bluuebunny/crossref_metadata_2025_split huggingface dataset:
An assessment of selected preventive screenings among children aged 12 to 35 months in a hospital‐based, Medicaid managed care practice
Authors: Vivier Patrick M , Flanagan Patricia , Simon Peter , Diana Birkin James , Brown Lois , Alario Anthony J 
Published: March 2003

ABSTRACTObjectives The goal of this study was to assess (i) whether preschool children enrolled in a hospital‐based, Medicaid managed care practice had received recommended preventive screenings, including blood lead, hematocrit and tuberculosis testing, and (ii) the prevalence of positive results in these screens.Design and methods All children between 12 and 35 months of age who had been continuously enrolled in the practice for the last 6 months of 1996 were included in the study, regardless of their visit frequency. Medical records were reviewed for the study children. The dates and results of all blood lead, hematocrit and tuberculosis tests were abstracted.Results Eight hundred and twelve children met the study inclusion criteria. All but two of these children had a hospital medical record available for review. Six hundred and ninety of the 812 children (85.0%) had a documented blood lead test. Of those screened, more than one‐quarter (190 of 690; 27.5%) had at least one result ≥ 10 μg/dL. A hematocrit result was documented for 742 of the study children (91.4%), and 377 of these children (50.8%) were anemic on at least one test (defined as a hematocrit two standard deviations below published norms). Two‐thirds of study children (536) had documentation of a tuberculosis screen being performed, with two‐thirds of these having a documented reading. None of the 342 children with a documented tuberclin skin test reading had a positive test.Conclusions Screening rates were relatively high in this study group, especially when one considers that the denominator for screening rates was based on enrollment in the practice, regardless of whether or not the child had been seen. The results of these screening tests provide evidence for the high burden of lead poisoning and anemia in this low‐income population.Implications for practice This study demonstrates that it is feasible to carry out assessments basedon defined primary care responsibilities, allowing for a more population‐based approach to health care in hospital‐based clinics.
HIV in primary care: an educational initiative for child health providers
Authors: Stille Christopher J , Berrien Virginia , Krause Peter J 
Published: March 2003

ABSTRACTBackground With recent progress in controlling HIV disease in children, infected children are living longer than ever before. Their health care needs include health supervision services, such as developmental monitoring and anticipatory guidance, which are best provided by child health providers (Providers). Providers need to know about the care of children with HIV infection in order to provide optimal health supervision services.Objective To design a curriculum to educate providers about the care of children with HIV infection, targeted to the needs of local providers.Setting The primary care centre of an urban children's hospital in Connecticut during 1997–98.Intervention We observed clinical cases; conducted a needs assessment, including discussions with providers and a review of educational resources; and held discussions with infectious disease subspecialists. From these, we designed a series of seminars covering individual topics generated mainly by providers. We then conducted a grand rounds lecture to cover the topics more broadly. All participants received a booklet covering the topics discussed.Impact Providers received the sessions well. Self‐reporting suggested changes in their care of children with HIV infection, including increased confidence in decision‐making about routine health issues, more aggressive immunization, and better coordination of care with subspecialists. Many suggestions for further sessions were generated.Conclusion An educational program tailored to the needs of local child health providers may be helpful in the care of their patients with HIV infection. This program can promote high‐quality, co‐ordinated care for the complex needs of these patients.
Early predictors of admission or prolonged emergency department treatment for children with acute asthma
Authors: Shope Timothy R , Cabana Michael D , Zorc Joseph J 
Published: March 2003

ABSTRACTObjective To determine whether demographic, historical and clinical information available at the time of presentation to the pediatric emergency department (ED) can be used to predict which children with acute asthma are likely to require extended treatment (>5 hours in ED or hospital admission).Design Concurrent cohort study.Setting and sample Inner‐city, university‐based pediatric ED. Subjects were 1–18 years old (n = 181) receiving standardized asthma therapy with frequent beta‐agonists and corticosteroids.Measurement Upon ED presentation, demographic information, asthma history and seven clinical variables were assessed. Bivariate analysis and multivariable logistic regression were used to identify significant predictors of extended treatment. Positive predictive values (PPVs) for individual and combined variables were calculated.Results Overall, 30% (54 of 181) subjects required extended treatment; 8% (15 of 181) required treatment in the ED > 5 hours and 22% (39 of 181) were admitted. All but one of the asthma severity score items were significantly associated with prolonged treatment (suprasternal indrawing, P = 0.07; all others, P < 0.05). When these items were combined into the asthma scores from which they were originally derived, PPVs for extended treatment were only 45 and 50%, respectively. These PPVs for extended treatment were no better than those for individual items, which ranged between 36 and 50%. Demographic information and prior asthma history were not associated with extended treatment.Conclusions/implications for practice Although individual asthma severity score items and asthma severity scores assessed at ED presentation were associated with extended treatment, no variable, alone or in combination, had a clinically useful PPV. Decisions regarding observation unit admission for pediatric asthmatics should not solely be based on initial clinical assessment.
Resilience programs for children in disaster
Authors: Grotberg Edith Henderson 
Published: March 2003

ABSTRACTOBJECTIVES The long‐term objectives of the International Resilience Research Project (IRRP), were to indicate: a. how children become resilient and how service providers incorporate the promotion of resilience into their programs. The intermediary objectives were to: (1) indicate how resilience is promoted in different cultures with different age groups; (2) identify what resilience behaviors deal with and overcome the potentially damaging aspects of adversities and disasters; and (3) identify the role of adults in promoting resilience in their children and in themselves.METHOD The data from the International Resilience Research Project were reanalysed in order to link the results to subsequent research and program development, including resilience programs for children in disaster. The methodology was based on purposeful samples of selected families with children in specific age groups (0–3; 4–6; 9–11 years). Each researcher, representing 27 sites in 22 countries, received the Methodology Guidance and Manual for the Training of Interviewers, designed and developed by an International Advisory Committee; a demographic sheet; a packet of the 15 constructed situations and forms with the questions to be answered; and additional standardized tests for validation. Data were returned to the project director for scoring, with reliability checks, and qualitative data analysis at Civitan International Research Center, University of Alabama, Birmingham.RESULTS Parents and children at 27 sites in 22 countries, from Russia to Vietnam, from Namibia to Finland, from Chile to Canada, provided the data. A total of 1225 target children and their families participated, with 2204 responses from parents, and 1194 responses from children. The results of the data gathered from 1993 to 1997 were, briefly, these: (1) one‐third of the respondents exhibited resilience or its promotion; (2) by the age of 9 years, children can promote their own resilience at the same rate as adults; (3) socio‐economic status had an insignificant impact on resilience promotion and behavior; (4) boys and girls had the same frequency of resilience promotion and behavior, with girls relying more on interpersonal skills in dealing with adversities and boys relying more on pragmatic problem solving skills; and (5) cultural differences exist, but do not prevent the promotion of resilience.CONCLUSION Resilience can be promoted, and programs for children in disaster are feasible. Such programs can be adapted to children, adults, service providers, students, and those working with children in disasters. The programs can be independent or incorporated as part of existing service programs. Further, such programs can be adapted to different cultures.IMPLICATIONS FOR PRACTICE Professionals can incorporate the promotion of resilience into their service programs in regular or disaster settings. As a consequence, they can improve services and thereby the physical and mental health of children and families coping with disaster.
Increased health care utilization associated with child day care among health maintenance organization and Medicaid enrollees
Authors: Lu Ning , Samuels Michael E 
Published: March 2003

ABSTRACTObjective This study examined the association between child day care and the utilization of health care resources. It also investigated whether increased use of health care resources in day‐care children is due to acute diarrheal illness or upper respiratory tract infections (URI).Sample Study subjects were recruited as day‐care children (n = 435) and home‐care children (n = 753) through a health maintenance organization (HMO) and a consortium of Medicaid providers in Columbia, South Carolina, and were followed bimonthly for 18 months.Method A survey was conducted to collect data on children aged 5 years or younger from their parents. The questionnaires collected familial information, individual characteristics, disease‐related symptoms, and the information on physician visits, antibiotic use, and use of other medicines. The association between day care attendance and the likelihood of using health care resources was examined by multivariate logistic regression analyses.Results Compared with home‐care children, the odds ratios for physician visits, use of antibiotics, and use of other medicines were all significantly greater for children attending day care. However, the increased likelihood of physician visits in day‐care children may not be attributable to diarrheal illness or URI.Conclusions Day care attendance is associated with the increased use of health care. Antibiotics are more likely to be prescribed in day‐care children than in home‐care children for diarrheal illness and URI.Implications for practice Understanding the association between child day care attendance and utilization of health care resources will assist health care providers in evaluating their practice in providing medical care to children.
Levels of Care: primary care residents' self‐assessment of ability to care for children with chronic health conditions
Authors: Burke Robert T , Kiessling Louise S 
Published: March 2003

ABSTRACTObjectives To investigate the use of Levels of Care model to measure the self‐assessed ability of physicians in training to care for children with chronic health conditions.Design Questionnaire presenting 45 case scenarios of children with various chronic health conditions was given to 85 residents training in pediatrics (46) or family medicine (39). The resident estimated for each case scenario the Level of Care (LoC I–V) that the resident felt able to provide ‘now, while in training’, and would want to provide when entering ‘practice’.Setting University‐based, postgraduate, primary care specialty training programs in pediatric and family medicine.Participants A total of 85 resident physicians in postgraduate training programs in the primary care specialties of family medicine (FM) and pediatrics (Pd).Results Thirty‐nine family medicine (100%) and 30 pediatric residents (65%) responded. Median Level of Care (LoC FM‐1) that the family medicine residents felt able to provide while in ‘training’ was III and for the pediatric residents (LoC Pd‐1) was IV, χ2 = 42.595, p = 0.0001. The median Level of Care residents wanted to be able to provide in ‘practice’ for each group was LoC‐IV, χ2 = 13.85, p = 0.0078. There were statistically significant differences in responses between family medicine (FM) and pediatric (Pd) residents to both the ‘training’ and ‘practice’ questions.Conclusions A self‐assessment instrument incorporating the Levels of Care (LoC) concept was useful to assess the self‐perceived ability of resident physicians in training to care for children with chronic health conditions.
Support of universal newborn hearing screening among mothers and health care providers
Authors: Wall Terry C , Peralta‐Carcelen Myriam , Fargason Crayton A , Evans H Hughes , Snyder Erin Dunn , Woolley Audie L 
Published: March 2003

ABSTRACTBackground Despite the 1994 Joint Committee on Infant Hearing recommendation that all newborns receive hearing screens, many in the United States are not screened by 3 months of age.Objectives To assess mothers’, pediatricians’, and hearing specialists’ preferences for targeted versus universal newborn hearing screening.Study design An interactive computer‐based interview, applying the analytical hierarchical process, was used to quantify preference scores for 95 post‐partum women selected randomly from an obstetric ward at a university hospital and for 40 primary care pediatricians and 40 hearing specialists (audiologists and otolaryngologists) randomly selected from a local community. The main outcome of interest was preference for targeted versus universal newborn hearing screening. Three objectives were compared minimize missed hearing loss, minimize unnecessary tests, and minimize cost. Unnecessary tests included consideration of test time, test accuracy, and need for follow‐up hearing evaluations.Results The majority of respondents in all three groups (97.5% hearing specialists, 82.5% pediatricians, and 89.5% mothers) favored universal over targeted screening. Differences in mean preference scores were statistically significant between hearing specialists and pediatricians (p < 0.005) and between hearing specialists and mothers (p < 0.005). All three groups ranked risk of missed hearing impairment as the most important consideration. Hearing specialists placed more weight on importance of not missing a case of hearing loss and less on unnecessary tests than mothers and pediatricians.Conclusions Even though universal newborn hearing screening was preferred by the three groups examined, a small but significant minority of pediatricians and mothers preferred targeted screening.
Asthma, wheeze and cough in 7‐ to 9‐year‐old British schoolchildren
Authors: Coleman Helen , McCann Donna C , McWhirter Jenny , Calvert Marguerite , Warner John O 
Published: March 2003

ABSTRACTBackground Report on the characteristics of a cohort of children, aged 7–9 years, attending schools in the south of England and participating in a controlled intervention study to improve the care and knowledge of asthma in junior and primary schools and highlight problems for potential intervention.Methods A survey employing the International Study of Asthma and Allergies in Childhood (ISAAC) asthma questionnaire was undertaken to record the prevalence of asthma and the characteristics of children with asthma and wheeze in Year 3 and 4 pupils (age 7–9 years) in 25 schools, and to define disease severity and its management.Results Responses on 1732 children were received. Reports of asthma and wheeze in this study were similar to those in recent ISAAC studies. The frequency and severity of symptoms was associated with appropriate therapeutic intervention suggesting adherence to published British Thoracic Society (BTS) guidelines. However, 80% of children with asthma at any BTS level of treatment reported exercise‐induced wheeze, indicating a need for education on pre‐exercise inhaler use. One in 20 children who had wheezed in the past 12 months reported a symptom profile suggestive of unrecognised asthma. Significant associations were found between maternal smoking and both wheeze in the last 12 months [odds ratio (OR), 1.35; confidence interval (CI): 1.01–1.81, p < 0.05] and nocturnal cough [OR, 1.70; CI: 1.31–2.20, p < 0.001].Conclusions The characteristics of this sample are similar to those found for children of a similar age group in other studies. Therapeutic intervention is appropriate for the severity of disease but there are high levels of exercise‐induced wheeze despite adequate control of other symptoms. Five percent of children who reported wheezing in the previous 12 months had a symptom profile of untreated asthma. Maternal cigarette smoking was associated with wheeze and cough.Implications for practic Recurrent untreated wheeze remains a problem for 5% of children reporting wheeze. A therapeutic hole has been identified – there is a need for further education on pre exercise inhaler use. Both these problems could be addressed by a school‐based asthma management strategy. Maternal smoking and its effects on childhood asthma and wheeze need to be addressed.
The greatest impact of war and conflict
Authors: Mandalakas Anna Maria 
Published: March 2003

ABSTRACTOBJECTIVE To review the available literature, explore developmental vulnerability, and highlight long‐term outcomes found in children exposed to complex humanitarian emergencies (CHEs).DESIGN Literature review.RESULTS Children involved in CHEs are at risk for a number of poor long‐term outcomes. Children exposed to malnutrition during the first two trimesters and early in life are at risk for poor cognitive, behavioral and psychological function. The existing literature consistently describes the high incidence of psychological trauma experienced by children involved in CHEs. There is limited research examining the long‐term outcomes and/or effectiveness of interventions applied in these children.CONCLUSIONS These insults affect children's subsequent development and diminish their ability to function successfully as adults. Communities suffer from these insults for decades as these children become the adults challenged with rebuilding their societies and avoiding future conflict.IMPLICATIONS FOR PRACTICE Recognition of children's vulnerability, advocacy on the part of child health professionals and inclusion of appropriately trained child health specialists on emergency response teams are critical to minimizing children's risk of poor long‐term outcome. It is important to recognize the great amount of variability in children's resiliency and coping abilities. This variability is determined by a number of factors that are both fixed and modifiable. There are several broad, conceptual approaches that child health professional can employ to modify these factors, empower children and optimize long‐term outcome. Future research designed to examine these issues is greatly needed.
Phenylketonuria – a problem in eugenics
Authors: PENROSE L. S. 
Published: March 2003

Inaugural Lecture delivered at University College on 21 Jan. 1946 and reprinted with permission from The Lancet, 29 June 1946, pp. 949–953 For academic purposes, eugenics is defined as the study of agencies under social control that may improve or impair the racial qualities of future generations either physically or mentally. This formula allows many different interpretations. The subject matter might involve almost any material studied in medicine, psychology or social science. In the light of knowledge of its frequent misuse, inclusion of the term “racial” in the definition seems unfortunate. A racial quality is presumably any character which differs in frequency or which (when it is metrical) differs in average value in two or more large groups of people. No qualities have been found to occur in every member of one race and in no member of another. Furthermore, as Morant (1939) has shown in his analysis of European populations, differences between average measurements in the so‐called races are often much smaller than commonly supposed. The qualities by which people differ can be treated as legitimate material for scientific investigation without employing any invidious concept of race. The human race constitutes the field of eugenic inquiry.A popular view of eugenics, which has in the past been encouraged by propaganda groups such as eugenic societies and human betterment foundations, implies active interference in human reproduction. The general grounds for interference are often held to be that civilisation has tended to reverse the process of natural selection because the weaklings are now being fostered at the expense of the naturally strong. Not only are the physically and mentally inferior prevented from perishing in infancy by the activities of medical and social services but also, when the weaklings grow up, they are supposed to be more fertile than the normal. As Karl Pearson (1909) once put it, “we have suspended the racial purgation maintained in the less developed communities by natural selection.” Degeneration of the physical and mental level of civilised peoples is believed to be inevitable unless eugenic measures are taken to counteract it.
Detailed haplotype analysis in Ashkenazi Jewish and non‐Jewish British dystonic patients carrying the GAG deletion in the DYT1 gene: evidence for a limited number of founder mutations
Authors: VALENTE E. M. , POVEY S. , WARNER T. T. , WOOD N. W. , DAVIS M. B. 
Published: March 2003

The DYT1 gene on human chromosome 9q34 appears to be responsible for most cases of early onset primary torsion dystonia (PTD) both in Ashkenazi Jewish (AJ) and in non‐Jewish patients. Previous haplotype analysis in a 2 cM region surrounding the DYT1 gene showed that a single founder mutation (DYT1AJ) was responsible for most cases of early onset PTD in the North American AJ population and refined the most likely location of the gene to a 150 kb interval between the marker loci D9S2161 and D9S63.Recently, the majority of cases of early onset PTD in both AJ and non‐Jewish patients were found to carry a unique 3‐bp (GAG) deletion in the coding region of the DYT1 gene. This deletion appears to have arisen more than once, suggesting independent mutational events.In this study, we analysed the haplotypes surrounding DYT1 in 9 AJ and 15 non‐Jewish British patients carrying the GAG deletion in the DYT1 gene. We found that all AJ British patients carried the same haplotype as the North American Jews, sustaining the theory that the current British AJ community descends from the same small group of individuals as the North American Jewry. Furthermore, in the non‐Jewish British patients, only a limited number of distinct founder mutations was observed. This supports the hypothesis that the GAG deletion in the DYT1 gene is not a very frequent mutation, and that it has arisen only a limited number of times throughout the centuries.