bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of pre‐operative state‐anxiety in the determination of intra‐operative neuroendocrine responses and recovery
Authors: Pearson Sue , Maddern Guy J. , Fitridge Robert 
Published: May 2005

Objectives. The psychophysiological model of adjustment to surgery predicts associations between (1) heightened pre‐operative state‐anxiety and intra‐operative neuroendocrine responses, (2) neuroendocrine responses and complications; and (3) heightened pre‐operative state‐anxiety and post‐operative recovery. The present study examined these associations.Methods. Participants were 39 patients (mean age 71.9±6.1 years) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery, patients completed baseline measures of physical and mental functioning using the MOS 36‐item Short‐Form Health Survey (SF‐36). In addition to this, they undertook a 24‐hour urine save to measure cortisol and catecholamines. Measures of state‐anxiety were completed on the evening prior to surgery. A second 24‐hour urine save was started at the time of anaesthetic induction. Follow‐up measures of physical and mental functioning were completed 1 month following surgery. All complications were recorded during hospitalization.Results. There was a significant negative association between pre‐operative state‐anxiety and intra‐operative cortisol (r =−.52, p ≤.001). Using hierarchical regression analysis, pre‐operative state‐anxiety accounted for 10% of the variance in intra‐operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and complications. Pre‐operative state‐anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning.Conclusions. Results from this study show increasing pre‐operative anxiety to be associated with lower intra‐operative cortisol responses and poorer mental functioning 1 month following surgery.
Traumatic Stress Symptoms in Adolescent Organ Transplant Recipients
Authors: Mintzer Lisa Libman , Stuber Margaret L. , Seacord Debra , Castaneda Marleen , Mesrkhani Violet , Glover Dorie 
Published: June 2005

Objective. Symptoms of posttraumatic stress disorder (PTSD) after life-threatening medical illness have been found to predict poor outcome in preliminary studies of adults and children. However, these symptoms are rarely recognized in general medical or pediatric settings. Here we report on the first large investigation to assess prevalence and correlates of self-reported symptoms of posttraumatic stress in a nonreferred sample of adolescent liver, heart, and kidney transplant recipients.
Methods. One hundred four adolescents, ages 12 to 20 years (mean: 15.7; SD: 2.1), completed and returned the University of California, Los Angeles, PTSD Index for the Diagnostic and Statistical Manual of Mental Disorders. All participants were at least 1 year post-initial transplant and were fluent speakers of English and/or Spanish.
Results. More than 16% of the adolescents met all symptom criteria for PTSD, and an additional 14.4% met 2 of 3 symptom-cluster criteria. Regression analysis indicated no effect of gender, ethnicity, age at interview, organ type, time since transplant, or age at transplant.
Conclusions. As has been found with other life-threatening pediatric conditions, solid organ transplantation can precipitate symptoms of posttraumatic stress. Symptoms are not predicted by what would be considered objective factors increasing life threat, suggesting a greater salience of subjective appraisal of threat, as has been seen in studies of childhood cancer survivors.
Factors Associated With Sensorineural Hearing Loss Among Survivors of Extracorporeal Membrane Oxygenation Therapy
Authors: Fligor Brian J. , Neault Marilyn W. , Mullen Charlotte H. , Feldman Henry A. , Jones Dwight T. 
Published: June 2005

Objectives. To endeavor to explain why some graduates of extracorporeal membrane oxygenation (ECMO) therapy develop sensorineural hearing loss (SNHL) whereas others do not, to study the variability seen in the degree of SNHL, to attempt to explain why some graduates with SNHL experience progressive worsening whereas others do not, and to describe the time course of the onset of SNHL on the basis of identified risk factors.Design. A retrospective chart review with proportional-hazards regression analysis to identify specific risk factors for SNHL from a list of patient and treatment variables.Setting. Children’s Hospital Boston, a pediatric tertiary-care facility and ECMO center.Patients. Neonatal ECMO graduates born in 1986–1994 who survived to discharge and underwent audiologic evaluations (n = 111) and a random sample of ECMO graduates who survived to discharge and did not undergo audiologic evaluations (n = 30).Outcome Measures. Audiologic data, including the presence or absence of SNHL, the severity of SNHL at the most recent evaluation, the stability or progressive worsening of hearing (with the first evaluation compared with the most recent evaluation), and the occurrence of delayed-onset SNHL.Results. Twenty-nine (26%) of 111 ECMO graduates who underwent audiologic testing had SNHL at the last evaluation. Of these 29 subjects with SNHL, 21 (72%) had progressive SNHL, of whom 14 (48%) had delayed-onset SNHL. The age of identification of SNHL ranged from 4 months to 8 years 11 months. Factors identified with proportional-hazards regression analyses as being associated significantly with the time to onset of SNHL were a primary diagnosis of congenital diaphragmatic hernia (hazard ratio: 2.60), length of ECMO therapy (hazard ratio: 7.18), and number of days children received aminoglycoside antibiotics (hazard ratio: 5.56). Kaplan-Meier “time-to-event” curves were constructed to illustrate the time course of onset of SNHL, as affected by each of the variables identified as significant risk factors.Conclusions. These findings illustrate the need for early, routine, audiologic evaluations throughout childhood for all ECMO graduates. Children at even greater risk for developing SNHL because of a history of congenital diaphragmatic hernia, prolonged ECMO therapy, and/or a lengthy course of aminoglycoside antibiotic therapy should be monitored even more closely throughout childhood, depending on the child’s individual risk indicators, as suggested here. On the basis of these risk indicators, efforts can be made to minimize the risk of hearing loss while a child is being treated with ECMO. In addition, these risk indicators can assist with counseling families of ECMO graduates regarding the child’s specific risk of developing SNHL and how it can be managed should it occur.
Effects of Child Age and Body Size on Serious Injury From Passenger Air-Bag Presence in Motor Vehicle Crashes
Authors: Newgard Craig D. , Lewis Roger J. 
Published: June 2005

Background. Current recommendations regarding children traveling in passenger vehicles equipped with passenger air bags are based, in part, on evidence that the air-bag–related risk of injury and death is higher for children ≤12 years of age. However, the age or body size required to allow a child to be seated safely in front of a passenger air bag is unknown.Objective. To evaluate specific cutoff points for age, height, and weight as effect modifiers of the association between the presence of a passenger air bag and serious injury among children involved in motor vehicle crashes (MVCs), while controlling for important crash factors.Design. A national population-based cohort of children involved in MVCs and included in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database from 1995 to 2002 was studied. NASS CDS clusters, strata, and weights were included in all analyses.Subjects. Children 0 to 18 years of age involved in MVCs and seated in the right front passenger seat.Main Outcome Measure. Serious injury, defined as an Abbreviated Injury Scale score of ≥3 for any body region.Results. A total of 3790 patients (1 month to 18 years of age) were represented in the NASS CDS database during the 8-year period. Sixty children (1.6%) were seriously injured (Abbreviated Injury Scale score of ≥3). Among age, height, and weight, age of 0 to 14 years (versus 15–18 years) was the only consistent effect modifier of the association between air-bag presence (or air-bag deployment) and serious injury, particularly for crashes with a moderate probability of injury. In analyses stratified according to age and adjusted for important crash factors, children 0 to 14 years of age involved in frontal collisions seemed to be at increased risk of serious injury from air-bag presence (odds ratio [OR]: 2.66; 95% confidence interval [CI]: 0.23–30.9) and deployment (OR: 6.13; 95% CI: 0.30–126), although these values did not reach statistical significance. Among children 15 to 18 years of age involved in frontal collisions, there was a protective effect on injury from both air-bag presence (OR: 0.19; 95% CI: 0.05–0.75) and deployment (OR: 0.31; 95% CI: 0.09–0.99). These findings persisted in analyses involving all collision types. We did not identify similar cutoff points for height or weight.Conclusions. Children up to 14 years of age may be at risk for serious preventable injury when seated in front of a passenger air bag, and children 15 to 18 years of age seem to experience protective effects of air-bag presence and deployment. Age may be a better marker than height or weight for risk assessment regarding children and air bags.
Femur Fractures Resulting From Stair Falls Among Children: An Injury Plausibility Model
Authors: Pierce Mary Clyde , Bertocci Gina E. , Janosky Janine E. , Aguel Fernando , Deemer Ernest , Moreland Morey , Boal Danielle K. B. , Garcia Sylvia , Herr Sandra , Zuckerbraun Noel , Vogeley Eva 
Published: June 2005

Background. Stair falls are common among young children and are also common false histories in cases of child abuse. When a child presents with a femur fracture and a stair-fall history, a judgment of plausibility must be made. A lack of objective injury and biomechanical data makes plausibility determination more difficult. Our objective was to characterize key features associated with femur fractures from reported stair falls, to develop a model for assessing injury plausibility (IP).Methods. Children 2 to 36 months of age who presented with a femur fracture from a reported stair fall were studied prospectively. Detailed history recording, examinations, fracture characterization, and injury scene analyses were conducted, and biomechanical measures associated with injury prediction were calculated. With our proposed IP model, all cases were then scored for the detail of history, biomechanical compatibility of fracture morphologic features, time to seeking care, and presence of other injuries.Results. Twenty-nine children were diagnosed with a femur fracture resulting from a reported stair fall. The IP model made a clear distinction between 2 groups, designated plausible and suspicious. Significant differences were observed for the detail of history, biomechanical compatibility of fracture, time to seeking care, presence of other injuries, and total IP scores. In the plausible group, the minimal linear momentum associated with a transverse fracture was almost 10-fold greater than that for spiral or buckle fracture types.Conclusions. This study adds new information to the current body of knowledge regarding injury biomechanics and fractures among children. The IP model provides an objective means of assessing plausibility of reported stair-fall–related femur fractures and identifies key characteristics to facilitate decision-making.
The Impact of Severe Respiratory Syncytial Virus on the Child, Caregiver, and Family During Hospitalization and Recovery
Authors: Leidy Nancy Kline , Margolis Mary Kay , Marcin James P. , Flynn Jennifer A. , Frankel Lorry R. , Johnson Susan , Langkamp Diane , Simoes Eric A. F. 
Published: June 2005

Objective. To quantify the magnitude of child, caregiver, and family distress associated with hospitalization for severe respiratory syncytial virus (RSV) and the posthospitalization recovery period.
Design. A prospective study of 46 RSV-hospitalized infants and children ≤30 months of age with a history of prematurity (gestational age of ≤35 weeks) and 45 age-matched control subjects was performed. RSV group data were gathered during hospitalization and on days 4, 14, 21, and 60 after discharge; control group data were collected at the end of the RSV season and 60 days thereafter.
Main Outcome Measures. RSV severity; caregiver's rating of the child's health (100-point rating) and functional status (Functional Status IIR); caregiver health, stress (7-point rating), and anxiety (Spielberger State Anxiety Inventory); and family health and functioning (Family Adaptability and Cohesion Evaluation Scale II) were recorded.
Results. The mean age of the sample was 10.2 months; 51% of the subjects were male. The average duration of hospital stay for the RSV group was 5.8 ± 8 days. Most patients received supplemental oxygen (76%) and were monitored for apnea (60%). The mean age of the caregivers (93% mothers) was 29 years. During hospitalization, the RSV-infected patients' health and functional status were significantly poorer than those of control subjects. Caregivers of RSV-infected children reported more stress, greater anxiety, poorer health, and poorer family health and functioning. As long as 60 days after discharge, caregivers of RSV-infected children reported the children's health as significantly poorer and were personally more anxious, compared with control subjects.
Conclusions. RSV-related hospitalization creates significant distress for infants and children, caregivers, and families, with some effects extending as long as 60 days after discharge.
Prophylactic Ibuprofen for the Prevention of Intraventricular Hemorrhage Among Preterm Infants: A Multicenter, Randomized Study
Authors: Dani Carlo , Bertini Giovanna , Pezzati Marco , Poggi Chiara , Guerrini Pietro , Martano Claudio , Rubaltelli Firmino F. ,   and the IntraVentricular Ibuprofen Study Group
Published: June 2005

Objective. Ibuprofen enhances cerebral blood flow autoregulation and was shown to protect neurologic functions after oxidative stresses in an animal model. For these reasons, we hypothesized that the prophylactic use of ibuprofen would reduce the occurrence of intraventricular hemorrhage (IVH) and its worsening toward grades 2 to 4 among preterm infants. To confirm this hypothesis, we planned the present prospective study.Methods. This was a double-blind, randomized, controlled trial in which preterm infants with gestational ages of &lt;28 weeks received ibuprofen or placebo within the first 6 hours of life. The infants were assigned randomly, at 7 neonatal care units, to receive ibuprofen (10 mg/kg, followed by 5 mg/kg after 24 and 48 hours) or placebo. Serial echoencephalography was performed 24 and 48 hours after the initial cerebral ultrasound study, on postnatal days 7, 15, and 30, and at 40 weeks' postconceptional age. Grade 1 IVH or no IVH was considered a successful outcome, whereas grade 2 to 4 IVH represented failure. The rates of ductal closure, side effects, and complications were recorded.Results. We studied 155 infants. Grade 2 to 4 IVH developed for 16% of the ibuprofen-treated infants and 13% of the infants in the placebo group. The occurrence of patent ductus arteriosus was less frequent only on day 3 of life in the ibuprofen group. There were no significant differences with respect to other complications or adverse effects.Conclusions. Our study demonstrated that prophylactic ibuprofen is ineffective in preventing grade 2 to 4 IVH and that its use for this indication cannot be recommended.
Transition Planning for Youth With Special Health Care Needs: Results From the National Survey of Children With Special Health Care Needs
Authors: Lotstein Debra S. , McPherson Merle , Strickland Bonnie , Newacheck Paul W. 
Published: June 2005

Objective. To describe the proportion of youth with special health care needs (YSHCN) who are receiving services for medical transitions and to describe which sociodemographic and health care-related factors are associated with receiving transition services.Methods. We analyzed responses to questions about medical transitions from the 2001 National Survey of Children With Special Health Care Needs (NS-CSHCN). Parents or guardians of youth aged 13 to 17 years who screened positive for the survey were asked (1) whether they had discussed with health care providers how their child's health care needs might change in adulthood, (2) if they had a plan to address these changing needs, and (3) if their child's health care providers had discussed having their child eventually see a doctor who treats adults. Bivariate and multivariate associations were estimated to identify sociodemographic and health care factors related to receiving medical-transition services.Results. Overall, 50% of respondents had discussed their child's changing health care needs with their physicians, although significantly fewer Hispanic youth compared with other youth reported these discussions. Youth who met criteria for a medical home were more likely to have discussed changing needs and to have a plan addressing these needs. Of those who had discussed changing needs, 59% had a plan to address these needs and ∼42% had reported discussing shifting care to adult-oriented providers. Younger teens and non-Hispanic black children were less likely to have discussed changing providers. Fifteen percent of YSHCN met the Maternal and Child Health Bureau's core outcome for medical transitions. A multivariate logistic-regression model found that older age and having a medical home were significantly associated with increased odds of meeting the outcome measure.Conclusion. The proportion of YSHCN meeting the medical-transition outcome measure is quite low, particularly for youth from ethnic minorities. Higher rates are seen for older teens and those receiving care within a medical home. Significant efforts will be required to meet the proposed goal of all YSHCN receiving the services necessary to transition to adult health care.
Cardiovascular Support for Low Birth Weight Infants and Cerebral Hemodynamics: A Randomized, Blinded, Clinical Trial
Authors: Pellicer Adelina , Valverde Eva , Elorza María Dolores , Madero Rosario , Gayá Francisco , Quero José , Cabañas Fernando 
Published: June 2005

Background. Maintaining adequate organ blood flow is the target of vasopressor treatment, but the impact of these measures on cerebral perfusion has not yet been evaluated systematically in a randomized, blinded, clinical trial.Objectives. To explore the effects on brain hemodynamics of 2 different inotropic agents used to treat systemic hypotension among low birth weight (LBW) infants.Design and Methods. Newborns of &lt;1501 g birth weight or &lt;32 weeks' gestational age, with a mean blood pressure (MBP) lower than gestational age in the first 24 hours of life, were assigned randomly to receive dopamine (DP) (2.5, 5, 7.5, or 10 μg/kg per minute; n = 28) or epinephrine (EP) (0.125, 0.250, 0.375, or 0.5 μg/kg per minute; n = 32), at doses that were increased in a stepwise manner every 20 minutes until the optimal MBP (MBP-OP) was attained and maintained.Outcome Measures. Continuous monitoring of quantitative changes in cerebral concentrations of oxyhemoglobin and deoxyhemoglobin, cerebral intravascular oxygenation (HbD) (the difference between oxyhemoglobin and deoxyhemoglobin), and cerebral blood volume (CBV) were assessed with near-infrared spectroscopy. MBP, heart rate, transcutaneous Pco2 and Po2, and peripheral oxygen saturation were recorded continuously and analyzed at baseline, 20 minutes after each dose increase (T1, T2, T3, and T4) until MBP-OP was reached, and then every 20 minutes up to 1 hour of stable MBP-OP.Results. Fifty-nine infants were considered for analysis. Patients did not differ in birth weight or gestational age (1008 ± 286 g and 28.3 ± 2.3 weeks, respectively, in the DP group and 944 ± 281 g and 27.7 ± 2.4 weeks in the EP group). Studies were performed at a mean age of 5.3 ± 3.7 hours of life (range: 2–16 hours). MBP-OP was attained for 96.3% of patients with DP and 93.7% with EP (responders). For those patients, MBP, heart rate, CBV, and HbD increased from baseline throughout the study period, with no differences between groups except for a higher heart rate with EP. Changes in MBP were correlated significantly with changes in HbD. Dose escalation of drugs produced no differences between groups in the behavior of the variables, except for a greater heart rate with EP from 20 minutes after dose 2 (T2) onward. Drug-induced changes in cerebral hemodynamics varied with gestational age; the EP-induced increase in CBV was greater among less mature patients (&lt;28 weeks), whereas the DP-induced increase in CBV was greater among patients of ≥28 weeks.Conclusions. Among hypotensive LBW infants, cardiovascular support with low/moderate-dose DP or low-dose EP increased cerebral perfusion, as indicated by the increase in both CBV and HbD. Low-dose EP was as effective as low/moderate-dose DP in increasing MBP among LBW infants.
The Impact of School Daily Schedule on Adolescent Sleep
Authors: Hansen Martha , Janssen Imke , Schiff Adam , Zee Phyllis C. , Dubocovich Margarita L. 
Published: June 2005

Objectives. This study was initiated to examine the impact of starting school on adolescent sleep, to compare weekday and weekend sleep times, and to attempt to normalize the timing of the circadian sleep/wake cycle by administering bright light in the morning. This was a collaborative project involving high school students and their parents, as well as high school and university faculty members, for the purpose of contributing information to the scientific community while educating students about research processes and their own sleep/wake cycles and patterns.Methods. Sixty incoming high school seniors kept sleep/wake diaries beginning in August and continuing through 2 weeks after the start of school in September. Sleep diaries were also kept for 1 month in November and 1 month in February. Early-morning light treatments were given to 19 students in the last 2 weeks of November and the last 2 weeks of February. Neuropsychologic performance was measured with computer-administered tests. Paper-and-pencil tests were used for assessment of mood and vigor. A testing period consisted of 2 consecutive days at the beginning and end of November and at the beginning and end of February. Tests were given 3 times per day, ie, in the morning before school (6:30–8:00 am), during midday lunch periods (11:30 am to 1:00 pm), and in the afternoon (3:00–4:30 pm), on each of the test days.Results. Adolescents lost as much as 120 minutes of sleep per night during the week after the start of school, and weekend sleep time was also significantly longer (∼30 minutes) than that seen before the start of school (August). No significant differences were found between weekday sleep in the summer and weekend sleep during the school year. Early-morning light treatments did not modify total minutes of sleep per night, mood, or computer-administered vigilance test results. All students performed better in the afternoon than in the morning. Students in early morning classes reported being wearier, being less alert, and having to expend greater effort.Conclusions. The results of this study demonstrated that current high school start times contribute to sleep deprivation among adolescents. Consistent with a delay in circadian sleep phase, students performed better later in the day than in the early morning. However, exposure to bright light in the morning did not change the sleep/wake cycle or improve daytime performance during weekdays. Both short-term and long-term strategies that address the epidemic of sleep deprivation among adolescents will be necessary to improve health and maximize school performance.