bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tattooing and High-Risk Behavior in Adolescents
Authors: Roberts Timothy A. , Ryan Sheryl A. 
Published: August 2004

Objectives. We sought to determine the prevalence and sociodemographic characteristics of tattooed adolescents in a nationally representative sample and to evaluate the association between tattooing and several high-risk behaviors.
Methods. This is a secondary analysis of the National Longitudinal Survey of Adolescent Health Public Use Dataset, which provides a nationally representative sample of 6072 adolescents collected in 1995 and 1996. The association among permanent tattoos, sociodemographic factors, and high-risk behaviors was evaluated using bivariate and logistic regression analyses using SUDAAN.
Results. Of the total sample of youths, 4.5% reported having permanent tattoos. Tattooing was significantly associated with older age, living in a single-parent household, and lower socioeconomic status but was not significantly associated with gender, ethnicity, or neighborhood type. Tattooing was strongly associated with peer substance use. Adjusting for sociodemographic factors and peer substance use, tattooing in adolescents was independently and significantly associated with reported sexual intercourse, substance use, violent behaviors, and school problems.
Conclusion. Permanent tattoos are strongly associated with high-risk behaviors among adolescents. In the clinical setting, the presence of a tattoo noted during clinical examination of an adolescent should prompt in-depth assessment for a variety of high-risk behaviors.
Longitudinal, 15-Year Follow-up of Children Born at Less Than 29 Weeks’ Gestation After Introduction of Surfactant Therapy Into a Region: Neurologic, Cognitive, and Educational Outcomes
Authors: D’Angio Carl T. , Sinkin Robert A. , Stevens Timothy P. , Landfish Nancy K. , Merzbach Joan L. , Ryan Rita M. , Phelps Dale L. , Palumbo Donna R. , Myers Gary J. 
Published: August 2004

Objective. To measure the primary and secondary school-age neurologic, cognitive, and educational outcomes in a cohort of extremely premature infants born after the introduction of exogenous surfactant therapy in a circumscribed region.Methods. Two hundred thirteen infants born at &lt;29 weeks’ gestation were cared for at a regional referral center during 1985–1987. At primary school age, neurologic and cognitive outcomes, educational achievement, school placement, health status, and socioeconomic status were determined by follow-up visit. At secondary school age, school placement and health status were evaluated by telephone interview.Results. One hundred thirty-two infants survived to school age, of whom 127 (96%) were evaluated in 1992–1995 and 126 (95%) were evaluated in 2000. Mean ages were 7.0 years at first follow-up and 14.1 years at second follow-up. At primary-school age follow-up, 19 children (15%) had cerebral palsy, 24 (19%) had a general cognitive index &lt;70, and 41 (32%) were placed in a self-contained, special classroom. Thirty-nine children (31%) had no physical or educational impairment, whereas 27 (21%) had at least 1 severe disability. At secondary school age, cerebral palsy incidence remained unchanged, whereas 36 children (29%) were placed in a special classroom. Fifty-one children (41%) had no physical or educational impairment, whereas 24 (19%) had at least 1 severe disability. Neonatal intraventricular hemorrhage and low socioeconomic status were the strongest predictors of adverse outcomes.Conclusions. Premature infants born in the surfactant era remain at high risk of neurodevelopmental compromise. Although many of these children do well, a significant minority will require intensive special educational services through secondary school age.
Regional After-Hours Urgent Care Provided by a Tertiary Children’s Hospital
Authors: Hampers Louis C. , Faries S. Glenn , Poole Steven R. 
Published: August 2004

Background. Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals.Objective. To describe a regional, community-based pediatric urgent care network (PUCN).Methods. The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children’s hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area.Results. Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3).A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network.Conclusions. The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.
A Functional Magnetic Resonance Imaging Study of Language Processing and Its Cognitive Correlates in Prematurely Born Children
Authors: Peterson Bradley S. , Vohr Betty , Kane Michael J. , Whalen Douglas H. , Schneider Karen C. , Katz Karol H. , Zhang Heping , Duncan Charles C. , Makuch Robert , Gore John C. , Ment Laura R. 
Published: August 2004

Objective. Abnormalities in brain structure, cognition, and behavior have been described in children born prematurely. However, no direct in vivo evidence has yet demonstrated abnormal neural processing in these children. Our aim was to compare brain activity associated with phonologic and semantic processing of language between term and preterm children using functional magnetic resonance imaging (fMRI).Methods. fMRI scans were acquired during a passive language comprehension task in 26 preterm children at 8 years of age and in 13 term community control children who were comparable in age, sex, maternal education, and minority status. IQ was assessed using a standard measure of intelligence.Results. The pattern of brain activity identified in a semantic processing task in the preterm children closely resembled the pattern of brain activity identified in a phonologic processing task in term controls. The greater this resemblance in the preterm children, the lower their verbal comprehension IQ scores and the poorer their language comprehension during the scanning task.Conclusions. Preterm children with the poorest language comprehension seemed not to fully engage normal semantic processing pathways in a language comprehension task. These children instead engaged pathways that normal term children used to process meaningless phonologic sounds. Aberrant processing of semantic content in these preterm children may account in part for their lower verbal IQ scores.
Infant Mortality Among Singletons and Twins in the United States During 2 Decades: Effects of Maternal Age
Authors: Misra Dawn P. , Ananth Cande V. 
Published: August 2004

Objective. Whereas it is well-established that maternal age has a U-shaped relationship with infant mortality among singletons, effects on the risk of mortality among multiple births remains unexplored. If there is a relationship, then assessment of maternal age may identify pregnancies and births that should be targeted by both clinical and public health interventions. The objective of this study was to characterize the relationship between maternal age and infant mortality in singleton and twin births in the United States.
Methods. A retrospective cohort study was conducted of all live births (singleton: n = 22 546 718; twin: n = 535 544) in the United States in 1985–1986, 1990–1991, and 1995–1996. Risks and relative risks for infant deaths by maternal age before and after adjustments for birth cohort, gravidity, birth weight, and gestational age were measured.
Results. Maternal age had a U-shaped association with mortality among singletons, with highest rates seen at extremes of age. Among twins, however, there was a steep and inverse relationship between age and mortality, with those born to young mothers experiencing the highest mortality rates. Seven percent of twin births resulted in an infant death for women who were younger than 20 years, 2.7% for those 30 to 34 years, and 2.0% for women 40 to 49 years. Even after adjustments for gravidity, birth weight, and gestational age, these trends persisted. Additional examination by timing of death indicated that this relationship was primarily a function of postneonatal rather than neonatal mortality.
Conclusions. The highest mortality among twins occurred to women who delivered in their teens and early 20s. The implications of these findings, both from a clinical and a public health perspective, deserve attention.
Growth and Metabolic Consequences of Bladder Augmentation in Children With Myelomeningocele and Bladder Exstrophy
Authors: Mingin Gerald C. , Nguyen Hiep T. , Mathias Robert S. , Shepherd John A. , Glidden David , Baskin Laurence S. 
Published: August 2004

Objective. Bladder augmentation using intestinal segments is reported to cause decreased linear growth in bladder exstrophy and myelomeningocele patients. We studied changes in calcium metabolism, height, bone chemistry, and bone density in exstrophy and myelomeningocele patients after bladder augmentation.
Methods. Thirty-three patients were prospectively admitted to the Pediatric Clinical Research Center at the University of California San Francisco for 24 hours. Blood and urine were analyzed for electrolytes, and serum was obtained for markers of calcium metabolism. Dual radiograph bone densitometry of the forearm was performed. Myelomeningocele patients were compared with nonaugmented myelomeningocele patients matched by age, gender, level of defect, and ambulatory status. Exstrophy augmented patients were compared with nonaugmented exstrophy patients. The bone densities in both groups were compared with normal children. Laboratory values and percentile heights were statistically analyzed using the Student t test; bone densitometry was analyzed using the Tukey test.
Results. Twenty-two patients with myelomeningocele and 11 with bladder exstrophy were studied. Mean follow-up was 3.7 years postaugmentation (range: 1–13 years). The results indicate a significant difference in serum bicarbonate and chloride levels between myelomeningocele patients who underwent ileal augmentation and those who did not. Although this may be indicative of chronic metabolic acidosis, there was no affect on growth or bone density when compared with controls. There were no other significant differences in laboratory values, or percentile heights, nor were any differences noted in patients who underwent gastrocystoplasty. In the exstrophy group, there were no observable differences in percentile height or laboratory values between the augmented and nonaugmented group. There were no significant differences in bone density between these 2 groups when matched for age and gender. No significant difference was seen in bone density when these groups were compared with normal children.
Conclusion. Bladder augmentation is safe and does not impact negatively on the linear growth or bone densities of patients with myelomeningocele or bladder exstrophy.
What Is the System of Care for Abused and Neglected Children in Children’s Institutions?
Authors: Tien Irene , Bauchner Howard , Reece Robert M. 
Published: August 2004

Objectives. The objectives of this study were to describe the number of children with suspected abuse or neglect (CAN) cared for in selected children’s hospitals, to determine how they are tracked and followed, and to better describe the composition, function, and financial support of child protection teams (CPTs).Methods. A self-administered survey was mailed to child abuse contact leaders at institutions that were members of the National Association of Children’s Hospitals and Related Institutions in 2001. Responses from rehabilitation hospitals and those that did not indicate whether a CPT was present were excluded.Results. One hundred thirty-four of 157 leaders responded. One hundred twenty-two (91%) met study criteria. Eighty-eight hospitals (72%) had a CPT—54% were pediatric facilities, 59% had &gt;100 beds, and 89% had a pediatric residency. Compared with institutions without a CPT, institutions with a CPT were less likely to be located in the South (28% vs 70%) and more likely to have &gt;200 beds (26% vs 1%), a medical school affiliation (92% vs 74%), and a pediatric residency (98% vs 68%).Sixty-one percent of institutions cared for &lt;300 suspected CAN cases, and 66% had 5 or fewer CAN-associated deaths the previous year. Institutions with a CPT used more comprehensive documentation for CAN, including special CAN forms (55% vs 21%) and photographs (77% vs 53%). They also more commonly referred CAN cases to law enforcement (58% vs 35%) or a CAN clinic for follow-up (52% vs 26%).Fifty-two percent of CPTs had an annual budget of $500 000 or less. The most common primary source of financial support for CPTs was the hospital (51%), although funding was usually composed of a combination of funds from the hospital, patient fees, and state government.Functions performed by CPTs included consulting on cases of CAN (89%), functioning as a liaison with child protective services (85%), tracking cases of abuse or neglect (70%), providing quality assurance on CAN cases (63%), and filing reports with child protective services (61%). Twenty-four hour consultative coverage was provided by most CPTs (79%), for which 94% provided phone consultation and 81% provided in-person consultation when necessary.Conclusions. The institutions surveyed cared for many children suspected of abuse and neglect. Thirty-eight percent did &gt;300 evaluations per year. In general, institutions with CPTs provided more comprehensive documentation and follow-up of children suspected of having been abused or neglected than institutions without CPTs. Whether this is associated with better outcomes for children suspected of abuse or neglect is unknown.
Incidence of Cranial Asymmetry in Healthy Newborns
Authors: Peitsch Wiebke K. , Keefer Constance H. , LaBrie Richard A. , Mulliken John B. 
Published: August 2004

Objective. During recent years, coincident with the recommendation to position infants supine, the incidence of posterior deformational plagiocephaly has increased dramatically. The purpose of our study was to determine whether early signs of cranial flattening could be detected in healthy neonates and to document incidence and potential risk factors.Design. A cross-sectional study was performed in healthy newborns. Physical findings, anthropometric cranial measurements, and data on pregnancy and birth were recorded.Results. The incidence of localized cranial flattening in singletons was 13%; other anomalous head shapes were found in 11% of single-born neonates. In twins, localized flat areas were much more frequent with an incidence of 56%. The following risk factors for cranial deformation were identified: assisted vaginal delivery, prolonged labor, unusual birth position, primiparity, and male gender.Conclusion. We propose that localized lateral or occipital cranial flattening at birth is a precursor to posterior deformational plagiocephaly. The infant lies supine, with the head turned to the flattened area, and is unable to roll. Intrauterine risk factors for localized cranial flattening are the same as for deformational plagiocephaly. To avoid postnatal progression from a localized cranial flattening to posterior-lateral deformational plagiocephaly, we suggest amending the recommendation of the American Academy of Pediatrics on sleep position: Alternate the head position and allow sleeping on the side and, when awake, supervise prone time.
Severe Hypersomnolence After Pituitary/Hypothalamic Surgery in Adolescents: Clinical Characteristics and Potential Mechanisms
Authors: Snow Ayelet , Gozal Evelyne , Malhotra Atul , Tiosano Dov , Perlman Rina , Vega Céline , Shahar Eli , Gozal David , Hochberg Ze’ev , Pillar Giora 
Published: August 2004

Objectives. After resection of hypothalamic/pituitary tumors, children are at risk for development of hormonal deficiencies, obesity, and hypersomnolence. However, the prevalence and pathophysiology of these complications are unclear. The purpose of this study was to assess the prevalence and severity of hypersomnolence in children after resection of pituitary tumors and to study the potential factors that contribute to this sleepiness if present. We further hypothesized that decrements in orexin levels may contribute to the sleepiness.
Methods. Six children who underwent hypothalamic/pituitary surgery were identified. Five of these patients and 5 matched control subjects underwent overnight polysomnography followed by a multiple sleep latency test. Children who had a primary sleep disorder (eg, obstructive sleep apnea) underwent treatment and were restudied subsequently (n = 2). Blood levels of pituitary hormones were measured. Blood and cerebrospinal fluid (CSF) were drawn from 4 patients and 3 control subjects to measure orexin levels.
Results. Endocrine control was appropriate in all children. Although patients had longer sleep duration but similar sleep efficiency than control subjects, relatively severe daytime somnolence was present (mean sleep latency: 10.3 ± 5.3 minutes vs 26.2 ± 1.1 minute in control subjects). Sleepiness did not correlate with body mass index or age. Furthermore, serum and CSF orexin levels did not differ between patients and control subjects.
Conclusions. Severe daytime sleepiness is frequent among children who undergo pituitary/hypothalamic surgery and does not seem to result from inappropriate cortisol or thyroxine replacement, disturbed nocturnal sleep, or low levels of orexin in the serum or CSF. We therefore speculate that other, unidentified neurohormonal mechanisms may mediate the excessive sleepiness of these patients.
Efficacy of Atomoxetine Versus Placebo in School-Age Girls With Attention-Deficit/Hyperactivity Disorder
Authors: Biederman Joseph , Heiligenstein John H. , Faries Douglas E. , Galil Nora , Dittmann Ralf , Emslie Graham J. , Kratochvil Christopher J. , Laws Harry F. , Schuh Kory J. ,   Atomoxetine ADHD Study Group
Published: August 2004

Objective. The efficacy of atomoxetine was assessed in school-age girls with attention-deficit/hyperactivity disorder (ADHD). Atomoxetine is a potent inhibitor of the presynaptic norepinephrine transporter with minimal affinity for other noradrenergic receptors or for other neurotransmitter transporters or receptors.
Methods. A total of 291 children who were 7 to 13 years of age and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for ADHD participated in 1 of 2 combined, double-blind, placebo-controlled, multisite, identical clinical trials. This intent-to-treat subset analysis examined the effects of atomoxetine versus placebo in 51 girls who were randomized to atomoxetine (n = 30) or placebo (n = 21) for 9 weeks. ADHD symptoms were assessed using parent- and investigator-rated scales.
Results. Atomoxetine was superior to placebo on the following measures: the Attention-Deficit Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator Administered and Scored Total Score; the Inattentive and Hyperactive/Impulsive subscales of the Attention-Deficit Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator Administered and Scored Total Score; the ADHD Index subscale of the Conners’ Parent Rating Scale-Revised: Short Form; and the Clinical Global Impressions of Severity of ADHD. Statistically significant efficacy was seen 1 week after randomization and remained so for the duration of the study. One patient from each of the atomoxetine and placebo groups discontinued the study as a result of an adverse event.
Conclusion. Atomoxetine was found to be effective and well tolerated for the treatment of ADHD in school-age girls.
Age at Menarche and Racial Comparisons in US Girls
Authors: Chumlea William Cameron , Schubert Christine M. , Roche Alex F. , Kulin Howard E. , Lee Peter A. , Himes John H. , Sun Shumei S. 
Published: August 2004

Background. Concern regarding change in the onset of sexual maturation of US girls has increased the need for current information on age at menarche from a national sample. Previous reports have been sparse and interpretation has been limited because of the racial composition and ages of the samples.
Objective. The objectives of this study were to estimate the distribution of age at menarche for all US girls and for non-Hispanic white, black, and Mexican American girls in the Third National Health and Nutrition Examination Survey and to test for racial differences.
Design. Menstrual status data were collected from 2510 girls aged 8.0 to 20.0 years. The Third National Health and Nutrition Examination Survey followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate proportions of girls reaching menarche at an age. Ages at menarche were estimated by probit analysis at the ages at which 10%, 25%, 50%, 75%, and 90% of the girls attained menarche.
Results. Less than 10% of US girls start to menstruate before 11 years, and 90% of all US girls are menstruating by 13.75 years of age, with a median age of 12.43 years. This age at menarche is not significantly different (0.34 years earlier) than that reported for US girls in 1973. Age at menarche for non-Hispanic black girls was significantly earlier than that of white girls at 10%, 25%, and 50% of those who had attained menarche, whereas Mexican American girls were only significantly earlier than the white girls at 25%.
Conclusion. Overall, US girls are not gaining reproductive potential earlier than in the past. The age at menarche of non-Hispanic black girls is significantly earlier than that of non-Hispanic white and Mexican American girls.
Screening and Counseling for Adolescent Alcohol Use Among Primary Care Physicians in the United States
Authors: Millstein Susan G. , Marcell Arik V. 
Published: August 2004

Objective. To examine the prevalence and quality of alcohol prevention services delivered to adolescents in the United States.Methods. A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association Masterfile. The response rate was 63%, and the final sample size was 1842 physicians. Quality of services delivered was assessed by 2 scales: quality of screening (percentage of patients screened and depth of screening questions used) and quality of education (level of effectiveness of educational methods used and frequency of use).Results. Although most physicians reported providing some degree of alcohol prevention services, their efforts were typically inconsistent, not in enough depth, and they failed to incorporate the most effective educational methods. Reported rates of universal screening and counseling were low, and younger adolescents were less likely to receive services. Physicians’ beliefs about their alcohol management skills and perceptions of resource availability were the most consistent correlates of higher quality service.Conclusions. Prospective studies that elucidate the conditions under which individual physicians do and do not screen, as well as future efforts to educate physicians about the most effective brief intervention approaches, seem warranted.