bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in Recommendation Affects Influenza Vaccinations Among Children 6 to 59 Months of Age
Authors: Hemingway Celeste Ojeda , Poehling Katherine A. 
Published: October 2004

Objective. To evaluate the impact of the 2002–2003 recommendation to “encourage when feasible” the influenza vaccine for healthy children 6 to 23 months of age.
Methods. A cross-sectional study of children who were 6 to 59 months of age and presented to a large, pediatric resident's continuity clinic or the affiliated acute care clinic in the summers of 2002 and 2003 was performed. The influenza vaccination status of children in the winter before enrollment and factors that influenced this status were determined by parental questionnaire.
Results. Of 245 and 329 children in the 2002 and 2003 study populations, influenza vaccinations increased from 7% to 18%, respectively. For healthy children 6 to 23 months of age, influenza vaccinations increased from 1% in 2002 to 17% in 2003 and accounted for most of the increase seen in the study population. Multivariate analysis revealed that the strongest predictor of pediatric influenza vaccination was parental recall of a physician recommendation (odds ratio: 39.3; 95% confidence interval: 17.3-89.4 in 2003). However, 65% of parents of high-risk children did not recall a physician recommendation despite the fact that the influenza vaccine was recommended for high-risk patients during both study years.
Conclusion. Concomitant with the 2002-2003 influenza vaccine recommendation for healthy children 6 to 23 months of age, influenza vaccinations for these children increased significantly. Because most children for whom the influenza vaccine was recommended were not vaccinated, physicians have the opportunity to increase the pediatric influenza vaccination rate by improving their recommendation strategies.
Social Smoking Among US College Students
Authors: Moran Susan , Wechsler Henry , Rigotti Nancy A. 
Published: October 2004

Objective. Young smokers commonly identify themselves as “social smokers,” a pattern of smoking behavior that is poorly understood. We assessed the prevalence and correlates of social smoking among US college students.
Methods. Cross-sectional survey of a random sample of 10 904 students enrolled at 119 nationally representative US colleges in 2001.
Results. A total of 51% of 2401 current (past 30-day) smokers were social smokers. (To assess social smoking, students were asked, “In the past 30 days, do you smoke mainly when you are with people, mainly when you are alone, or do you smoke as often by yourself as with others?” Students who stated that they smoked mainly with others rather than alone or equally by themselves and others were defined as social smokers for this analysis.) Social smoking was independently associated with a lower frequency and intensity of tobacco use, less nicotine dependence, less intention to quit, and fewer recent quit attempts.
Conclusions. Social smoking is a distinct pattern of tobacco use that is common among college students and may represent a stage in the uptake of smoking.
Plagiocephaly and Brachycephaly in the First Two Years of Life: A Prospective Cohort Study
Authors: Hutchison B. Lynne , Hutchison Luke A.D. , Thompson John M.D. , Mitchell Ed A. 
Published: October 2004

Objectives.Although referrals for nonsynostotic plagiocephaly (NSP) have increased in recent years, the prevalence, natural history, and determinants of the condition have been unclear. The objective of this study was to assess the prevalence and natural history of NSP in normal infants in the first 2 years of life and to identify factors that may contribute to the development of NSP.Methods.Two hundred infants were recruited at birth. At 6 weeks, 4 months, 8 months, 12 months, and 2 years, the head circumference shape was digitally photographed, and head shape was quantified using custom-written software. At each age, infants were classified as cases when the cephalic index was ≥93% and/or the oblique cranial length ratio was ≥106%. Neck rotation and a range of infant, infant care, socioeconomic, and obstetric factors were assessed.Results.Ninety-six percent of infants were followed to 12 months, and 90.5% were followed to 2 years. Prevalence of plagiocephaly and/or brachycephaly at 6 weeks and 4, 8, 12, and 24 months was 16.0%, 19.7%, 9.2%, 6.8%, and 3.3% respectively. The mean cephalic index by 2 years was 81.6% (range: 72.0%–102.6%); the mean oblique cranial length ratio was 102.6% (range: 100.1%–109.4%). Significant univariate risk factors of NSP at 6 weeks include limited passive neck rotation at birth, preferential head orientation, supine sleep position, and head position not varied when put to sleep. At 4 months, risk factors were male gender, firstborn, limited passive neck rotation at birth, limited active head rotation at 4 months, supine sleeping at birth and 6 weeks, lower activity level, and trying unsuccessfully to vary the head position when putting the infant down to sleep.Conclusions.There is a wide range of head shapes in infants, and prevalence of NSP increases to 4 months but diminishes as infants grow older. The majority of cases will have resolved by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position seem to be important determinants.
Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration
Authors: Paul Ian M. , Phillips Troy A. , Widome Mark D. , Hollenbeak Christopher S. 
Published: October 2004

Objectives. (1) To describe the relationship between postnatal home nursing visitation and readmissions and emergency department (ED) visits for neonatal jaundice and dehydration in the first 10 days of life. (2) To evaluate the cost-effectiveness of providing home nursing visits after newborn discharge with specific attention to prevention of jaundice and dehydration that require hospital-based services.Methods. A retrospective analysis of a financial database allowed for review of the discharge disposition and subsequent care for all neonates who were born at a single center from January 2000 through December 2002. Financial data reflect reimbursement values and costs of care from the payers’ perspective at the single center. We performed a deterministic cost-effectiveness analysis using a decision tree that reflected the costs and probabilities of infants in each particular health state after nursery discharge.Results. A total of 73 (2.8%) of 2641 newborns who did not receive a home visit were readmitted to the hospital in the first 10 days of life with jaundice and/or dehydration compared with 2 (0.6%) of 326 who did receive a home visit. Similarly, 92 (3.5%) of 2641 newborns who were discharged without subsequent home nursing care had an ED visit for these reasons in the first 10 days of life compared with 0 (0%) of 326 who did have such a visit. Of infants who received a home visit, 324 (99.4%) of 326 did not require subsequent hospital services in this time period compared with 2497 (94.5%) of 2641 of those who did not receive a visit. After nursery discharge, the average cost per child who received a home health visit was $109.80 compared with $118.70 for each newborn who did not receive a visit. The incremental cost-effectiveness ratio of a routine home visit strategy compared with a no visit strategy was −$181.82.Conclusions. A home nursing visit after newborn nursery discharge is highly cost-effective for reducing the need for subsequent hospital-based services.
Neonatal Brain Magnetic Resonance Imaging Before Discharge Is Better Than Serial Cranial Ultrasound in Predicting Cerebral Palsy in Very Low Birth Weight Preterm Infants
Authors: Mirmiran Majid , Barnes Patrick D. , Keller Kathy , Constantinou Janet C. , Fleisher Barry E. , Hintz Susan R. , Ariagno Ronald L. 
Published: October 2004

Objective. To compare the value of serial cranial ultrasound (US) with a single magnetic resonance imaging (MRI) before discharge in very low birth weight preterm infants to predict cerebral palsy (CP).Methods. Infants who weighed &lt;1250 g at birth and were &lt;30 weeks' gestational age underwent conventional brain MRI at near term (36–40 weeks' postmenstrual age) using 1.5 Tesla MRI scanner. Sagittal and axial T1 and T2 fluid attenuated inversion recovery and gradient recalled echo images were obtained. Cranial US was also obtained at least twice during the first 2 weeks of life. MRI and US images were interpreted by 2 independent radiologists, who were masked to clinical outcome, and scored as follows: category 1, no abnormality; category 2, subependymal hemorrhage or mineralization; category 3, moderate to severe ventriculomegaly; category 4, focal parenchymal abnormality with or without ventriculomegaly. For the purpose of this study, 1 and 2 were categorized as “normal,” and 3 and 4 were categorized as “abnormal.” The infants were assessed at a mean age of 20 and 31 months using the Amiel-Tison standardized neurodevelopmental examination.Results. The sensitivity and specificity of MRI for predicting CP were 71% and 91% at 20 month and 86% and 89% at 31 months, respectively. The sensitivity and specificity of US for predicting CP were 29% and 86% at 20 months and 43% and 82% at 31 months.Conclusions. As a predictor of outcome for CP, MRI at near-term in very low birth weight preterm neonates is superior to US. However, both US and MRI demonstrate high specificity.
Apparent Diffusion Coefficient in the Posterior Limb of the Internal Capsule Predicts Outcome After Perinatal Asphyxia
Authors: Hunt Rod W. , Neil Jeffrey J. , Coleman Lee T. , Kean Michael J. , Inder Terrie E. 
Published: October 2004

Objective. Predicting long-term outcome in infants with hypoxic-ischemic encephalopathy (HIE) is a difficult task. Magnetic resonance imaging, particularly diffusion imaging, holds promise in this regard as it is more sensitive to brain injury than any other available imaging modality. Previous studies have suggested that abnormal signal intensity in the posterior limb of the internal capsule (PLIC), detectable on inversion-recovery T1-weighted imaging, is a strong predictor of outcome. The aim of this study was to assess the relationship between apparent diffusion coefficient (ADC) values from the PLIC, measured by diffusion imaging, and neuromotor outcome in term infants with HIE.
Methods. Twenty-eight term infants with a clinical diagnosis of HIE underwent magnetic resonance imaging as soon as practicable after birth (mean age: 5.6 days), including diffusion-weighted imaging, from which ADC values in the PLIC were measured. Motor outcome was assessed in 12 of 16 survivors.
Results. The ADC value in the PLIC was significantly associated with survival in term infants with HIE. For survivors, the mean ADC value in the PLIC was 0.89 ± 0.17 μm2/ms, whereas the mean ADC value for nonsurvivors was 0.75 ± 0.17 μm2/ms (t = 2.25). Among survivors, the ADC value in the PLIC was also associated with neuromotor outcome (F = 5.60).
Conclusion. The ADC value in the PLIC is an indicator of ischemic injury and may be of use as an objective prognostic marker for infants with HIE.
The Mortality Index for Neonatal Transportation Score: A New Mortality Prediction Model for Retrieved Neonates
Authors: Broughton Simon J. , Berry Andrew , Jacobe Stephen , Cheeseman Paul , Tarnow-Mordi William O. ,   and Neonatal Intensive Care Unit Study Group, Greenough Anne 
Published: October 2004

Objective. To develop a mortality prediction score for retrieved neonates based on the information given at the first telephone contact with a retrieval service.Methods. Data from the New South Wales Newborn and Pediatric Emergency Transport Service database were examined. Analysis was performed with the results for 2504 infants (median gestational age: 36 weeks; range: 24–43 weeks) who were &lt;72 hours of age at the time of referral and whose outcome (neonatal death or survival) was known. The study population was divided randomly into 2 halves, the derivation and validation cohorts. Univariate analysis was performed to identify variables in the derivation cohort related to neonatal death. The variables were entered into a multivariate logistic regression analysis with neonatal death as the outcome. Receiver operator characteristic (ROC) curves were constructed with the regression model and data from the derivation cohort and then the validation cohort. The results were used to generate an integer-based score, the Mortality Index for Neonatal Transportation (MINT) score. ROC curves were constructed to assess the ability of the MINT score to predict perinatal and neonatal death.Results. A 7-variable (Apgar score at 1 minute, birth weight, presence of a congenital anomaly, and infant’s age, pH, arterial partial pressure of oxygen, and heart rate at the time of the call) model was constructed that generated areas under ROC curves of 0.82 and 0.83 for the derivation and validation cohorts, respectively. The 7 variables were then used to generate the MINT score, which gave areas under ROC curves of 0.80 for both neonatal and perinatal death.Conclusion. Data collected at the first telephone contact by the referring hospital with a regionalized transport service can identify neonates at the greatest risk of dying.
Behavioral Outcomes and Evidence of Psychopathology Among Very Low Birth Weight Infants at Age 20 Years
Authors: Hack Maureen , Youngstrom Eric A. , Cartar Lydia , Schluchter Mark , Taylor H. Gerry , Flannery Daniel , Klein Nancy , Borawski Elaine 
Published: October 2004

Objective. Information on the mental health of very low birth weight (VLBW; &lt;1500 g) children in young adulthood is sparse. We thus sought to examine gender-specific behavioral outcomes and evidence of psychopathology in a cohort of VLBW young adults at 20 years of age.Methods. We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status.Results. VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD.Conclusion. The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.
Externalizing Problem Behaviors and Headache: A Follow-up Study of Adolescent Finnish Twins
Authors: Virtanen Ruut , Aromaa Minna , Koskenvuo Markku , Sillanpää Matti , Pulkkinen Lea , Metsähonkala Liisa , Suominen Sakari , Rose Richard J. , Helenius Hans , Kaprio Jaakko 
Published: October 2004

Objective.To examine the association of teacher- and parent-rated behavior with headache in a prospective follow-up study of adolescent Finnish twins.Methods.Questionnaire data were collected during 1995–2001 from a nationwide sample of Finnish families of 11-year-old twins who were born 1983–1987 (n = 5393) and again at age of 14. Psychological factors were measured by using parents’ and teachers’ ratings of a 37-item multidimensional rating instrument at the ages of 11 and 14.Results.At age 11, headache frequency (5 categories) was associated with total scales of externalizing and internalizing problem behaviors and adaptive behaviors, assessed by parents, but only with externalizing problem behaviors assessed by teachers. Results were similar at age 14. The incidence of at least monthly headache between the ages of 11 and 14 years was predicted by externalizing problem behaviors and 2 subscales of adaptive behaviors: constructiveness and poor compliance. In twin pairs discordant for headache, externalizing and internalizing problem behaviors were more common among headache sufferers than among headache-nonsufferers. Headache-discordant monozygotic co-twins confirmed the association of externalizing problem behaviors with headache.Conclusions.The frequency of adolescents’ headache is predicted by psychological factors, especially by externalizing problem behaviors. This seems to be independent of genetic or familial influences on behavior and headache. Behavioral problems may be a sign of worsening of headache or vice versa.
Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children
Authors: Urschitz Michael S. , Eitner Steffen , Guenther Anke , Eggebrecht Esther , Wolff Judith , Urschitz-Duprat Pilar M. , Schlaud Martin , Poets Christian F. 
Published: October 2004

Objectives. Sleep-disordered breathing is associated with impaired behavior and poor academic performance in children. We aimed to determine the extent of behavioral problems in snoring children, clarify the role of intermittent hypoxia, and test the reversibility of impaired behavior and poor academic performance.
Methods. In 1144 children, habitual snoring (HS; snoring frequently or always) and impaired behavior were assessed using parental questionnaires. Intermittent hypoxia (ie, presence of ≥5 arterial oxygen desaturations by ≥4% or ≥1 desaturation to ≤90%) was investigated with pulse oximetry. Poor academic performance (grade 4–6 on a 6-point scale in mathematics, science, or spelling) was based on the last school report. HS, impaired behavior, and academic performance were reevaluated after 1 year. Adjusted odds ratios (ORs) were calculated using unconditional logistic regression.
Results. HS was significantly associated with hyperactive (OR: 2.4) and inattentive behavior (OR: 4.0), daytime tiredness (OR: 7.1), and sleepiness (OR: 2.6–4.8). These associations were independent of intermittent hypoxia. HS was also significantly associated with bad conduct (OR: 2.8), emotional symptoms (OR: 5.5), and peer problems (OR: 9.7). At follow-up, hyperactive and inattentive behavior but not academic success had significantly improved in children in whom HS had ceased.
Conclusions. We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.
Limits of the HEDIS Criteria in Determining Asthma Severity for Children
Authors: Cabana Michael D. , Slish Kathryn K. , Nan Bin , Clark Noreen M. 
Published: October 2004

Objective. Although the Health Plan Employer Data Information Set (HEDIS) is a common method for evaluating the quality of asthma care, its accuracy in characterizing persistent asthma in children is unknown. The objective of this study was to compare the assessment of asthma severity (persistent vs nonpersistent asthma) using the HEDIS criteria versus clinical criteria using National Heart, Lung, and Blood Institute (NHLBI) guidelines.Methods. In a cross-sectional study, we analyzed baseline data from interviews with the parents of 896 children who had asthma and participated in a randomized controlled trial. Patients had an active clinical diagnosis of asthma, were between 2 and 12 years of age, and had no other pulmonary diseases. Patients had persistent asthma by parent report according to the HEDIS criteria when, within the last year, they had 1 asthma inpatient admission or emergency department visit or 4 asthma medication dispensing events, or 4 outpatient asthma visits and at least 2 asthma medication dispensing events. Patients had persistent asthma by parent report according to the NHLBI criteria when, within the last 2 months, they had nighttime asthma symptoms &gt;2 nights/mo or daytime asthma symptoms &gt;2 days/wk. We calculated the sensitivity of each HEDIS criterion, separately and then combined, using the NHLBI criteria as a gold standard.Results. On the basis of HEDIS criteria, 656 (73%) patients had persistent asthma, compared with 338 (38%) using NHLBI criteria. Although the HEDIS criteria for persistent asthma were fairly sensitive (0.89), they were not very specific (0.70). For children without daily controller medications (n = 346), the sensitivity was even lower (0.45), but the specificity was similar (0.68). We found that the test characteristics were fairly consistent across different age group strata (2–4, 5–9, and 10–12 years of age).Conclusions. HEDIS criteria used to determine the quality of asthma care should be interpreted with caution. Although the criteria for persistent disease—used to determine which children require daily controller medications—are fairly sensitive, they are not very specific and include children who may not require such medications.
Follow-up After a Pediatric Emergency Department Visit: Telephone Versus E-Mail?
Authors: Goldman Ran D. , Mehrotra Shruti , Pinto Tanya R. , Mounstephen William 
Published: October 2004

Objective.The Internet has become in recent years an unlimited source of health-related information and revolutionized health information access. Follow-up after an emergency department (ED) visit is important for continuity of care but is difficult to achieve. We conducted this study to determine whether e-mail could become a method for a follow-up contact after leaving the pediatric ED.
Methods.Over a 2-month period, parents who had a telephone line and e-mail access and whose child was discharged from the ED at the Hospital for Sick Children in Toronto were randomized to receive an e-mail or a telephone follow-up. Main outcome measure was the response rates by parents to the telephone or e-mail.
Results.A total of 265 (79%) of the 337 families who were approached had Internet access, and the majority (75%) check e-mails at least once a day. Eighty-seven percent (85 of 98) and 53% (53 of 100) of the families who were contacted by telephone or e-mail, respectively, were reached within an average of 17 and 46 hours, respectively. Fourteen percent of families from the study population were unreachable either by telephone or by e-mail. Most (57%) parents who did not respond to the e-mail did not check or did not remember reading the e-mail or had trouble with access. Ten percent of the e-mails were undeliverable.
Conclusions.The telephone is better than e-mail as a follow-up channel with families of children who visit the pediatric ED. The main reason for not responding to e-mails is “technical problems.” E-mail could be a mean for follow-up contact for part of our patient population, especially for nonurgent purposes.