bluuebunny/crossref_metadata_2025_split huggingface dataset:
Will I Be Alive in 2005? Adolescent Level of Involvement in Risk Behaviors and Belief in Near-Future Death
Authors: Valadez-Meltzer Adela , Silber Tomas J. , Meltzer Arthur A. , D'Angelo Lawrence J. 
Published: July 2005

Objective.We examined the association between a belief in one's future mortality and various risk-taking behaviors among urban black adolescents. In particular, we investigated whether adolescents with higher levels of participation in various risk behaviors were more likely to believe in their future death as compared with adolescents with lesser levels of risk-taking behavior.Methods.Data obtained from April 1994 to March 1997 were analyzed for a total of 2694 adolescents, aged 12 to 21 years. The odds of believing that one would die within the next 2 years were calculated for various levels of participation in risk behaviors involving alcohol, drugs, and criminal or violent acts.Results.A total of 160 adolescents (7.1% of all boys and 5.4% of all girls) reported that they believed that they would die within the next 2 years. The adjusted odds of future death belief among adolescents who both actively engaged in and knew others who participated in all of the various risk behaviors, relative to adolescents who neither personally engaged in nor knew others who participated in any of the risk behaviors, was 3.22 (95% confidence interval [CI]: 2.01–5.17) vs 1.14 (95% CI: 0.67–1.95) for drug use and drug selling, 2.01 (95% CI: 1.38–2.92) vs 0.8 (95% CI: 0.39–1.62) for combined alcohol and drug use, and 5.60 (95% CI: 2.03–15.47) vs 1.61 (95% CI: 1.08–2.42) for violent physical behavior. In addition, residence in a foster home was significantly associated with death belief after adjustment for all other variables.Conclusions.There is a significant relationship between certain risk behaviors and belief in near-future death. Moreover, higher levels of involvement in risk behaviors were associated with a stronger likelihood of belief in near-future mortality. Identification of adolescents who engage in certain risky behaviors, combined with a recognition of the degree to which the adolescent participates in the particular behavior(s), may be used to facilitate more rapid intervention among youths who either believe in their imminent demise or engage in behaviors that increase the likelihood of their untimely death.
Comparison of Minitrampoline- and Full-Sized Trampoline-Related Injuries in the United States, 1990–2002
Authors: Shields Brenda J. , Fernandez Soledad A. , Smith Gary A. 
Published: July 2005

Objective. To compare mini- and full-sized trampoline–related injuries in the United States.Methods. A retrospective analysis of data was conducted for all ages from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission from 1990 to 2002. We compared 137 minitrampoline-related injuries with 143 full-sized trampoline–related injuries, randomly selected from all full-sized trampoline–related injuries reported to the NEISS during the study period.Results. Patients ranged in age from 1 to 80 years (mean [SD]: 13.9 [17.7]) and 2 to 52 years (mean [SD]: 11.0 [8.0]) for mini- and full-sized trampoline–related injuries, respectively. Most patients were younger than 18 years (82% mini, 91% full-sized). Thirty-two percent of minitrampoline- and 19% of full-sized trampoline–related injuries were to children who were younger than 6 years; girls predominated (63% mini, 51% full-sized). Children who were younger than 6 years were more likely to be injured on a minitrampoline than on a full-sized trampoline, when compared with 6- to 17-year-olds (odds ratio [OR]: 2.43; 95% confidence interval [CI]: 1.33–4.47). The majority of injuries occurred at home (87% mini, 89% full-sized). All patients who were injured on a minitrampoline were treated and released, whereas 5% of patients who were injured on a full-sized trampoline were admitted to the hospital. On minitrampolines, children who were younger than 6 years were at risk for head lacerations (OR: 4.98; 95% CI: 1.71–16.03), and children who were 6 to 17 years were at risk for lower extremity strains or sprains (OR: 6.26; 95% CI: 1.35–59.14). Children who were 6 to 17 years and injured on a full-sized trampoline were at risk for lower extremity strains or sprains (OR: 4.85; 95% CI: 1.09–44.93). Lower extremity strains or sprains were the most common injury sustained by adults (18 years and older; 33% mini, 15% full-sized).Conclusions. Injury patterns were similar for mini- and full-sized trampolines, although minitrampoline–related injuries were less likely to require admission to the hospital and more commonly resulted in head lacerations among children who were younger than 6 years. Risk for injury could not be determined because of the lack of data regarding duration of exposure to risk. We therefore conclude that the use of full-sized trampolines by children should follow the policy recommendations of the American Academy of Pediatrics. Trampolines, including minitrampolines, should be regarded as training devices and not as toys. Until more data are available regarding exposure to risk, we caution against the use of the minitrampoline as a play device by children in the home, which is where most minitrampoline-related injuries occur.
Screening and Counseling Associated With Obesity Diagnosis in a National Survey of Ambulatory Pediatric Visits
Authors: Cook Stephen , Weitzman Michael , Auinger Peggy , Barlow Sarah E. 
Published: July 2005

Objective. To examine clinician-reported diagnosis of obesity and frequency of blood pressure assessment and diet and exercise counseling during ambulatory visits made by children and adolescents.Methods. The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey 1997 to 2000 were combined for visits to clinicians of 2- to 18-year-olds. Well-child visits (WCVs) were examined for frequencies of obesity diagnosis, blood pressure screening, and diet and exercise counseling in relation to patient and clinician characteristics. Multivariate models examined the relationship of patient and visit characteristics with diet and exercise counseling.Results. Of the 32 930 ambulatory visits made by 2- to 18-year-olds in 1997–2000, obesity was diagnosed at 0.78% of all visits and 0.93% of WCVs. Blood pressure assessment was reported in 61.1% of WCVs with obesity diagnosis compared with 43.9% of WCVs without obesity diagnosis. WCVs with obesity diagnosis had higher diet counseling rates (88.4% vs 35.7%) and higher exercise counseling rates (69.2% vs 18.6%). Diet counseling was reported for 88.4% and exercise counseling was reported for 69.2% of visits with an obesity diagnosis compared with 35.7% and 18.6% during WCVs without a diagnosis of obesity. In multivariate analyses, factors associated with diet counseling at WCVs were diagnosis of obesity (odds ratio [OR]: 12.9; 95% confidence interval [CI]: 3.0–55.3), being seen by pediatricians (OR: 2.5; 95% CI: 1.6–3.9), 2- to 5-year-olds compared with 12- to 18-year-olds (OR: 0.7; 95% CI: 0.5–1.0), and self-pay compared with private insurance visits (OR: 0.6; 95% CI: 0.4–0.9). Associations with exercise counseling were similar to those for diet counseling, but exercise counseling occurred less frequently in visits by black youths compared with white youths (OR: 0.5; 95% CI: 0.3–0.8).Conclusions. Clinicians may overlook obesity during WCVs. Programs to increase obesity diagnosis could improve diet and exercise counseling rates, but even with diagnosis of obesity, significant opportunities for screening and intervention are missed.
Increased Expression of Urinary Matrix Metalloproteinases Parallels the Extent and Activity of Vascular Anomalies
Authors: Marler Jennifer J. , Fishman Steven J. , Kilroy Susan M. , Fang Jianmin , Upton Joseph , Mulliken John B. , Burrows Patricia E. , Zurakowski David , Folkman Judah , Moses Marsha A. 
Published: July 2005

Objective. Matrix metalloproteinases (MMPs) and the angiogenic proteins basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) have been implicated in mechanisms of human cancer and metastasis. Assays were conducted on the urine of patients with vascular anomalies (tumors and malformations), relatively common and occasionally life-threatening disorders for which few therapies exist. We sought to determine whether these angiogenesis modulators are present in the urine and whether their expression is associated with the extent and clinical course of the vascular lesion.
Methods. A total of 217 patients with vascular anomalies and 74 age-matched control subjects participated. Urinary MMP expression was determined by substrate gel electrophoresis. Urinary bFGF and VEGF levels were measured by enzyme-linked immunosorbent assay. Each patient was assigned to 1 of 2 categories (tumor or malformation) and 1 of 9 specific groups. Extent of the vascular lesion and activity were scored by a blinded clinician.
Results. Urinary high molecular weight (hMW) MMPs and bFGF were significantly increased in patients with vascular tumors (53%) and vascular malformations (41%), compared with control subjects (22%). These percentages increased as a function of extent of the lesion and disease activity. hMW MMPs were increased in 4 groups: infantile hemangioma, other vascular neoplasms, lymphatic malformation and capillary-lymphaticovenous malformations, and extensive and unremitting capillary malformation and arteriovenous malformation. No significant differences among the groups were detected for low molecular weight MMPs or VEGF.
Conclusions. Expression patterns of hMW MMPs and bFGF in the urine of patients with tumors and malformations are consistent with their different clinical behavior. These data represent the first evidence that MMPs are elevated in the urine of children with vascular anomalies. These data also suggest that the increased expression of urinary MMPs parallels the extent and activity of vascular anomalies in children. In addition to tumors, vascular malformations are angiogenesis dependent, suggesting that progression of a vascular malformation might be suppressed by angiogenic inhibitors, which would target bFGF and MMPs.
Adverse Health Consequences That Co-occur With Depression: A Longitudinal Study of Black Adolescent Females
Authors: DiClemente Ralph J. , Wingood Gina M. , Lang Delia L. , Crosby Richard A. , Salazar Laura F. , Harrington Kathy , Hertzberg Vicki Stover 
Published: July 2005

Objective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents.Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14–18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior.Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors.Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.
Pediatricians' Reported Practices Regarding Developmental Screening: Do Guidelines Work? Do They Help?
Authors: Sand Nina , Silverstein Michael , Glascoe Frances P. , Gupta Vidya B. , Tonniges Thomas P. , O'Connor Karen G. 
Published: July 2005

Background. In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties.Objectives. To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties.Methods. We mailed a survey to a random sample of AAP members. We used multivariate logistic/linearregression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities.Results. Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a &gt;10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates.Conclusions. Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities.
Spectrum of Gross Motor Function in Extremely Low Birth Weight Children With Cerebral Palsy at 18 Months of Age
Authors: Vohr Betty R. , Msall Michael E. , Wilson Dee , Wright Linda L. , McDonald Scott , Poole W. Kenneth 
Published: July 2005

Objective. The purpose of this study was to evaluate the relationship between cerebral palsy (CP) diagnoses as measured by the topographic distribution of the tone abnormality with level of function on the Gross Motor Function Classification System (GMFCS) and developmental performance on the Bayley Scales of Infant Development II (BSID-II). It was hypothesized that (1) the greater the number of limbs involved, the higher the GMFCS and the lower the BSID-II Motor Scores and (2) there would be a spectrum of function and skill achievement on the GMFCS and BSID-II Motor Scores for children in each of the CP categories.Methods. A multicenter, longitudinal cohort study was conducted of 1860 extremely low birth weight (ELBW) infants who were born between August 1, 1995 and February 1, 1998, and evaluated at 18 to 22 months' corrected age. Children were categorized into impairment groups on the basis of the typography of neurologic findings: spastic quadriplegia, triplegia, diplegia, hemiplegia, monoplegia, hypotonic and/or athetotic CP, other abnormal neurologic findings, and normal. The neurologic category then was compared with GMFCS level and BSID-II Motor Scores.Results. A total of 282 (15.2%) of the 1860 children evaluated had CP. Children with more limbs involved had more abnormal GMFCS levels and lower BSID-II scores, reflecting more severe functional limitations. However, for each CP diagnostic category, there was a spectrum of gross motor functional levels and BSID-II scores. Although more than 1 (26.6%) in 4 of the children with CP had moderate to severe gross motor functional impairment, 1 (27.6%) in 4 had motor functional skills that allowed for ambulation.Conclusions. Given the range of gross motor skill outcomes for specific types of CP, the GMFCS is a better indicator of gross motor functional impairment than the traditional categorization of CP that specifies the number of limbs with neurologic impairment. The neurodevelopmental assessment of young children is optimized by combining a standard neurologic examination with measures of gross and fine motor function (GMFCS and Bayley Psychomotor Developmental Index). Additional studies to examine longer term functional motor and adaptive-functional developmental skills are required to devise strategies that delineate therapies to optimize functional performance.
Association Between Streptococcal Infection and Obsessive-Compulsive Disorder, Tourette's Syndrome, and Tic Disorder
Authors: Mell Loren K. , Davis Robert L. , Owens David 
Published: July 2005

Objective. Reports have suggested that streptococcal infection may be etiologically related to pediatric autoimmune neuropsychiatric disorders (PANDAS), but there are few good epidemiologic studies to support this theory. Using population-based data from a large West-Coast health maintenance organization, we assessed whether streptococcal infection was associated with increased risk for obsessive-compulsive disorder (OCD), Tourette's syndrome (TS), or tic disorder.Methods. This is a case-control study of children 4 to 13 years old receiving their first diagnosis of OCD, TS, or tic disorder between January 1992 and December 1999 at Group Health Cooperative outpatient facilities. Cases were matched to controls by birth date, gender, primary physician, and propensity to seek health care.Results. Patients with OCD, TS, or tic disorder were more likely than controls to have had prior streptococcal infection (OR: 2.22; 95% CI: 1.05, 4.69) in the 3 months before onset date. The risk was higher among children with multiple streptococcal infections within 12 months (OR: 3.10; 95% CI: 1.77, 8.96). Having multiple infections with group A β-hemolytic streptococcus within a 12-month period was associated with an increased risk for TS (OR: 13.6; 95% CI: 1.93, 51.0). These associations did not change appreciably when limited to cases with a clear date of onset of symptoms or with tighter matching on health care behavior.Conclusion. These findings lend epidemiologic evidence that PANDAS may arise as a result of a postinfectious autoimmune phenomenon induced by childhood streptococcal infection.
Clinical Effectiveness and Cost-Effectiveness of the Use of the Thyroxine/Thyroxine-Binding Globulin Ratio to Detect Congenital Hypothyroidism of Thyroidal and Central Origin in a Neonatal Screening Program
Authors: Lanting Caren I. , van Tijn David A. , Loeber J. Gerard , Vulsma Thomas , de Vijlder Jan J. M. , Verkerk Paul H. 
Published: July 2005

Context. Since the introduction of screening for congenital hypothyroidism (CH) in 1974, the optimal laboratory strategy has been the subject of debate.
Objective. To assess the clinical effectiveness and cost-effectiveness of various types of thyroxine (T4)-based strategies to screen for CH.
Design, Setting, and Participants. In the Netherlands, since January 1, 1995, a primary T4 determination with supplemental thyroid-stimulating hormone (TSH) and T4-binding globulin (TBG) measurements has been used. Results were calculated from cumulative findings for 1181079 children screened between January 1, 1995, and December 31, 2000.
Main Outcome Measures. Rates of detection of patients with CH of thyroidal origin (CH-T) or CH of central origin (CH-C), false-positive rates, laboratory costs, and costs of initial diagnostic evaluations.
Results. All known infants (n = 393) with CH-T and 92% (n = 66) of infants with CH-C were detected on the basis of low T4 levels, TSH elevation, and/or low T4/TBG ratios. If the decision to refer had been based solely on TSH elevation, then 94% of patients with CH-T and none of the patients with CH-C would have been detected. If low T4 levels (≤−3.0 SD) and TSH elevation had been used as the criteria for referral, then the rates of detection would have been 96% for CH-T and 31% for CH-C. The false-positive rates for the 3 approaches were 0.5, 3.3, and 4.7 cases per case detected, respectively. The introduction of the T4/TBG ratio into a program using a primary T4 with supplemental TSH approach generates an extra cost of $11206 per additional case detected. The average costs to detect 1 patient are comparable for the 3 approaches. In addition, our data revealed a substantially greater prevalence of CH-C than reported previously (1 case per 16404 children, compared with earlier estimates of 1 case per 26000 infants to 1 case per 29000 infants).
Conclusions. The T4 plus TSH plus TBG approach is a recommendable strategy for neonatal CH screening. It offers outstanding detection of patients with CH-C, in addition to those with CH-T, with acceptable costs.
Standard Drug Concentrations and Smart-Pump Technology Reduce Continuous-Medication-Infusion Errors in Pediatric Patients
Authors: Larsen Gitte Y. , Parker Howard B. , Cash Jared , O’Connell Mary , Grant MaryJo C. 
Published: July 2005

Objective. To determine if combining standard drug concentrations with “smart-pump” technology reduces reported medication-infusion errors.
Design. Preintervention and postintervention comparison of reported medication errors related to infusion therapies during the calendar years 2002 and 2003.
Setting. A 242-bed university-affiliated tertiary pediatric hospital.
Intervention. Change in continuous-medication-infusion process, comprising the adoption of (1) standard drug concentrations, (2) “smart” syringe pumps, and (3) human-engineered medication labels.
Main Outcome Measures. Comparison of reported continuous-medication-infusion errors before and after the intervention.
Results. The number of reported errors dropped by 73% for an absolute risk reduction of 3.1 to 0.8 per 1000 doses. Preparation errors that occurred in the pharmacy decreased from 0.66 to 0.16 per 1000 doses; the number of 10-fold errors in dosage decreased from 0.41 to 0.08 per 1000 doses.
Conclusions. The use of standard drug concentrations, smart syringe pumps, and user-friendly labels reduces reported errors associated with continuous medication infusions. Standard drug concentrations can be chosen to allow most neonates to receive needed medications without concerns related to excess fluid administration.