bluuebunny/crossref_metadata_2025_split huggingface dataset:
Employment, Child Care, and Mental Health of Mothers Caring for Children Assisted by Technology
Authors: Thyen Ute , Kuhlthau Karen , Perrin James M. 
Published: August 2004

Objective.This study examines 1) the way that children with chronic conditions are cared for at home and assisted by technology affects maternal employment and child care; 2) the social and clinical factors associated with the decision of a mother to quit employment to care for a child at home; and 3) the way in which care at home and the decision of a mother to quit a job affects maternal mental health.Design.The 6-month postdischarge status of 70 mothers of children assisted by technology (study group) was compared with the 6-month postdischarge status of 58 mothers of children (matched for age and gender) hospitalized for acute illnesses (comparison group). Between January and December 1993, we gathered information on sociodemographic status, employment status and changes in employment, severity of the child's condition, child care and nursing services at home, family support, and maternal mental health.Results.One third of mothers in the study group reported that they quit employment to take care of a child at home with only 37.1% remaining employed outside the home, compared with 69.0% of comparison group mothers. Single caretakers were 15 times more likely to quit employment compared with mothers in two-parent families. Availability of child care had an independent effect on a mother's decision to quit a job, whereas the severity of the child's condition did not. Child care hours were significantly lower in study group families and were provided mostly by relatives compared with day-care facilities and regular babysitters in comparison families. Family support was highest among employed mothers in both the study and the comparison groups and lowest in study group mothers who were neither employed currently nor before the child's illness or who had quit employment to care for the child. Family income was significantly lower in families with a child assisted by technology. Families in the study group had 20-fold higher uncompensated health care costs than did the comparison group. Mothers caring for a child assisted by technology reported less good mental health than did comparison group mothers, and employment seems to mediate this relationship.Conclusions.Caring for a child assisted by technology seems to create barriers to maternal employment diminishing family resources at a time when financial needs actually may increase. Lack of family support and child care services increase the likelihood that mothers of children assisted by technology will stay out of the labor force. Remaining employed buffers the negative effects of care at home on maternal mental health. Health policies for children with chronic health problems should address issues of financial burdens and the labor force participation of their caretakers. chronic illness, home care, technology assisted, family support, employment, quality of life, child care.
Fatal Child Abuse by Forced Water Intoxication
Authors: Arieff Allen I. , Kronlund Barbara A. 
Published: August 2004

Background.
Although water intoxication leading to brain damage is common in children, fatal child abuse by forced water intoxication is virtually unknown.

Methods.
During the prosecution of the homicide of an abused child by forced water intoxication, we reviewed all similar cases in the United States where the perpetrators were found guilty of homicide. In 3 children punished by forced water intoxication who died, we evaluated: the types of child abuse, clinical presentation, electrolytes, blood gases, autopsy findings, and the fate of the perpetrators.

Findings.
Three children were forced to drink copious amounts of water (over 6 L). All had seizures, emesis, and coma, presenting to hospitals with hypoxemia (Po2 = 44 ± 8 mm Hg) and hyponatremia (plasma Na = 112 ± 2 mmol/L). Although all showed evidence of extensive physical abuse, the history of forced water intoxication was not revealed to medical personnel, thus none of the 3 children were treated for their hyponatremia. All 3 patients died and at autopsy had cerebral edema and aspiration pneumonia. The perpetrators of all three deaths by forced water intoxication were eventually tried and convicted.

Interpretation.
Forced water intoxication is a new generally fatal syndrome of child abuse that occurs in children previously subjected to other types of physical abuse. Patients present with coma, hyponatraemia, and hypoxemia of unknown etiology. If health providers were made aware of the association, the hyponatremia is potentially treatable.
Thalidomide Responsiveness in an Infant With Behçet's Syndrome
Authors: Shek Lynette Pei-Chi , MD Yoke Sun Lee , Lee Bee Wah , Lehman Thomas Joseph Anjorge 
Published: August 2004

Background.
Behçet's syndrome is a chronic relapsing vasculitis characterized by aphthous stomatitis, genital ulcerations, and uveitis. The disease is a multisystem illness, which may involve the skin, joints, gastrointestinal tract, blood vessels, central nervous system, and other organs.

Case Study.
We report a case of an infant with features of Behçet's syndrome who did not respond to conventional immunosuppression with high-dose corticosteroids and cytotoxic agents. Thalidomide, a potent immune response-modifying drug, was used with marked improvement and resolution of symptoms.

Conclusion.
This finding supports a trial of thalidomide treatment in patients with Behçet's syndrome who are unresponsive to other forms of immunosuppressive therapy or develop undesirable side effects.
Practice Parameter: Long-term Treatment of the Child With Simple Febrile Seizures
Authors:   Committee on Quality Improvement, Subcommittee on Febrile Seizures
Published: August 2004

The Committee on Quality Improvement, Subcommittee on Febrile Seizures, of the American Academy of Pediatrics, in collaboration with experts from the Section on Neurology, general pediatricians, consultants in the fields of child neurology and epilepsy, and research methodologists, developed this practice parameter. This guideline provides recommendations for the treatment of a child with simple febrile seizures. These recommendations are derived from a thorough search and analysis of the literature. The methods and results of the literature review can be found in the accompanying technical report. This guideline is designed to assist pediatricians by providing an analytic framework for the treatment of children with simple febrile seizures. It is not intended to replace clinical judgment or establish a protocol for all patients with this condition. It rarely will be the only appropriate approach to the problem.The technical report entitled “Treatment of the Child With Simple Febrile Seizures” provides in-depth information on the studies used to form guideline recommendations. A complete bibliography is included as well as evidence tables that summarize data extracted from scientific studies. This report also provides pertinent evidence on the individual therapeutic agents studied including study results and dosing information. Readers of this clinical practice guideline are urged to review the technical report to enhance the evidence-based decision-making process. The report is available on thePediatrics electronic pages website at the following URL:http://www.pediatrics.org/cgi/content/full/103/6/e86.
The Cost of Medical Care for Patients With Cystic Fibrosis in a Health Maintenance Organization
Authors: Lieu Tracy A. , Ray G. Thomas , Farmer Gail , Shay Gregory F. 
Published: August 2004

Background.
Cystic fibrosis (CF) is the most common life-shortening genetic disorder among white individuals worldwide. Previous estimates of the costs of medical care have been based on expert opinion rather than observed costs. Accurate cost estimates are needed to enable evaluation of the cost-effectiveness of new interventions and prenatal genetic screening recommendations.

Objective.
To evaluate the cost of medical care for patients (N = 136) served by a health maintenance organization with a CF center.

Methods.
Retrospective analysis of data from computerized cost databases and the Cystic Fibrosis Foundation annual survey. Severity of disease was classified based on the percent predicted forced expiratory volume at 1 second.

Results.
The annual cost of medical care in 1996 averaged $13 300 and ranged from $6200 among patients with mild disease to $43 300 among patients with severe disease. Of total costs, 47% were from hospitalization, 18% were from DNase (Pulmozyme), 12% were from clinic visits, and 10% were from outpatient antibiotics. When the observed costs were used to estimate the costs of medical care for the entire population of CF patients in the United States, these costs were estimated to be $314 million per year in 1996 dollars.

Conclusions.
We conclude that the cost of medical care for CF varies greatly with severity but is substantial even among patients with mild disease. These findings underscore the need for strategies to ensure good health insurance coverage and high quality care for all individuals with this condition.
Potential Cost Savings Attributable to Influenza Vaccination of School-aged Children
Authors: White Terry , Lavoie Suzanne , Nettleman Mary D. 
Published: August 2004

Objective.
To analyze the costs and benefits of influenza vaccination of healthy school-aged children.

Design.
The analysis was based on data from the literature. Total costs included direct medical costs for vaccination, physician visits, and treatment as well as indirect costs. Indirect costs were in the form of lost productivity when working parents stayed home to care for ill children or to take children to an office for vaccination. The total costs of vaccination strategies were compared with the total cost of not vaccinating. For the base case, the vaccine was assumed to have no effect on rates of otitis media.

Setting.
Two hypothetical scenarios were investigated 1) individual-initiated vaccination and 2) vaccination in a group-based setting. The former scenario required the child to be accompanied to a clinic by a parent during usual work hours.

Results.
Vaccination resulted in a net savings per child vaccinated of $4 for individual-initiated vaccination and of $35 for group-based vaccination. The savings were caused primarily by averted indirect costs. Moderate increases in the cost of vaccination or reductions in the rate of influenza would eliminate the savings for individual-initiated vaccination but not for group-based vaccination. Alternatively, if influenza vaccination was effective in reducing rates of otitis media, the net savings from vaccination would be substantially higher than the base case.

Conclusion.
Vaccination of school-aged children against influenza could have substantial financial benefits to society, especially if performed in a group-based setting. influenza, cost-effectiveness, vaccination, children, cost.
Can Pediatricians Define and Apply the Concept of Brain Death?
Authors: Harrison A. Marc , Botkin Jeffrey R. 
Published: August 2004

Objective.We sought to determine pediatric residents' and attending physicians' ability to define brain death, their ability to apply this standard of death to a clinical scenario, and their knowledge regarding the legal necessity of confirmatory testing when determining death by brain criteria. We compared resident and attending self-confidence at discussing brain death with their ability to define brain death and apply this concept to a clinical scenario.Methodology.A questionnaire was sent to 136 residents, postgraduate years 1 through 3, at four accredited pediatric training programs in the United States. Participation was tracked by return address. One follow-up request for participation was made. A similar procedure was followed for 140 faculty pediatricians at two of the institutions.Demographic information including level of training, subspecialty training, training program, and formal ethics training was collected. Respondents defined brain death, interpreted a clinical scenario, and stated whether confirmatory testing is legally required to determine death by brain criteria. Respondents rated their confidence at explaining brain death to a patient's family on a scale from 1 to 5.Results.Eighty-seven percent (118/136) of resident surveys were returned. Thirty-six percent (42/118) of the residents correctly defined brain death. Forty-three percent (51/118) of residents correctly interpreted the clinical scenario. Fifty-five percent (65/118) of the residents correctly recognized that brain death could be determined without a confirmatory test. Residents who correctly defined brain death were as confident as those who did not (2.8 ± 1 vs 1.5 ± 1). Residents who correctly interpreted the clinical scenario were as confident as those who did not (2.6 ± 1 vs 1.9 ± 0.9).Eighty percent (112/140) of attending physician surveys were returned. Thirty-nine percent (44/112) of attending physicians correctly defined brain death. Fifty-three percent (59/112) correctly interpreted the clinical scenario. Fifty-eight percent (65/112) recognized that brain death can be diagnosed without confirmatory testing. All pediatric intensivists (n = 12) correctly answered all three questions. Their performance was significantly better than other pediatricians. Attendings who correctly defined brain death were more confident than those who did not (4.2 ± 1 vs 1.1 ± 0.9). Attendings who correctly interpreted the clinical scenario were more confident than those who did not (3.8 ± 1.2 vs 2.2 ± 1.2).Conclusions.Pediatric residents and attendings have difficulty defining and applying the concept of brain death. This concept is difficult to grasp and internalize for many pediatricians. To ensure that critical decisions are made by knowledgeable physicians and well-informed families, more effective educational strategies need to be identified.
Gatekeeping and Referral of Children and Adolescents to Specialty Care
Authors: Forrest Christopher B. , Glade Gordon B. , Starfield Barbara , Baker Alison E. , Kang Myungsa , Reid Robert J. 
Published: August 2004

Objective.
In this study we examined how gatekeeping arrangements influence referrals to specialty care for children and adolescents in private and Medicaid insurance plans.

Design/Participants.
We conducted a prospective study of office visits (n = 27 104) made to 142 pediatricians in 94 practices distributed throughout 36 states in a national primary care practice-based research network. During 10 practice-days, physicians and patients completed questionnaires on referred patients, while office staff kept logs of all visits. Physicians used medical records to complete questionnaires for a subset of patients 3 months after their referral was made.

Results.
Gatekeeping arrangements were common among children and adolescents with private (57.8%) and Medicaid (43.3%) insurance. Patients in gatekeeping plans were more likely to be referred with private (3.16% vs 1.85% visits referred) and Medicaid (5.39% vs 3.73%) financing. Increased parental requests for specialty care among gatekeeping patients did not explain the increased referral rate. Physicians' reasons for making the referral were similar between the two groups. Physicians were less likely to schedule an appointment or communicate with the specialist for referred patients in gatekeeping plans. However, rates of physician awareness that a specialist visit occurred and specialist communication back to pediatricians did not differ between the two groups 3 months after the referrals were made.

Conclusions.
Gatekeeping arrangements are common among insured children and adolescents in the United States. Our study suggests that gatekeeping arrangements increase referrals from pediatricians' offices to specialty care and compromise some aspects of coordination.
Evidence for Independent Genetic Influences on Fat Mass and Body Mass Index in a Pediatric Twin Sample
Authors: Faith Myles S. , Pietrobelli Angelo , Nuñez Christopher , Heo Moonseong , Heymsfield Steven B. , Allison David B. 
Published: August 2004

Objective.
Insight into genetic and environmental influences on fat mass, independent of body mass index (BMI; kg/m2), is expected to enhance methods for treating pediatric obesity. However, few studies have estimated the heritability of fat mass in pediatric samples, and those conducted have relied primarily on BMI measurements.

Present Study.
Using bioimpedance analysis, the present study tested a series of hypotheses predicting significant genetic and environmental influences on percent body fat (PBF) above and beyond BMI. Subjects were 66 pairs of twins, including 41 monozygotic and 25 dizygotic pairs, from 3 to 17 years of age. Structural equation modeling tested hypotheses, adjusting for demographic variables.

Results.
Analyses indicated significant genetic influences on PBF, with genes estimated to account for 75% to 80% of the phenotypic variation. The remaining variation was attributable to nonshared environmental influences. Multivariate analyses revealed sizable genetic correlations and environmental correlations between BMI and PBF (rg = .74 andre = .67, respectively), suggesting that some genes and environmental experiences influence both phenotypes. However, analyses confirmed genetic and environmental influences on PBF above and beyond BMI. For example, 62.5% of the total genetic variation in PBF was attributable to genes that influenced PBF but not BMI.

Conclusion.
There seems to be a substantial genetic contribution to fat mass distinct from BMI in a sample of children and adolescents. Studies testing putative genetic or environmental determinants of pediatric obesity might be strengthened further by including research-based body composition methods. pediatric obesity, twin design, heritability, nonshared environment, bioimpedance analysis, body mass index, body composition.
Early Initiation of Breastfeeding and the Risk of Infant Diarrhea in Rural Egypt
Authors: Clemens John , Elyazeed Remon Abu , Rao Malla , MPH MEngg, , Savarino Stephen , Morsy Badria Z. , Kim Yongdai , Wierzba Thomas , Naficy Abdollah , Lee Y. Jack 
Published: August 2004

Background.
Initiation of breastfeeding shortly after delivery may enhance breastfeeding's protective effect against diarrhea because of the protective properties of human colostrum contained in early breast milk.

Objective.
To evaluate whether initiation of breastfeeding within the first 3 days of life, when breast milk contains colostrum, was associated with a lower rate of diarrhea in rural Egyptian infants during the first 6 months of life.

Methods.
Infants initially breastfed (n = 198) were monitored prospectively with twice-weekly home visits to ascertain dietary practices and diarrheal illnesses.

Results.
The burden of diarrhea during the first 6 months of life in the cohort was high: seven episodes per child-year of follow-up. Only 151 (76%) infants initiated breastfeeding during the first 3 days of life (“early initiation”). Infants in whom breastfeeding was initiated early had a 26% (95% CI: 2%,44%) lower rate of diarrhea than those initiated late. The protective association between early initiation and diarrhea was independent of the pattern of postinitiation dietary practices and was evident throughout the first 6 months of life.

Conclusions.
Early initiation of breastfeeding was associated with a marked reduction of the rate of diarrhea throughout the first 6 months of life, possibly because of the salutary effects of human colostrum. These data highlight the need for interventions to encourage early initiation of breastfeeding in less developed settings.
Immigration and Tuberculosis Among Children on the United States–Mexico Border, County of San Diego, California
Authors: Kenyon Thomas A. , Driver Cynthia , Haas Elisabeth , Valway Sarah E. , Moser Kathleen S. , Onorato Ida M. 
Published: August 2004

Objective.
To identify factors contributing to a 400% increase in tuberculosis among children in San Diego County, California, from 1985 to 1993.

Design.
Review of medical records of reported cases in 1989, 1991, and 1993 and their source case.

Results.
Of 192 children with tuberculosis, the largest increase was observed in children younger than 5 years old, of whom 77.4% were born in the United States, 67.8% had a foreign-born parent, 73.1% came from a non-English-speaking household, and 46.2% were known to visit Mexico. Of 28 source cases, 82.1% were born outside the United States, primarily in Mexico (67.9%). Resistance to at least one first-line antituberculous drug was identified in 27.5% of isolates from children and in 33.3% of isolates from source cases.

Conclusions.
The increase in tuberculosis and high level of drug-resistance among children born in the United States may be attributed to transmission outside of the United States or within the United States from household contacts born in countries in which tuberculosis is highly endemic.
Has Asthma Medication Use in Children Become More Frequent, More Appropriate, or Both?
Authors: Goodman David C. , Lozano Paula , Stukel Therese A. , Chang Chiang-hua , Hecht Julia 
Published: August 2004

Objective.Despite national initiatives to improve asthma medical treatment, the appropriateness of physician prescribing for children with asthma remains unknown. This study measures trends and recent patterns in the pediatric use of medications approved for reversible obstructive airway disease (asthma medications).Design.Population-based longitudinal and cross-sectional analyses.Setting.A nonprofit staff model health maintenance organization located in the Puget Sound area of Washington state.Participants.Children 0 to 17 years of age enrolled continuously during any one of the years from 1984 to 1993 (N = 83 232 in 1993).Primary Outcome Measures.Percent of enrollees filling prescriptions for asthma medications and fill rates by medication class and estimated duration of inhaled antiinflammatory medication use.Results.Between 1984 and 1993, the frequency of asthma medication use increased: the percent of children filling any asthma medication prescription increased from 4.0% to 8.1%, whereas the percent filling an inhaled antiinflammatory inhaler rose from 0.4% to 2.4%. In contrast, the intensity of inhaled antiinflammatory use decreased among users; 37% of users filled more than two inhalers during the year in 1984, and 29% in 1993. In high β-agonist users (filling more than two β-agonist inhalers each quarter per year), the estimated duration of inhaled antiinflammatory use increased slightly from a mean of 4.1 months per year in 1984–1986 to 5.0 months in 1991–1993; estimated duration of use in adolescents 10 to 17 years of age was approximately half that of children 5 to 9 years of age.Conclusions.The proportion of children using asthma medications increased substantially during the study period, but the use of inhaled antiinflammatory medication per patient remained low even for those using large amounts of inhaled β-agonists. These findings suggest that most asthma medications were used by children with mild lower airway symptoms and that inhaled antiinflammatory medication use in children with more severe disease fell short of national guidelines.