bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexuality Education for Children and Adolescents
Authors:   Committee on Psychosocial Aspects of Child and Family Health and Committee on Adolescence
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2016-1348.
Children and adolescents need accurate and comprehensive education about sexuality to practice healthy sexual behavior as adults. Early, exploitative, or risky sexual activity may lead to health and social problems, such as unintended pregnancy and sexually transmitted diseases, including human immunodeficiency virus infection and acquired immunodeficiency syndrome. This statement reviews the role of the pediatrician in providing sexuality education to children, adolescents, and their families. Pediatricians should integrate sexuality education into the confidential and longitudinal relationship they develop with children, adolescents, and families to complement the education children obtain at school and at home. Pediatricians must be aware of their own attitudes, beliefs, and values so their effectiveness in discussing sexuality in the clinical setting is not limited.
Cost-Effectiveness Analysis of an Intranasal Influenza Vaccine for the Prevention of Influenza in Healthy Children
Authors: Luce Bryan R. , Zangwill Kenneth M. , Palmer Cynthia S. , Mendelman Paul M. , Yan Lihan , Wolff Mark C. , Cho Iksung , Marcy S. Michael , Iacuzio Dominick , Belshe Robert B. 
Published: August 2004

Objective.Intranasal influenza vaccine has proven clinical efficacy and may be better tolerated by young children and their families than an injectable vaccine. This study determined the potential cost-effectiveness (CE) of an intranasal influenza vaccine among healthy children.Methods.We conducted a CE analysis of data collected between 1996 and 1998 during a prospective 2-year efficacy trial of intranasal influenza vaccine, supplemented with data from the literature. The CE analysis included both direct and indirect costs. We enrolled 1602 healthy children aged 15 to 71 months in year 1, 1358 of whom were enrolled in year 2. One or 2 doses of intranasal influenza vaccine or placebo were administered to measure the cost per febrile influenza-like illness (ILI) day avoided.Results.During the 2-year study period, vaccinated children had an average of 1.2 fewer ILI fever days/child than unvaccinated children. In an individual-based vaccine delivery scenario with vaccine given twice in the first year and once each year thereafter at an assumed base case total cost of $20 for the vaccine and its administration (ie, per dose), CE was approximately $30/febrile ILI day avoided. CE ranged from $10 to $69/febrile ILI day avoided at $10 to $40/dose, respectively. In a group-based delivery scenario, vaccination was cost saving compared with placebo and remained so if vaccine cost was &lt;$28 (the break-even price per dose). In the individual-based scenario, vaccination was cost saving if vaccine cost was &lt;$5. In this scenario, nearly half of lost productivity in the vaccine group was attributable to vaccine visits, which overshadowed the relatively modest savings in ILI-associated costs averted.Conclusions.Routine use of intranasal influenza vaccine among healthy children may be cost-effective and may be maximized by using group-based vaccination approaches. cost-effectiveness, influenza, vaccine, children.
A Statewide Assessment of Lead Screening Histories of Preschool Children Enrolled in a Medicaid Managed Care Program
Authors: Vivier Patrick M. , Hogan Joseph W. , Simon Peter , Leddy Tricia , Dansereau Lynne M. , Alario Anthony J. 
Published: August 2004

Objectives.Despite the prominence of lead poisoning as a public health problem, recent Government Accounting Office reports indicate that only one fifth of children who are covered by Medicaid have been screened for lead poisoning. The purpose of this study was to examine the lead screening histories of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being screened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened.Methods.A random sample of 2000 preschool-age children was chosen from those who were enrolled continuously in the statewide, expanded, Medicaid managed care program for a 1-year period and between the ages of 19 and 35 months at the end of that year. Sociodemographic characteristics and lists of primary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the lead screening histories of the children, including test dates and results.Results.Data on 1988 children were used for study analyses, and 80% of these children had at least 1 documented blood lead level. Children whose primary care provider was an office-based physician were less likely to be screened as compared with patients of health centers, hospital-based clinics, and staff model health maintenance organizations (68%, 86%, 89%, and 91% respectively). Variation in screening rates persisted in a multivariate analysis controlling for family sociodemographic characteristics and practice level variation. Of the 1587 children who had a documented blood lead test, 467 children (29%) had a blood lead level of ≥10 mg/dL on at least 1 test.Conclusions.Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children who are enrolled in Medicaid. Potential explanations for this finding are 1) a high sensitization to the problem of lead poisoning in Rhode Island, 2) the primary care focus of the Medicaid program in Rhode Island facilitates the delivery of preventive services, and 3) the medical record audit approach used in this study was more comprehensive in identifying blood lead screens than techniques used in national studies. The high prevalence of elevated blood lead levels found in this study emphasizes the importance of screening among children who are enrolled in Medicaid.
Adolescents' Perceptions of Social Status: Development and Evaluation of a New Indicator
Authors: Goodman Elizabeth , Adler Nancy E. , Kawachi Ichiro , Frazier A. Lindsay , Huang Bin , Colditz Graham A. 
Published: August 2004

Objective.
Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health.

Methods.
A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES.

Results.
Mean society ladder ranking, a subjective measure of SES, was 7.2 ± 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 ± 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers (μteen = 7.2 ± 1.3 vs μmom = 6.8 ± 1.2; P = .002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rhoteens &lt;15 years = 0.31 vs Spearman's rhoteens ≥15 years = 0.45; P &lt; .001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratiosociety = 0.89, 95% confidence interval = 0.83, 0.95; odds ratiocommunity = 0.91, 95% confidence interval = 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS.

Conclusions.
This new instrument can reliably measure SSS among adolescents. Social stratification as reflected by SSS is associated with adolescents' health. The findings suggest that as adolescents mature, SSS may undergo a developmental shift. Determining how these changes in SSS relate to health and how SSS functions prospectively with regard to health outcomes requires additional research.
Use of Telehealth Technology to Extend Child Protection Team Services
Authors: Pammer William , Haney Michael , LMHC NCC, , Wood Betsy M. , Brooks Robert G. , Morse Karen , Hicks Patricia , Handler Eric G. , Rogers Howard , Jennett Penny 
Published: August 2004

Objective.
In response to increased referrals to Florida's Child Protection Teams and concern regarding statewide availability of medical expertise in the area of child abuse and neglect, Children's Medical Services of the Florida Department of Health established a telemedicine project to facilitate immediate expert medical evaluations of alleged child abuse or neglect. This article describes a baseline examination of the project, including the technique of concept mapping, to examine how larger systematic factors influence the adaptation of telemedicine technology in child abuse examination settings.

Methods.
This study included interviews of key staff plus the incorporation of concept mapping, which takes qualitative data (individual statements and opinions) and quantifies them (sorts and ranks them by order of group importance).

Results.
Findings from interviews revealed that the frequency of use of telehealth services varies across the state as a result of several factors, including space limitations and staff training. Patients, however, seem to be comfortable with the use of the new technology. The concept mapping exercise displayed a progression of issues that are perceived to have an impact on the use of this technology.

Conclusions.
Technology use is affected by unforeseen variables, such as physical space limitations and examination room availability. Family concerns about patient privacy issues were rare and were resolved quickly by the health care practitioner. Although using this equipment is not difficult, the search for user-friendliness should be continued. Staff engagement early in the process likely will result in a greater likelihood of use of the technology.telehealth, telemedicine, child protection, child abuse and neglect, concept mapping.
Childhood Outcome After Early High-Frequency Oscillatory Ventilation for Neonatal Respiratory Distress Syndrome
Authors: Gerstmann Dale R. , Wood Kari , Miller Annie , Steffen Mike , Ogden Bob , Stoddard Ronald A. , Minton Stephen D. 
Published: August 2004

Objective.In a previous multicenter controlled clinical trial, we randomly assigned surfactant-treated premature newborns with moderate to severe respiratory distress syndrome to early treatment with high-frequency oscillatory ventilation (HFOV) or to conventional ventilation (CV). Compared with control infants who were treated with CV, neonates who were treated with HFOV using a strategy designed to recruit and maintain lung volume and minimize oxygen exposure had clinical evidence of improved pulmonary outcome and less lung injury. We report a follow-up study designed to determine whether clinical differences persisted between these study groups.Methods.Patients were recruited from 81 survivors at 1 center (Provo, Utah) and evaluated for sociodemographic and health history, growth, mental development, motor proficiency, and pulmonary function.Results.Eighty-seven percent of the cohort who originally were assigned to treatment with HFOV (n = 36) or CV (n = 33) were seen in follow-up at a mean age of 77 months (6.4 years). There were no differences in the frequency of hospitalization, pulmonary illness, asthma, or disabilities. Growth, verbal IQ, and motor development were appropriate for age and not different between groups. Patients who initially were randomized to treatment with CV showed pulmonary function evidence of decreased peak expiratory flow, increased residual lung volume, and maldistribution of ventilation.Conclusion.Neurodevelopmental childhood outcome after early intervention HFOV was normal and not different compared with patients who were treated with CV. Surfactant replacement combined with early HFOV using a lung recruitment strategy ameliorates the acute lung injury in respiratory distress syndrome that predisposes some preterm infants to develop chronic lung disease.
A Population-Based Assessment of Pediatric All-Terrain Vehicle Injuries
Authors: Cvijanovich Natalie Z. , Cook Lawrence J. , Mann N. Clay , Dean J. Michael 
Published: August 2004

Objective.To describe the types of injuries sustained by children who ride all-terrain vehicles (ATVs), to estimate the hospital charges associated with these injuries, and to determine adherence to existing rules and regulations governing ATV use.Methods.Analysis of statewide hospital admissions (1992–1996) and emergency department (ED) visits (1996) in Utah. All patients who were younger than 16 years and had an external cause of injury code for ATV use were included.Results.In 1996, 268 ED visits by children involved an ATV. Boys were twice as commonly injured as girls (male:female ratio: 2.1:1), and skin and orthopedic injuries were most frequent. The median ED charge was $368, and ED charges for these patients totaled $138 000. From 1992 to 1996, 130 children were hospitalized as a result of injuries sustained during ATV use, with median charges of $4240 per admission. Male to female ratio was 2.7:1, and the average age was 11.2 ± 3.6 years. Mean injury severity score was 8.0 ± 6.0, and median length of stay was 2 days (range: 0–43 days). Orthopedic injuries were most frequent, but 25% (n= 32) of children sustained head or spinal cord injury. Most children (94%) were discharged from the hospital, but 8 children died as a result of their injuries. Utah regulations prohibit children who are younger than 8 years from driving an ATV and advise against carrying passengers on ATVs. However, 25% (n = 15) of all injured children who were younger than 8 were driving the ATV when injured, and 15% (n = 60) of injured children were passengers on ATVs. Four of the 8 fatally injured children were younger than 8, and all were driving the ATV at the time of the crash. Finally, the estimated injury rate per 100 registered ATVs is significantly higher for children than for adults (3.41 vs 1.71).Conclusions.ATV use results in significant injuries to children. Efforts to educate parents regarding the risks of ATV use, proper supervision, and use of safety equipment are warranted. Manufacturers of ATVs should continue to improve the safety profile of these inherently unstable vehicles.
Prevalence and Predictors of Immunization Among Inner-City Infants: A Birth Cohort Study
Authors: Brenner Ruth A. , Simons-Morton Bruce G. , Bhaskar Brinda , Das Abhik , Clemens John D. ,   the NIH-D.C. Initiative Immunization Working Group
Published: August 2004

Context.Although the proportion of US children who are appropriately immunized increased dramatically in the past decade, rates remain suboptimal among low-income, inner-city youth. Timely initiation of immunization is an important predictor of immunization status later in childhood; however, prospective studies identifying predictors of initiation are lacking.Objectives.The objectives of this study were to: 1) describe immunization patterns in a cohort of infants born to predominantly low-income, inner-city mothers; 2) identify determinants, as measured at birth, of immunization status at 3 and 7 months of age; and 3) identify determinants of continuation of immunization among those who initiate immunization by 3 months of age.Design.Prospective, birth cohort study.Methods.Maternal/infant dyads were systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996. Three hundred sixty-nine mothers were interviewed shortly after delivery, at 3 to 7 months postpartum, and at 7 to 12 months postpartum. Medical records were reviewed at all reported sites of care for 324 (88%) infants. Vaccinations assessed included diphtheria, tetanus, and pertussis; polio; and Haemophilus influenzae type B. Multivariate logistic regression analyses were used to determine factors associated with immunization status of infants at 3 and 7 months of age.Results.At 3 months of age, 75% of infants were up-to-date (UTD) versus only 41% at 7 months. In adjusted analyses, baseline factors associated with being UTD at 3 months included enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy, intention to breastfeed, and presence of the infant's grandmother in the household. Infants were less likely to be UTD if their mothers perceived higher barriers to immunization. Baseline factors associated with being UTD at 7 months included lower birth order and maternal employment. Among the subset of infants who were UTD at 3 months, only 53% remained UTD at 7 months. Factors measured at the first follow-up interview that were associated with continuation of immunization at 7 months included maternal employment and lower perceived barriers.Conclusions.Immunization rates during the first 7 months of life were low in this inner-city population. Factors associated with immunization status that are potentially amenable to change included perceived barriers to immunization and enrollment in WIC during pregnancy.
Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting
Authors: Philipp Barbara L. , Merewood Anne , Miller Lisa W. , Chawla Neetu , Murphy-Smith Melissa M. , Gomes Jenifer S. , Cimo Sabrina , Cook John T. 
Published: August 2004

Objective.Breastfeeding initiation rates were compared at Boston Medical Center before (1995), during (1998), and after (1999) Baby-Friendly policies were in place. Boston Medical Center, an inner-city teaching hospital that provides care primarily to poor, minority, and immigrant families, achieved Baby-Friendly status in 1999.Methods.Two hundred complete medical records, randomly selected by a computer, were reviewed from each of 3 years: 1995, 1998, and 1999. Infants were excluded for medical records missing feeding data, human immunodeficiency virus–positive parent, neonatal intensive care unit admission, maternal substance abuse, adoption, incarceration, or hepatitis C–positive mother. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: exclusive breast milk, mostly breast milk, mostly formula , and exclusive formula.Results.Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999). Initiation rates increased among US-born black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999).Conclusions.Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.
Work of Breathing During Constant- and Variable-Flow Nasal Continuous Positive Airway Pressure in Preterm Neonates
Authors: Pandit Paresh B. , Courtney Sherry E. , Pyon Kee H. , Saslow Judy G. , Habib Robert H. 
Published: August 2004

Background.Constant-flow nasal continuous positive airway pressure (NCPAP) often is used in preterm neonates to recruit and maintain lung volume. Physical model studies indicate that a variable-flow NCPAP device provides more stable volume recruitment with less imposed work of breathing (WOB). Although superior lung recruitment with variable-flow NCPAP has been demonstrated in preterm neonates, corroborating WOB data are lacking.Objective.To measure and compare WOB associated with the use of variable-flow versus constant-flow NCPAP in preterm neonates.Methods.Twenty-four preterm infants who were receiving constant-flow NCPAP (means, SD) and had birth weight of 1024 ± 253 g, gestational age of 28 ± 1.7 weeks, age of 14 ± 13 days, and Fio2 of 0.3 ± 0.1 were studied. Variable-flow and constant-flow NCPAP were applied in random order. We measured changes in lung volume and tidal ventilation (VT) by DC-coupled/calibrated respiratory inductance plethysmography as well as esophageal pressures at NCPAP of 8, 6, 4, and 0 cm H2O. Inspiratory WOB (WOBI) and lung compliance were calculated from the esophageal pressure and VT data using standard methods. WOB was divided by VT to standardize the results.Results.WOBI decreased at all CPAP levels with variable-flow NCPAP, with a maximal decrease at 4 cm H2O. WOBI increased at all CPAP levels with constant-flow CPAP. Lung compliance increased at all NCPAP levels with variable-flow, with a relative decrease at 8 cm H2O, whereas it increased only at 8 cm H2O with constant-flow NCPAP. Compared with constant-flow NCPAP, WOBI was 13% to 29% lower with variable-flow NCPAP.Conclusion.WOBI is decreased with variable-flow NCPAP compared with constant-flow NCPAP. The increase in WOBI with constant-flow NCPAP indicates the presence of appreciable imposed WOB with this device. Our study, performed in neonates with little lung disease, indicates the possibility of lung overdistention at CPAP of 6 to 8 cm H2O with the variable-flow device. Further study is necessary to determine the efficacy of variable-flow NCPAP in neonates with significant lung disease and its use over extended periods of time.continuous-flow and variable-flow NCPAP, work of breathing, premature neonates, lung compliance.