bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolongation of Satiety After Low Versus Moderately High Glycemic Index Meals in Obese Adolescents
Authors: Ball Shauna D. , Keller Kelly R. , Moyer-Mileur Laurie J. , Ding Yi-Wen , Donaldson David , Jackson W. Daniel 
Published: August 2004

Background. One in 5 American children is overweight, despite a decrease in total fat consumption. This has sparked an interest in the carbohydrate composition of diets, including the glycemic index (GI).
Objective. To investigate whether a low-GI meal replacement (LMR) produced similar metabolic, hormonal, and satiety responses in overweight adolescents as a low-GI whole-food meal (LWM) when compared with a moderately high-GI meal replacement (HMR).
Methods. Randomized, crossover study comparing LMR, HMR, and LWM in 16 (8 male/8 female) adolescents during 3 separate 24-hour admissions. The meal replacements consisted of a shake and a nutrition bar. Identical test meals were provided at breakfast and lunch. Metabolic and hormonal indices were assessed between meals. Measures of participants’ perceived satiety included hunger scales and ad libitum food intake.
Results. The incremental areas under the curve for glucose were 46% and 43% lower after the LMR and LWM, respectively, compared with the HMR. Insulin’s incremental area under the curve was also significantly lower after both low GI test meals (LMR = 36%; LWM = 51%) compared with the HMR. Additional food was requested earlier after the HMR than the LMR (3.1 vs 3.9 hours, respectively), although voluntary energy intake did not differ.
Conclusions. Differences in insulin response between the meal replacements occurred, and prolongation of satiety after the LMR, based on time to request additional food, was observed. We speculate that the prolonged satiety associated with low GI foods may prove an effective method for reducing caloric intake and achieving long-term weight control.
Internet-Enabled Interactive Multimedia Asthma Education Program: A Randomized Trial
Authors: Krishna Santosh , Francisco Benjamin D. , Balas E. Andrew , König Peter , Graff Gavin R. , Madsen Richard W. 
Published: August 2004

Objective. To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program.Methods. Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program. Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking. Pediatric Asthma Care Knowledge Survey, Pediatric Asthma Caregiver’s Quality of Life Questionnaire, asthma symptom history, spirometry, and health services utilization data were collected at the initial visit and at 3 and 12 months.Results. Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers, decreased asthma symptom days (81 vs 51 per year), and decreased number of emergency department visits (1.93 vs 0.62 per year) among the intervention group participants. The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids (434 vs 754 μg [beclomethasone equivalents]) at visit 3. Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits (r = 0.37) and less frequent use of quick-relief medicines (r = 0.30).Conclusions. Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma.
Effects on Breastfeeding of Changes in Maternity Length-of-Stay Policy in a Large Health Maintenance Organization
Authors: Madden Jeanne M. , Soumerai Stephen B. , Lieu Tracy A. , Mandl Kenneth D. , Zhang Fang , Ross-Degnan Dennis 
Published: August 2004

Objective. The purpose of this study was to evaluate the effects on breastfeeding rates of a private-sector early discharge program and a subsequent government mandate guaranteeing 48 hours of hospital coverage.Methods. Interrupted time-series analyses were conducted on retrospective data from the automated medical records of a large health maintenance organization in eastern Massachusetts. A population of 20 366 mother-infant pairs with normal vaginal deliveries between October 1990 and March 1998 was identified. This study period spanned the 2 interventions of interest: 1) the introduction of a new health maintenance organization protocol of 1 postpartum overnight hospitalization followed by a nurse home visit for normal vaginal deliveries, then 2) Massachusetts state minimum coverage legislation. Breastfeeding initiation and breastfeeding continuation among initiators (exclusive or with supplements) into the third month of life were determined through a text search of the first 90 days of infants’ automated medical records.Results. Both policies had dramatic impacts on length of stay (LOS); postpartum LOS &lt;2 nights rose from 29% of pairs to 65% when the early discharge program was implemented, then fell to 15% after the state mandate. Breastfeeding initiation, however, rose gradually from 71% in the fourth quarter of 1990 to 82% in the first quarter of 1998, with no changes after the interventions. Continuation of breastfeeding among those who initiated remained constant at 73%. Younger maternal age, primiparity, low socioeconomic status, and nonwhite race all were found to be risk factors for lower rates of breastfeeding (either initiation or continuation), but there was no evidence of a decline in breastfeeding associated with shorter LOS among these vulnerable groups.Conclusions. Early postpartum discharge with outpatient breastfeeding support and a home visitor program has no adverse effects on initiation or continuation of breastfeeding.
Early-Onset Group B Streptococcal Infection After a Combined Maternal and Neonatal Group B Streptococcal Chemoprophylaxis Strategy
Authors: Velaphi Sithembiso , Siegel Jane D. , Wendel George D. , Cushion Nancy , Eid Walid M. , Sánchez Pablo J. 
Published: August 2004

Objective. In January 1995, a combined maternal and neonatal protocol for prevention of early-onset group B streptococcal (GBS) infection was implemented that consisted of a risk factor-based approach for maternal intrapartum chemoprophylaxis using ampicillin combined with a single intramuscular dose of penicillin given to all newborns within 1 hour of delivery. The objective of this study was to review the cases of early-onset GBS infections that occurred from 1995 to 1999 to identify factors associated with their continued occurrence despite implementation of a GBS chemoprophylaxis protocol.Methods. Infants ≤72 hours of age with early-onset GBS infection born at Parkland Memorial Hospital in Dallas from January 1995 to December 1999 were identified through a prospective laboratory-based surveillance system. Maternal and infant medical records were reviewed for clinical and demographic data.Results. There were 32 cases (0.47/1000 live births) of early-onset GBS infection for the 5-year period. This represented a 76% reduction compared with the rate from 1986 to 1994 (1.95/1000), when there was no protocol for GBS chemoprophylaxis. Thirteen cases (41%) did not have any identifiable maternal risk factor. Of the 19 cases (59%) with risk factors, maternal intrapartum fever was the most frequent (15 [79%]), followed by prematurity (6 [32%]) and prolonged rupture of membranes (6 [32%]). Among the 19 mothers with risk factors, 15 (79%) mothers received intrapartum chemoprophylaxis, and 12 (80%) of the 15 mothers had intrapartum fever. Only 33% of mothers with risk factors received ≥2 doses of intrapartum chemoprophylaxis, and among those with intrapartum fever, 25% received ≥2 doses. None of the 32 infants with early-onset GBS infection received the combination of intrapartum ampicillin and postnatal penicillin.Conclusions. A combined obstetric and neonatal chemoprophylaxis protocol significantly reduced early-onset GBS infection. Maternal intrapartum fever was the most frequent risk factor associated with failure of chemoprophylaxis.
Functional Disability and School Activity Limitations in 41 300 School-Age Children: Relationship to Medical Impairments
Authors: Msall Michael E. , Avery Roger C. , Tremont Michelle R. , Lima Julie C. , Rogers Michelle L. , Hogan Dennis P. 
Published: August 2004

Objective. Our purpose was to examine the contribution of medical impairments to functional disability and school activity limitations in 41 300 school-age children participating in the 1994–1995 National Health Interview Survey.
Methods. The 1994 and 1995 National Health Interview Survey and Disability Interview Supplement samples provide International Classification of Diseases, Ninth Revision medical impairment codes for children with functional limitations or school activity limitations in a nationally representative US sample. Functional limitations were distributed as follows: mobility 12.4/1000 (95% confidence interval [CI]: 11.1–13.6), self-care 8.8/1000 (95% CI: 7.7–9.8), communication 52.9/1000 (95% CI: 50.2–55.5), and learning 104.6/1000 (95% CI: 100.7–108.4). Functional disability status was classified as 4.1% mild, 5.9% major, and 1.9% multiple. School activity limitations included 4.1% needing or receiving special education, 0.7% unable to attend, and 0.9% limited attendance. We categorized International Classification of Diseases, Ninth Revision impairment codes reported in conjunction with medical usage as physical disorders (n = 1251; eg, leukemia, diabetes), asthma (n = 916), neurodevelopmental disorders (n = 802; eg, cerebral palsy, epilepsy, mental retardation, autism, blindness, deafness), and learning-behavior disorders (n = 806; eg, attention-deficit/hyperactivity disorder, learning disability, anxiety) for children with functional or school activity limitations. Of children with multiple functional disabilities, 29.9% had neurodevelopmental disorders, 27.1% had learning-behavior disorders, 18.1% had physical disorders, 4.2% had asthma, and 20.8% did not have an identified medical impairment because they had not received medical services in the past year. Among children requiring special education, physical disorders accounted for 9.4%, neurodevelopmental disorders for 16.7%, learning and behavior disorders for 17%, asthma for 3.4%, and 53.4% did not have an identified medical impairment because they had not received medical services in the past year.
Conclusions. Chronic health impairments, neurodevelopmental disorders, learning-behavior disorders, and functional limitations in essential activities are required to understand the complexity of disability in school-age children. A large number of children with functional disability or school activity limitations have not received ongoing medical services.
Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study
Authors: Dube Shanta R. , Felitti Vincent J. , Dong Maxia , Chapman Daniel P. , Giles Wayne H. , Anda Robert F. 
Published: August 2004

Objective. Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed.
Methods. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: ≤14 years, 15 to 18 years, or as an adult (≥19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use.
Results. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with ≥5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use.
Conclusions. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.
Intravenous Bisphosphonate Therapy in Children With Osteogenesis Imperfecta
Authors: Falk Marni J. , Heeger Shauna , Lynch Katherine A. , DeCaro Kathleen R. , Bohach Deborah , Gibson Karen S. , Warman Matthew L. 
Published: August 2004

Objective. Several studies have reported beneficial effects of bisphosphonates in children with osteogenesis imperfecta (OI); however, these studies have differed in the protocols they used, and none has been independently replicated. We intended to confirm the efficacy of a specific intravenous bisphosphonate protocol in children with moderate to severe OI.
Methods. We used the protocol described by Glorieux et al and performed a prospective clinical trial in 6 children who were aged 22 months to 14 years. Each patient received intravenous pamidronate therapy for a minimum of 2 years in cycles of 1 mg/kg daily over 3 consecutive days at a mean cycle interval of 3.8 months. Outcome measures included lumbar spine areal bone mineral density (BMD) and z score, fracture rate, and occupational therapy functional assessment with serial Pediatric Evaluation of Disability Inventory.
Results. While on therapy, the average annual increase in areal BMD was 48% and the average annual increase in BMD z score was 1.0. This increase in z score is statistically significant. There was no clear correlation between changes in BMD and fracture rate. All patients experienced functional improvement in mobility.
Conclusions. Our results support the findings of Glorieux et al that cyclic administration of intravenous pamidronate in children with OI has beneficial effects with respect to BMD z scores and physical disability. Long-term follow-up will be required to determine whether bisphosphonate therapy will decrease fracture rates and increase mobility in children with moderate to severe OI.
Physical and Psychosocial Health in Children Who Have Had Kawasaki Disease
Authors: Baker Annette L. , Gauvreau Kimberlee , Newburger Jane W. , Sundel Robert P. , Fulton David R. , Jenkins Kathy J. 
Published: August 2004

Objective. The purpose of this study was to examine the physical and psychosocial well-being of children who have had Kawasaki disease (KD), including the influence of coronary artery status on health and health perceptions.
Methods. The Child Health Questionnaire (CHQ) measures overall physical and psychosocial well-being in children 5 to 18 years. To study the long-term impact of KD on overall health status, we mailed the CHQ to patients without a history of coronary artery abnormalities (normal group), with regressed aneurysms (regressed group), with current coronary aneurysms &lt;8 mm (mild-moderate aneurysm group), and with giant aneurysms ≥8 mm (giant group).
Results. Of 201 questionnaires mailed, 174 were delivered and 110 (63%) were completed. Median age (range) at completion was 10.5 years (5.1–17.9 years) and at illness onset was 3.1 years (0.2–12 years). There were no significant differences in psychosocial summary scores in any of the Kawasaki groups when compared with the US population sample. Physical summary scores were also similar to the US population sample in the normal coronary, mild-moderate aneurysm, and regressed aneurysm groups. However, the giant aneurysm group had significantly lower physical summary scores compared with the US population sample. Among subscales, general health perceptions in the KD groups were lower than in the US population sample, reaching statistical significance in all but the mild to moderate aneurysm group. In addition, parents whose children have had KD reported a higher proportion of anxiety issues, allergies, and orthopedic/bone/joint issues in their children than did the general US population sample. We did not find any difference in the incidence of attentional, behavioral, or learning issues when compared with the US population sample.
Conclusions. KD patients without coronary artery aneurysms were similar to the general population in their general physical and psychosocial health. However, the parents of children in all KD groups reported lower general health perceptions than parents in the US population sample, suggesting that long-term concerns about their children’s health exist regardless of overall health status. In addition, children with giant coronary artery aneurysms had lower overall physical summary scores.
How Readable Are Child Safety Seat Installation Instructions?
Authors: Wegner Mark V. , Girasek Deborah C. 
Published: August 2004

Objectives. To measure the required reading level of a sample of child safety seat (CSS) installation instructions and to compare readability levels among different prices of CSSs to determine whether the lower cost seats to which low-income parents have greater access are written to a lower level of education.Methods. A CD-ROM containing CSS installation instructions was obtained from the National Highway Traffic Safety Administration. Pricing information was obtained for available models from an Internet-based company that provides comparative shopping information. Paper copies of the instruction sets were generated, and their readability levels were determined using the SMOG test. A second rater was used in addition to the primary investigator to assess interrater reliability of the SMOG as applied to the instruction sets.Results. The readability of instruction sets ranged from the 7th- to 12th-grade levels, with an overall mean SMOG score of 10.34. No significant associations were found to exist between readability and seat prices; this was observed whether the data were treated as continuous or categorical.Conclusions. CSS instruction manuals are written at a reading level that exceeds the reading skills of most American consumers. These instruction sets should be rewritten at a lower reading level to encourage the proper installation of CSSs.
Risk of Seizures in Survivors of Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest
Authors: Clancy Robert R. , McGaurn Susan A. , Wernovsky Gil , Gaynor J. William , Spray Thomas L. , Norwood William I. , Jacobs Marshall L. , Goin James E. 
Published: August 2004

Objective. To identify pre- and intraoperative variables associated with postoperative acute neurologic events (ANEs), including seizures and coma, in newborn survivors of congenital heart surgery undergoing deep hypothermic circulatory arrest (DHCA), and to risk-stratify this population on the basis of preoperative risk variables for the purpose of designing future neuroprotection trials.
Methods. Survivors of newborn heart surgery who were enrolled in a neuroprotection trial provided a comprehensive database for the evaluation of pre- and intraoperative variables that influence the postoperative occurrence of ANEs (seizures or coma). Patients with hypoplastic heart syndrome were excluded. After characterization of the study population, stepwise logistic regression, combined with clinical judgment, was used to identify variables that were most likely to be associated with an increased risk of seizures in the study sample and that were most likely to be generalized to other populations.
Results. Data were available on 164 nonhypoplastic left heart syndrome survivors who underwent newborn heart surgery using DHCA. ANEs occurred in 31 (18.9%) including “seizures alone” (n = 28), “coma alone” (n = 2) or “seizures and coma” (n = 1). A preoperative risk model was constructed demonstrating that infants with a genetic condition and aortic arch obstruction had a 47.8% risk of ANEs compared with all other remaining infants, who had a 9.9% risk. It was also found that prolonged DHCA time (≥60 minutes) can be a significant risk for infants who have a preexisting genetic condition; however, infants who have genetic conditions and do not undergo prolonged DHCA time or have an aortic arch obstruction are not at increased risk of ANEs.
Conclusions. This study provides new information about the occurrence of ANEs after newborn heart surgery. Seizures or coma, which appeared in approximately 19% of all non–hypoplastic left heart syndrome survivors, were not random events but were significantly associated with specific types of congenital heart disease, the presence of genetic conditions, and prolonged DHCA time. The 3 identified variables permitted individual cases to be assigned to low-, intermediate-, or high-risk categories. Because neonatal seizures are a good surrogate marker of long-term neurologic outcome, these models provide useful information to stratify individual patients for risk of seizures in future neuroprotection trials.
Can the Initial History Predict Whether a Child With a Head Injury Has Been Abused?
Authors: Hettler Joeli , Greenes David S. 
Published: August 2004

Objective. Previous studies of child abuse have used the presenting history as part of the case definition of abuse. Thus, data from these studies cannot be used to determine the diagnostic utility of historical features for identifying cases of abuse. The objective of this study was to determine the diagnostic utility of certain historical features for identifying cases of abusive head trauma.Methods. We retrospectively studied all children, aged 0 to 3 years, who had acute traumatic intracranial injury and were admitted to a tertiary care pediatric hospital from 1993 to 2000. Cases were categorized as either “definite abuse” or “not definite abuse” on the basis of radiologic, ophthalmologic, and physical examination findings, without regard to the presenting history.Results. Forty-nine (30%) of 163 children met the criteria for definite abuse. Having no history of trauma had a high specificity (0.97) and positive predictive value (PPV; 0.92) for abuse. Among the subgroup of patients with persistent neurologic abnormality at hospital discharge (n = 34), having a history of no or low-impact trauma had a specificity of 1.0 and a PPV of 1.0 for definite abuse. Injuries were blamed on home resuscitative efforts in 12% of definite abuse cases and 0% of not definite abuse cases. The initial history of trauma was changed in 9% of definite abuse cases, as compared with 0% of not definite abuse cases.Conclusion. Among young children with a head injury, certain historical features have high specificity and PPV for diagnosing child abuse.