bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Health and Service Use Patterns in Homeless and Low-income Housed Children
Authors: Weinreb Linda , Goldberg Robert , Bassuk Ellen , Perloff Jennifer 
Published: August 2004

Objective.Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children.Methods.Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes.Results.Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings.Conclusions.Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.
Trial on Timing of Introduction to Solids and Food Type on Infant Growth
Authors: Mehta Ketan C. , Specker Bonny L. , Bartholmey Sandra , Giddens Jacqueline , Ho Mona L. 
Published: August 2004

Objective.The optimal time and choice of solid foods to introduce to an infant's diet is unknown. The aim of this randomized trial was to determine whether early versus late introduction of solid foods and commercially prepared versus parent's choice of solid foods affects growth or body composition in the first year.Methods.White infants (n = 165) were recruited before 3 months of age and were randomized to receive: 1) commercially prepared solid foods (commercial) from 3 to 12 months, 2) commercially prepared solid foods from 6 to 12 months, 3) parent's choice of solid foods (choice) from 3 to 12 months, or 4) parent's choice of solid foods from 6 to 12 months. Anthropometrics and body composition, using dual energy x-ray absorptiometry, were determined at 3, 6, and 12 months. Three-day diet diaries were completed at 3, 6, 9, and 12 months.Results.There were no differences in growth or body composition between infants in early versus late introduction groups or commercial versus choice groups at any age. The total energy intake was not different among infants in the early compared with the late group at any age. Infants in the commercial group consumed less protein calories at 9 months (80 ± 3 kcal/d vs 88 ± 3 kcal/d) and 12 months (101 ± 5 kcal/d vs 148 ± 5 kcal/d), less fat calories at 12 months (263 ± 10 kcal/d vs 343 ± 10 kcal/d), and less total calories at 12 months (884 ± 24 kcal/d vs 1022 ± 25 kcal/d) compared with the choice group.Conclusion.The early introduction of solid foods to an infant's diet does not alter growth or body composition during the first year of life and results in a displacement of energy intake from formula. Infants consuming commercially prepared foods have a decreased caloric intake from protein and fat; however, despite this difference, there is no effect on growth or body composition.
High-expenditure Children With Supplemental Security Income
Authors: Kuhlthau Karen , Perrin James M. , Ettner Susan L. , McLaughlin Thomas J. , Gortmaker Steven L. 
Published: August 2004

Objective.
To examine the clinical characteristics and health service use of children with high Medicaid expenditures.

Methodology.
We examined 1992 Medicaid claims and eligibility files from four states (California, Georgia, Michigan, Tennessee) for children with at least $10 000 billed to Medicaid who obtained Medicaid through the Supplemental Security Income (SSI) Program and a comparison group (matched by age group and gender) of children receiving Medicaid for other reasons. We compared mean expenditures, examined expenses by category, and examined diagnoses associated with at least $10 000 in expenses.

Results.
In 1992, Medicaid paid on average ∼$1000 for children with non-SSI Medicaid enrollment. Expenditures for children with SSI were 2.9 to 9.4 times higher, but once the ∼10% of children with high expenditures were excluded, SSI average expenditures were only 1.5 to 2.7 times higher than the non-SSI average. Children with high expenditures are likely to use hospitals and long-term care, and these services account for more than half of the average expenditures. Children with high expenditures and SSI are more likely to have chronic medical conditions than are their peers enrolled in Medicaid but not through SSI.

Conclusions.
A small proportion of children, even on SSI, account for very large proportions of Medicaid expenditures. Most children with SSI, despite having relatively severe mental health, physical, or developmental disabilities, have relatively modest Medicaid expenditures.
Sleep-Disordered Breathing and School Performance in Children
Authors: Gozal David 
Published: August 2004

Objective.
To assess the impact of sleep-associated gas exchange abnormalities (SAGEA) on school academic performance in children.

Design.
Prospective study.

Setting.
Urban public elementary schools.

Participants.
Two hundred ninety-seven first-grade children whose school performance was in the lowest 10th percentile of their class ranking.

Methods.
Children were screened for obstructive sleep apnea syndrome at home using a detailed parental questionnaire and a single night recording of pulse oximetry and transcutaneous partial pressure of carbon dioxide. If SAGEA was diagnosed, parents were encouraged to seek medical intervention for SAGEA. School grades of all participating children for the school year preceding and after the overnight study were obtained.

Results.
SAGEA was identified in 54 children (18.1%). Of these, 24 underwent surgical tonsillectomy and adenoidectomy (TR), whereas in the remaining 30 children, parents elected not to seek any therapeutic intervention (NT). Overall mean grades during the second grade increased from 2.43 ± 0.17 (SEM) to 2.87 ± 0.19 in TR, although no significant changes occurred in NT (2.44 ± 0.13 to 2.46 ± 0.15). Similarly, no academic improvements occurred in children without SAGEA.

Conclusions.
SAGEA is frequently present in poorly performing first-grade students in whom it adversely affects learning performance. The data suggest that a subset of children with behavioral and learning disabilities could have SAGEA and may benefit from prospective medical evaluation and treatment.
Selective Head Cooling in Newborn Infants After Perinatal Asphyxia: A Safety Study
Authors: Gunn Alistair J. , Gluckman Peter D. , Gunn Tania R. 
Published: August 2004

Aims.To determine the practicality and safety of head cooling with mild or minimal systemic hypothermia in term neonates with moderate to severe hypoxic-ischemic encephalopathy.Methods.Study group infants ≥37 weeks' gestation, who had an umbilical artery pH ≤7.09 or Apgars ≤6 at 5 minutes, plus evidence of encephalopathy. Infants with major congenital abnormalities were excluded.Trial Design.Infants were randomized to either no cooling (controls; rectal temperature = 37.0 ± 0.2°C,n = 10) or sequentially, either minimal systemic cooling (rectal temperature = 36.3 ± 0.2°C,n = 6) or mild systemic cooling (rectal temperature = 35.7 ± 0.2°C, n = 6). Head cooling was accomplished by circulating water at 10°C through a coil of tubing wrapped around the head for up to 72 hours. All infants were warmed by servo-controlled overhead heaters to maintain the allocated rectal temperature. The rectal, fontanelle, and nasopharyngeal temperatures were continuously monitored.Results.From January 1996 to October 1997, 22 term infants were randomized from 2 to 5 hours after birth. All infants showed a metabolic acidosis at delivery, with similar umbilical artery pH in the control group (mean ± standard deviation, 6.79 ± 0.25), minimal cooling group (6.98 ± 0.21), and mild cooling group (6.93 ± 0.11), and depressed Apgar scores at 5 minutes in the control group (4.5 ± 2), minimal cooling group, (4.7 ± 2) and mild cooling group (6.0 ± 1). In the mild-cooled infants, the nasopharyngeal temperature was 34.5°C during cooling, 1.2°C lower than the rectal temperature. This gradient narrowed to 0.5°C after cooling was stopped. No adverse effects because of cooling were observed. No infants developed cardiac arrhythmias, hypotension, or bradycardia during cooling. Thrombocytopenia occurred in 2 out of 10 controls, 2 out of 6 minimal cooling infants, and 1 out of 6 mild cooling infants. Hypoglycemia (glucose &lt;2.6 mM) was seen on at least one occasion in 2 out of 10 controls, 4 out of 6 minimal cooling infants, and 1 out of 6 mild cooling infants. Acute renal failure occurred in all infants. The metabolic acidosis present in all infants at the time of enrollment into the study progressively resolved despite cooling, even in the mild hypothermia group.Conclusions.Mild selective head cooling combined with mild systemic hypothermia in term newborn infants after perinatal asphyxia is a safe and convenient method of quickly reducing cerebral temperature with an increased gradient between the surface of the scalp and core temperature. The safety of mild hypothermia with selective head cooling is in contrast with the historical evidence of adverse effects with greater depths of whole-body hypothermia. This safety study and the strong experimental evidence for improved cerebral outcome justify a multicenter trial of selective head cooling for neonatal encephalopathy in term infants.
Lyme Arthritis in Children: Clinical Epidemiology and Long-term Outcomes
Authors: Gerber Michael A. , Zemel Lawrence S. , Shapiro Eugene D. 
Published: August 2004

Objective.Although Lyme disease has become a relatively common cause of arthritis among children in areas of the country in which the disease is endemic, little information is available about the clinical epidemiology and long-term outcomes of children with Lyme arthritis. We conducted a long-term follow-up study to determine the clinical epidemiology of Lyme arthritis in children as well as their long-term outcomes.Patients and Methods.All children seen between 1982 and 1991 at the Pediatric Rheumatology Clinic at Newington Children's Hospital (Newington, CT) with an initial diagnosis of Lyme disease were identified. Medical records were reviewed and structured telephone interviews were conducted to obtain demographic, clinical, and follow-up data.Results.A total of 90 children (63% boys) with a mean age of 8.3 years (range, 1.8–16 years) at the time of diagnosis of Lyme arthritis were evaluated. Lyme arthritis was preceded by early Lyme disease in 23 (26%) of the children; however, only 8 (35%) of these children had been treated with appropriate antimicrobial therapy at that early stage. Ninety percent of the children had arthritis of at least one knee, while small joints were rarely involved. For the 31 children who underwent arthrocentesis, the mean white blood cell count in the synovial fluid was 38 000 cells/mm3 (range, 7000–99 000 cells/mm3) with predominantly neutrophils. For the 79 children for whom an erythrocyte sedimentation rate was determined, the highest level for 61 (77%) was &gt;20 mm/h and for 36 (46%) was &gt;50 mm/h. Antimicrobial therapy was initiated 2 days to 5.5 years (median, 2 months) after the onset of symptoms. However, 5 of the children were never treated with antimicrobials. Fifty-one percent of the patients had a single episode of arthritis, while 49% reported recurrent episodes of arthritis over a period of 1 week to 8 years (median, 6 months). Two children (2%) developed chronic arthritis and underwent arthroscopic synovectomy. At the time of the telephone follow-up evaluation, performed 2 to 12 years (median, 7 years) after the onset of the Lyme arthritis, 4 children had ongoing musculoskeletal complaints that resulted in mild to moderate impairment of school or sports activities, but none of the children had evidence of active arthritis.Conclusion.The results of this investigation suggest that the prognosis for children with Lyme arthritis who are treated with appropriate antimicrobial therapy is excellent.
Early Clinical Markers for the Development of Bronchopulmonary Dysplasia: Soluble E-Selectin and ICAM-1
Authors: Ramsay Patricia L. , O'Brian Smith E. , Hegemier Suzanne , Welty Stephen E. 
Published: August 2004

Objective.To test the hypothesis that in infants born at ≤29 weeks' gestation soluble adhesion molecule concentrations would be higher in the first week of life in infants that subsequently develop bronchopulmonary dysplasia than in infants that do not.Design and Methods.In cord blood and on days of life 1, 3, and 7, we measured serum concentrations of soluble P-Selectin, E-Selectin, and intercellular adhesion molecule-1 in samples obtained from infants ≤29 weeks' gestational age. At 1 month of age we assessed the infants' clinical courses to determine whether the infants met the criteria for the diagnosis of bronchopulmonary dysplasia (BPD) and evaluated the infants' radiographic studies to stage the level of BPD. On discharge, the duration of oxygen therapy, the requirement for home oxygen therapy, and length of hospital stay were determined.Results.Concentrations of soluble P-Selectin were greatest in cord blood samples obtained from all infants and were markedly reduced on day of life 1, regardless of the subsequent development of BPD. In serum samples obtained from cord blood and on days of life 1 and 3, soluble E-Selectin levels were higher in infants that developed BPD than in infants that did not develop BPD. In addition, the highest concentrations of soluble E-Selectin in serum samples from cord blood and on day of life 1 were associated with the development of stage 3 or 4 BPD. Soluble intercellular adhesion molecule-1 concentrations were higher on days of life 3 and 7 in the infants that went on to develop BPD than in those that did not.Conclusions.Because neutrophil attachment to endothelial cell adhesion molecules is a key event in the initiation of an inflammatory response, the association of higher early concentrations of soluble E-Selectin with the development of BPD suggests that E-Selectin may play a key role in the pathogenesis of lung inflammation and the development of BPD. This association also suggests that inflammatory events or effects leading to inflammatory responses occurring in the prenatal and/or very early perinatal periods contribute significantly to the pathogenesis of BPD.
Cost-effective Treatment of Phimosis
Authors: Van Howe Robert S. 
Published: August 2004

Objective.To determine the most cost-effective treatment for phimosis.Design.The costs of three treatment strategies for treating phimosis were evaluated using a decision-tree analysis. Three therapeutic approaches were considered: circumcision, preputial plasty (the use of plastic surgical techniques to enlarge the preputial opening without removing tissue), and topical therapy with steroids and nonsteroidal antiinflammatories. Published failure and complication rates were used to calculate the cost per case.Outcome Measures.Cost in dollars to treat each case of phimosis.Results.Topical steroid therapy was the most cost-effective strategy, costing between $758 and $800 per case. Preputial plasty cost between $2515 and $2580 per case. Circumcision cost between $3009 and $3241 per case.Conclusions.The most cost-effective management for treating phimosis is to initiate topical therapy. Daily external application from the tip of the foreskin to the glandis corona with betamethasone 0.05% cream for 4 to 6 weeks has been demonstrated to be very effective, resulting in a 75% savings compared with circumcision. Surgical intervention should not be considered until topical therapy has been given an adequate trial. When contemplating surgery, the lower morbidity, lower costs, and tissue preservation of preputial plasty may make it preferable.
Parent Reports on Willingness to Accept Childhood Immunizations During Urgent Care Visits
Authors: Udovic Shannon L. , Lieu Tracy A. , Black Steven B. , Ray Paula M. , Ray G. Thomas , Shinefield Henry R. 
Published: August 2004

Objectives.To 1) describe whether parents would be willing to accept childhood immunizations at urgent care visits; and 2) identify predictors of parents' willingness to accept childhood immunizations at urgent care visits.Design and Participants.Cross-sectional telephone survey of parents of children aged 18 to 24 months who were underimmunized according to a computerized immunization tracking system and who had recently made an urgent care visit in a regional group-model health maintenance organization in Northern California. Chart review was conducted to confirm immunization status and to identify contraindications to vaccination.Results.Of the 424 eligible participants, 351 (83%) completed interviews. Children with contraindications to vaccination and children who were actually up-to-date at the time of the urgent care visit were excluded, leaving 263 families in the final analysis. Among these parents, 75% said they would have been willing to have their child immunized at the urgent care visit in question if the physician had suggested it. An additional 11% said they would have accepted vaccination if the physician told them that the shot would be safe and strongly encouraged them to accept it. Overall, 86% reported they theoretically would have accepted an immunization during the urgent care visit. In the multivariate analysis, the strongest predictors of stated willingness to accept shots at the urgent care visit were the parent: 1) not being aware that their child was underimmunized (odds ratio [OR] 3.5, 95% confidence interval [CI], 1.6–7.7); 2) perceiving that the child was not very sick at the visit (OR 1.8, 95% CI, 1.1–3.0); 3) being less concerned about the risk of shots (OR 1.8, 95% CI, 1.2–2.5); and 4) being of nonwhite race (OR 3.6, 95% CI, 1.6–7.7). Income and education were not significantly associated with reported willingness to accept immunization.Conclusions.We conclude that most parents of underimmunized toddlers report being willing to accept immunizations during urgent care visits if the clinician recommends it. More effective ways of alerting providers in urgent care settings when immunizations are due, such as indications on a chart or registration form, hold promise for improving immunization coverage rates.
Fetal Versus Maternal and Gestational Age Effects of Repetitive Antenatal Glucocorticoids
Authors: Jobe Alan H. , Newnham John , Willet Karen , Sly Peter , Ikegami Machiko 
Published: August 2004

Background.
Although single courses of antenatal glucocorticoids decrease respiratory distress syndrome and mortality, repetitive courses of antenatal glucocorticoids are being given to women at risk of preterm delivery without evidence of benefit or appreciation of potential risks.

Objectives.
To evaluate the effects of single and repetitive antenatal glucocorticoid exposures on fetal growth and postnatal lung function in sheep.

Methods.
Pregnant ewes were randomized to three protocols that included one or three doses (at 7-day intervals) of 0.5 mg/kg of betamethasone (β) given to the ewe or fetus beginning at gestations ranging from 104 to 128 days' gestation with delivery at 125, 135, and 146 days' gestation. Postnatal assessments included measurements of gas exchange, compliance, ventilation efficiency, static lung volume, and lung tissue and alveolar wash saturated phosphatidylcholine.

Results.
Single or repetitive maternal β but not fetal β caused fetal growth retardation at delivery at 125, 135, and 146 days' gestation. Single-dose fetal β had no effect on postnatal lung function whereas single-dose maternal β significantly increased compliance, lung volume, and tissue and alveolar surfactant after preterm delivery. Although three-dose fetal β improved all indicators of postnatal lung function, three-dose maternal β resulted in larger responses. The added benefits of repetitive β relative to a single-dose β on postnatal lung function after preterm delivery were not as great when therapy was begun later in gestation. Postnatal lung function after delivery at 146 days' gestation (term is 150 days) was improved after repetitive maternal β at early gestational age.

Conclusions.
In sheep, single or repetitive maternal β causes growth retardation from 104 to 121 days' gestation and the growth retardation persists to term. In contrast, single or repetitive fetal β does not cause fetal growth retardation and is less potent at improving postnatal lung function and increasing surfactant pools. There are potential benefits as well as risks for the use of repetitive antenatal glucocorticoids. Randomized, controlled trials in humans are essential given the widespread use of repetitive courses of antenatal glucocorticoids in women at risk of preterm delivery. respiratory distress syndrome, maturation, prematurity, growth retardation, surfactant.
Effects of Sleep Position on Infant Motor Development
Authors: Davis Beth Ellen , Moon Rachel Y. , Sachs Hari C. , Ottolini Mary C. 
Published: August 2004

Background.
As a result of the American Academy of Pediatrics' recommendation that healthy infants be placed on their side or back for sleep, the percentage of infants sleeping prone has decreased dramatically. With the increase in supine sleeping, pediatricians have questioned if there are differences in the rate of acquisition of early motor milestones between prone and supine sleeping infants.

Methods.
To examine this question, we performed a prospective, practice-based study of healthy term infants. Infants were recruited before the age of 2 months. Parents were asked to record infant sleep position and awake time spent prone until 6 months of age. A developmental log was used to track milestones from birth until the infant was walking. Age of acquisition of eight motor milestones was determined, and the mean ages of milestone attainment of prone and supine sleepers were compared.

Results.
Three hundred fifty-one infants completed the study. Prone sleepers acquired motor milestones at an earlier age than supine sleepers. There was a significant difference in the age of attainment of rolling prone to supine, tripod sitting, creeping, crawling, and pulling to stand. There was no significant difference in age when infants walked.

Conclusions.
The pattern of early motor development is affected by sleep position. Prone sleepers attain several motor milestones earlier than supine sleepers. However, all infants achieved all milestones within the accepted normal age range. Pediatricians can use this information to reassure parents. This difference in milestone attainment is not a reason to abandon the American Academy of Pediatrics' sleep position recommendations.