to age 1, 2, or 3 years and larger body weight and BMI at ages 1 to 5 years. No significant associations were seen in breastfed infants (N = 299).
CONCLUSIONS. Among formula- or mixed-fed infants, dietary energy intake at age 4 months predicted postnatal weight gain and childhood obesity risk. Both prenatal and postnatal factors may influence infant energy intake and postnatal weight gain.
Redeeming Hollow Promises: The Case for Mandatory Spending on Health Care for American Indians and Alaska Natives
Authors: Westmoreland Timothy M. , Watson Kathryn R. 
Published: March 2006

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need.
Research Careers for American Indian/Alaska Native Nurses: Pathway to Elimination of Health Disparities
Authors: Henly Susan J. , Struthers Roxanne , Dahlen Barbara K. , Ide Bette , Patchell Beverly , Holtzclaw Barbara J. 
Published: March 2006

The health status of American Indians/Alaska Natives lags behind that of the US population. American Indian/Alaska Native (AIAN) nurses are on the front lines of health services for AIAN people. They have the potential to make scientific contributions as well, but are under-represented among researchers working to understand health disparities. The AIAN MS-to-PhD Nursing Science Bridge, at the University of Minnesota, in partnership with the Universities of North Dakota and Oklahoma, provides support for AIAN nurses during the critical training transition from masters of science to doctoral programs. Partner schools collaborate with AIAN elders, medicine people/spiritual leaders, and academic consultants to (1) foster academic success and strengthen the AIAN identity of students during their research training and (2) bring about institutional change to optimize student experiences. Future research programs developed by this cadre of AIAN nurse scientists will contribute scientifically sound, culturally acceptable knowledge to effectively improve the health of AIAN people.
Swimming Pool Drownings Among US Residents Aged 5–24 Years: Understanding Racial/Ethnic Disparities
Authors: Saluja Gitanjali , Brenner Ruth A. , Trumble Ann C. , Smith Gordon S. , Schroeder Tom , Cox Christopher 
Published: March 2006

Objective. We examined circumstances surrounding swimming pool drownings among US residents aged 5 to 24 years to understand why Black males and other racial/ethnic groups have high drowning rates. Methods. We obtained data about drowning deaths in the United States (1995–1998) from death certificates, medical examiner reports, and newspaper clippings collected by the US Consumer Product Safety Commission. Results. During the study period, 678 US residents aged 5 to 24 years drowned in pools. Seventy-five percent were male, 47% were Black, 33% were White, and 12% were Hispanic. Drowning rates were highest among Black males, and this increased risk persisted after we controlled for income. The majority of Black victims (51%) drowned in public pools, the majority of White victims (55%) drowned in residential pools, and the majority of Hispanic victims (35%) drowned in neighborhood pools (e.g., an apartment complex pool). Foreign-born males also had an increased risk for drowning compared with American-born males. Conclusions. Targeted interventions are needed to reduce the incidence of swimming pool drownings across racial/ethnic groups, particularly adult supervision at public pools.
Retail Tobacco Outlet Density and Youth Cigarette Smoking: A Propensity-Modeling Approach
Authors: Novak Scott P. , Reardon Sean F. , Raudenbush Stephen W. , Buka Stephen L. 
Published: March 2006

Objectives. We examined whether retail tobacco outlet density was related to youth cigarette smoking after control for a diverse range of neighborhood characteristics.Methods. Data were gathered from 2116 respondents (aged 11 to 23 years) residing in 178 census tracts in Chicago, Ill. Propensity score stratification methods for continuous exposures were used to adjust for potentially confounding neighborhood characteristics, thus strengthening causal inferences.Results. Retail tobacco outlets were disproportionately located in neighborhoods characterized by social and economic disadvantage. In a model that excluded neighborhood confounders, a marginally significant effect was found. Youths in areas at the highest 75th percentile in retail tobacco outlet density were 13% more likely (odds ratio [OR]=1.13; 95% confidence interval [CI]=0.99, 1.28) to have smoked in the past month compared with those living at the lowest 25th percentile. However, the relation became stronger and significant (OR=0.21; 95% CI=1.04, 1.41) after introduction of tract-level confounders and was statistically significant in the propensity score–adjusted model (OR = 1.20; 95% CI = 1.001, 1.44). Results did not differ significantly between minors and those legally permitted to smoke.Conclusions. Reductions in retail tobacco outlet density may reduce rates of youth smoking.
Couples’ Immigration Status and Ethnicity as Determinants of Breastfeeding
Authors: Gibson-Davis Christina M. , Brooks-Gunn Jeanne 
Published: March 2006

Objectives: We investigated how couples’ immigration status and ethnicity determined the decision to initiate breastfeeding and to breastfeed at 6 months. Methods: From data collected on 4207 mothers and 3013 fathers participating in a longitudinal birth cohort study, we used linear regression and covariate-adjusted proportions to estimate the determinants of breastfeeding behaviors. The sample was divided by immigration status (either foreign born or born in the United States) and further subdivided by ethnicity (Mexican Hispanic, non-Mexican Hispanic, and non-Hispanic). Results: Mothers born in the United States had an 85% reduction in the odds of breastfeeding as compared to foreign-born mothers and a 66% reduction in the odds of breastfeeding at 6 months. Each additional year of US residency decreased the odds of breastfeeding by 4%. These differences by immigration status were seen for Mexicans, other Hispanics, and non-Hispanics. Conclusion: The Hispanic paradox may extend to other non-Hispanic immigrants for breastfeeding behaviors, but may not be true for Hispanic mothers born in the United States. Low rates of breastfeeding for Hispanic American mothers indicate that they should not be overlooked by breastfeeding promotion programs.
Diabetes Decision Support: Initial Experience With the Vermont Diabetes Information System
Authors: MacLean Charles D. , Littenberg Benjamin , Gagnon Michael 
Published: March 2006

Interventions that have proven effective in the management of chronic illness have often been difficult to establish in widespread practice. The Chronic Care Model provides a framework for implementing interventions, but it is expensive and difficult to implement. We developed a decision support system based on this model to improve the care of adults who have diabetes and receive primary care in Vermont or adjacent New York. The Vermont Diabetes Information System uses a network of community laboratories for providing data to produce flowsheets, reminders, action alerts, and population reports that are sent to primary care providers by fax and to patients by mail. Currently, 7295 patients are cared for by 124 primary care providers in 62 practices and are enrolled in a randomized controlled trial to study its effects.
Associations Between Witnessing Parental Domestic Violence and Experiencing Depressive Symptoms in Filipino Adolescents
Authors: Hindin Michelle J. , Gultiano Socorro 
Published: March 2006

Objectives. We examined the association between 2 important public health problems in the developing world: parental domestic violence and depressive symptoms during adolescence. Methods. Data on depressive symptoms and witnessing of domestic violence were obtained during private face-to-face interviews conducted in 2002 with 2051 Filipino adolescents 17–19 years of age. Results. Symptoms of depression were common; 11% of young men and 19% of young women reported wishing that they were dead occasionally or most of the time, and nearly half of all respondents recalled parental domestic violence. Female adolescents had significantly higher scores than male adolescents on a 12-item index of depressive symptoms. Both male and female adolescents who had witnessed parental domestic violence reported more depressive symptoms. Conclusions. Filipino adolescents who have witnessed parental domestic violence are significantly more likely to report depressive symptoms.
Racial and Ethnic Disparities in Diagnosed and Possible Undiagnosed Asthma Among Public-School Children in Chicago
Authors: Quinn Kelly , Shalowitz Madeleine U. , Berry Carolyn A. , Mijanovich Tod , Wolf Raoul L. 
Published: March 2006

Objectives. We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools. Methods. We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. Results. Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. Conclusions. There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.