bluuebunny/crossref_metadata_2025_split huggingface dataset:
Firearm Safety Counseling in Primary Care Pediatrics: A Randomized, Controlled Trial
Authors: Grossman David C. , Cummings Peter , Koepsell Thomas D. , Marshall Jean , D'Ambrosio Luann , Thompson Robert S. , Mack Chris 
Published: August 2004

Context.Physicians have been encouraged to counsel families about risks associated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown.Objective.To determine the effectiveness of gun safety counseling during well-child care visits.Design.Group randomized, controlled trial. Physicians, nurse practitioners, and physician assistants were randomized to either the intervention group or a control group.Setting.Group Health Cooperative, a staff-model health maintenance organization.Patients.Consecutive sample of families (n = 1295) seen for a scheduled appointment for well-child care for a child &lt;18 years of age. Of the families originally scheduled for a visit, 80.3% were seen and completed the outcomes surveys.Intervention.Each family in the intervention group was given a 60-second message by their practitioner that depended on the presence of guns in the home. Families without guns were informed of the health risks associated with gun ownership and given a standard information pamphlet. Families with guns were given the same information about risks and were told that if they chose to keep a gun, they should store it locked and unloaded. They were given instructions on storage and a folder with material, including the same pamphlet, a letter from the police department, written storage guidelines, and discount coupons for gun storage devices.Main Outcome Measure.Changes in the following self-reported events: 1) acquisition of a safe storage device; 2) removal of firearms from the home; and 3) acquisition of firearms.Results.There were no important differences between intervention and control groups in the rate of acquisition of new guns (intervention: 1.3% vs control: .9%) after the intervention. Among households with guns at baseline, there were also no differences between groups in the removal of guns (intervention: 6.7% vs control: 5.7%), but there was a fairly large nonsignificant difference in the proportion who purchased trigger locks (intervention: 8.0% vs control: 2.5%).Conclusions.A single firearm safety-counseling session during well-child care, combined with economic incentives to purchase safe storage devices, did not lead to changes in household gun ownership and did not lead to statistically significant overall changes in storage patterns.
Choice of Breastfeeding and Physicians' Advice: A Cohort Study of Women Receiving Propylthiouracil
Authors: Lee Amy , Moretti Myla Emily , Collantes Alexis , Chong Debbie , Mazzotta Paolo , Koren Gideon , Merchant Shehzad Salim , Ito Shinya 
Published: August 2004

Objective.To examine the gap between the current social/medical practice and the evidence-based recommendation in favor of breastfeeding during maternal propylthiouracil (PTU) therapy.Design.Prospective, observational, cohort study.Subjects.Women requiring PTU during pregnancy, and endocrinologists and family physicians in Ontario, Canada.Interventions.Questionnaire.Main Outcome Measures.Women were interviewed postpartum regarding their choice of infant feeding method and relevant advice received from physicians. Physicians were questioned about their advice to nursing women receiving PTU.Results.Of 78 women, 66 had live births. Thirty-six required PTU postpartum (group 1), and 30 did not (group 2). Thirty-six healthy women served as controls (group 3). Breastfeeding initiation rates for groups 1, 2, and 3 were 44%, 83%, and 83%, respectively. In group 1, 15 women who breastfed received advice from 22 physicians regarding breastfeeding (20 in favor, 1 against, and 1 equivocal). Eleven who formula fed received advice from 17 physicians (4 in favor, 12 against, and 1 equivocal). A logistic regression analysis of group 1 showed that physicians' advice was the only significant predictor of the woman's choice to breastfeed during PTU therapy (relative risk: 5.48; 95% confidence interval: 1.28–23.40). The physician survey showed that 44% of endocrinologists do not recommend breastfeeding during PTU therapy.Conclusions.A substantial proportion of the lactating patients on PTU still receive advice against breastfeeding from their physicians. Physicians' advice and attitudes toward breastfeeding during PTU therapy are a major factor in women's final decision to breastfeed. Physicians' compliance with evidence-based data will facilitate breastfeeding in this group. propylthiouracil, breastfeeding, decision-making.
Adult Female Hip Bone Density Reflects Teenage Sports–Exercise Patterns But Not Teenage Calcium Intake
Authors: Lloyd Tom , Chinchilli Vernon M. , Johnson-Rollings Nan , Kieselhorst Kessey , Eggli Douglas F. , Marcus Robert 
Published: August 2004

Objective.
To examine how cumulative teenage sports histories and time-averaged teenage calcium intake are related to total body bone mineral gain between ages 12 and 18 years and to proximal femur bone mineral density (BMD) at age 18 years.

Design.
Longitudinal.

Setting.
University Hospital and local suburban community in Central Pennsylvania.

Study Participants.
Eighty-one white females in the ongoing Penn State Young Women's Health Study.

Outcome Measures.
Total body and proximal femur (hip) bone measurements by dual energy radiograph absorptiometry; nutrient intakes, including calcium, from 33 days of prospective food records collected at regular intervals between ages 12 and 18 years; and self-reported sports–exercise scores between ages 12 and 18 years.

Results.
Cumulative sports–exercise scores between ages 12 and 18 years were associated with hip BMD at age 18 years (r = .42) but were not related to total body bone mineral gain. Time-averaged daily calcium intake, which ranged from 500 to 1500 mg/day in this cohort was not associated with hip BMD at age 18 years, or with total body bone mineral gain at age 12 through 18 years.

Conclusions.
The amount of physical activity that distinguishes a primarily sedentary teenager from one who engages in some form of exercise on a nearly daily basis is related to a significant increase in peak hip BMD.
Tone Abnormalities Are Associated With Maternal Cigarette Smoking During Pregnancy in In Utero Cocaine-Exposed Infants
Authors: Dempsey Delia A. , Hajnal Beatrice Latal , Partridge J. Colin , Jacobson Sarah N. , Good William , Jones Reese T. , Ferriero Donna M. 
Published: August 2004

Objective.Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables.Design.Healthy newborns with birth weights ≥2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at ∼6 weeks of age by an examiner blinded to history.Results.At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04–8.25), if the maternal urine cotinine level was &gt;200 ng/mL.Conclusion.Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.
Antenatal Corticosteroids and Outcome at 14 Years of Age in Children With Birth Weight Less Than 1501 Grams
Authors: Doyle Lex W. , Ford Geoffrey W. , Rickards Anne L. , Kelly Elaine A. , Davis Noni M. , Callanan Catherine , Olinsky Anthony 
Published: August 2004

Objective.To determine whether exposure to antenatal corticosteroid therapy was associated with adverse effects on growth, sensorineural outcome, or lung function of children of birth weight &lt;1501 g at 14 years of age.Design.Cohort study.Setting.The Royal Women's Hospital, Melbourne, Australia.Subjects.One hundred fifty-four consecutive survivors born from October 1, 1980 to March 31, 1982.Interventions.The mothers of 78 survivors (51%) had been given corticosteroids antenatally to accelerate fetal lung maturation. Treatment with antenatal corticosteroids was nonrandom. No mother received &gt;1 course of corticosteroids.Outcome Measures.The children were assessed at 14 years of age, corrected for prematurity. All assessors were unaware of the exposure of the child to antenatal corticosteroids. The assessments included measurements of growth and neurological, cognitive, and lung function. Growth measurements were converted into zscores (standard deviation) for the appropriate age and gender.Results.Of the 154 survivors, 130 (84%) were assessed at 14 years of age. Overall, the children exposed to antenatal corticosteroids were significantly taller (height zscore; mean difference: .39; 95% confidence interval: .001–.79) and had better cognitive functioning (Wechsler Intelligence Scale for Children-Third Edition Full Scale; IQ mean difference: 6.2; 95% confidence interval: .8–11.6) than those not exposed to corticosteroids. There were no other differences in sensorineural outcomes between the groups. Lung function was not significantly different between the groups. No conclusions were altered by adjustment for confounding variables.Conclusions.Exposure to 1 course of antenatal corticosteroid therapy was associated with some clinically and statistically improved outcomes at 14 years of age in children of birth weight &lt;1501 g, with no obvious adverse effects on growth or on sensorineural, cognitive, or lung function. corticosteroids, growth, cognitive, IQ, lung function, adolescence.
The Matthew Effect: Infant Mortality in Canada and Internationally
Authors: Dzakpasu Susie , Joseph K. S. , Kramer Michael S. , Allen Alexander C. 
Published: August 2004

Objective.
To examine whether the magnitude of improvement in the health status of a population over time is dependent on the previous health status of that population.

Design and Setting.
A study of infant mortality rates in Canada's 12 provinces and territories between the periods 1961–1965 and 1991–1995, and of infant mortality rates in 133 countries between 1960 and 1995.

Main Outcome Measures.
Spearman's rank correlations, relative risks, and risk differences to measure the relationship between infant mortality in the 1960s and changes in infant mortality between the 1960s and 1990s.

Results.
In Canada, regional rankings based on infant mortality rates in 1961–1965 were strongly correlated (inversely) with rankings based on the percent change in infant mortality between 1961–1965 and 1991–1995 (correlation coefficient = −.85). In contrast, internationally, rankings based on infant mortality rates in 133 countries in 1960 were positively correlated with percent change between 1960 and 1995 (correlation coefficient = .56). Regional differences in infant mortality rates, measured using relative risks, declined in Canada (highest relative risk: 4.2, compared with Ontario in the 1960s; highest relative risk: 2.2, compared with Ontario in the 1990s) but increased globally (highest relative risk: 5.0, compared with industrialized countries in 1960; highest relative risk: 15.1, compared with industrialized countries in 1995).

Conclusions.
Canadian regions with higher infant mortality rates in 1961–1965 achieved larger improvements compared with regions with initially lower infant mortality rates. The pattern observed within Canada is unlike the pattern observed internationally.
Head Growth in Infants With Hypoxic–Ischemic Encephalopathy: Correlation With Neonatal Magnetic Resonance Imaging
Authors: Mercuri Eugenio , Ricci Daniela , Cowan Frances M. , Lessing Daniella , Frisone Maria F. , Haataja Leena , Counsell Serena J. , Dubowitz Lilly M. , Rutherford Mary A. 
Published: August 2004

Objectives.The aims of the study were to establish the relationship between head growth in the first year of life with the pattern on injury on neonatal magnetic resonance imaging (MRI) in infants with hypoxic–ischemic encephalopathy (HIE) and to relate these to the neurodevelopmental outcome.Methods.Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was classified as a drop of &gt;2 standard deviations across the percentiles with or without the development of microcephaly, which was classified as a head circumference below the third percentile.Results.There was no statistical difference between the neonatal head circumferences of the infants presenting with HIE and control infants. At 12 months, microcephaly was present in 48% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was documented in 53% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular to involvement of severe white matter and to severe basal ganglia and thalamic lesions. Suboptimal head growth predicted abnormal neurodevelopmental outcome with a sensitivity of 79% and a specificity of 78%, compared with the presence of microcephaly at 1 year of age, which had a sensitivity of only 65% and a specificity of 73%. The exceptions were explained by infants with only moderate white matter abnormalities who had suboptimal head growth but normal outcome at 1 year of age and by infants with moderate basal ganglia and thalamic lesions only who had normal head growth but significant motor abnormality.
The Influence of Intrapartum Antibiotics on the Clinical Spectrum of Early-Onset Group B Streptococcal Infection in Term Infants
Authors: Bromberger Patricia , Lawrence Jean M. , Braun David , Saunders Brian , Contreras Richard , Petitti Diana B. 
Published: August 2004

Objective.
The use of intrapartum antibiotics to prevent early-onset group B streptococcal (EOGBS) infection has left pediatricians in a quandary about the appropriate evaluation and treatment of infants at risk for this infection. The aim of this study was to determine whether intrapartum antibiotic prophylaxis changed the constellation and timing of onset of clinical signs of group B streptococcal (GBS) infection in term infants.

Methodology.
We conducted a retrospective chart review of infants who had EOGBS infection and were born in Southern California Kaiser Permanente Hospitals from 1988 through 1996. Objective criteria were used to ascertain maternal risk of infection, intrapartum antibiotic prophylaxis, and onset of clinical signs of infection.

Results.
Three hundred nineteen infants with EOGBS sepsis, bacteremia, or clinically suspected infection were identified from a population of 277 912 live births. Of the 172 term infants with culture-positive infection who had clinical signs of infection, 95% exhibited them in the first 24 hours of life. All of the infants exposed to intrapartum antibiotics became ill within the first 24 hours of life.

Conclusions.
Exposure to antibiotics during labor did not change the clinical spectrum of disease or the onset of clinical signs of infection within 24 hours of birth for term infants with EOGBS infection. A 48-hour stay is not required to monitor asymptomatic term infants exposed to intrapartum antibiotics for onset of GBS infection.
Volume–Outcome Relationships in Pediatric Intensive Care Units
Authors: Tilford John M. , Simpson Pippa M. , Green Jerril W. , Lensing Shelly , Fiser Debra H. 
Published: August 2004

Context.
Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.

Objectives.
This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.

Design and Setting.
A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group.

Participants.
Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.

Main Outcome Measures.
Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.

Results.
The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio: .95; 95% confidence interval: .91–.99), and reduced length of stay (incident rate ratio: .98; 95% confidence interval: .975–.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.

Conclusions.
The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.
Can Falls on Stairs Result in Small Intestine Perforations?
Authors: Huntimer Cynthia Marie , Muret-Wagstaff Sharon , Leland Nancy Lee 
Published: August 2004

Objective.Abusive parents often report that a fall on stairs resulted in their children's injuries. This review explores whether there is any evidence in the medical literature that a fall on stairs could be a plausible explanation for a small intestine perforation.Methodology.The English-language medical literature was searched by Medline, for a 29-year period (1970–1998), for reports of the types of injuries sustained in falls on stairs and for reports of the types of blunt abdominal trauma that result in small intestine perforations. Articles that exclusively focused on infant walker injuries or the elderly were excluded. Duodenal, jejunal, and ileal perforations were included, whereas intestinal hematomas and undescribed intestinal injuries were excluded. All types of injuries to the stomach, colon, and rectum were excluded.Results.Falls on stairs were not reported to be a cause for any of the 312 cases of small intestine perforations reviewed. There were no reports of any intraabdominal injuries, including small intestine perforations, in any of the 677 cases of falls on stairs reviewed. Falls on stairs rarely resulted in any type of truncal injury.Conclusions.Although falls on stairs have been reported to be the most common cause of injury in childhood, no evidence was found to support the contention that an unobstructed fall on stairs could be consistent with perforation of the small intestine.
Impact of Race and Gestational Age on Red Blood Cell Indices in Very Low Birth Weight Infants
Authors: Alur Pradeep , Devapatla Sri Satish , Super Dennis M. , Danish Elizabeth , Stern Thomas , Inagandla Radha , Moore John J. 
Published: August 2004

Background.Normative data for hematologic values in the very low birth weight infants are limited and inconsistent, with the reported mean hematocrit (HCT) in these infants ranging from 43.5% to 60%. No data are available on the effect of race.Objectives.To establish normative data for hemoglobin (Hb) and HCT by arterial sampling obtained during the first 3 hours after birth in black and white premature infants ≤31 weeks of gestation.Methods.Retrospective chart review of all infants ≤ 31 weeks of gestation born between June 1994 and October 1998. Inclusion criteria: infant ≤31 weeks of gestation who had an arterial blood sample obtained in the first 3 hours after birth. Exclusion criteria: infants were excluded if they had any medical condition that may affect the red blood cell indices (eg, twin-to-twin transfusion or fetomaternal hemorrhage).Results.Of 428 infants, 188 who met both inclusion and exclusion criteria were classified into 3 gestational age groups: group 1 = 23 to 25 weeks of gestation (n = 40); group 2 = 26 to 28 weeks (n = 60); and group 3 = 29 to 31 weeks (n = 88). There were statistically significant differences between groups 1 and 3 in HCT, Hb, mean corpuscular Hb (MCH), and mean corpuscular volume (MCV). No differences in HCT and Hb values were noted in relation to sex, mode of delivery, multiple gestation, antenatal steroids, or maternal smoking. In group 3, the mean Hb, HCT, and MCV values were higher in white infants than in black infants (16.7 ± 1.6 g/dL vs 15.4 ± 1.7 g/dL; 50.0 ± 5.0 vs 45.5 ± 4.6; and 112 ± 5 fL vs 107 ± 8 fL, respectively).Conclusions.Hb, HCT, and MCH values are described for premature infants ≤31 weeks of gestation born in North America. Hb and HCT increased, whereas MCV decreased with gestational age. Hb, HCT, and MCV values are statistically higher in white infants than in black infants.
Precertification Process
Authors:   Committee on Hospital Care
Published: August 2004

This Policy Statement was retired April 2018.
Precertification is a process still used by health insurance companies to control health care costs. Although we believe precertification is unnecessary and not cost-effective, in those instances where precertification is still being utilized, we suggest that the following procedures be adopted. This statement suggests guidelines that should help achieve this goal while allowing optimal access to care for children.