bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep of Excessively Crying Infants: A 24-Hour Ambulatory Sleep Polygraphy Study
Authors: Kirjavainen Jarkko , Lehtonen Liisa , Kirjavainen Turkka , Kero Pentti 
Published: November 2004

Objective. Parents’ reports suggest that excessively crying or colicky infants sleep less compared with control subjects. The aim of this study was to determine the sleep-wake structure of excessively crying infants throughout a 24-hour cycle.
Methods. A 24-hour sleep polygraphy study was conducted at home for 24 excessively crying infants and 23 control subjects at the age of 6 weeks. In addition, parental diaries were kept for 4 days.
Results. In sleep polygraphy recordings, no major differences between study groups were observed in either the duration or the structure of the 24-hour sleep. In the diaries, the parents overestimated the amount of sleep in both study groups. The parents of the control infants overestimated the amount of sleep more than the parents of excessively crying infants (69.8 minutes [standard deviation: 79.3] compared with 27.1 minutes [standard deviation: 65.4], respectively). In excessively crying infants, the proportion of rapid eye movement sleep was higher during the 3-hour period from the beginning of the first long sleep in the evening and lower during the preceding 3-hour period compared with the control group.
Conclusions. The results of this study suggest that diary-based studies are prone to be biased as the parents of the control infants are more likely to overestimate the amount of infant’s sleep and, therefore, report more sleep than the parents of the crying infants. Although no differences in the total amount of sleep or proportions of sleep stages were observed, excessively crying infants may be characterized by a disturbance that affects rapid eye movement and non–rapid eye movement sleep stage proportion during evening hours.
Circumstances Surrounding the Deaths of Hospitalized Children: Opportunities for Pediatric Palliative Care
Authors: Carter Brian S. , Howenstein Matthew , Gilmer Mary Jo , Throop Pat , France Dan , Whitlock James A. 
Published: November 2004

Objectives. Little is known regarding the assessment and treatment of symptoms during end-of-life (EOL) care for children. This study was conducted to describe the circumstances surrounding the deaths of hospitalized terminally ill children, especially pain and symptom management by the multidisciplinary pediatric care team.Design. Patients in the neonatal intensive care unit, pediatric critical care unit, or general pediatric units of Vanderbilt Children’s Hospital who were hospitalized at the time of death, between July 1, 2000, and June 30, 2001, were identified. Children eligible for the survey had received inpatient EOL care at the hospital for at least 24 hours before death. A retrospective medical record review was completed to describe documentation of care for these children and their families during the last 72 hours of life.Results. Records of children who had received inpatient EOL care were identified (n = 105). A majority (87%) of children were in an intensive care setting at the time of death. Most deaths occurred in the pediatric critical care unit (56%), followed by the neonatal intensive care unit (31%). Pain medication was received by 90% of the children in the last 72 hours of life, and 55% received additional comfort care measures. The presence of symptoms other than pain was infrequently documented.Conclusions. The duration of hospitalization for most children dying in this inpatient setting was sufficient for provision of interdisciplinary pediatric palliative care. Management of pain and other symptoms was accomplished for many children. The documentation of pain and symptom assessment and management can be improved but requires new tools.
A Simple Treatment for Head Lice: Dry-On, Suffocation-Based Pediculicide
Authors: Pearlman Dale Lawrence 
Published: November 2004

Objectives. The emergence of drug-resistant lice has created the need for new therapies. This study assesses a new method without neurotoxins, extensive household cleaning, or nit removal.
Methods. One hundred thirty-three subjects participated in 2 open clinical trials. In the first trial, 93 subjects completed treatment using a nontoxic, dry-on, suffocation-based, pediculicide lotion, minimal household cleaning measures, and physical removal of the nits. In the second trial, 40 subjects completed treatment using an identical protocol except that the nits were not removed. Head lice infestation was defined as a wet combing test showing lice. Cure was defined as a wet combing test showing no lice, with an absence of symptoms. Subjects were contacted 6 months later, for assessment of their disease status.
Results. Cure was achieved for 97% of the patients in the first trial and 95% in the second trial. Remission at the follow-up assessment was reported for 77 of 82 subjects (94%) in the first trial and 36 of 38 subjects (95%) in the second trial. There was no statistical difference in cure rates or remission rates between the protocols with and without nit removal. The overall cure rate was 96%, with a remission rate of 94%. There were no adverse effects.
Conclusions. Dry-on, suffocation-based, pediculicide lotion effectively treats head lice without neurotoxins, nit removal, or extensive house cleaning. These results are comparable or superior to the results previously reported for treatments with permethrin, pyrethrin, and malathion.
Predictors of Hospital Readmission of Manitoba Newborns Within Six Weeks Postbirth Discharge: A Population-Based Study
Authors: Martens Patricia J. , Derksen Shelley , Gupta Sumit 
Published: November 2004

Objectives. To examine the proportion, geographic variation, and predictors of infant hospital readmission within 6 weeks of the postbirth discharge.
Methods. A cross-sectional, population-based study was conducted of all infants who were born from 1997 through 2001, linkable to the birth mother, and discharged alive from the hospital (N = 68 681) using hospital discharge files in the Canadian province of Manitoba. The following predictors of readmission were examined using logistic regression: preterm, low birth weight, neighborhood income, geographic location (the North, Rural South, and Urban areas of Winnipeg and Brandon), breastfeeding status, length of stay, maternal age, and type of delivery. Using 9 non-Winnipeg regions and 12 Winnipeg subregions, ecologic correlations (1-tailed Spearman) between newborn hospital readmission rates and the following were examined: 1) a region's overall health status, measured by the premature mortality rate (PMR), or death before aged 75 years and 2) a region's socioeconomic risk, using the Socio-Economic Factor Index (SEFI).
Results. The proportion of infants who were readmitted to the hospital at least once within 6 weeks of postbirth hospital discharge was 3.95%, with respiratory illness the leading cause (22.3% of readmissions). Risk of readmission was higher for infants who were born preterm (adjusted odds ratio [AOR]: 1.80; 95% confidence interval [CI]: 1.55–2.10), who were of the 3 lowest income quintiles (lowest: AOR: 2.02; 95% CI: 1.77–2.32; low: AOR: 1.48; 95% CI: 1.29–1.71; middle: AOR: 1.26; 95% CI: 1.08–1.47), who resided in the North (AOR: 1.85; 95% CI: 1.66–2.07) or Rural South (AOR: 1.25; 95% CI: 1.14–1.36), who were not breastfed (AOR: 1.32; 95% CI: 1.20–1.44), whose mother's age was 17 or younger (AOR: 1.30; 95% CI: 1.10–1.55), whose mother was 18 to 19 years of age (AOR: 1.25; 95% CI: 1.09–144), or who were born by cesarean section (AOR: 1.30; 95% CI: 1.19–1.43). Regional readmission rates were correlated with PMR (9 non-Winnipeg regions: r = 0.77 for PMR and r = 0.68 for SEFI; 12 Winnipeg Community Areas: r = 0.49 for PMR and r = 0.73 for SEFI).
Conclusions. Income and geography are strongly associated with newborn hospital readmission. Modifiable risk factors include increasing breastfeeding rates, decreasing cesarean section rates, and decreasing adolescent pregnancy rates (or increasing adolescent parental support), but these need additional study to establish causation.
Use of Voice Recognition Software in an Outpatient Pediatric Specialty Practice
Authors: Issenman Robert M. , Jaffer Iqbal H. 
Published: November 2004

Background. Voice recognition software (VRS), with specialized medical vocabulary, is being promoted to enhance physician efficiency, decrease costs, and improve patient safety. This study reports the experience of a pediatric subspecialist (pediatric gastroenterology) physician with the use of Dragon Naturally Speaking (version 6; ScanSoft Inc, Peabody, MA), incorporated for use with a proprietary electronic medical record, in a large university medical center ambulatory care service.
Methods. After 2 hours of group orientation and 2 hours of individual VRS instruction, the physician trained the software for 1 month (30 letters) during a hospital slowdown. Set-up, dictation, and correction times for the physician and medical transcriptionist were recorded for these training sessions, as well as for 42 subsequently dictated letters. Figures were extrapolated to the yearly clinic volume for the physician, to estimate costs (physician: $110 per hour; transcriptionist: $11 per hour, US dollars).
Results. The use of VRS required an additional 200% of physician dictation and correction time (9 minutes vs 3 minutes), compared with the use of electronic signatures for letters typed by an experienced transcriptionist and imported into the electronic medical record. When the cost of the license agreement and the costs of physician and transcriptionist time were included, the use of the software cost 100% more, for the amount of dictation performed annually by the physician.
Conclusions. VRS is an intriguing technology. It holds the possibility of streamlining medical practice. However, the learning curve and accuracy of the tested version of the software limit broad physician acceptance at this time.
Behavioral and Emotional Adjustment of Teenagers in Mainstream School Who Were Born Before 29 Weeks’ Gestation
Authors: Gardner Frances , Johnson Ann , Yudkin Patricia , Bowler Ursula , Hockley Christine , Mutch Lesley , Wariyar Unni ,   on behalf of ELGA (Extremely Low Gestational Age) Steering Group
Published: November 2004

Objectives. To investigate behavioral and emotional problems and positive adjustment of 15-to 16-year-olds who were born at extremely low gestational age (ELGA), from the perspective of parents, teachers, and teenagers.Methods. Prospective follow-up was conducted of birth cohorts, with classroom control subjects. All infants who were born before 29 weeks in 1983–1984 (mean gestational age: 27 weeks) to mothers who resided in 3 regions of the United Kingdom were studied. A total of 82% (179 of 218) of survivors were traced at age 15 to 16. The 150 in mainstream school were compared with age- and gender-matched classroom control subjects (n = 108). Behavioral and emotional problems, delinquency, peer relations, self-esteem, and hobbies, were assessed by standardized, well-validated instruments, including the Strengths and Difficulties Questionnaire, administered by mail to parents, teenagers, and teachers.Results. Parents were more likely to rate ELGA teenagers than control subjects as in the “abnormal” range for hyperactivity (8% vs 1%; difference: 7%; (95% confidence interval [CI]: 2–12), peer relationship problems (19% vs 5%; difference: 14%; 95% CI: 6-21), and emotional problems (18% vs 7%; difference: 11%; 95% CI: 3-19), but not conduct problems (10% vs 5%; difference: 5%; 95% CI: −1 to 12)). Teachers reported a similar pattern. In contrast, compared with control subjects, ELGA teenagers did not rate themselves as having more problems with peers, hyperactivity, conduct, depression, or low self-esteem. They reported more emotional problems but less delinquency, alcohol, cannabis, and other drug use.Conclusions. Compared with mainstream classmates, children who are born extremely early continue to have higher levels of parent- and teacher-reported emotional, attentional, and peer problems well into their teens. However, despite these problems, they do not show signs of more serious conduct disorders, delinquency, drug use, or depression.
Hospital Staff and Family Perspectives Regarding Quality of Pediatric Palliative Care
Authors: Contro Nancy A. , Larson Judith , Scofield Sarah , Sourkes Barbara , Cohen Harvey J. 
Published: November 2004

Background. Development of a pediatric palliative care program was preceded by a needs assessment that included a staff survey and family interviews regarding improving pediatric palliative care.
Methods. Four hundred forty-six staff members and community physicians responded to a written survey regarding comfort and expertise in delivering end of life care. Sixty-eight family members of 44 deceased children were interviewed regarding treatment, transition to palliative care, and bereavement follow-up contact. Frequencies were generated for responses to the staff survey. Five interviewers reviewed the families' narratives and identified frequently occurring themes.
Results. Staff members reported feeling inexperienced in communicating with patients and families about end of life issues, transition to palliative care, and do not resuscitate status. Families reported distress caused by uncaring delivery of bad news and careless remarks made by staff members. Staff members reported feeling inexperienced in symptom and pain management and described occasions when pain could have been better managed. Families believed pain had been managed as well as possible despite observing their children suffer. Fifty-four percent of staff members reported that adequate support was not provided for those who treat dying children. Staff members and family members stated their desire for more support. Staff members who described their most difficult experiences caring for a dying child referenced personal pain and inadequate support most frequently.
Conclusions. Albeit from different perspectives, staff members and family members shared common concerns and experiences regarding pediatric palliative care. These experiences emphasize the need for additional systematic study, improved education and support for staff members, and continued development of more effective and compassionate delivery of pediatric palliative care.
Continuity of Binge and Harmful Drinking From Late Adolescence to Early Adulthood
Authors: McCarty Carolyn A. , Ebel Beth E. , Garrison Michelle M. , DiGiuseppe David L. , Christakis Dimitri A. , Rivara Frederick P. 
Published: November 2004

Objective. To test the hypothesis that late adolescent drinking behavior (ages 17–20) is associated with harmful and binge drinking in early adulthood (ages 30–31).
Methods. We used the National Longitudinal Survey of Youth (NLSY), a nationally representative longitudinal data set. We used harmful and binge drinking at ages 17 to 20 to predict harmful and binge drinking at ages 30 to 31, stratifying for gender and controlling for confounders.
Results. Data were available on harmful drinking at both the adolescent and the early adult age period for 3790 individuals and on binge drinking for 2387 individuals. Harmful drinking during adolescence was significantly associated with harmful drinking at ages 30 to 31 for men only. Among male adolescents, 14% of harmful drinkers continued harmful drinking at ages 30 to 31, compared with 4% of nonharmful drinkers who became harmful drinkers. In Poisson regression models, binge drinking during adolescence was associated with binge drinking at ages 30 to 31 for both men and women, generating relative risks of 2.3 (95% confidence interval: 1.8–3.0) and 3.0 (95% confidence interval: 2.4–4.8), respectively. Half of binge-drinking male adolescents and one third of binge-drinking female adolescents engaged in binge drinking into early adulthood, compared with 19% for non–binge-drinking male adolescents and 8% of non–binge-drinking female adolescents.
Conclusions. Problem drinking during adolescence is associated with problem drinking in early adulthood. Efforts to prevent and treat adolescent problem drinking could have an impact on the progression of alcohol-related disease.
Screening for Domestic Violence in a General Pediatric Clinic: Be Prepared!
Authors: Holtrop Teresa G. , Fischer Howard , Gray Shirley M. , Barry Kathlyn , Bryant Tina , Du Wei 
Published: November 2004

Objectives. Exposure to violence, particularly domestic violence (DV), negatively affects children's physical, emotional, and cognitive well-being. The American Academy of Pediatrics recommends routine DV screening of female caretakers of pediatric patients. Few reports of screening in pediatric practices exist, and none have reported outcomes from a resident-run urban academic center. We set out to determine whether the use of the Partner Violence Screen (PVS) increases detection of DV and to test the mechanics of implementing large-scale DV screening in a busy, pediatric residency training clinic.
Methods. Using the PVS, we screened a sample of consecutive female caretakers/guardians of children seen for pediatric care in the general pediatric clinic of Children's Hospital of Michigan from March 1, 2002, through February 28, 2003. Positive screens obtained during the study period were compared with the number of DV referrals received by the clinic social workers from January 1, 2001, through December 31, 2001, before PVS screening began. To test the mechanics of screening, we also analyzed the number of forms returned blank or marked “no opportunity to screen” in the last 8 months of the study period.
Results. In the 12 months before use of the PVS, our social work department received 9 referrals because of DV from the general pediatric clinic, among a total of 5446 caretakers/guardians bringing 6380 children for a total of 13 576 patient care visits. In contrast, the social work department received 164 referrals because of positive screening results among 5445 caretakers/guardians bringing 7429 children for 17 346 patient care visits in the 12-month study period after introduction of the PVS. Fourteen of 164 positive PVSs were found to involve nondomestic violence perpetrated by nonpartners or violence with the patient as the victim, not the mother or female caretaker. A total of 150 PVSs involved true DV. The difference in identification of DV with the PVS, compared with the rate before its introduction, was highly significant. The positive predictive value for the PVS was 91.5%, and the identified prevalence rate was 3.7%. In the last 8 months of the study period, 6301 of 8055 PVS forms (78%) were completed; 1754 of 8055 PVS forms (22%) were left blank, but it was not possible to determine whether these represented duplicate screening forms for instances in which the mother or female caretaker had brought &gt;1 child for care.
Conclusions. Formal screening for DV with the PVS in this study setting of a busy, urban, academic, general pediatric clinic appeared to be very successful, in terms of increasing referrals and documentation of previously unrecognized DV situations. This increase signals the need for resources (time and/or social work services) to provide appropriate referral services. The PVS identifies nonpartner violence occasionally.
Effect of Botulinum Toxin in the Treatment of Drooling: A Controlled Clinical Trial
Authors: Jongerius Peter H. , Hoogen Frank J.A. van den , Limbeek Jacques van , Gabreëls Fons J. , Hulst Karen van , Rotteveel Jan J. 
Published: November 2004

Objective. To investigate the clinical effectiveness of botulinum neurotoxin type A (BoNT) to reduce drooling in children with cerebral palsy (CP).
Methods. A controlled clinical trial was performed in which the results of single-dose BoNT injections in the submandibular glands were compared with treatment with scopolamine. Forty-five children who had CP and experienced severe drooling were enrolled. Drooling severity was measured at baseline, during application of scopolamine, and at different intervals after BoNT injections up to 24 weeks, using the Drooling Quotient (DQ), the Teacher Drooling Scale (TDS), and Visual Analog Scales (VAS).
Results. Drooling was reduced during scopolamine application as well as after BoNT injections. Compared with baseline, the mean DQ showed a significant decrease throughout the study. Greatest reductions were achieved 2 to 8 weeks after BoNT injection. No significant differences were found between scopolamine measurements and those up to 24 months after BoNT injection. Using VAS, parents recorded the effect on drooling in which significant differences were found between baseline VAS score and all follow-up assessments. According to our definition of “success to therapy,” demanding a 2-point decrease on the TDS, 61.5% of patients responded to BoNT injections. Analysis of the DQ demonstrated a response rate of 53% of the patients to scopolamine and 48.7% to BoNT until 24 weeks after BoNT injections, the actual duration of this study. As a reaction to scopolamine, 71.1% of the patients had moderate to severe side effects. Only nonsevere, incidental side effects were reported after BoNT injections.
Conclusions. During scopolamine application as well as after intraglandular BoNT injections, a clinically relevant reduction in drooling was achieved in children with CP, demonstrating maximum effect 2 to 8 weeks after injections. This is the first controlled clinical trial that confirmed a significant effect of BoNT injections in the treatment of drooling. General anesthesia was needed for all children. BoNT injections show fewer and less serious side effects than transdermal scopolamine treatment.