bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Program to Immunize Hospitalized Preschool-aged Children: Evaluation and Impact
Authors: Bell Louis M. , Pritchard Michele , Anderko Rebecca , Levenson Robert 
Published: August 2004

Objective. The Standards for Pediatric Immunization Practices suggest that hospitalization be viewed as an opportunity to vaccinate children. The purpose of the present study is 1) to determine the immunization status of an urban population of hospitalized preschool-aged children, 2) to study the impact of an immunization program designed to vaccinate hospitalized 0 to 2-year-old children who are underimmunized at admission, and 3) to make immunization a routine part of care for the hospitalized child.Methods. Prospective evaluation of the immunization status of hospitalized 0 to 2-year-old residents of Philadelphia admitted to an urban children's hospital was performed. With verification of the child's immunization record through the primary care provider (PCP), needed immunizations were given and records were forwarded to notify the PCP. Educational information was provided to families and health care providers.Main Outcome Measure. The percentage of children fully immunized on admission compared with the percentage at the time of discharge.Results. Two thousand three hundred twenty-nine children from 0 to 2 years of age were hospitalized during the 22-month study period. Immunization records were verified in 86% (2006), requiring an average of 1.5 phone calls to the PCP. The mean patient age was 10 months. Average hospital length of stay was 4 days. On admission, 49% (980) of the 2006 study patients were fully immunized. The remaining 51% (1026) were eligible for vaccination. Immunizations were delayed greater than or equal to 2 months in 18% (355) of the children. Neither type of health care insurance nor site of primary care affected the immunization status of those evaluated at the time of admission.Sixty-six percent (N = 674) of eligible patients received at least one vaccination before hospital discharge. Medical contraindications accounted for only 4% of the reasons eligible patients were not immunized. Of the 2006 children evaluated, the percentage of those fully vaccinated for age increased significantly from 44% on admission to 70% on discharge.Conclusion. As a result of this program, there was a significant improvement in vaccination percentage at the time of hospital discharge in this group of urban preschool-aged children. The development of an immunization program to vaccinate hospitalized preschool children is an opportunity to immunize in the urban setting where there is a high prevalence of underimmunization.In addition, it provides an opening for educational programs for families, nurses, and housestaff and linkage to the community PCPs.
Expenditures for Care of Children With Chronic Illnesses Enrolled in the Washington State Medicaid Program, Fiscal Year 1993
Authors: Ireys Henry T. , Anderson Gerard F. , Shaffer Tom J. , Neff John M. 
Published: August 2004

Objective. We calculated expenditures for children with one of eight selected chronic health conditions who were enrolled in the Washington State Medicaid program and compared them with payments for all Medicaid-enrolled children. We examined variation in mean, median, and total expenditures and identified expenditure sources.
Methods. This study analyzed Medicaid claims data for 310 977 children aged 0 to 18 who were enrolled at any time in fiscal year 1993. Tracer conditions were used to examine expenditure variation within and between diagnostic groupings. A total of 18 233 children (5.9%) had at least one of the conditions. Expenditures were calculated based on payments made by the Medicaid program.
Results. Children with one of the eight selected conditions incurred mean expenditures of $3800, compared with $955 for all Medicaid-enrolled children. Mean payments associated with the selected conditions ranged from 2.5 times to 20 times more than payments to all children. Approximately 10% of children accounted for approximately 70% of the payments in general and in each diagnostic grouping. Variation in mean, median, and total expenditures was extensive among the conditions. For most conditions, inpatient stays accounted for the greatest proportion of expenditures; for some conditions, durable equipment, home nursing, and medication-related services accounted for substantial proportions of total expenditures.
Conclusions. Medical care for children with selected chronic health conditions is 2.5 to 20 times more expensive than children in general, depending on the condition. A relatively few children account for the majority of expenditures. Extensive variation in mean, median, and total expenditures suggests that different conditions will need to be kept distinct for purposes of establishing payment rates. Children with certain conditions are vulnerable to restrictions in specific services, depending on what restrictions are imposed by a financing program. Further analyses are needed to identify risk-adjustment strategies to support delivery of high-quality services to this population of children as they migrate into managed-care environments.
Outcome of Small-for-Gestational Age and Appropriate-for-Gestational Age Infants Born Before 27 Weeks of Gestation
Authors: Bardin Claudette , Zelkowitz Phyllis , Papageorgiou Apostolos 
Published: August 2004

Objective. To evaluate the consequences of being small-for-gestational age at extremely low gestational age.
Methodology. Comparison of two historical cohorts of small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) infants born between 24 and 26 6/7 weeks of gestation (gestational age estimated by early ultrasound at 16 to 18 weeks). Data were collected retrospectively on 191 successive admissions to the neonatal intensive care unit between January 1, 1983, and December 31, 1992. These included: demographic and maternal information, delivery mode and condition at birth, mortality, neonatal intensive care unit morbidities (respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosis [PDA], chronic lung disease [CLD], retinopathy of prematurity [ROP], necrotizing enterocolitis, infection), nutrition, and length of hospitalization.
Results. Forty-one (21%) of the 191 infants were classified as SGA. Those with congenital anomalies (10% in the SGA and 2% in the AGA group) were excluded from further analysis. Despite a similar rate of respiratory distress syndrome (50%), the SGA infants had a greater rate of failure of indomethacin treatment for PDA closure (54% vs 32% for AGA), a higher risk for CLD defined as a need for supplementary oxygen at 36 weeks (65% vs 32% for AGA), a more prolonged need for oxygen supplementation and ventilatory support (94 days vs 68 days for AGA and 58 days vs 40 days for AGA, respectively). SGA infants were also at greater risk for developing severe ROP (stage ≥III) (65% vs 12% for AGA).
Conclusions.  For infants born before 27 weeks, being small-for-gestational age confers additional risks for severe morbidity, ie, PDA ligation, CLD, and ROP.
Treatment of Childhood Syndrome X
Authors: Hardin Dana S. , Hebert Jesse D. , Bayden Todd , Dehart Mary , Mazur Lynette 
Published: August 2004

Objective. Hyperinsulinemia, hyperlipidemia, hypertension, and coronary artery disease comprise a quartet known as Syndrome X. This syndrome was first described in adults, but has recently been described in children and adolescents. The purpose of our study was to determine if diet or exercise is able to change the clinical profile of Syndrome X in children.
Study Design. We recruited 36 obese (% ideal body weight = 170.3 ± 31.1), children (9 to 12 yrs old) known to have high fasting cholesterol levels (177.5 ± 33.5 mg/dL). Each participated in a 6-week protocol in one of three groups: control (C), diet (D), or exercise (E). Twenty-five of the patients completed the study with full compliance. At the beginning and end of the study, we measured weight, height, blood pressure, serum insulin, and a lipid profile including: cholesterol, low density lipoprotein, high density lipoprotein (HDL), triglycerides, and apolipoprotein A (ApoA). All subject groups were similar before the study. The D group had the greatest attrition (40%) and all of the E group completed the study.
Results. After the 6-week study period, there was no significant weight loss or change in body mass index for any group. There was no significant change in blood pressure and there was no significant decline of fasting cholesterol or low density lipoprotein levels in any of the groups. HDL levels were low in all groups and did not significantly change with treatment. There was a significant decline in the triglyceride levels in both the diet and exercise groups after the study (preD = 150 ± 60; postD = 122 ± 50; preE = 165 ± 50; postE = 116 ± 39). Both the D and E groups also demonstrated a significant decrease in ApoA levels (preD = 174 ± 33; postD = 142 ± 24; preE = 200 ± 50; postE = 161 ± 23). Most impressively, fasting insulin levels significantly decreased with both diet and exercise, but did not change in controls during the 6 weeks (preC = 52 ± 19; postC = 53 ± 21; preD = 54 ± 23; postD = 15 ± 8; preE = 48 ± 21; postE = 9).
Conclusions. The findings of this study are consistent with previous studies describing the presence of Syndrome X in childhood. Both diet and exercise were effective in lowering triglyceride, ApoA levels, and insulin levels. However, due to the large rate of noncompliance in the diet group, exercise seems to be the best treatment for improvement in Syndrome X in children.
Predictors of Injury Mortality in Early Childhood
Authors: Scholer Seth J. , Mitchel Edward F. , Ray Wayne A. 
Published: August 2004

Objective. To study the association between maternal/infant characteristics and mortality from injury for children 0 through 4 years of age.
Design. Historical cohort.
Setting. State of Tennessee.
Participants. Children 0 through 4 years of age at any time between January 1, 1985 and December 31, 1994. We linked birth certificates and US census data to obtain information on maternal age, race, education, neighborhood income, parity, use of prenatal care, residence location, infant's gender, and gestational age.
Main Outcome Measures. The outcome was death from injury, as determined from linked death certificates. The incidence density rates for each stratum (defined by maternal/child characteristics) were calculated by dividing the number of injury deaths by child years in the stratum. We used multivariate analysis to assess the independent contribution of each characteristic to risk of injury death.
Results. There were 1 035 504 children 0 through 4 years of age who contributed 3 414 436 child years. There were 803 deaths from injury, ie, 23.5 deaths per 100 000 child years. In the multivariate analysis, children had at least a 50% increased risk of injury mortality if they were born to a mother who had less than a high school education (relative risk [RR] = 2.88; 95% confidence interval [CI]: 1.92–4.34) compared with a college education, was &lt;20 years of age (RR = 2.42; 95% CI: 1.76–3.31) compared with &gt;30 years, or had &gt;2 other children (RR = 2.97; 95% CI: 2.29–3.85) compared with no other children. Neither race nor income was significantly associated with childhood injury mortality in the multivariate analysis. Classification of children by maternal education, age, and parity defined a pronounced risk gradient in which high-risk children had an injury mortality rate &gt;15 times that of low-risk children. The steep risk gradient was present for both infants (24-fold increase for high-risk children) and children 1 through 4 years of age (13-fold increase for high-risk children). If the injury mortality rate for all children were equal to that of the low-risk group, 614/803 (76.3%) of injury deaths would not have occurred.
Conclusions. For young children, maternal education, age, and parity are strongly and independently associated with injury mortality. These factors define a steep gradient of risk, suggesting that many injury deaths could be prevented.
Neonatal Morbidity After Elective Repeat Cesarean Section and Trial of Labor
Authors: Hook Brenda , Kiwi Robert , Amini Saeid B. , Fanaroff Avroy , Hack Maureen 
Published: August 2004

Objective. To evaluate neonatal outcomes after an elective repeat cesarean section (ERCS) compared with a trial of labor (TOL).Population and Method. All mothers who underwent previous cesarean section and delivered singleton infants at term gestation were identified during a 1-year period. Neonatal outcomes were compared between infants delivered by ERCS (n = 497) and those delivered by TOL (n = 492), and between infants delivered by a successful (n = 336) and a failed (n = 156) TOL. A cohort of mothers and their term infants delivered by routine vaginal delivery were also identified.Results. Infants delivered by ERCS had an increased rate of transient tachypnea compared with infants born by TOL (6% vs 3%). Compared with routine vaginal deliveries, the adjusted odds ratio of developing any respiratory problem after an ERCS was 2.3 (95% confidence interval [CI]: 1.4, 3.8), and for developing transient tachypnea was 2.6 (CI: 1.5, 4.5). In addition, two infants delivered by ERCS developed respiratory distress syndrome. Infants delivered after a TOL had increased rates of suspected and proven sepsis (5% vs 2% and 1% vs 0.1%, respectively).Compared with a successful TOL, the infants delivered by cesarean section after a failed TOL had more neonatal morbidity and had a longer hospital stay (4.8 ± 2 vs 3.1 ± 2 days). The odds ratio for developing any respiratory illness after a failed TOL was 2.1 (95% CI: 1.1, 4.1), for suspected sepsis was 4.8 (95% CI: 2.6, 9.0), and for proven sepsis was 19.3 (95% CI: 2.0, 187). Neonatal outcomes after a successful TOL were similar to routine vaginal births.Conclusion. Infants born by ERCS are at increased risk for developing respiratory problems compared with those born by TOL. However, TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to infants delivered by cesarean section after a failed TOL.
Factors Associated With HIV Testing Among Sexually Active Adolescents: A Massachusetts Survey
Authors: Samet Jeffrey H. , Winter Michael R. , Grant Linda , Hingson Ralph 
Published: August 2004

Objective. To assess sexually active adolescents' knowledge, attitudes, and behaviors associated with human immunodeficiency virus (HIV) testing and to determine the factors important in their decision to obtain voluntary HIV testing.
Design. Anonymous, random, digit-dial telephone survey undertaken in 1993.
Setting. Massachusetts households.
Participants. Adolescents, 16 to 19 years of age.
Results. Of the 567 adolescents surveyed who had sexual intercourse within the past year, 127 (22%) had received HIV testing, with 54 (10%) stating that this testing was for personal reasons. A “great deal” or “some” worry about getting HIV/acquired immunodeficiency syndrome (AIDS) was expressed by 51%, and 56% felt that it was at least a little likely that they will get AIDS. Misconceptions were common about aspects of HIV testing: 35% did not believe or did not know that the HIV test results were kept in confidence, 19% thought that AIDS testers informed partners if the results were positive, and 30% did not think that the HIV test was very accurate. Although 92% (452/490) had seen a physician in the past year, only 30% (136/452) had ever discussed AIDS with a doctor. Multivariable analysis identified five factors as independently associated with voluntary adolescent HIV testing: 1) having had more than one sexual partner within the past year [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.5, 5.5]; 2) believing that condoms are only somewhat effective at preventing the spread of AIDS (OR: 2.6; 95% CI: 1.4, 4.8); 3) having discussed AIDS with a doctor (OR: 2.6; 95% CI: 1.4, 4.8); 4) not having had a teacher discuss AIDS (OR: 2.2; 95% CI: 1.2, 4.2); and 5) believing that a positive test result means one has AIDS as opposed to carrying the virus (OR: 2.0; 95% CI: 1.1, 3.7). High-risk behavior of infrequent condom use and a history of a sexually transmitted disease were not significantly associated with voluntary HIV testing.
Conclusion. Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.
Health Care Utilization and Health Status in High-risk Children Randomized to Receive Group or Individual Well Child Care
Authors: Taylor James A. , Davis Robert L. , Kemper Kathi J. 
Published: August 2004

Objective. To determine if health care utilization and health status among high-risk children is modified by the use of group well child care (GWCC) as compared with traditional one-to-one individual well child care (IWCC).Study Design. Randomized controlled trial.Participants. Children less than 4 months old from families with at least one of the following maternal risk factors: poverty, single marital status, age &lt;20 years at delivery, less than a high school education, previous substance abuse, or history of abuse as a child.Setting. Two urban, university pediatric clinics in Seattle, Washington.Interventions. Children were randomized to receive GWCC or IWCC at the time of enrollment. Health supervision visits with two study nurse practitioners were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. GWCC study visits consisted of a group discussion of age-appropriate child-rearing issues, along with a physical examination, health screening, and immunizations. Health care utilization among children receiving GWCC and those randomized to IWCC was assessed using the following measures: compliance with study visits, compliance with any age-appropriate health supervision visit, emergency department utilization, and immunization rates (defined as the proportion of children in each group who had received all recommended vaccines by 1 year of age). Provider time for GWCC and IWCC study visits was also recorded. Health status was measured using Stein's Functional Status IIR, completed by the mothers of study patients when their children completed the study at 15 months of age.Results. A total of 106 children received GWCC, whereas 104 were randomized to IWCC. Compliance with scheduled study visits was 47% for GWCC patients and 54% for IWCC recipients; overall compliance with any age-appropriate health supervision visit was 68% and 66%, respectively. Provider time was similar for GWCC and IWCC visits. By the age of 1 year, 67% of GWCC recipients and 73% of those receiving IWCC had received three DTP/DT, three OPV/IPV, three Hib, and three hepatitis B immunizations. A total of 242 emergency department visits were made by study patients during their enrollment in the project; there was no difference in the average number of visits between GWCC or IWCC children. However, children receiving IWCC were more likely to have at least one emergency department visit than GWCC recipients. At the conclusion of the project, health status, as measured by the Functional Status IIR, was similar in GWCC and IWCC patients (mean scores 92.4 ± 1.4 and 92.5 ± 1.1, respectively).Conclusions. Health care utilization and health status was similar in high-risk children whether they received GWCC or IWCC. GWCC is a viable format for health supervision visits in this population.
A Missense Cystic Fibrosis Transmembrane Conductance Regulator Mutation With Variable Phenotype
Authors: Kerem Eitan , Nissim-Rafinia Malka , Argaman Zvi , Augarten Arie , Bentur Lea , Klar Aharon , Yahav Yaacov , Szeinberg Amir , Hiba Ornit , Branski David , Corey Mary , Kerem Batsheva 
Published: August 2004

Objective. Cystic fibrosis (CF) has variable clinical presentation. Disease severity is partially associated with the type of mutation. The aim of this study was to report genotype-phenotype analysis of the G85E mutation.
Patients. The phenotype of 12 patients (8 were from the same extended family, and 5 of them were siblings from 2 families) carrying at least one copy of the G85E mutation was evaluated and compared with the phenotype of 40 patients carrying the two severe mutations, W1282X and/or ΔF508 (group 1), and with 20 patients carrying the splicing mutation, 3849+10kb C-&gt;T, which was found to be associated with milder disease (group 2).
Results. A high phenotypic variability was found among the patients carrying the G85E mutation. This high variability was found among patients carrying the same genotype and among siblings. All the studied chromosomes carrying the G85E mutation had the 7T variant in the polythymidine tract at the branch/acceptor site in intron 8. Of the G85E patients, 25% had pancreatic sufficiency and none had meconium ileus, compared with 0% and 32%, respectively, of patients from group 1, and 80% and 0%, respectively, from group 2. Two patients carrying the G85E mutation had sweat chloride levels &lt;60 mmol/L whereas all the others had typically elevated levels &gt;80 mmol/L. Compared with group 2, patients carrying the G85E mutation were diagnosed at an earlier age and had higher sweat chloride levels, with mean values similar to group 1 but significantly more variable. Forced expiratory volume in 1 second (FEV1) was similar in the three groups, with no differences in the slope or in age-adjusted mean values of FEV1. The levels of transcripts lacking exon 9 transcribed from the G85E allele measured in 3 patients were 55%, 49%, and 35% and their FEV1 values were 82%, 83%, and 50% predicated, respectively.
Conclusions. The G85E mutation shows variable clinical presentation in all clinical parameters. This variability could be seen among patients carrying on the other chromosome the same CFTR mutation, and also among siblings. This variability is not associated with the level of exon 9 skipping. Thus, the G85E mutation cannot be classified either as a severe or as a mild mutation.