bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Contraception: Pediatricians' Knowledge, Attitudes, and Opinions
Authors: Golden Neville H. , Seigel Warren M. , Fisher Martin , Schneider Marcie , Quijano Emilyn , Suss Amy , Bergeson Rachel , Seitz Michele , Saunders Deborah 
Published: August 2004

Emergency contraception (EC) is the use of a method of contraception after unprotected intercourse to prevent unintended pregnancy. Although first described over 20 years ago, physician awareness of EC has been limited and many feel uncomfortable prescribing it.
Objective. To assess the knowledge, attitudes, and opinions of practicing pediatricians regarding the use of EC in adolescents.
Methods. An anonymous questionnaire was mailed to all 954 active members of New York Chapter 2, District II of the American Academy of Pediatrics. The questionnaire assessed basic knowledge, attitudes, and opinions regarding EC in adolescents. Data were analyzed by physician age, gender, year completed residency, and practice type.
Results. Two hundred thirty-three practicing pediatricians (24.4%) completed the survey. Of the respondents, 23.7% had been asked to prescribe EC to an adolescent and 49% of these cases involved a rape victim. Only 16.7% of pediatricians routinely counsel adolescent patients about the availability of EC, with female pediatricians more likely to do so. Most respondents (72.9%) were unable to identify any of the Food and Drug Administration-approved methods of EC. Only 27.9% correctly identified the timing for its initiation and only 31.6% of respondents felt comfortable prescribing EC. Inexperience with use was cited as the primary reason for not prescribing EC by 70% of respondents. Twelve percent cited moral or religious reasons and 17% were concerned about teratogenic effects. There were no differences in comfort level based on age, gender, or practice type. Twenty-two percent of respondents believed that providing EC encourages adolescent risk-taking behavior and 52.4% would restrict the number of times they would dispense EC to an individual patient. A minority of respondents (17%) believed that adolescents should have EC available at home to use if necessary and only 19.6% believed that EC should be available without a prescription. The vast majority (87.5%) were interested in learning more about EC.
Conclusions. Despite the safety and efficacy of EC, the low rate of use is of concern. Pediatricians are being confronted with the decision to prescribe EC but do not feel comfortable prescribing it because of inadequate training in its use. Practicing pediatricians are aware of their lack of experience and are interested in improving their knowledge base.
Lung Recruitment and Breathing Pattern During Variable Versus Continuous Flow Nasal Continuous Positive Airway Pressure in Premature Infants: An Evaluation of Three Devices
Authors: Courtney Sherry E. , Pyon Kee H. , Saslow Judy G. , Arnold Gerald K. , Pandit Paresh B. , Habib Robert H. 
Published: August 2004

Objective.To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants.Methods.Thirty-two premature infants receiving nasal CPAP for apnea or mild respiratory distress were enrolled. Birth weight was (mean ± standard deviation) 1081 ± 316 g, gestational age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction of inspired oxygen (Fio2) at study .29 ± .1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (ΔVL) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H2O using calibrated direct current-coupled respiratory inductance plethysmography.Results.ΔVL was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, ΔVL was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and Fio2 were greater with the modified cannula than for either of the other 2 devices.Conclusion.Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased respiratory effort and Fio2.
The Maternal Lifestyle Study: Drug Use by Meconium Toxicology and Maternal Self-Report
Authors: Lester Barry M. , ElSohly Mahmoud , Wright Linda L. , Smeriglio Vincent L. , Verter Joel , Bauer Charles R. , Shankaran Seetha , Bada Henrietta S. , Walls H. Chip , Huestis Marilyn A. , Finnegan Loretta P. , Maza Penelope L. 
Published: August 2004

Objective.The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero cocaine and/or opiate exposure.Methods.Meconium specimens of 8527 newborns were analyzed by immunoassay with GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, amphetamines, and phencyclidine. Maternal self-report of drug use was determined by hospital interview.Results.The prevalence of cocaine/opiate exposure in the 4 sites was 10.7% with the majority (9.5%) exposed to cocaine based on the combination of meconium analysis and maternal self-report. However, exposure status varied by site and was higher in low birth weight infants (18.6% for very low birth weight and 21.1% for low birth weight). Gas chromatography/mass spectrometry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother denied use but the meconium was positive. There was 66% agreement between positive meconium results and positive maternal report. Only 2% of mothers reported that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine.Conclusion.Accurate identification of prenatal drug exposure is improved with GC/MS confirmation and when the meconium assay is coupled with a maternal hospital interview. However, the use of GC/MS may have different implications for research than for public policy. We caution against the use of quantitative analysis of drugs in meconium to estimate the degree of exposure. Our study also highlights the polydrug nature of what used to be thought of as a cocaine problem.
Childhood Body Composition in Relation to Body Mass Index
Authors: Maynard L. Michele , Wisemandle Wayne , Roche Alex F. , Chumlea Wm. Cameron , Guo Shumei S. , Siervogel Roger M. 
Published: August 2004

Objective.
The aim is to describe body composition in relation to body mass index (BMI; body weight/stature2) to provide health care professionals insight into the meaning, significance, and limitations of BMI as an index of adiposity during childhood.

Methods.
Data from 387 healthy, white children 8 to 18 years of age from the Fels Longitudinal Study were analyzed. Measurements were scheduled annually and each child was examined 1 to 11 times, totaling 1748 observations. Total body fat (TBF) and fat-free mass (FFM) were determined from hydrodensitometry. Stature and weight were measured using standard methods and BMI and the components of BMI, TBF/stature2, and FFM/stature2 were calculated. Analyses included correlations between BMI and body composition variables; age-related patterns of BMI, TBF/stature2, and FFM/stature2; and annual changes in BMI, TBF/stature2, and FFM/stature2.

Results.
Generally, correlations between BMI and body composition variables were strong and significantly different from zero. Means for BMI throughout childhood were similar for boys and girls, although significantly larger values were observed for girls at ages 12 to 13 years. Age-related patterns of TBF/stature2and FFM/stature2 differed between sexes. In each sex, annual increases in BMI were driven primarily by increases in FFM/stature2 until late adolescence, with increases in TBF/stature2 contributing to a larger proportion of the BMI increases in girls than in boys.

Conclusions.
Unlike adults, annual increases in BMI during childhood are generally attributed to the lean rather than to the fat component of BMI. Because the properties of BMI vary during childhood, health care professionals must consider factors such as age and sex when interpreting BMI.
Maternal Prenatal Lifestyle Factors and Infectious Disease in Early Childhood: A Follow-Up Study of Hospitalization Within a Danish Birth Cohort
Authors: Yuan Wei , Basso Olga , Sørensen Henrik Toft , Olsen Jørn 
Published: August 2004

Objectives.To examine whether maternal prenatal lifestyle factors were associated with the risk of hospitalization with infectious disease during early childhood and whether a possible association was modified by fetal growth reduction.Methods.The study was based on a birth cohort of 10 400 newborns whose mothers attended the midwife centers in Odense and Aalborg, Denmark, from April 1984 to April 1987 at approximately the 36th week of gestation. Information on hospitalization with infectious disease was extracted from the National Hospital Discharge Registry, and newborns were followed up to the end of 1996.Results.Among 6022 children who were hospitalized at least once, 31.4% (n = 1892) were hospitalized with infectious diseases. The cumulative incidence rate of hospitalization with infections in children from the age of 6 months to 12 years was 18.9%. The incidence rate ratio in children born to mothers smoking during pregnancy was 1.24 (95% confidence interval: 1.13–1.36) compared with those of nonsmoking mothers. Mothers whose body mass index was &lt;18 kg/m2 were more likely to give birth to infants who were hospitalized with infectious disease (incidence rate ratio: 1.29; 95% confidence interval: 1.05–1.59). The increased risk was present in children only up to the age of 5 years.Conclusions.The study shows that maternal smoking during pregnancy and a low prepregnancy body mass index are associated with a higher risk of hospitalization with infectious disease during early childhood. These associations are independent of fetal growth indicators.
Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome
Authors: Moriette Guy , Paris-Llado Josefa , Walti Hervé , Escande Benoı̂t , Magny Jean-François , Cambonie Gilles , Thiriez Gérard , Cantagrel Sylvain , Lacaze-Masmonteil Thierry , Storme Laurent , Blanc Thierry , Liet Jean-Michel , André Christine , Salanave Benoı̂t , Bréart Gérard 
Published: August 2004

Background.Early use of high-frequency ventilation and exogenous surfactant is proposed as the optimal mode of ventilatory support in infants with respiratory distress syndrome. In very premature infants, we tested the hypothesis that high-frequency versus conventional ventilation could decrease exogenous surfactant requirements and improve pulmonary outcome, without altering the complication rate, including that of severe intraventricular hemorrhage.Methods.Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syndrome were randomly assigned to high-frequency oscillatory ventilation (lung volume recruitment strategy) or conventional ventilation.Results.Two hundred seventy-three infants were enrolled. One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weight ≤1000 g. One hundred thirty-four infants were randomized at 142 minutes of life (median) to receive conventional ventilation (mean postmenstrual age at birth: 27. 6 ± 1.5 weeks; mean birth weight: 997 ± 245 g); and 139 infants were randomized at 145 minutes of life to receive high-frequency ventilation (mean postmenstrual age at birth: 27.5 ± 1.4 weeks; mean birth weight: 976 ± 219 g).High-frequency ventilation, compared with conventional ventilation, was associated with a twofold reduction in the requirement for ≥2 instillations of exogenous surfactant (30% vs 62%; odds ratio: .27; 95% confidence interval: .16–.44) and no difference in pulmonary outcome. The incidence of severe intraventricular hemorrhage was 24% in the high-frequency group and 14% in the conventional ventilation group (adjusted odds ratio: 1.50; 95% confidence interval: .68–3.30).Conclusion.Early use of high-frequency oscillatory ventilation in very premature infants decreases exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.
A Randomized Controlled Trial of Point-of-Care Evidence to Improve the Antibiotic Prescribing Practices for Otitis Media in Children
Authors: Christakis Dimitri A. , Zimmerman Frederick J. , Wright Jeffrey A. , Garrison Michelle M. , Rivara Frederick P. , Davis Robert L. 
Published: August 2004

Context.
Prescribing practices for otitis media are not consistent with current evidence-based recommendations.

Objective.
To determine whether point-of-care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of therapy from 10 days and decreases the frequency of prescriptions written.

Design.
Randomized, controlled trial.

Setting.
Primary care pediatric clinic affiliated with university training program.

Intervention.
A point-of-care evidence-based message system presenting real time evidence to providers based on their prescribing practice for otitis media.

Main Outcome Measures.
Proportion of prescriptions for otitis media that were for &lt;10 days and frequency with which antibiotics were prescribed.

Results.
Intervention providers had a 34% greater reduction in the proportion of time they prescribed antibiotics for &lt;10 days. Intervention providers were less likely to prescribe antibiotics than were control providers.

Conclusions.
A point-of-care information system integrated into outpatient pediatric care can significantly influence provider behavior for a common condition.
Trends in the Rural-Urban Distribution of General Pediatricians
Authors: MD Greg D. Randolph , MD Donald E. Pathman 
Published: August 2004

Objective.A major objective of national and state health policy has been to increase primary care physician supply in rural areas. It is not known whether this objective has been met for general pediatricians. This study examines trends in the rural-urban distribution of general pediatricians in the United States from 1981 to 1996.Design.Descriptive serial cross-sectional study.Participants.At selected 5-year intervals, all clinically active general pediatricians in the United States listed in the American Medical Association Physician Masterfile.Main Outcome Measures.The proportion of pediatricians practicing in rural counties and the ratio of pediatricians to the child population (per 100 000 children &lt;18 years old) for US counties.Results.Between 1981 and 1996, the total number of general pediatricians increased from 19 739 to 34 100. However, rural pediatrician-to-child population ratios (PCPRs) remained well below urban ratios. Although rural counties of all population sizes experienced some gains over time, only those over 25 000 populations had a meaningful increase in their PCPR. Overall, the urban PCPR increased by 14.0 (or an additional pediatrician for every 7150 children) whereas the rural ratio only increased by 4.1 (an additional pediatrician for every 24 400 children). The percentage of recent residency graduates opting for rural practice declined by half (14.6% to 7.4%) over the 15-year study period. Women and international graduates were consistently less likely to practice in rural counties than were men and US graduates, respectively.Conclusions.The near doubling in general pediatrician numbers from 1981 to 1996 yielded only a modest increase in pediatrician availability for rural children. The discrepancy between urban and rural pediatrician supply increased during this period and should continue growing based on the increasingly urban location of recent residency graduates and the continued growth of women in pediatrics. New policy strategies are needed to improve rural pediatrician availability, including focusing on larger rural counties and addressing barriers to rural practice for women. pediatrics/manpower, pediatrics/trends, rural health, physicians/supply and distribution, medically underserved area.
Circumcision: We Have Heard From the Experts; Now Let's Hear From the Parents
Authors: Adler Robert , Ottaway MsED*; Sandra , Gould Stacey 
Published: August 2004

Objective.The current study sought to investigate parental attitudes about circumcision and their satisfaction with the decision.Methodology.Parents of boys (6 months to 36 months old) in 3 different practices filled out a questionnaire while waiting for their child's well-child examination.Results.A total of 149 families were surveyed. Families (68) who did not have their sons circumcised were less satisfied with their decision. Compared with families (81) of circumcised children, parents of uncircumcised boys were less likely to have been asked by their physician about whether they wanted their child circumcised, believed that they did not receive adequate information about the procedure, felt less respected by their medical provider, and were more likely to reconsider their decision.Conclusion.The importance of adequate information and discussion is highlighted by this study.
A Case-Crossover Study of Sleep and Childhood Injury
Authors: Valent Francesca , Brusaferro Silvio , Barbone Fabio 
Published: August 2004

Objective.To evaluate the association between sleep and wakefulness duration and childhood unintentional injury.Study Design.Case-crossover study.Methods.Two hundred ninety-two injured children who presented at the Children's Emergency Center of Udine, Italy, or their parents were interviewed after a structured questionnaire. Information was collected concerning sociodemographic variables, participant's habits, and injury characteristics, including a brief description of the accident dynamics. Sleep or wakefulness status of the child was assessed retrospectively for each of the 48 hours before injury. For each child, we compared the 24 hours immediately before the injury (hours 1–24; case period) with hours 25 to 48 (control period). Nonparametric tests were conducted to compare the difference of sleep duration between case and control periods. In addition, we conducted intrapersonal conditional logistic regression analyses and estimated relative risks (RRs) and 95% confidence intervals (CIs).Results.Overall, more children had longer hours of sleep during the control period than during the case period. However, this difference was significant for boys only. A direct association between injury risk and sleeping &lt;10 hours was found among boys (RR: 2.33; 95% CI: 1.07–5.09) but not among girls (RR: 1.00; 95% CI: .29–3.45). This association was particularly strong among boys attending nursery school. We also found a direct association between injury occurring between 4 pm and midnight, and being awake for at least 8 hours before injury occurred (both sexes, RR: 4.00; 95% CI: 1.13–14.17).Conclusions.Our findings show that inadequate sleep duration and lack of daytime naps are transient exposures that may increase the risk of injury among children. These results suggest new prospects for injury prevention in childhood. children, injury, sleep, case-crossover, epidemiology.
Pediatric Peripherally Inserted Central Catheters: Complication Rates Related to Catheter Tip Location
Authors: Racadio John M. , Doellman Darcy A. , Johnson Neil D. , Bean Judy A. , Jacobs Brian R. 
Published: August 2004

Objective.
To compare complication rates between central venous catheter tip location and noncentral tip location after peripherally inserted central catheter (PICC) placement in children.

Methods.
Between 1994 and 1998, data from all children who underwent PICC placement were analyzed. Patient demographics, catheter characteristics, catheter duration, infusate composition, and catheter complications were entered prospectively into a computerized database. Catheter tip locations were determined by fluoroscopy and were defined as central if they resided in the superior vena cava, right atrium, or high inferior vena cava at or above the level of the diaphragm, and as noncentral if located elsewhere. Differences in complication rates between the central and noncentral groups were analyzed.

Results.
Data from a total of 1266 PICCs were analyzed from 1053 patients with a mean age of 6.49 ± .2 years (range: 0–45.0 years). Of the 1266 PICCs, 1096 (87%) were central in tip location, and 170 (13%) were noncentral in tip location. The central group had 42 complications of 1096 catheters (3.8%), while the noncentral group had 49 complications of 170 catheters (28.8%). Controlling for patient age, catheter size, gender, and catheter duration with a logistic regression model, there remained a statistically significant increased likelihood of complication in the noncentral group versus the central group (adjusted odds ratio: 8.28; 95% confidence interval: 5.11–13.43).

Conclusions.
Centrally placed catheter tips are associated with fewer complications than are noncentrally placed catheter tips. Clinicians should ensure that catheter tips reside centrally after PICC placement in infants and children.
Combined Use of Electroencephalogram and Magnetic Resonance Imaging in Full-Term Neonates With Acute Encephalopathy
Authors: Biagioni Enrico , Mercuri Eugenio , Rutherford Mary , Cowan Frances , Azzopardi Denis , Frisone Maria F. , Cioni Giovanni , Dubowitz Lilly 
Published: August 2004

Objective.
The electroencephalogram (EEG) is widely used in full-term infants with acute neonatal encephalopathy, and its prognostic value has been confirmed by several studies. Magnetic resonance imaging (MRI) of the brain has also been applied in these patients, and increasing numbers of reports affirm its prognostic reliability. The aim of this study has been to investigate the correlation between an early EEG and MRI findings in infants with acute neonatal encephalopathy and to assess the prognostic value of a combination of EEG and MRI findings.

Participants and Methods.
Twenty-five full-term infants had an EEG recorded within the first 72 hours after birth and a neonatal brain MRI scan after the end of the first week.

Results.
Both EEG and MRI were predictive of outcome. A normal MRI was always associated with normal EEG background activity and normal outcome and severe abnormalities on MRI with marked EEG abnormalities and an abnormal outcome. When the MRI showed moderate abnormalities, the EEG in all cases but one identified patients with normal and abnormal outcome.EEG, MRI, HIE, neurodevelopment.