bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of femoral fractures in children in the West Midlands region of England 1991 to 2001
Authors: Bridgman S. , Wilson R. 
Published: November 2004

We have attempted to describe the epidemiology of femoral fractures in children in the West Midlands region of the National Health Service in England. Our source of data was the Regional Hospital Episode Statistics database for the years 1991-2 to 2001-2. Cases were defined as emergency hospital admissions in patients aged under 16 years, with a diagnostic code of femoral fractures in any field, and resident in the West Midlands. Between 1991-2 and 2001-2, 3272 children aged under 16 years with femoral fractures were admitted to hospital. The crude incidence during this period decreased from 0.33 to 0.22 femoral fractures/1000/year. Those caused by traffic accidents decreased by 43%, and by falls by 29%. The peak age-gender-specific incidence (0.91/1000/year) was in two-year-old boys, and this was 50% higher than in the next highest age-gender group. In the first year of life, the incidence in boys and girls was the same. Thereafter the rate in boys exceeded that in girls, varying from 1.6 times at 11 years to 4.7 times at 14 years. Falls accounted for 49% of the fractures, varying from 77% in one-year-olds to 26% in eight-year-old children. Traffic accidents were responsible for 26% of fractures varying from 55% in ten-year-old to 2% in one-year-old children. Maltreatment was recorded in 1.3% of all cases, and in 8.5% of children under one year. Twice as many fractures were seen in May to August than in January (winter). The rates of fractures were associated with deprivation for all age-gender groups. Fractures of the shaft accounted for 58% of all fractures, varying from 70% in three-year-old to 34% in 13-year-old children. Our findings show that there has been a decrease in the incidence of femoral fractures during the 1990s and early 2000s. Two-year-old boys had twice the rate than any other single-year age-gender group. More deprived areas had much higher rates which suggests the potential for greater prevention. A relatively low rate of maltreatment was recorded compared with that in some other studies.
Fracture of a Y-TZP ceramic femoral head
Authors: Maccauro G. , Piconi C. , Burger W. , Pilloni L. , De Santis E. , Muratori F. , Learmonth I. D. 
Published: November 2004

We studied factors contributing to the initiation of fracture and failure of a zirconia ceramic femoral head. The materials retrieved during a revision total hip replacement were submitted to either visual, stereomicroscopic and scanning electron microscopy (SEM) or SEM and energy-dispersive x-ray analysis. X-ray diffraction was performed in order to investigate the extent of tetragonal to monoclinic phase transition. Histological examination was performed on the periprosthetic tissues. The results showed that failure was due to the propagation during clinical use of defects which may have been introduced into the material during the processing of the ceramic, rather than those intrinsic to zirconia. The literature relating to previous failures of zirconia components is reviewed.
Does the Experience With the Use of Nasal Continuous Positive Airway Pressure Improve Over Time in Extremely Low Birth Weight Infants?
Authors: Aly Hany , Milner Joshua D. , Patel Kantilal , El-Mohandes Ayman A.E. 
Published: November 2004

Objective. Early use of nasal continuous positive airway pressure (ENCPAP) in extremely low birth weight (ELBW) infants continues to be a source of debate. Centers are applying this management strategy with varying success. Our center has implemented this strategy of care over the past 4 years, and the objective of this study was to evaluate the impact of experience over time with the use of ENCPAP on outcomes of ELBW infants.
Methods. All ELBW infants who were born at our hospital since the institution of the ENCPAP practice (n = 101) were analyzed retrospectively. Patients were divided into 3 terciles according to their birth date. A baseline group of ELBW infants who were born in the 2 years preceding the institution of the ENCPAP practice (group 0; n = 45) were used for comparison. Trends in practices and outcomes over time were analyzed using the 2-sided Cochran-Armitage linear trend test. Statistical significance for these trends were then analyzed again using a multivariate regression model controlling for significant variables. Bivariate analyses comparing individual groups were also conducted.
Results. There were no significant trends in mortality rate among the baseline group and the 3 terciles since the institution of the ENCPAP practice (26.7% vs 26.5% vs 11.8% vs 18.2%). ENCPAP management increased in the surviving infants over time (14% vs 19.2% vs 65.52% vs 70.4%), whereas the use of surfactant decreased (51.5% vs 48% vs 13.3% vs 33.3%) and the incidence of bronchopulmonary dysplasia (BPD) decreased (33.3% vs 46.2% vs 25.9% vs 11.1%). The average ventilator days per infant decreased, the rate of sepsis decreased, and the average daily weight gain increased. There were no significant trends in the incidence of intraventricular hemorrhage or necrotizing enterocolitis (NEC). When comparing the cohorts of survivors in the 3 terciles since the institution of ENCPAP system, ELBW infants who were started on ENCPAP but intubated within 1 week (CPAP failure) decreased over time (38.5% vs 13.8% vs 7.4%). There were other trends that did not reach significance, such as increased incidence of necrotizing enterocolitis (NEC). In a multivariate analysis controlling for gestational age, birth weight, and sepsis, the incidence of BPD was significantly lower over time (regression coefficient = −1.002 ± 0.375).
Conclusions. The frequency of use of ENCPAP in ELBW infants and its success improved in our unit over time. The major positive association in this population was a reduction in BPD rates and an increase in average weight gain. Relation of ENCPAP and NEC should be evaluated further.
Comparison of Two Programs to Teach Firearm Injury Prevention Skills to 6- and 7-Year-Old Children
Authors: Gatheridge Brian J. , Miltenberger Raymond G. , Huneke Daniel F. , Satterlund Melisa J. , Mattern Amanda R. , Johnson Brigette M. , Flessner Christopher A. 
Published: November 2004

Background. Each year, hundreds of children unintentionally kill or injure other children while playing with firearms in the United States. Although the numbers of these deaths and injuries are distressing, few prevention programs have been developed to prevent gun play among children.Objective. This study compared the efficacy of 2 programs designed to prevent gun play among young children.Design. A posttest-only, control group design with 2 treatment groups was used. Children were randomly assigned to 1 of 2 treatment groups or a control group. For all children who did not exhibit the skills after training, 1 in situ (ie, real-life situation) training session was conducted.Setting. Participant recruitment, training sessions, and assessments were all conducted in the children’s after-school program facility.Participants. Forty-five children, 6 or 7 years of age, were recruited for participation.Interventions. The efficacy of the Eddie Eagle GunSafe Program, developed by the National Rifle Association, and a behavioral skills training program that emphasized the use of instruction, modeling, rehearsal, and feedback was evaluated.Main Outcome Measures. The criterion firearm safety behaviors included both motor and verbal responses, which were assessed in a naturalistic setting and then assigned a numerical value based on a scale of 0 to 3.Results. Both programs were effective for teaching children to verbalize the safety skills message (don’t touch the gun, get away, and tell an adult). However, children who received behavioral skills training were significantly more likely to demonstrate the desired safety skills in role-playing assessments and in situ assessments than were children who received Eddie Eagle program training. In addition, in situ training was found to be effective for teaching the desired safety skills for both groups of children.Conclusions. Injury prevention programs using education-based learning materials are less effective for teaching children the desired safety skills, compared with programs incorporating active learning approaches (eg, modeling, rehearsal, and feedback). The efficacy of both types of injury prevention programs for teaching the desired skills could be significantly enhanced with the use of in situ training. This program, when implemented with 6- and 7-year-old children, was effective in teaching the desired safety skills.
Continuous Quality Improvement: Reducing Unplanned Extubations in a Pediatric Intensive Care Unit
Authors: Sadowski Roxanne , Dechert Ronald E. , Bandy Kenneth P. , Juno Julie , Bhatt-Mehta Varsha , Custer Joseph R. , Moler Frank W. , Bratton Susan L. 
Published: November 2004

Objective. Unplanned extubation (UEX) is a potentially serious complication of mechanical ventilation. Limited information is available regarding factors that contribute to UEXs and subsequent reintubation of children. We monitored UEXs in our pediatric intensive care unit (PICU) for a 5-year period to assess the incidence and patient conditions associated with UEX and to evaluate whether targeted interventions were associated with a reduced rate of UEXs.
Methods. Over a 5-year period, demographic and clinical information was collected prospectively on all patients who required an artificial airway while admitted to the PICU. Additional information was collected for patients who experienced an UEX. Educational sessions and care management protocols were developed, implemented, and modified according to issues identified via the monitoring program.
Results. From a total of 2192 patients who required 13 630 airway days (AWD), 141 (6%) patients experienced 164 UEXs. The overall rate of UEX for the study period was 1.2 UEXs per 100 AWD, and this rate decreased from 1.5 in the first year to 0.8 in the last year. UEXs were more common in children who were younger than 5 years (1.6 vs 0.6 UEX per 100 AWD) compared with older children. The UEX children experienced significantly longer length of mechanical ventilation (6 vs 3 days) and longer length of PICU stay (8 vs 4 days) compared with non-UEX children. Forty-six percent of the UEXs occurred in patients who were weaning from mechanical ventilation, and 22% of those patients required reintubation.
Conclusions. We conclude that UEX in pediatric patients is associated with longer length of mechanical ventilation and length of stay in the PICU. A continuous quality improvement monitoring and educational program that identified high-risk patients for UEX (younger patients) and patients who were at low risk for subsequent reintubation (weaning patients) contributed to a reduction of these potentially adverse events.
The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium
Authors: Vanhaesebrouck Piet , Allegaert Karel , Bottu Jean , Debauche Christian , Devlieger Hugo , Docx Martine , François Anne , Haumont Dominique , Lombet Jacques , Rigo Jacques , Smets Koenraad , Vanherreweghe Inge , Overmeire Bart Van , Reempts Patrick Van ,   for the EPIBEL Study Group
Published: November 2004

Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at ≤26 weeks' gestation.
Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.
Results. A total of 525 infants were recorded. Life-supporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was &lt;15% (21 of 158) for the admitted infants with a gestation &lt;26 weeks.
Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of &lt;26 weeks' gestation within the limits of medical feasibility and appropriateness.
Watching Sex on Television Predicts Adolescent Initiation of Sexual Behavior
Authors: Collins Rebecca L. , Elliott Marc N. , Berry Sandra H. , Kanouse David E. , Kunkel Dale , Hunter Sarah B. , Miu Angela 
Published: November 2004

Background. Early sexual initiation is an important social and health issue. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancies and sexually transmitted diseases are more common among those who begin sexual activity earlier. The American Academy of Pediatrics has suggested that portrayals of sex on entertainment television (TV) may contribute to precocious adolescent sex. Approximately two-thirds of TV programs contain sexual content. However, empirical data examining the relationships between exposure to sex on TV and adolescent sexual behaviors are rare and inadequate for addressing the issue of causal effects.
Design and Participants. We conducted a national longitudinal survey of 1792 adolescents, 12 to 17 years of age. In baseline and 1-year follow-up interviews, participants reported their TV viewing habits and sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behavior (versus talk about sex but no behavior).
Outcome Measures. Initiation of intercourse and advancement in noncoital sexual activity level, during a 1-year period.
Results. Multivariate regression analysis indicated that adolescents who viewed more sexual content at baseline were more likely to initiate intercourse and progress to more advanced noncoital sexual activities during the subsequent year, controlling for respondent characteristics that might otherwise explain these relationships. The size of the adjusted intercourse effect was such that youths in the 90th percentile of TV sex viewing had a predicted probability of intercourse initiation that was approximately double that of youths in the 10th percentile, for all ages studied. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior. African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the subsequent year.
Conclusions. Watching sex on TV predicts and may hasten adolescent sexual initiation. Reducing the amount of sexual content in entertainment programming, reducing adolescent exposure to this content, or increasing references to and depictions of possible negative consequences of sexual activity could appreciably delay the initiation of coital and noncoital activities. Alternatively, parents may be able to reduce the effects of sexual content by watching TV with their teenaged children and discussing their own beliefs about sex and the behaviors portrayed. Pediatricians should encourage these family discussions.
Thimerosal Exposure in Infants and Developmental Disorders: A Retrospective Cohort Study in the United Kingdom Does Not Support a Causal Association
Authors: Andrews Nick , Miller Elizabeth , Grant Andrew , Stowe Julia , Osborne Velda , Taylor Brent 
Published: November 2004

Objective. After concerns about the possible toxicity of thimerosal-containing vaccines in the United States, this study was designed to investigate whether there is a relationship between the amount of thimerosal that an infant receives via diphtheria-tetanus-whole-cell pertussis (DTP) or diphtheria-tetanus (DT) vaccination at a young age and subsequent neurodevelopmental disorders.
Methods. A retrospective cohort study was performed using 109 863 children who were born from 1988 to 1997 and were registered in general practices in the United Kingdom that contributed to a research database. The disorders investigated were general developmental disorders, language or speech delay, tics, attention-deficit disorder, autism, unspecified developmental delays, behavior problems, encopresis, and enuresis. Exposure was defined according to the number of DTP/DT doses received by 3 and 4 months of age and also the cumulative age-specific DTP/DT exposure by 6 months. Each DTP/DT dose of vaccine contains 50 μg of thimerosal (25 μg of ethyl mercury). Hazard ratios (HRs) for the disorders were calculated per dose of DTP/DT vaccine or per unit of cumulative DTP/DT exposure.
Results. Only in 1 analysis for tics was there some evidence of a higher risk with increasing doses (Cox's HR: 1.50 per dose at 4 months; 95% confidence interval [CI]: 1.02–2.20). Statistically significant negative associations with increasing doses at 4 months were found for general developmental disorders (HR: 0.87; 95% CI: 0.81–0.93), unspecified developmental delay (HR: 0.80; 95% CI: 0.69–0.92), and attention-deficit disorder (HR: 0.79; 95% CI: 0.64–0.98). For the other disorders, there was no evidence of an association with thimerosal exposure.
Conclusions. With the possible exception of tics, there was no evidence that thimerosal exposure via DTP/DT vaccines causes neurodevelopmental disorders.
Decline in Varicella-Related Hospitalizations and Expenditures for Children and Adults After Introduction of Varicella Vaccine in the United States
Authors: Davis Matthew M. , Patel Mitesh S. , Gebremariam Achamyeleh 
Published: November 2004

Objective. Universal childhood immunization against varicella in the United States, first recommended in 1995, was predicted to lead to significant decreases in varicella-related hospitalization rates and corresponding charges. Previous studies have not found such effects. We studied trends in varicella-related hospitalization rates and associated charges before and after introduction of varicella vaccine.Methods. We examined hospitalization and charge data from the Nationwide Inpatient Sample for the years 1993–2001, representative of national hospitalization patterns for children and adults. We derived weighted estimates of population-adjusted, varicella-related hospitalization rates and inflation-adjusted, varicella-related hospital charges.Results. The annual varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10 000 US population from 1993 to 1995, declined to 0.26 per 10 000 by 1999, and again halved to 0.13 per 10 000 by 2001. Hospitalization rates declined most substantially among individuals primarily targeted for vaccination (0- to 4-year-old children) but decreased among youths aged 5 to 19 years and among adults as well. Concomitantly, varicella-related hospital charges declined from $161.1 million (95% confidence interval: $130.5 million–$191.8 million) in 1993 to $66.3 million (95% confidence interval: $50.9 million–$81.7 million) in 2001 (all 2001 $US). Among expected primary payers, inflation-adjusted declines in varicella-related hospital discharges–related charges accrued to Medicaid, private insurance, and “other” payers (including uninsured and self-pay) but not to Medicare.Conclusions. This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.
“Who Is Sitting Across From Me?” Immigrant Mothers’ Knowledge of Parenting and Children’s Development
Authors: Bornstein Marc H. , Cote Linda R. 
Published: November 2004

Objective. Although parents’ knowledge about child development and child rearing is relevant to pediatric practice, very little is known about immigrant parents’ knowledge. To fill this gap in research, this study investigated parenting knowledge in 2 groups of mothers who had immigrated to the United States.Design. Japanese and South American immigrant mothers of 2-year-olds completed a standardized survey of parenting knowledge and provided information about sociodemographic and infant health status. Their data were compared with European American mothers in the United States.Results. Immigrant mothers scored ∼70% on the evaluation of parenting knowledge, significantly lower than multigenerational US mothers. The majority of immigrant mothers did not know correct answers for 25% of the items, and their incorrect answers were mostly to questions about normative child development.Conclusions. Parents’ knowledge is relevant to pediatricians’ evaluations of the health and welfare of children as understood by their parents. Gaps in parenting knowledge have implications for clinical interactions with parents, child diagnosis, pediatric training, and parent education.
“Social Medication” and the Control of Children: A Qualitative Study of Over-the-Counter Medication Among Australian Children
Authors: Allotey Pascale , Reidpath Daniel Diamond , Elisha Danielle 
Published: November 2004

Objective. The aim of the study was to identify the patterns of use of over-the-counter (OTC) medications among children.Methods. The study used a qualitative design, with in-depth interviews of 40 parents with children &lt;5 years of age.Results. There were 3 striking and readily apparent themes in the use of OTC medications among children. One was the administration of OTC medications as a form of “social medication,” to give parents control over children's behavior that they perceived as fractious and irritating. A related theme was the use of OTC medications to reduce the inconvenience to the parents of having a sick child, again giving parents greater control and better time-management abilities. Finally, acetaminophen was considered by many parents to have almost miraculous properties in calming, sedating, and lifting the mood of children.Conclusions. The use of OTC medications for the treatment of minor ailments among children is widespread, despite the lack of evidence of efficacy of the most commonly used medications and the potential for toxicity. With the increasing propensity to look to medication as a means of supporting changing lifestyles, there is an urgent need to review the prevalence and effects of social medication.
Age Terminology During the Perinatal Period
Authors:   Committee on Fetus and Newborn
Published: November 2004

This Policy Statement was reaffirmed November 2008 and July 2021.
Consistent definitions to describe the length of gestation and age in neonates are needed to compare neurodevelopmental, medical, and growth outcomes. The purposes of this policy statement are to review conventional definitions of age during the perinatal period and to recommend use of standard terminology including gestational age, postmenstrual age, chronological age, corrected age, adjusted age, and estimated date of delivery.