bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor Formulation Information in Published Pediatric Drug Trials
Authors: Standing Joseph F. , Khaki Zahra F. , Wong Ian C. K. 
Published: September 2005

Objective. The International Conference on Harmonisation Steering Committee recommends that appropriate formulations be used in pediatric drug trials. However, a lack of formulation research and/or economic constraints means that appropriate formulations are not always used. It is important for investigators who report the results of pediatric drug trials to provide sufficient information on the formulation and method of administration to ensure that the results can be reproduced in other clinical studies (reliability) and, more important, implemented in clinical practice (validity). The objective of this study was to evaluate whether pediatric formulation information was adequately reported in recent published trials of oral medicines that included children who were younger than 12 years.Methods. Studies that were published between July 2002 and June 2004 in 10 highly cited journals (5 pediatric and 5 general medicine) were hand-searched and data were extracted independently by 2 reviewers according to a protocol. Papers that reported oral medication studies that included children who were younger than 12 years were classified as containing adequate, some, or no information on drug formulation.Results. Of 3992 papers reviewed, 76 fulfilled the inclusion criteria. Only 28 (37%) gave adequate information for the study to be reproduced accurately, and 20 (26%) did not state the formulation used. When the formulation was reported, only 37 (49%) studies used a pediatric formulation (liquid, chewable tablet, granules). No significant differences between pediatric and general medical journals were seen, and no single journal consistently met the criteria for adequate information.Conclusion. Highly cited journals seem to permit inadequate formulation information in pediatric drug trials that they publish, impairing their validity and reliability. Authors should provide full formulation information in all pediatric clinical trial reports.
Opportunities for Health Promotion Education in Child Care
Authors: Gupta Ruchi S. , Shuman Steve , Taveras Elsie M. , Kulldorff Martin , Finkelstein Jonathan A. 
Published: September 2005

Objectives. Comprehensive health promotion education is not feasible through pediatric office visits alone. Opportunities may exist for enhanced health promotion in child care settings. The objectives of this study were to understand the attitudes toward, barriers to, and strategies for incorporating health promotion activities in child care settings as well as topics that are deemed most useful from the perspectives of parents, child care directors, and health consultants. We also sought to understand the health consultants' (health professionals serving as consultants to child care centers) current and desired roles in leading health promotion activities in child care settings.Methods. We conducted simultaneous surveys of all licensed child care center directors and their health consultants in Boston. A total of 240 parents in 16 randomly selected centers were also surveyed.Results. A total of 97 (65%) directors in the 150 child care centers identified responded. A total of 71% (56 of 79) of consultants and 58% (138 of 240) of parents responded. Parents (89%), child care directors (88%), and health consultants (80%) believe that health promotion activities through child care centers would improve the health knowledge and behaviors of preschool children. A total of 45% of parents reported already receiving useful health information from child care staff and materials distributed in child care. Most topic areas that were suggested to parents were considered useful, with the greatest utility in the areas of behavior/discipline, child development, and emergency management. No significant barriers were identified by health professionals. Lack of funds (63%) and lack of someone to provide information (59%) were the top barriers identified by directors. An educational session on health topics by health care professionals was believed to be the best strategy to improve health promotion education for families. Among the health consultants, 83% of nurses or nurse practitioners said that they would be able to provide health education in child care compared with 53% of physicians.Conclusion. Parents, child care center directors, and health professionals believe that enhancing health promotion education in child care could improve child health. Collaboration between pediatricians and early care and education professionals has the potential to improve the breadth and effectiveness of health promotion education. Effective strategies are necessary to optimize access to health professionals by early educators, and effectively utilize the unique skills and preferences of physicians and nurses to promote health education in child care.
A Controlled Trial of the Father's Role in Breastfeeding Promotion
Authors: Pisacane Alfredo , Continisio Grazia Isabella , Aldinucci Maria , D'Amora Stefania , Continisio Paola 
Published: September 2005

Objective. To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding.Methods. A controlled trial, in which the participating fathers were allocated in 2-month blocks to a child care training session, was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples, Italy. Support and advice about breastfeeding was provided to all of the mothers. Among the fathers of the intervention group, the training session included the management of breastfeeding; among those of the control group, it did not. Primary outcome was the prevalence of full breastfeeding at 6 months. Secondary outcomes were the proportion of women who perceived their milk to be insufficient, who stopped breastfeeding because of problems, and who reported to have received help in breastfeeding management by their partners.Results The prevalence of full breastfeeding at 6 months was 25% (35 of 140) in the intervention group and 15% (21 of 140) in the control group and that of any breastfeeding at 12 months was 19% (27) and 11% (16), respectively. Perceived milk insufficiency was significantly more frequent among the mothers of the control group (38 [27%] of 140 vs 12 [8.6%] of 140), as well as breastfeeding interruption because of problems with lactation (25 [18%] of 140 vs 6 [4%] of 140). Moreover, significantly more women in the intervention group reported receiving support and relevant help with infant feeding management from their partners (128 [91%] of 140 vs 48 [34%] of 140). Among the women who had reported difficulties with lactation in the intervention and control groups (96 [69%] and 89 [64%], respectively), the prevalence of full breastfeeding at 6 months was 24% and 4.5%, respectively.Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months.
Pediatric Use of Complementary Therapies: Ethical and Policy Choices
Authors: Cohen Michael H. , Kemper Kathi J. , Stevens Laura , Hashimoto Dean , Gilmour Joan 
Published: September 2005

Objective. Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children.Methods. We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases.Results. Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies.Conclusions. Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.
Peer and Adult Companion Helmet Use Is Associated With Bicycle Helmet Use by Children
Authors: Khambalia Amina , MacArthur Colin , Parkin Patricia C. 
Published: September 2005

Objective. To examine whether the helmet status of riding companions (child or adult) influences helmet use by children (5–14 years).Methods. This study is part of a larger prospective observational survey that was conducted in a defined urban region of Toronto, Canada (1990–1997, 1999, and 2001). Trained observers collected data on children who were riding bicycles in April through October each year. Observation sites included school yards, parks, major intersections, and residential streets.Results. Of the 2094 children who were observed riding a bicycle, 50% were riding alone, 36% were riding with at least 1 child companion, and 14% were riding with at least 1 adult companion. Compared with riding alone, children were less likely to wear a helmet when riding with nonhelmeted child companions (relative risk [RR]: 0.29; 95% confidence interval [CI]: 0.22–0.38) and were more than twice as likely to wear a helmet when riding with either helmeted child (RR: 2.18; 95% CI: 1.97–2.42) or adult companions (RR: 2.67; 95% CI: 2.44–2.93). Compared with children who were riding with nonhelmeted child companions, children were more likely to wear a helmet when riding with nonhelmeted adults (RR: 3.93; 95% CI: 2.86–5.40), helmeted adults (RR: 9.18; 95% CI: 7.04–11.98), or helmeted children (RR: 7.49; 95% CI: 5.72–9.82). Adjusted analyses showed no difference between companion helmet status and helmet use by children before and after legislation.Conclusions. Helmeted and nonhelmeted adult riding companions were positively associated with child helmet use. The association between child riding companions and child helmet use was positive for helmeted child riding companions and negative for nonhelmeted child riding companions. Efforts need to be made toward improving adult helmet use and children's perceptions and attitudes toward helmet use.
Intentional Injury Management and Prevention in Pediatric Practice: Results From 1998 and 2003 American Academy of Pediatrics Periodic Surveys
Authors: Trowbridge Matthew J. , Sege Robert D. , Olson Lynn , O’Connor Karen , Flaherty Emalee , Spivak Howard 
Published: September 2005

Objective. Intentional injuries are significant causes of pediatric morbidity and mortality in the United States. A 1998 American Academy of Pediatrics (AAP) survey identified child abuse, domestic violence, and community violence as concerns for pediatricians, although the majority of pediatricians also reported feeling unprepared to manage these issues. A second AAP survey in 2003 analyzed trends in pediatrician experience and attitudes related to these issues.Methods. Surveys were sent to national random samples of AAP members in 1998 (n = 1629) and 2003 (n = 1603); response rates were 62% and 53%, respectively. Surveys measured pediatrician experience in the past 12 months in managing injuries caused by child abuse, domestic violence, and community violence. Attitudes regarding available resources and adequacy of training about intentional injury management were also collected. Trends between surveys were analyzed using χ2 analysis.Results. The proportion of pediatricians who reported treatment of intentional injuries increased between surveys. The percentage of pediatricians who indicated that screening for domestic violence and community violence risk should be included in routine health visits increased from 66% to 72% and 71% to 77%, respectively. Confidence in ability to identify and manage injuries that were caused by domestic violence and community violence increased but remained low, whereas the proportion of pediatricians who expressed confidence in ability to identify child abuse decreased (65% vs 60%).Conclusions. Despite overall improvement in acceptance of intentional injury prevention in routine care as well as confidence in intentional injury management, pediatrician confidence to identify and manage intentional injuries remains low.
Anogenital and Respiratory Tract Human Papillomavirus Infections Among Children: Age, Gender, and Potential Transmission Through Sexual Abuse
Authors: Sinclair Kelly A. , Woods Charles R. , Kirse Daniel J. , Sinal Sara H. 
Published: September 2005

Objectives. To evaluate human papillomavirus (HPV) presentation among children &lt;13 years of age and its association with suspected child sexual abuse (CSA), and to assess sexual abuse consideration among different clinical services treating these children.Methods. Records of children &lt;13 years of age from 1985 to 2003 were selected for review if the children had a HPV-related International Classification of Diseases, Ninth Revision, code or had been examined in the CSA clinic. Abstracted data included demographic features, clinical findings, clinical services involved, age at diagnosis, age when care was first sought, and age when symptoms were first noted.Results. HPV was identified by clinical examination and/or biopsy for 124 children, 40 with laryngeal lesions, 67 with anogenital lesions, 10 with oral lesions, and 7 with both anogenital and oral lesions. The mean age at HPV diagnosis was 4.0 ± 2.9 years, compared with 6.4 ± 3.0 years for 1565 HPV-negative children. Among 108 HPV cases with data for age when symptoms were first noted, the mean age was 3.3 ± 2.9 years (median: 2.2 years) for children with anogenital and oral HPV and 2.4 ± 2.3 years (median: 1.9 years) for children with laryngeal HPV. Among HPV-positive patients, 56% were female, compared with 82% of HPV-negative children. Fifty-five (73%) of 75 children with anogenital HPV infections were referred to the CSA clinic for evaluation, compared with none of 49 children with laryngeal or oral HPV infections treated by the otolaryngology service. Laryngeal cases presented earlier than anogenital and oral lesions. Abuse was considered at least possible for 17 of 55 children with any CSA evaluation. The mean age of likely abused, HPV-positive children was 6.5 ± 3.8 years (median: 5.3 years), compared with 3.6 ± 2.3 years (median: 2.6 years) for likely not abused, HPV-positive children. The likelihood of possible abuse as a source of HPV infection increased with age. The positive predictive value of HPV for possible sexual abuse was 36% (95% confidence interval: 13–65%) for children 4 to 8 years of age and 70% (95% confidence interval: 35–93%) for children &gt;8 years of age.Conclusions. The data from this epidemiologic study of HPV suggest that many anogenital and laryngeal HPV infections among preadolescent children are a result of nonsexual horizontal transmission, acquired either perinatally or postnatally. It seems that many children &gt;2 years of age acquire HPV infection from nonsexual contact. Different subspecialties vary greatly in their suspicion and evaluation of CSA. At this time, there remains no clear age below which sexual abuse is never a concern for children with anogenital HPV infections. Every case needs a medical evaluation to determine whether enough concern for abuse exists to pursue additional investigations.
Keeping Children With Asthma Out of Hospitals: Parents' and Physicians' Perspectives on How Pediatric Asthma Hospitalizations Can Be Prevented
Authors: Flores Glenn , Abreu Milagros , Tomany-Korman Sandra , Meurer John 
Published: September 2005

Background. A total of 196000 hospitalizations occur each year among the 9 million US children who have been diagnosed with asthma. Not enough is known about how to prevent pediatric asthma hospitalizations.Objectives. To identify the proportion of preventable pediatric asthma hospitalizations and how such hospitalizations might be prevented, according to parents and physicians of hospitalized children with asthma.Methods. A cross-sectional survey was conducted of parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) of a consecutive series of all children who were admitted for asthma to an urban hospital in a 14-month period.Results. The 230 hospitalized children had a median age of 5 years; most were poor (median annual family income: $13356), were nonwhite (93%), and had public (74%) or no (14%) health insurance. Compared with children who were hospitalized for other ambulatory care–sensitive conditions, hospitalized children with asthma were significantly more likely to be African American (70% vs 57%), to be older, and not to have made a physician visit or telephone contact before admission (52% vs 41%). Only 26% of parents said that their child's admission was preventable, compared with 38% of PCPs and 43% of IAPs. The proportion of asthma hospitalizations that were assessed as preventable varied according to the source or combination of sources, from 15% for agreement among all 3 sources to 54% as identified by any 1 of the 3 sources. PCPs (83%) and IAPs (67%) significantly more often than parents (44%) cited parent/patient-related reasons for how hospitalizations could have been prevented, including adhering to and refilling medications, better outpatient follow-up, and avoiding known disease triggers. Parents (27%) and IAPs (26%) significantly more often than PCPs (11%) cited physician-related reasons for how hospitalizations could have been avoided, including better education by physicians about the child's condition, and better quality of care. Multivariate analyses revealed that an age ≥11 years and no physician contact before the hospitalization were associated with ∼2 times the odds of a preventable asthma hospitalization.Conclusions. The proportion of asthma hospitalizations assessed as preventable varies from 15% to 54%, depending on the source. Adolescents and families who fail to contact physicians before hospitalization are at greatest risk for preventable hospitalizations. Many pediatric asthma hospitalizations might be prevented if parents and children were better educated about the child's condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers.
Stable Prevalence but Changing Risk Factors for Sudden Infant Death Syndrome in Child Care Settings in 2001
Authors: Moon Rachel Y. , Sprague Bruce M. , Patel Kantilal M. 
Published: September 2005

Objective. A total of 20% of sudden infant death syndrome (SIDS) cases in the 1990s occurred in child care settings. This is much higher than the 8% expected from Census Bureau data. Factors that were associated with child care SIDS included older age; white race; older, more educated mothers; and unaccustomed prone position. Since these findings, much emphasis has been placed on promoting a safe sleep environment in child care. The objectives of this study were to determine the proportion of SIDS occurring in child care in 2001 and to assess risk factors for SIDS in child care.Methods. We conducted a retrospective review of all SIDS deaths that occurred in 2001 in 13 US states. Information regarding demographics, SIDS risk factors, and child care arrangements were collected and analyzed. Deaths that occurred in child care were compared with deaths that occurred during parental care.Results. Of 480 deaths, 79 (16.5%) occurred in child care settings. Of these child care deaths, 36.7% occurred in family child care homes, 17.7% occurred in child care centers, 21.3% occurred in relative care, and 17.7% occurred with a nanny/babysitter at home. Infants in child care were more likely to be older and to die between the hours of 8 am and 4 pm and less likely to be exposed to secondhand smoke. There was no difference in usual, found, or placed sleep position between child care and home deaths. Approximately one half of the infants who died of SIDS in both settings were found prone, and 20% of deaths in both settings were among infants who were unaccustomed to prone sleep.Conclusions. The proportion of SIDS deaths in child care has declined slightly but still remains high at 16.5%. Infants in child care are no more likely to be placed or found prone and no more likely to be on an unsafe sleep surface. Educational efforts with child care providers have been effective and should be expanded to unregulated child care providers. In addition, there may be other, yet-unidentified factors in child care that place infants in those settings at higher risk for SIDS.
Reducing Low Birthweight by Resolving Risks: Results from Colorado’s Prenatal Plus Program
Authors: Ricketts Sue Austin , Murray Erin K. , Schwalberg Renee 
Published: September 2005

Objectives. We examined low-birthweight (LBW) rates among participants in Colorado’s Prenatal Plus program by prenatal risk factors (smoking, inadequate weight gain during pregnancy, and psychosocial problems) and the effect of successful resolution of these risks during pregnancy. Methods. Data for 3569 Medicaid-eligible women who received care coordination, nutritional counseling, or psychosocial counseling through the Prenatal Plus Program in 2002 were analyzed to determine the prevalence of specific risks, the proportion of women who resolved each specific risk, and the low birthweight rates for births to women who did and did not resolve risk. LBW rates were analyzed with χ2 tests of significance. Results. Women who quit smoking had an LBW rate of 8.5%, compared with an LBW rate of 13.7% among women who did not. Women with adequate weight gain had an LBW rate of 6.7%, compared with 17.2% among women with inadequate weight gain. Women who resolved all of their risks had a low-birthweight rate of 7.0%, compared with a rate of 13.2% among women who resolved no risks. Women who had at least 10 Prenatal Plus visits were more likely to resolve their risks than were women who had fewer visits. Conclusions. Multidisciplinary prenatal interventions targeted toward specific risks demonstrate success at significantly improving infant birthweight.
Establishing Priorities for Reducing Suicide and Its Antecedents in the United States
Authors: Knox Kerry L. , Caine Eric D. 
Published: September 2005

There is now a substantial literature on risk factors for suicide across the life course. Therefore, it is essential to extend this knowledge by considering more fully which age- and gender-specific groups bear the greatest public health burden owing to suicide and its antecedents. With this in mind, suicide mortality rates alone may not sufficiently inform U.S. policy makers who must distribute scarce suicide prevention resources.We compared age- and gender-specific mortality rates, age- and gender-specific estimates of years of potential life lost, and age- and gender-specific present value of lost earnings that individuals would have contributed to society had they lived to their full life expectancies.Men in the middle years of life contribute disproportionately to the public health burden because of completed suicide. The substantial burden evident in this group has not translated into a public health priority.