bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elementary School-based Health Center Use
Authors: Kaplan David W. , Brindis Claire , Naylor Kelly E. , Phibbs Stephanie L. , Ahlstrand Karin R. , Melinkovich Paul 
Published: August 2004

Background. The number of school-based health centers (SBHCs) has grown from 40 in 1985 to &gt;900 in 1996. During the 1996–1997 school year there were 914 SBHCs, 32% of which were located in elementary schools. Despite the relatively large number of elementary SBHCs in existence, SBHCs serving elementary-aged students are not adequately represented in the literature.
Objective. To analyze physical and mental primary health care utilization in a comprehensive elementary SBHC for an underserved Hispanic population.
Design. Retrospective analyses of services used at an elementary SBHC during the 1995–1996 school year. We describe physical and mental health services utilization provided by SBHC staff who offered a range of primary medical and mental health services.
Patients. The study population was predominately Hispanic, and comprised of 811 elementary school students (grades preschool through fifth) registered for SBHC use. Analyses were conducted on 591 students who used the SBHC.
Results. The 591 SBHC users made 2443 visits, ranging between 1 and 54 visits/individual; mean 4 visits/student. Two thirds of visits (1638) were medical provider visits, and 33% (798) were mental health provider visits. Most students (75%) saw a medical provider exclusively, 9% saw a mental health provider exclusively, and 16% of students were seen by both. Mean duration of medical provider visits ±SD was 15 ± 13 minutes, mean for mental health provider visits ±SD, 37 ± 16 minutes. Of the 3035 diagnoses, 64% were medical and 36% were mental health diagnoses. These diagnostic frequencies are grouped as follows: acute medical (31%), health maintenance (22%), depression (10%), non-Diagnostic and Statistical Manual of Mental Disorders-IV mental health diagnoses (8%), conflict disorder/emotional disturbance (8%), chronic medical (8%), academic/learning disorder (7%), anxiety disorder (3%), and other (4%).
Conclusions. High rates of SBHC utilization by this population and the range of diagnoses recorded suggest health care delivered in a comprehensive, culturally-sensitive SBHC has the potential for impacting the health and well-being of underserved elementary-aged students.
The Internet as a Source for Current Patient Information
Authors: McClung H. Juhling , Murray Robert D. , Heitlinger Leo A. 
Published: August 2004

Objective. The purpose of this study was to assess the quality of information a lay person could obtain from Internet (Net) sources regarding the treatment of childhood diarrhea. It also afforded an opportunity to evaluate the awareness and compliance of the general medical community with the American Academy of Pediatrics (AAP) guidelines on the management of acute diarrhea.Methods. This was a prospective, open, observational, literature review performed with a computer workstation and medical library. The AAP practice parameter on the management of acute gastroenteritis in young children was selected as the current standard by which to judge all other documents. The Net was searched, and all documents retrievable from the first 300 references were evaluated for compliance with current recommendations on the management of diarrhea in children.Results. Of 60 articles published by traditional medical sources, only 12 (20%) conformed to current AAP recommendations for treatment of children. The source of the information, even if from a major academic medical center, did not improve the likelihood of compliance.Conclusions. As demonstrated by information supplied on World Wide Web sites by traditional medical sources, recommendations for the treatment of acute diarrhea show a low percentage of concurrence with the AAP guidelines. Major medical institutions, schools, and hospitals need to devise ways to carefully monitor and establish quality control of what is being distributed from their home pages. Patients must be warned about the voluminous misinformation available on medical subjects on the Net.
The Association Between Adequacy of Prenatal Care Utilization and Subsequent Pediatric Care Utilization in the United States
Authors: Kogan Michael D. , Alexander Greg R. , Jack Brian W. , Allen Marilee C. 
Published: August 2004

Objective. To explore the association between adequacy of prenatal care utilization and subsequent pediatric care utilization.Design. A longitudinal follow-up of a nationally representative sample of infants born in 1988.Participants. Nine thousand four hundred forty women who had a live birth in 1988, and whose child was alive at the time of interview, and 8285 women from the original sample who were reinterviewed in 1991.Main Outcome Measure. There were four outcome measures: number of well-child visits; adequate immunization for diphtheria, tetanus, and pertussis; adequate immunization for polio; and continuity of a regular source of care, as measured by the number of sites for pediatric care.Results. Children whose mothers had less than adequate prenatal care utilization had significantly fewer well-child visits, and were significantly less likely to have adequate immunizations, even after income, health insurance coverage, content of prenatal care, wantedness of child, sites of prenatal and pediatric care, and maternal and pregnancy risk characteristics were taken into account. Less than adequate prenatal care utilization was not associated with having more than one pediatric care site.Conclusions. Prenatal care utilization can be used to identify and target interventions to women who are at risk for not obtaining well-child care or complete immunizations for their children.
Documentation of Child Physical Abuse: How Far Have We Come?
Authors: Limbos Mary Ann P. , Berkowitz Carol D. 
Published: August 2004

Objectives. To determine the effects of increased physician training and a structured clinical form on physician documentation of child physical abuse.Design. Retrospective chart review.Participants. Children evaluated in the pediatric emergency department in 1980 and 1995 who were given the diagnosis of physical abuse.Measurements. The unstructured pediatric emergency department form and the structured child abuse reporting form were reviewed for documentation of 20 items including history, physical examination, diagnostic procedures, and disposition. Data documented in 1980 were compared with that in 1995.Results. The only significant differences between 1980 and 1995 concerning documentation on the unstructured pediatric emergency department form were better recording in the latter year of Child Protective Services involvement and case disposition. Half or more of the records omitted documentation of at least one of the following: witnesses to injury, past injuries, description of size and/or color of injuries, illustration, and a genital exam. None of the records contained a developmental history. Significantly fewer skeletal surveys were obtained in 1995, although notation of the results was similar to 1980. For both years, the structured child abuse reporting form improved documentation of only two items: time of arrival to the pediatric emergency department and illustrations of injuries.Conclusions. Little improvement in physician documentation of child physical abuse was noted between 1980 and 1995 despite increased efforts to educate housestaff in the evaluation of child abuse during this time period. Although a structured form prompted physicians to document dates and times and to illustrate physical injuries on the diagram provided, it did not significantly improve documentation of other items.
Pharmacologic and Psychologic Interventions for Procedural Pain
Authors: Kazak Anne E. , Penati Biancamaria , Brophy Patricia , Himelstein Bruce 
Published: August 2004

Objective. This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required).Methodology. This was a randomized, controlled prospective study that compared the PO (n = 45) and CI arms (n = 47), at 1, 6, and &gt;12 months after diagnosis. A cross-sectional control group consisted of parents of 70 patients in first remission before the prospective study. Parent questionnaires, staff and parent ratings, and data on medications administered, technical difficulty of the procedure, and needle insertions were obtained for each procedure. This article reports on the final data point for the project (&gt;12 months).Results. Mothers and nurses reported lower levels of child distress in the CI than the PO group. The CI and PO groups showed lower levels of child and parent distress than the cross-sectional control group. Distress decreased throughout the time, and child age was inversely related to distress (younger children had more distress) regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with child age, but not with medications administered.Conclusions. The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols.
Asthma in Non–Inner City Head Start Children
Authors: McGill Kelly A. , Sorkness Christine A. , Ferguson-Page Carole , Gern James E. , Havighurst Thomas C. , Knipfer Barbara , Lemanske Robert F. , Busse William W. 
Published: August 2004

Objective. Asthma is a significant cause of morbidity and mortality in children. The objective of this study was to determine whether the federal program Head Start in Dane County, Wisconsin, could be used as a mechanism to identify preschool-aged children with asthma.Design. Five-year, cross-sectional survey of parents with children enrolled in Head Start.Methods. Investigator-administered asthma screening questionnaire to parents of enrolling Head Start children in Dane County, Wisconsin.Measurements. Asthma prevalence and asthma-related health care use, including emergency department visits, hospitalizations, and medication usage, were measured using an asthma screening questionnaire developed by investigators.Results. Information was gathered on 2215 children. The prevalence of physician-diagnosed asthma in the screened children was 15.8%. Parental reports of physician-diagnosed asthma were validated in a subset of 133 children, with a 98.5% confirmation rate. Independent risk factors for asthma included male gender (relative risk, 1.4) and African-American ethnicity (relative risk, 1.4). Asthma-related morbidity was substantial with 26.7% of identified children hospitalized for asthma and 54.5% with an emergency department visit during their lifetime. The majority of children (46.4%) were treated with intermittent, quick relief medications (β-agonists) alone, whereas only 6.1% were on daily, long-term controller medications.Conclusions. Asthma screening through a Head Start program provides an effective means of targeting preschool-aged children from socioeconomic groups at high risk for asthma. Identification of children early in the disease course and those at high risk for asthma provides an ideal opportunity for the implementation of preventive and therapeutic interventions.
Consequences of the Delayed Diagnosis of Ataxia-Telangiectasia
Authors: Cabana Michael D. , Crawford Thomas O. , Winkelstein Jerry A. , Christensen James R. , Lederman Howard M. 
Published: August 2004

Objectives. Ataxia-telangiectasia (AT) is a rare, autosomal recessive neurodegenerative disorder in which the diagnosis is obvious when ataxia and telangiectasia are both present. However, the diagnosis can be made upon the onset of ataxia and before the appearance of telangiectasia if confirmed by laboratory tests. Early diagnosis is important for genetic counseling, appropriate care, and avoidance of unnecessary tests. The purpose of this study is to identify factors responsible for delays in the diagnosis of AT.
Design. The records of all patients seen at the Ataxia-Telangiectasia Clinical Center from July 1, 1995 to April 1, 1997 were reviewed to determine age of onset of gait abnormality, recognition of telangiectasia, and diagnosis.
Results. In 48 patients with AT, who were the index cases in their respective families, the median age of diagnosis (78 months) occurred after the onset of gait abnormalities (15 months) and closely corresponded to the development of telangiectasia (72 months). In the majority of cases (34/48), telangiectasia appeared before the diagnosis was established. The most common misdiagnosis was cerebral palsy (29/48 cases). Twenty-one children (4 with AT) were born after the start of symptoms in the index case, but before the establishment of a diagnosis.
Conclusions. The term AT, although a concise and memorable label for the disorder, is also a barrier to early diagnosis. We recommend the use of routine serum α-fetoprotein testing for all children with persistent ataxia.
One-Week Triple Therapy With Omeprazole, Clarithromycin, and Nitroimidazole forHelicobacter pyloriInfection in Children and Adolescents
Authors: Moshkowitz Menachem , Reif Shimon , Brill Shlomo , Ringel Yehuda , Arber Nadir , Halpern Zamir , Bujanover Yoram 
Published: August 2004

Background. Resolution ofHelicobacter pylori infection is important in the management of peptic ulcer disease and reduces peptic ulcer recurrence in both adults and children. Various anti-H pyloritreatment regimens have been proposed, reflecting the incomplete clinical success of each. A combination of omeprazole, clarithromycin, and tinidazole, given for 1 week, has been shown to be highly tolerable and effective, achieving a success rate of &gt;90% in the adult population.Objective. The aim of this study was to evaluate this short-term regimen in pediatric and adolescent populations.Methods. The study group consisted of 35 children referred for evaluation of dyspeptic symptoms. They all underwent upper gastrointestinal endoscopy, in which H pylori infection was confirmed by rapid urease test and/or histologic staining. They were given omeprazole (20 mg twice daily), clarithromycin (250 mg twice daily), and tinidazole or metronidazole (500 mg twice daily) for 1 week. The patients were divided into two groups: those who received the first course of anti-H pylori therapy during this study (group 1) and those who had previously received standard metronidazole and bismuth combination therapies that failed to eradicate H pylori (group 2). Therapeutic efficacy was assessed by a13C-urea breath test performed 4 weeks after completion of treatment.Results. The 35 study patients had a mean age of 15.9 years (range, 10 to 19) and included 19 males and 16 females, of whom 22 were born in Israel and 13 were immigrants from the former USSR. There were 27 patients (77.1%) in group 1 and 8 patients (22.9%) in group 2. Endoscopic findings were nodular gastritis (14), gastritis (11), gastric ulcer (1), duodenal ulcer (5), and duodenitis (4).H pylori resolution was significantly higher in group 1 patients (24/27, 88.9%) than in group 2 patients (1/8, 12.5%). There was no difference between patients with nodular gastritis and those with nonnodular gastritis, and between Israeli-born patients and patients born in the former USSR. Compliance in both groups was equally good, and no major side effects were recorded.Conclusions. One-week omeprazole/clarithromycin/tinidazole triple therapy is highly tolerable and effective for treating H pylori in the pediatric age group, but previous treatment failure diminishes the likelihood of success with this regimen.
Reducing Risks to Children in Vehicles With Passenger Airbags
Authors: Graham John D. , Goldie Sue J. , Segui-Gomez Maria , Thompson Kimberly M. , Nelson Toben , Glass Roberta , Simpson Ashley , Woerner Leo G. 
Published: August 2004

This review examines the risk that passenger airbags pose for children and discusses behavioral and technologic measures aimed at protecting children from airbag deployment. Although airbags reduce fatal crash injuries among adult drivers and passengers, this safety technology increases mortality risk among children younger than age 12. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. As new vehicles are resold to buyers who tend to be less safety-conscious than new car owners, the number of children endangered by passenger airbag deployment may increase.For vehicles already in the fleet, strong measures are required to secure children in the rear seat and increase the proper use of appropriate restraint systems through police enforcement of laws. One promising strategy is to amend child passenger safety laws to require that parents secure children in the rear seats. For future vehicles, a mandatory performance standard should be adopted that suppresses airbag deployment automatically if a child is located in the front passenger seat. Other promising improvements in airbag design also are discussed. Major changes in passenger airbag design must be evaluated in a broad analytical framework that considers the welfare of adults as well as children.
Kawasaki Disease in the Older Child
Authors: Momenah Tarek , Sanatani Shubhayan , Potts Jim , Sandor George G. S. , Human Derek G. , Patterson Michael W. H. 
Published: August 2004

Objectives. To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease.Methodology. A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period.Results. A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1- to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 ± 2.3 for infants, 5.2 ± 1.5 for older children, and 1.9 ± 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients.Conclusion. We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease.
Early Language Development in Children Exposed to or Infected With Human Immunodeficiency Virus
Authors: Coplan James , Contello Kathie A. , Cunningham Coleen K. , Weiner Leonard B. , Dye Timothy D. , Roberge Linda , Wojtowycz Martha A. , Kirkwood Kim 
Published: August 2004

Objectives. To compare language development in infants and young children with human immunodeficiency virus (HIV) infection to language development in children who had been exposed to HIV but were uninfected, and (among subjects with HIV infection) to compare language development with cognitive and neurologic status.Design. Prospective evaluation of language development in infected and in exposed but uninfected infants and young children.Setting. Pediatric Infectious Disease Clinic, State University of New York–Health Science Center at Syracuse.Subjects. Nine infants and young children infected with HIV and 69 seropositive but uninfected infants and children, age 6 weeks to 45 months.Results. Mean Early Language Milestone Scale, 2nd edition (ELM-2) Global Language scores were significantly lower for subjects with HIV infection, compared with uninfected subjects (89.3 vs 96.2, Mann–Whitney U test). The proportion of subjects scoring &gt;2 SD below the mean on the ELM-2 on at least one occasion also was significantly greater for subjects with HIV infection, compared with uninfected subjects (4 of 9 infected subjects, but only 5 of 69 uninfected subjects; Fisher's exact test). Seven of the 9 subjects with HIV infection manifested deterioration of language function. Four manifested unremitting deterioration; only 1 of these 4 demonstrated unequivocal abnormality on neurologic examination. Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment. Magnetic resonance imaging or computed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration, and findings were normal in all 6. ELM-2 Global Language scaled scores showed good agreement with the Bayley Mental Developmental Index or the McCarthy Global Cognitive Index (r = 0.70). Language deterioration, or improvement in language after initiation of drug therapy, coincided with or preceded changes in global cognitive function, at times by intervals of up to 12 months.Conclusions. Language deterioration occurs commonly in infants and young children with HIV infection, is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imaging, and may precede evidence of deterioration in global cognitive ability. Periodic assessment of language development should be added to the developmental monitoring of infants and young children with HIV infection as a means of monitoring disease progression and the efficacy of drug treatment.