bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations Between Content Types of Early Media Exposure and Subsequent Attentional Problems
Authors: Zimmerman Frederick J. , Christakis Dimitri A. 
Published: November 2007

OBJECTIVE. Television and video/DVD viewing among very young children has become both pervasive and heavy. Previous studies have reported an association between early media exposure and problems with attention regulation but did not have data on the content type that children watched. We tested the hypothesis that early television viewing of 3 content types is associated with subsequent attentional problems. The 3 different content types are educational, nonviolent entertainment, and violent entertainment.
METHODS. Participants were children in a nationally representative sample collected in 1997 and reassessed in 2002. The analysis was a logistic regression of a high score on a validated parent-reported measure of attentional problems, regressed on early television exposure by content and several important sociodemographic control variables.
RESULTS. Viewing of educational television before age 3 was not associated with attentional problems 5 years later. However, viewing of either violent or non-violent entertainment television before age 3 was significantly associated with subsequent attentional problems, and the magnitude of the association was large. Viewing of any content type at ages 4 to 5 was not associated with subsequent problems.
CONCLUSIONS. The association between early television viewing and subsequent attentional problems is specific to noneducational viewing and to viewing before age 3.
Twelve-Month Neurofunctional Assessment and Cognitive Performance at 36 Months of Age in Extremely Low Birth Weight Infants
Authors: Giannì Maria Lorella , Picciolini Odoardo , Vegni Chiara , Gardon Laura , Fumagalli Monica , Mosca Fabio 
Published: November 2007

OBJECTIVE. The objective of this study was to investigate whether an early neurofunctional assessment (at 12 months’ corrected age) is predictive of cognitive outcome at 36 months of age in extremely low birth weight infants.
METHODS. We conducted an observational longitudinal study. Neurodevelopmental outcome by means of a neurofunctional assessment was evaluated at 12 months’ corrected age and 36 months’ chronological age in 141 extremely low birth weight children. Cognitive outcome was assessed with use of the Griffiths Mental Developmental Scale.
RESULTS. A significant association was found between the 12-month neurofunctional status and cognitive performance at 36 months. A higher general quotient on the Griffiths Mental Developmental Scale at 36 months was observed in infants who exhibited normal (score: ≤1) neurodevelopment compared with children who exhibited minor (score: 2) and major (score: ≥3) dysfunctions at the 12-month neurofunctional evaluation (99 ± 6.8 vs 85.3 ± 16.3 vs 57.3 ± 22.0). A score of ≥2 at the 12-month neurofunctional assessment, abnormal brain MRI results at term, and chronic lung disease remained predictive of cognitive delay at 36 months of age and also after adjustment for confounders.
CONCLUSIONS. The 12-month neurofunctional evaluation may be an additional useful clinical tool in predicting later cognitive outcome in extremely low birth weight children.
Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan
Authors: Molinari Noëlle-Angélique M. , Kolasa Maureen , Messonnier Mark L. , Schieber Richard A. 
Published: November 2007

BACKGROUND. The “Guide to Community Preventive Services” strongly recommends reducing out-of-pocket costs to increase vaccination rates among children. Nevertheless, out-of-pocket expenses are still incurred during the receipt of childhood vaccines, vaccine administration, and associated well-child visits.
OBJECTIVE. Our goal was to estimate total and out-of-pocket costs of childhood immunization.
METHODS. We used the 2003 benefit-plan data for all 1217 private and public health plans registered in Georgia and the 2003 Advisory Committee on Immunization Practices recommended vaccine schedule to calculate costs to vaccinate children aged 0 to 5 years in 2003 dollars. By applying published estimates of health insurance enrollment of Georgia children, we calculated the total and out-of-pocket costs per child according to insurance status and race/ethnicity. Immunization coverage according to payer type was based on National Immunization Survey data.
RESULTS. Out-of-pocket costs ranged between $0 (Medicaid/Peachcare) and $652 (uninsured/Medicare). Most out-of-pocket costs were incurred during the first year of life. Up-to-date immunization status ranged from 63.7% for uninsured persons to 83.2% for privately insured persons. Up-to-date status was negatively correlated with out-of-pocket costs and the proportion of the population below 250% of the federal poverty level.
CONCLUSIONS. For most Georgia families, out-of-pocket expenses for childhood immunizations were low, favoring compliance with the recommended immunization schedule. However, families least able to afford the expense faced disproportionately high out-of-pocket costs. Out-of-pocket costs were inversely correlated with immunization coverage levels. Uninsured children whose families lived below 250% of the federal poverty level experienced the lowest immunization coverage levels. Immunization coverage through the Vaccines for Children Program and Medicaid/State Children's Health Insurance Programs should be promoted to minimize or eliminate out-of-pocket costs related to childhood immunizations, especially among children of low-income families.
Effect of Vaccine Shortages on Timeliness of Pneumococcal Conjugate Vaccination: Results From the 2001–2005 National Immunization Survey
Authors: Smith Philip J. , Nuorti J. Pekka , Singleton James A. , Zhao Zhen , Wolter Kirk M. 
Published: November 2007

BACKGROUND. In September 2001 and again in February 2004, the Centers for Disease Control and Prevention announced shortages in the supply of the pneumococcal conjugate vaccine. We describe the effects of the pneumococcal conjugate vaccine shortages in 2001–2003 and 2004 on the timeliness of vaccination uptake for quarterly birth cohorts affected by the shortages.
METHODS. A total of 102478 19- to 35-month-old children were sampled by the National Immunization Survey between 2001 and 2005. Provider-reported vaccination histories were used to evaluate whether children had been administered ≥4 doses of pneumococcal conjugate vaccine by 16 months of age.
RESULTS. Among successive birth cohorts affected by the first shortage, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months declined significantly from 28.8% to 18.2%. As the first shortage ended, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months increased steadily with each successive birth cohort to 40.2%. From the onset of the second shortage, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months declined steadily and significantly to 13.7%. As many as 27% of parents whose child was affected by the first shortage reported that their child's vaccination provider had delayed the administration of pneumococcal conjugate vaccine doses. Of those parents who said that a pneumococcal conjugate vaccine dose was delayed and whose child was not administered ≥4 doses, 2.9% received a reminder notice from the provider to schedule administration of those delayed doses, and 0.2% had an appointment to receive those delayed or missed doses.
CONCLUSIONS. Vaccine shortages can result in delayed or missed doses and can have a dramatic impact on the vaccine coverage of children. Vaccination providers need to communicate effectively with parents so that doses that are delayed or missed during a vaccine shortage are administered when the shortage is resolved.
Current Definitions of Hypotension Do Not Predict Abnormal Cranial Ultrasound Findings in Preterm Infants
Authors: Limperopoulos Catherine , Bassan Haim , Kalish Leslie A. , Ringer Steven A. , Eichenwald Eric C. , Walter Gene , Moore Marianne , Vanasse Matthew , DiSalvo Donald N. , Soul Janet S. , Volpe Joseph J. , du Plessis Adré J. 
Published: November 2007

OBJECTIVE. Hypotension is a commonly treated complication of prematurity, although definitions and management guidelines vary widely. Our goal was to examine the relationship between current definitions of hypotension and early abnormal cranial ultrasound findings.
METHODS. We prospectively measured mean arterial pressure in 84 infants who were ≤30 weeks’ gestational age and had umbilical arterial catheters in the first 3 days of life. Sequential 5-minute epochs of continuous mean arterial pressure recordings were assigned a mean value and a coefficient of variation. We applied to our data 3 definitions of hypotension in current clinical use and derived a hypotensive index for each definition. We examined the association between these definitions of hypotension and abnormal cranial ultrasound findings between days 5 and 10. In addition, we evaluated the effect of illness severity (Score for Neonatal Acute Physiology II) on cranial ultrasound findings.
RESULTS. Acquired lesions as shown on cranial ultrasound, present in 34 (40%) infants, were not predicted by any of the standard definitions of hypotension or by mean arterial pressure variability. With hypotension defined as mean arterial pressure &lt; 10th percentile (&lt;33 mmHg) for our overall cohort, mean value for mean arterial pressure and hypotensive index predicted abnormal ultrasound findings but only in infants who were ≥27 weeks’ gestational age and those with lower illness severity scores.
CONCLUSIONS. Hypotension as diagnosed by currently applied thresholds for preterm infants is not associated with brain injury on early cranial ultrasounds. Blood pressure management directed at these population-based thresholds alone may not prevent brain injury in this vulnerable population.
Is There Differential Retention of Children With Special Health Care Needs in the State Children's Health Insurance Program?
Authors: Macon Tamarie , Miller Jane E. , Gaboda Dorothy , Simpson Theresa , Cantor Joel C. 
Published: November 2007

OBJECTIVE. The purpose of this work was to determine whether children with special health care needs in New Jersey's State Children's Health Insurance Program are less likely to become uninsured than children without special health care needs.
PATIENTS AND METHODS. We used the 2003 New Jersey FamilyCare Supplement to the New Jersey Family Health Survey. Children were randomly selected from the universe of children enrolled in New Jersey FamilyCare as of May 2002, and their families were surveyed during 2003 (N = 675). The Children With Special Health Care Needs Screener was used to identify 5 types of special health care needs. We estimated multinomial logistic regression models of final enrollment status according to the presence of ≥1 special health care need, controlling for demographic characteristics.
RESULTS. Roughly 1 of every 5 children in New Jersey FamilyCare had ≥1 special health care need. Older children and boys had greater odds of having special health care needs than others. Children with special health care needs had only one fourth the odds of becoming disenrolled and uninsured compared with children without special health care needs, even when controlling for age, gender, race/ethnicity, and insurance plan level. There was no difference in likelihood of finding other health insurance according to children with special health care needs status.
CONCLUSIONS. Children with special health care needs were more likely than children without such needs to be covered by health insurance at the time of the survey, either by retaining State Children's Health Insurance Program coverage or by finding other insurance. The higher retention of children with special health care needs in New Jersey FamilyCare is good news for families of these children and their advocates. However, higher health care costs for these children should be considered in federal and state budget planning for the State Children's Health Insurance Program.
Lipolysis and Insulin Sensitivity at Birth in Infants Who Are Large for Gestational Age
Authors: Ahlsson Fredrik S.E. , Diderholm Barbro , Ewald Uwe , Gustafsson Jan 
Published: November 2007

OBJECTIVE. In addition to neonatal hypoglycemia, infants who are born large for gestational age are at risk for developing obesity, cardiovascular disease, and diabetes later in life. The aim of this study was to investigate glucose production, lipolysis, and insulin sensitivity in infants who were born large for gestational age to mothers without diabetes. The effect of glucagon administration on production of energy substrates was also investigated.
METHODS. Ten healthy term infants who were born large for gestational age to mothers without diabetes were studied 16 ± 8 hours postnatally after a 3-hour fast. Rates of glucose production and lipolysis were analyzed by gas chromatography–mass spectrometry following constant rate infusion of [6,6-2H2]glucose and [2-13C]glycerol. Insulin sensitivity was assessed by the Homeostasis Assessment Model. In 8 of the infants, the effect of an intravenous injection of 0.2 mg/kg glucagon was also analyzed.
RESULTS. Plasma glucose and glycerol averaged 3.8 ± 0.5 mmol/L and 384 ± 183 μmol/L, respectively. The glycerol production rate, reflecting lipolysis, was 12.7 ± 2.9 μmol/kg per min. Mean rate of glucose production was 30.2 ± 4.6 μmol/kg per min. Homeostasis Assessment Model insulin sensitivity corresponded to 82% ± 19%, β-cell function to 221% ± 73%, and insulin resistance to 1.3 ± 0.3. After glucagon administration, rate of glucose production increased by 13.3 ± 8.3 μmol/kg per min and blood glucose by 1.4 ± 0.5 mmol/L. Glycerol production decreased from 12.8 ± 3.0 to 10.7 ± 2.9 μmol/kg per min. Mean insulin concentration increased from 10.9 ± 3.0 to 30.9 ± 10.3 mU/L. There was a strong inverse correlation between the decrease in lipolysis and increase in insulin after glucagon administration.
CONCLUSIONS. Infants who are born large for gestational age show increased lipolysis and a propensity for decreased insulin sensitivity already at birth. The simultaneous increase in plasma insulin correlated strongly with the noted decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.
Hearing Loss, Quality of Life, and Academic Problems in Long-term Neuroblastoma Survivors: A Report From the Children's Oncology Group
Authors: Gurney James G. , Tersak Jean M. , Ness Kirsten K. , Landier Wendy , Matthay Katherine K. , Schmidt Mary Lou 
Published: November 2007

OBJECTIVES. Among a cohort of long-term neuroblastoma survivors, our aims were to (1) assess the association between treatment intensity and parent-reported hearing loss in the child, (2) evaluate the strength of the association between hearing loss and parent-reported academic and psychosocial difficulties in the child, and (3) examine the association between parent-reported academic and psychosocial difficulties in the child and the child's self-reported quality of life.
PATIENTS AND METHODS. Through a mailed survey that included the Pediatric Quality of Life Inventory 4.0 and an outcomes questionnaire for parents, we evaluated 137 children (aged 8–17 years) who were previously enrolled in 1 of 2 Children's Cancer Group neuroblastoma clinical studies.
RESULTS. Childhood survivors of neuroblastoma who had prevalent hearing loss, as reported by their parents, had at least twice the risk of an identified problem with reading skills, math skills, and/or attention and a similarly higher risk of a general learning disability and/or special educational needs than did neuroblastoma survivors without hearing loss. Consistent with this finding, hearing loss was associated with a 10-point-lower mean score in the school-functioning scale of the Pediatric Quality of Life Inventory 4.0. We also observed a clear pattern of poorer self-reported quality-of-life scores among children with parent-reported academic and psychosocial problems compared with those without such problems, particularly with school functioning, even after controlling for reported hearing loss.
CONCLUSIONS. We found evidence that long-term neuroblastoma survivors, especially those with hearing loss, are at elevated risk for academic learning problems and psychosocial difficulties. We also found strong concordance between parent-reported learning problems in the child and indications of distress in the child's self-reported quality of life.
Does Current Asthma Control Predict Future Health Care Use Among Black Preschool-aged Inner-City Children?
Authors: Sharma Hemant P. , Matsui Elizabeth C. , Eggleston Peyton A. , Hansel Nadia N. , Curtin-Brosnan Jean , Diette Gregory B. 
Published: November 2007

OBJECTIVES. Factors predictive of future asthma must be identified among young inner-city children, who suffer disproportionately from asthma. We investigated whether current asthma control predicts future asthma-related health care use among inner-city preschool-aged children with asthma.
METHODS. A total of 150 inner-city preschool-aged children with asthma were followed prospectively for 6 months. At baseline, symptom frequency and reliever-medication use were assessed to classify children into National Asthma Education and Prevention Program–derived control categories. Long-term controller-medication use was also assessed, as well as asthma-related health care use at baseline and at 3 and 6 months.
RESULTS. The mean age was 4.4 years, 92% were black, and 39% reported long-term controller use. At baseline, 37% were classified as having mild-intermittent, 17% had mild-persistent, 21% had moderate-persistent, and 25% had severe-persistent asthma control. Significant changes in asthma control were observed over time, including 46% of children originally categorized with mild-intermittent asthma who had worsened asthma control by 3 months. Asthma control significantly predicted future health care use 3 months later but not 6 months later. Multivariate analyses showed that, once control status was known, reported use of long-term controller medication added little additional predictive value.
CONCLUSIONS. Among inner-city preschool-aged children, significant fluctuations in asthma control occur as early as 3 months after assessment. Poor control but not long-term controller-medication use is an independent predictor of future asthma-related health care use at 3 months but is not significantly predictive of 6-month outcomes. Therefore, clinicians caring for inner-city children with asthma should consider reassessing asthma control at least every 3 months to identify those at highest future risk and to provide early interventions.
Obesity Is a Common Comorbidity in Children With Congenital and Acquired Heart Disease
Authors: Pinto Nelangi M. , Marino Bradley S. , Wernovsky Gil , de Ferranti Sarah D. , Walsh Amy Z. , Laronde Meena , Hyland Kristen , Dunn Stanley O. , Cohen Meryl S. 
Published: November 2007

OBJECTIVES. Obesity may pose additional cardiovascular risk to children with acquired and congenital heart disease. Many children with heart disease are sedentary as a result of physician-, parent-, and/or self-imposed restrictions. The aim of this study was to evaluate the impact of the epidemic of obesity on children with heart disease.
PATIENTS AND METHODS. A cross-sectional review was performed of children evaluated in 2004 at 2 cardiology outpatient clinics. Differences in the prevalence of obese (BMI ≥ 95%) and overweight (BMI 85%–95%) children were compared with national data and healthy control subjects. Dictated letters were reviewed to determine whether obesity was discussed with referring practitioners.
RESULTS. Of 2921 patients assessed, 1523 had heart disease. Diagnostic subgroups included “mild” heart disease (n = 401), arrhythmia (n = 447), biventricular repair (n = 511), univentricular palliation (Fontan; n = 108), and heart transplantation (n = 56). More than 25% of the patients with heart disease were obese or overweight; the prevalence of obese and overweight children was significantly lower only in the Fontan group (15.9%). Pediatric cardiologists failed to document obesity or weight counseling in the majority of clinic letters.
CONCLUSIONS. Obesity is common in children with congenital and acquired heart disease. Pediatric cardiologists demonstrate inadequate communication regarding this problem to referring practitioners. Healthy-lifestyle counseling and routine exercise in children with heart disease may be underemphasized.
Aerobic Fitness Attenuates the Metabolic Syndrome Score in Normal-Weight, at-Risk-for-Overweight, and Overweight Children
Authors: DuBose Katrina D. , Eisenmann Joey C. , Donnelly Joseph E. 
Published: November 2007

OBJECTIVE. The purpose of this study was to examine the combined influence of aerobic fitness and BMI on the metabolic syndrome score in children.
METHODS. A total of 375 children (193 girls and 182 boys) aged 7 to 9 years were categorized as being normal weight, at risk for overweight, and overweight on the basis of BMI and aerobic fitness (high or low based on median split) via a submaximal physical working capacity test. Participants were cross-tabulated into 6 BMI fitness categories. High-density lipoprotein cholesterol and triglyceride levels, homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a continuous metabolic syndrome score.
RESULTS. Both BMI and fitness were associated with the metabolic syndrome score. In general, the metabolic syndrome score increased across the cross-tabulated groups with the normal-weight, high-fit group possessing the lowest metabolic syndrome score and the overweight, unfit group possessing the highest metabolic syndrome score. Children who were at risk for overweight and had high fitness had a lower metabolic syndrome score compared with those at-risk-for-overweight, less-fit children, and the score was similar to that of the less-fit, normal-weight children. Furthermore, a high fitness level resulted in a lower metabolic syndrome score in overweight children compared with overweight children with low fitness.
CONCLUSIONS. High fitness levels modified the impact that BMI had on the metabolic syndrome score in children. Increasing a child's fitness level could be one method for reducing the risk of obesity-related comorbidities.