bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychotropic Medication Use in a Population of Children Who Have Attention-Deficit/Hyperactivity Disorder
Authors: Guevara James , Lozano Paula , Wickizer Thomas , Mell Loren , Gephart Harlan 
Published: August 2004

Objective. Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders.Methods. A population-based retrospective matched cohort study was conducted of a large group model health maintenance organization located in western Washington State. Eligible patients were children who were ages 3 to 17 years and were continuously enrolled and used services from January 1 to December 31, 1997 (N = 57 216). Children with ADHD were identified by a diagnosis of ADHD or a pharmacy fill for a stimulant medication using automated patient files. Children without ADHD were randomly selected and matched 4:1 to children with ADHD on age and gender. Neurobehavioral disorders and pharmacy fills for psychotropic medications were measured.Results. During 1997, 2992 children were identified as having ADHD (5.2%). These children were more likely to have a diagnosis of a non-ADHD neurobehavioral disorders (adjusted odds ratio: 6.3; 95% confidence interval: 5.4–7.3) than children without ADHD. Although most (78%) were treated with stimulant medications, children who were identified as having ADHD were also more likely to receive pharmacy fills for nonstimulant medications than were children without ADHD. Nonstimulant medications were more often used along with stimulant medications and were frequently prescribed in association with ADHD after controlling for other disorders.Conclusions. Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed.
Reduced Risk of Sudden Death From Chest Wall Blows (Commotio Cordis) With Safety Baseballs
Authors: Link Mark S. , Maron Barry J. , Wang Paul J. , Pandian Natesa G. , VanderBrink Brian A. , Estes N. A. Mark 
Published: August 2004

Objectives. In an experimental model of sudden death from baseball chest wall impact (commotio cordis), we sought to determine if sudden death by baseball impact could be reduced with safety baseballs.Background. Sudden cardiac death can occur after chest wall impact with a baseball (commotio cordis). Whether softer-than-standard (safety) baseballs reduce the risk of sudden death is unresolved from the available human data. In a juvenile swine model, ventricular fibrillation (VF) has been shown to be induced reproducibly by precordial impact with a 30-mph baseball 10 to 30 ms before the T-wave peak, and this likelihood was reduced with the softest safety baseballs (T-balls). To further test whether safety baseballs would reduce the risk of sudden death at velocities more relevant to youth sports competition, we used our swine model of commotio cordis to test baseballs propelled at the 40-mph velocity commonly attained in that sport.Methods. Forty animals received up to 3 chest wall impacts at 40 mph during the vulnerable period of repolarization for VF with 1 of 3 different safety baseballs of varying hardness, and also by a standard baseball.Results. Safety baseballs propelled at 40 mph significantly reduced the risk for VF. The softest safety baseballs triggered VF in only 11% of impacts, compared with 19% and 22% with safety baseballs of intermediate hardness, and 69% with standard baseballs.Conclusion. In this experimental model of low-energy chest wall impact, safety baseballs reduced (but did not abolish) the risk of sudden cardiac death. More universal use of these safety baseballs may decrease the risk of sudden death on the playing field for young athletes.
Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation
Authors: Fleenor Jonathan T. , Hoffman Timothy M. , Bush David M. , Paridon Stephen M. , Clark Bernard J. , Spray Thomas L. , Bridges Nancy D. 
Published: August 2004

Objective. To review and describe pneumatosis intestinalis (PI) in children who have undergone thoracic organ transplantation and evaluate potential risk factors.
Methods. We retrospectively reviewed abdominal radiographs obtained from June 1992 through September 2000 in all pediatric (age &lt;21 years) thoracic organ recipients who survived at least 1 week after transplantation. In this group, a case was defined as an episode of radiographically confirmed PI; those without PI were assigned as controls. Variables analyzed included demographic data, gastroenteritis history (stool cultures or symptoms of gastroenteritis), and transplant-related factors (ie, graft type, rejection history, immunosuppression regimen). Significance was defined as P &lt; .05.
Results. Over this 8-year period, PI occurred in 8 (7%) of 116 patients (0.86% annual risk). No child had &gt;1 diagnosed episode of PI. Of these 8 cases, 7 presented with 1 or more abdominal symptoms. Three of these children had rotavirus antigen isolated in their stool, 2 others were noted to have stool positive for Clostridium difficile toxin, and in the other 3, no pathogen was identified. All cases were treated with a regimen of intravenous antibiotics and total parenteral nutrition. There were no deaths; however, 1 patient developed an Aspergillus pulmonary infection during his course of antibiotic therapy, and another underwent an exploratory laparotomy without bowel resection. Significant risk factors included black race (unadjusted odds ratio: 16), younger age at presentation (age &lt;5 years; unadjusted odds ratio: 9), higher steroid dose (steroid dose &gt;0.5 mg/kg/d; unadjusted odds ratio: 7), and a higher tacrolimus level at presentation (tacrolimus level &gt;1; unadjusted odds ratio: 6). PI did not occur with a steroid dose &lt;0.4 mg/kg/d. Variables not associated with increased risk for developing PI included gender, graft type, total white blood cell count, recent antibiotic use, concurrent use of an antimetabolite, cytomegaloviral infection, past use of extracorporeal membrane oxygenation, and graft rejection history.
Conclusions. Significant risk factors for the development of PI in our pediatric thoracic organ transplantation population included black race, younger age, higher daily steroid dosing, and a high tacrolimus level at presentation. In the children diagnosed with PI, there were no related deaths, significant gastrointestinal sequelae, or complications. These findings suggest that in this population, PI will often have a benign course when treated aggressively, and that steroid dosing should be reduced to &lt;0.5 mg/kg/d whenever possible.
Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979–1999
Authors: Wang Guijing , Dietz William H. 
Published: August 2004

Objective. To examine the trend of obesity-associated diseases in youths and related economic costs.
Methods. Using a multiyear data file of the National Hospital Discharge Survey, 1979–1999, we analyzed the changes in obesity-associated diseases and economic costs in youths (6–17 years of age) over time. Diabetes, obesity, sleep apnea, and gallbladder disease were examined to explore the trend of the disease burden. Other obesity-associated diseases for which obesity was listed as a secondary diagnosis were also analyzed. Obesity-associated hospital costs were estimated from the discharges with obesity listed as a principal or secondary diagnosis.
Results. From 1979–1981 to 1997–1999, the percentage of discharges with obesity-associated diseases increased. The discharges of diabetes nearly doubled (from 1.43% to 2.36%), obesity and gallbladder diseases tripled (0.36% to 1.07% and 0.18% to 0.59%, respectively), and sleep apnea increased fivefold (0.14% to 0.75%). Ninety-six percent of discharges with a diagnosis of obesity listed obesity as a secondary diagnosis. Asthma and some mental disorders were the most common principal diagnoses when obesity was listed as a secondary diagnosis. Obesity-associated annual hospital costs (based on 2001 constant US dollar value) increased more than threefold; from $35 million (0.43% of total hospital costs) during 1979–1981 to $127 million (1.70% of total hospital costs) during 1997–1999.
Conclusions. Among all hospital discharges, the proportion of discharges with obesity-associated diseases has increased dramatically in the past 20 years. This increase has led to a significant growth in economic costs. These findings may reflect the impact of increasing prevalence and severity of obesity. Diet and physical activity interventions should be developed for weight loss and prevention of weight gain in youths.
Pediatrician Counseling About Preventive Health Topics: Results From the Physicians’ Practices Survey, 1998–1999
Authors: Galuska Deborah A. , Fulton Janet E. , Powell Kenneth E. , Burgeson Charlene R. , Pratt Michael , Elster Arthur , Griesemer Bernard A. 
Published: August 2004

Objective. Government agencies and national organizations recommend that physicians counsel their child and adolescent patients about preventive health topics. Using data from a national survey, we describe the counseling patterns of pediatricians in regard to 9 recommended preventive health topics.Methodology. Between October 1998 and April 1999, information was collected from 907 of 1760 primary care pediatricians randomly selected from a nationally representative sample. Through either a telephone interview or a mail survey, pediatricians were asked how frequently in the past month they counseled about 9 preventive health topics during the well-care visits or routine check-ups of their patients. Pediatricians answered questions regarding their patients aged 2 to 5, 6 to 12, and 13 to 18 years.Results. Over 80% of the pediatricians counseled about 1 or more recommended preventive health topics during the well-care visits or routine check-ups of their patients. As compared with pediatricians who did not counsel about any topic, pediatricians who counseled were significantly more likely to be female and spend longer amounts of time with their patients during these visits. The frequency with which specific preventive health topics were discussed varied with the topic and the age of the patient.Conclusion. Most pediatricians routinely counsel about some, but not all, recommended preventive health topics. An understanding of why pediatricians selectively counsel about specific topics is needed.
Use of Sunscreen, Sunburning Rates, and Tanning Bed Use Among More Than 10 000 US Children and Adolescents
Authors: Geller Alan C. , Colditz Graham , Oliveria Susan , Emmons Karen , Jorgensen Cynthia , Aweh Gideon N. , Frazier A. Lindsay 
Published: August 2004

Objectives. To describe the association of sunscreen use, sunburning, and tanning bed use by age, sex, residence, and psychosocial variables associated with tan-seeking behaviors, and to compare these findings with sun protection recommendations from federal agencies and cancer organizations.Methods. A cross-sectional study, from all 50 states, of 10 079 boys and girls 12 to 18 years of age in 1999. Data were collected from self-report questionnaires with the children of the participants from the Nurses Health Study (Growing Up Today Study).Results. The prevalence of sunscreen use was 34.4% with girls more likely to use sunscreen than boys (40.0 vs 26.4, odds ratio: 1.86; 95% confidence interval: 1.70–2.03). Eighty-three percent of respondents had at least 1 sunburn during the previous summer, and 36% had 3 or more sunburns. Nearly 10% of respondents used a tanning bed during the previous year. Girls were far more likely than boys to report tanning bed use (14.4 vs 2.4), and older girls (ages 15–18) were far more likely than younger girls (ages 12–14) to report tanning bed use (24.6% vs 4.7). Tanning bed use increased from 7% among 14-year-old girls to 16% by age 15, and more than doubled again by age 17 (35%; N = 244). Multivariate analysis demonstrated that attitudes associated with tanning, such as the preference for tanned skin, having many friends who were tanned, and belief in the worth of burning to get a tan, were generally associated with sporadic sunscreen use, more frequent sunburns, and increased use of tanning beds.Conclusions. Our findings suggest that many children are at subsequent risk of skin cancer because of suboptimal sunscreen use, high rates of sunburning, and tanning bed use. Recommendations in the United States for improved sun protection and avoidance of tanning beds and sunburning, which began in the early 1990s, have been primarily unheeded. Nationally coordinated campaigns with strong policy components must be developed and sustained to prevent skin cancer in a new generation of children and adolescents.
Tattoos and Body Piercings as Indicators of Adolescent Risk-Taking Behaviors
Authors: Carroll Sean T. , Riffenburgh Robert H. , Roberts Timothy A. , Myhre Elizabeth B. 
Published: August 2004

Purpose. This study assessed tattoos and body piercings as markers of risk-taking behaviors in adolescents.
Methods. A 58-question survey, based on the 1997 Centers for Disease Control and Prevention Youth Risk Behavior Survey, was offered to all adolescent beneficiaries that came to the Adolescent Clinic. The survey contained standard Youth Risk Behavior Survey questions that inquire about eating behavior, violence, drug abuse, sexual behavior, and suicide. Questions about tattoos and body piercings were added for the purposes of this study.
Results. Participants with tattoos and/or body piercings were more likely to have engaged in risk-taking behaviors and at greater degrees of involvement than those without either. These included disordered eating behavior, gateway drug use, hard drug use, sexual activity, and suicide. Violence was associated with males having tattoos and with females having body piercings. Gateway drug use was associated with younger age of both tattooing and body piercing. Hard drug use was associated with number of body piercings. Suicide was associated with females having tattoos and younger age of both tattooing and body piercing. Tattoos and body piercings were found to be more common in females than males.
Conclusions. Tattoos and/or body piercings can alert practitioners to the possibility of other risk-taking behaviors in adolescents, leading to preventive measures, including counseling. Tattoo and body piercing discovery should be an important part of a health maintenance visit to best direct adolescent medical care.
Television Viewing and Television in Bedroom Associated With Overweight Risk Among Low-Income Preschool Children
Authors: Dennison Barbara A. , Erb Tara A. , Jenkins Paul L. 
Published: August 2004

Context. Television (TV) viewing is associated with obesity among school-aged children, adolescents, and adults, but this relationship has not been evaluated in preschool-aged children.Objective. To describe the TV/video viewing habits of a multiethnic, low-income preschool population of children and to determine whether TV/video viewing is related to their adiposity.Design. Cross-sectional survey of parents/guardians with measurements of children’s height and weight.Setting and Participants. Two thousand seven hundred sixty-one adults with children, 1 through &lt;5 years, from 49 New York State agencies of the Supplemental Nutrition Program for Women, Infants, and Children.Outcome Measures. Cross-sectional relationships between the amount of time the child spends viewing TV/video and the presence of a TV set in the child’s bedroom, with the prevalence of overweight children (body mass index [BMI] &gt;85th percentile) after adjustment for potential confounders.Results. Mean TV/video viewing times were higher among black children and Hispanic children than white children and increased with the child’s age. In multiple logistic regression, the odds ratio of children having a BMI &gt;85th percentile was 1.06 (95% confidence interval [CI]: 1.004–1.11) for each additional hour per day of TV/video viewed, independent of child age, child sex, parental educational attainment, and race/ethnicity. Almost 40% of children had a TV set in their bedroom; they were more likely to be overweight and spent more time (4.6 hours per week) watching TV/video than children without a TV in their bedroom. In multiple logistic regression, the odds ratio of having a BMI &gt;85th percentile was 1.31 (95% CI: 1.01–1.69) among those with a TV in their bedroom versus those without a TV, after statistical adjustment for child age, child sex, child TV/video viewing hours per week, maternal BMI, maternal education, and race/ethnicity.Conclusions. This study extends the association between TV viewing and risk of being overweight to younger, preschool-aged children. A TV in the child’s bedroom is an even stronger marker of increased risk of being overweight. Because most children watch TV by age 2, educational efforts about limiting child TV/video viewing and keeping the TV out of the child’s bedroom need to begin before then.
Randomized Trial of Postpartum Care After Hospital Discharge
Authors: Gagnon Anita J. , Dougherty Geoffrey , Jimenez Vania , Leduc Nicole 
Published: August 2004

Objective. Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants. These may be prevented by adequate breastfeeding frequency; however, rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent. This study addressed the question, “Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours’ postpartum who received either community nurse (home visit) or hospital nurse (clinic) follow-up?”Methods. A randomized, controlled trial was conducted at a university teaching hospital (3700 births/y) and affiliated community health centers. A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge; 513 (87.5%) contributed data on 1 or more outcomes. Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home (experimental) or at the hospital (control) were provided. The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks’ postpartum by maternal diary and weight at home by research assistants, masked to group allocation.Results. No clinically important or statistically significant group differences were found in daily breastfeeding frequency (mean difference experimental minus control = 0.1 feeds [95% confidence interval: −0.1–0.3]) or daily rate of infant weight gain (−1.1 g [−2.5–0.3]) based on intention-to-treat analyses.Conclusions. Follow-up by nurses after short postpartum hospital stays, in either the home or a hospital-based clinic, of healthy infants discharged at &lt;36 hours seems associated with satisfactory infant breastfeeding outcomes.
A Multicenter, Randomized, Controlled Trial Comparing Surfaxin (Lucinactant) Lavage With Standard Care for Treatment of Meconium Aspiration Syndrome
Authors: Wiswell Thomas E. , Knight Gail R. , Finer Neil N. , Donn Steven M. , Desai Hemant , Walsh William F. , Sekar Krishnamurthy C. , Bernstein Graham , Keszler Martin , Visser Valya E. , Merritt T. Allen , Mannino Frank L. , Mastrioianni Lisa , Marcy Brian , Revak Susan D. , Tsai Huei , Cochrane Charles G. 
Published: August 2004

Objective. Infants with meconium aspiration syndrome (MAS) have marked surfactant dysfunction. Airways and alveoli of affected neonates contain meconium, inflammatory cells, inflammatory mediators, edema fluid, protein, and other debris. The objective of this study was to compare treatment with bronchoalveolar lavage using dilute Surfaxin with standard therapy in a population of newborn infants with MAS.Methods. Inclusion criteria were 1) gestational age ≥35 weeks, 2) enrollment within 72 hours of birth, 3) diagnosis of MAS, 4) need for mechanical ventilation, and 5) an oxygenation index ≥8 and ≤25. Subjects were randomized to either lavage with Surfaxin or standard care (2:1 proportion). In lavaged infants, a volume of 8 mL/kg dilute Surfaxin (2.5 mg/mL) was instilled into each lung over approximately 20 seconds followed by suctioning after 5 ventilator breaths. The procedure was repeated twice. The third and final lavage was with a more concentrated solution (10 mg/mL) of Surfaxin.Results. Twenty-two infants were enrolled (15 Surfaxin and 7 control). Demographic characteristics were similar. There were trends (not significant) for Surfaxin-lavaged infants to be weaned from mechanical ventilation earlier (mean of 6.3 vs 9.9 days, respectively), as well as to have a more rapid decline in their oxygenation indexes compared with control infants, the latter difference persisting for the 96-hour-long study period. The therapy was safe and generally well tolerated by the infants.Conclusions. Dilute Surfaxin lavage seems to be a safe and potentially effective therapy in the treatment of MAS. Data from this investigation support future prospective, controlled clinical trials of bronchoalveolar lavage with Surfaxin in neonates with MAS.
Youth Access Interventions Do Not Affect Youth Smoking
Authors: Fichtenberg Caroline M. , Glantz Stanton A. 
Published: August 2004

Objective. To determine the effectiveness of laws restricting youth access to cigarettes on prevalence of smoking among teens.
Methods. We conducted a systematic review of studies that reported changes in smoking associated with the presence of restrictions on the ability of teens to purchase cigarettes. We calculated the correlation between merchant compliance levels with youth access laws and prevalence (30-day and regular) prevalence of youth smoking, and between changes in compliance and prevalence associated with youth access interventions. We also conducted a random effects meta-analysis to determine the change in youth prevalence associated with youth access interventions from studies that included control communities.
Results. Based on data from 9 studies, there was no detectable relationship between the level of merchant compliance and 30-day (r = .116; n = 38 communities) or regular (r = .017) smoking prevalence. There was no evidence of a threshold effect. There was no evidence that an increase in compliance with youth access restrictions was associated with a decrease in 30-day (r = .294; n = 18 communities) or regular (r = .274) smoking prevalence. There was no significant difference in youth smoking in communities with youth access interventions compared with control communities; the pooled estimate of the effect of intervention on 30-day prevalence was −1.5% (95% confidence interval: −6.0% to +2.9%).
Conclusions. Given the limited resources available for tobacco control, as well as the expense of conducting youth access programs, tobacco control advocates should abandon this strategy and devote the limited resources that are available for tobacco control toward other interventions with proven effectiveness.