bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates of Pediatric and Adolescent Injuries by Year of Age
Authors: Agran Phyllis F. , Winn Diane , Anderson Craig , Trent Roger , Walton-Haynes Lynn 
Published: August 2004

Objective.The purpose of this study was to analyze causes of injury hospitalization/death by individual year of age and by specific causes of injury and to examine how well aggregate age groups represented individual year-of-age rates.Methods.Hospital discharge data and death certificate data for California residents age 0 to 19 years with a principal external cause of injury code (E-code) of E800 to E869, E880 to E929, or E950 to E999, calendar year 1997, were analyzed. Annual rates of injury hospitalization/death by year of age were calculated using combined hospital discharges and deaths as the numerator for major causes and important subcategories. For comparison, rates of injury hospitalization/death were calculated for conventional vital statistics age groups: &lt;1 year, 1 to 4 years; 5 to 9 years, 10 to 14 years, and 15 to 19 years.Results.In 1997 in California, 35 277 children and adolescents 0 to 19 years were hospitalized and 1934 died as a result of injury, a ratio of 17 hospitalizations to 1 death. The distribution was bimodal with rates highest among 18-year-olds (732/100 000) and 1-year-olds (495/100 000). Except for children who were 5 to 9 years of age, the group rates for all injuries were not reflective of the individual year-of-age rates. In specific categories of injuries, variation in rates by year of age were masked by age group rates for unintentional poisoning among 1- to 4-year-olds, self-inflicted poisoning for 10- to 19-year-olds, falls from playground equipment among 5- to 9-year-olds, falls from furniture among 1- to 4-year-olds, and motor vehicle occupant injury rates among 10- to 19-year-olds. The peak rate of falls from playground equipment among 6-year-olds (34/100 000) was more than twice the rate for 9-year-olds (15/1000,000). Motor vehicle occupant injury rates doubled between 10 and 14 years of age and quadrupled between 14 and 18 years of age.Conclusions.Analyses using conventional age groups did not identify the age of highest risk for many causes of childhood injury. Changes in the rates often transected the traditional age groups and were not apparent with conventional age group analysis. These data can inform on the age at which to begin a specific injury intervention and on how to allocate resources. These data allow pediatricians and other health professionals to be anticipatory in providing injury prevention counseling. The greatest impact can be achieved by making the counseling topic most age appropriate in anticipation of the high-risk period.
The Association of Foster Care or Kinship Care With Adolescent Sexual Behavior and First Pregnancy
Authors: Carpenter Sara C. , Clyman Robert B. , Davidson Arthur J. , Steiner John F. 
Published: August 2004

Objective.Each year more than 500 000 children enter out-of-home placement. Few outcome studies of these children specifically address high-risk sexual behavior and adolescent pregnancy. Our study investigated the relationship between living in kinship or foster care and high-risk reproductive behaviors in a nationally representative sample of women.Methods.Data from 9620 women ages 15 to 44 years in the 1995 National Survey of Family Growth were analyzed in a cross-sectional study. Three groups—foster (n = 89), kinship (n = 513), and comparison (n = 9018)—were identified on the basis of self-reported childhood living situations. Bivariate and multiple linear regression analyses were performed. The outcome variables were age at first sexual intercourse and at first conception and the number of sexual partners.Results.After adjustment for multiple predictor variables, foster care was associated with younger age at first conception (difference: 11.3 months) and having greater than the median number of sexual partners (odds ratio: 1.7, 1.0–2.8). Kinship care was associated with younger age both at first intercourse (difference = 6 months) and at first conception (difference: 8.6 months) and having greater than the median number of sexual partners (odds ratio: 1.4, 1.1–1.8). There were no differences between the kinship and foster groups.Conclusions.A history of living in either foster or kinship care is a marker for high-risk sexual behaviors, and the risk is comparable in both out-of-home living arrangements. Recognition of these risks may enable health care providers to intervene with high-risk youth to prevent early initiation of sexual intercourse and early pregnancy.
Screening for Anemia in Children: AAP Recommendations—A Critique
Authors: Kohli-Kumar Mudra 
Published: August 2004

The American Academy of Pediatrics (AAP) recommends screening for anemia between the ages of 9 to 12 months with additional screening between the ages of 1 and 5 years for patients at risk. The screening may be universal or selective depending on the prevalence of iron deficiency anemia in the population. Improved infant rearing practices—including wider availability, acceptance, and use of iron-fortified formulas; iron fortification of foods; and increased awareness of the importance of dietary iron supplementation especially early in life—have lead to significant decline in the incidence of anemia in the first year of life. However, incidence of iron deficiency and ensuing anemia in children between 1 and 2 years continues to be significant and an important issue.
Although iron deficiency may develop soon after cessation of or inadequate iron intake, anemia secondary to iron deficiency develops gradually over a period of several weeks to months. For children who have received/are receiving iron-fortified infant formulas and foods, hemoglobin screening at 9 to 12 months of age is inappropriate as there may not have been sufficient time to develop anemia, despite the rapid growth rate at this age. Widespread implementation of hemoglobin electrophoresis included in the neonatal metabolic screening programs in many states in the United States now has resulted in earlier diagnosis of hemoglobinopathies. Screening children at 9 to 12 months of age for hemoglobinopathies is somewhat redundant now. Screening for anemia before or around 1 year of age should continue to be important for communities and children at risk.
Universal screening of toddlers at a later time allows sufficient time for nutritional anemia to become evident after the child has been weaned off iron-fortified formulas, for the influence of toddler dietary fads to manifest, and for evaluation of tolerance of cow's milk protein. This may be addressed via 2 approaches. The first involves postponing the currently recommended screening or an additional screening for anemia between 15 to 18 months of age.
Determination of hemoglobin (or hematocrit) is not the optimal way to identify children at risk from effects of iron deficiency as it fails to identify patients who are iron-deficient but are not anemic. Long-term psychomotor, behavioral, and developmental effects secondary to iron deficiency anemia are known but sufficient data are lacking regarding the role of iron deficiency without anemia. Development and evaluation of sensitive, specific, and cost-effective screening tools to identify children at risk for iron deficiency is important. Until such methods are instituted, the AAP should emphasize and recommend universal screening for anemia during the second year of life.
Management of Febrile Children in the Age of the Conjugate Pneumococcal Vaccine: A Cost-Effectiveness Analysis
Authors: Lee Grace M. , Fleisher Gary R. , Harper Marvin B. 
Published: August 2004

Objectives.The optimal practice management of highly febrile 3- to 36-month-old children without a focal source has been controversial. The recent release of a conjugate pneumococcal vaccine may reduce the rate of occult bacteremia and alter the utility of empiric testing and treatment. The objective of this study was to determine the cost-effectiveness of 6 different management strategies of febrile 3- to 36-month-old children at current and declining rates of occult pneumococcal bacteremia.Methods.A cost-effectiveness (CE) analysis was performed to compare the strategies of “no work-up,” “clinical judgment,” “blood culture,” “blood culture + treatment,” “complete blood count (CBC) + selective blood culture and treatment,” and “CBC and blood culture + selective treatment.” A hypothetical cohort of 100 000 children who were 3 to 36 months of age and had a fever of ≥39°C and no source of infection was modeled for each strategy. Our main outcome measures were cases of meningitis prevented, life-years saved compared with “no work-up,” total cost (1999 dollars), and incremental CE ratios.Results.When compared with “no work-up,” the strategy of “CBC + selective blood culture and treatment” using a white blood cell (WBC) cutoff of 15 × 109/L prevents 48 cases of meningitis, saves 86 life-years per 100 000 patients, and is less costly at the current rate of bacteremia (1.5%). Using the strategy of “CBC + selective blood culture and treatment” with a lower WBC cutoff of 10 × 109/L costs an additional $72 300 per life-year saved. If the rate of bacteremia declines to 0.5%, then the incremental CE ratio of “clinical judgment” compared with “no work-up” is $38 000 per life-year saved; however, strategies that include empiric testing or treatment result in CE ratios greater than $300 000 per life-year saved.Conclusions.“CBC + selective blood culture and treatment” using a WBC cutoff of 15 × 109/L is cost-effective at the current rate of pneumococcal bacteremia. If the rate of occult bacteremia falls below 0.5% with widespread use of the conjugate pneumococcal vaccine, then strategies that use empiric testing and treatment should be eliminated.
Effect of Practice Variation on Resource Utilization in Infants Hospitalized for Viral Lower Respiratory Illness
Authors: Willson Douglas F. , Horn Susan D. , Hendley J. Owen , Smout Randall , Gassaway Julie 
Published: August 2004

Objective.Hospital care for children with viral lower respiratory illness (VLRI) is highly variable, and its relationship to severity and impact on outcome is unclear. Using the Pediatric Comprehensive Severity Index, we analyzed the correlation of institutional practice variation with severity and resource utilization in 10 children's medical centers.Methods.Demographics, clinical information, laboratory results, interventions, and outcomes were extracted from the charts of consecutive infants with VLRI from 10 children's medical centers. Pediatric Component of the Comprehensive Severity Index scoring was performed at admission and at maximum during hospitalization. The correlation of patient variables, interventions, and resource utilization at the patient level was compared with their correlation at the aggregate institutional level.Results.Of 601 patients, 1 died, 6 were discharged to home health care, 4 were discharged to rehabilitative care, and 2 were discharged to chronic nursing care. Individual patient admission severity score correlated positively with patient hospital costs (r = 0.48), but institutional average patient severity was negatively correlated with average institutional costs (r = −0.26). Maximal severity score correlated well with costs (r = 0.66) and length of stay (LOS;r = 0.64) at the patient level but poorly at the institutional level (r = 0.07 costs; r= 0.40 LOS). The institutional intensity of therapy was negatively correlated with admission severity (r = −0.03) but strongly correlated with costs (r = 0.84) and LOS (r = 0.83).Conclusions.Institutional differences in care practices for children with VLRI were not explained by differences in patient severity and did not affect the children's recovery but correlated significantly with hospital costs and LOS.
Age of Drinking Onset and Involvement in Physical Fights After Drinking
Authors: Hingson Ralph , Heeren Timothy , Zakocs Ronda 
Published: August 2004

Objective.
To explore whether people who start drinking at an early age are more likely to have been in physical fights after drinking, independent of respondent history of alcohol dependence and frequency of heavy drinking.

Design.
In 1992, the US Census Bureau interviewed, in person, 42 862 randomly selected adults age 18 or older, mean age 44, household response rate 91.9%, and in-person response rate 97.4%. The survey included questions regarding the age respondents started drinking, frequency of heavy drinking, and whether respondents were ever or in the past year in a physical fight after drinking alcohol.

Results.
Relative to respondents who did not begin drinking until age 21 or older, those who started drinking before age 17 were 2.9 to 4.1 times more likely ever in their lives, and at least 3 times more likely in the past year, to have been in a fight after drinking. These relationships were found even after controlling for personal history of alcohol dependence, years of drinking, frequency of heavy drinking, smoking, drug use, and other personal characteristics associated with the age respondents started drinking.

Conclusions.
An early age of drinking onset was associated with alcohol-related violence not only among persons under age 21 but among adults as well. Physicians need to query adolescent patients about the age they began drinking and counsel them about the increased risks associated with early drinking onset, such as an increased risk of being involved in alcohol-related violence.
Excessive Infant Crying: The Impact of Varying Definitions
Authors: Reijneveld Sijmen A. , Brugman Emily , Hirasing Remy A. 
Published: August 2004

Objective.To assess the impact of varying definitions of excessive crying and infantile colic on prevalence estimates and to assess to what extent these definitions comprise the same children.Methods.Parents of 3345 infants aged 1, 3, and 6 months (response: 96.5%) were interviewed on the crying behavior of their infant in a Dutch cross-sectional national population-based study. We computed the prevalence of excessive crying according to 10 published definitions regarding parent-reported duration of infant crying and the parents' experience. We measured concordance between pairs of definitions by Cohen's κ (agreement adjusted for chance agreement).Results.Overall prevalence rates of excessive crying varied strongly between definitions, from 1.5% to 11.9%. They were always highest in 1-month-old infants. Concordance between definitions was only excellent (κ &gt; 0.75) if they were closely related, such as crying for &gt;3 hours/day for &gt;3 days/week for the preceding 2 or 3 weeks. Concordance between less closely related definitions was much weaker. Concordance between definitions that were based on duration and on parental experience was mostly poor (κ: 0.17–0.53 for infants aged 1 and 3 months).Conclusions.Different definitions of excessive crying lead to the inclusion of very dissimilar groups of infants. We recommend presenting study results using clearly described definitions, preferably concerning both duration of crying and parental distress. This may improve the comparability of studies on the cause and treatment of excessive infant crying. The impact of the method of data collection on this comparability needs additional study.colic, preventive child health care, prevention, infancy.
Estimating the Cost of Developmental and Behavioral Screening of Preschool Children in General Pediatric Practice
Authors: Dobrez Deborah , Sasso Anthony Lo , Holl Jane , Shalowitz Madeleine , Leon Scott , Budetti Peter 
Published: August 2004

Objective.Despite increased recognition of the importance of development and growth of young children, formal developmental and behavioral screening often is not included in general pediatric practice. Barriers to the provision of developmental and behavioral screening are considerable; among them are the need for specialized training and uncertain reimbursement. This article develops a model for estimating the cost of providing pediatric developmental and behavioral screening that can be scaled to reflect a pediatric practice's patient population and choice of screening offered.Methods.The framework for our scaleable cost model was drawn from work done in estimating the Resource-Based Relative Value Scale (RBRVS). RBRVS provides estimates of the work effort involved in the provision of health care services for individual Current Procedural Terminology codes. The American Academy of Pediatrics has assigned descriptions of pediatric services, including developmental and behavioral screening, to the Current Procedural Terminology codes originally created for adult health care services. The cost of conducting a screen was calculated as a function of the time and staff required and was loaded for practice costs using the RBRVS valuation. The cost of the follow-up consultation was calculated as a function of the time and staff required and the number of relative value units assigned in the RBRVS scale.Results.The practice cost of providing developmental and behavioral screening is driven primarily by the time and staff required to conduct and evaluate the screens. Administration costs are lowest for parent-administered developmental screens ($0 if no assistance is required) and highest ($67) for lengthy, pediatric provider–administered screens, such as the Neonatal Behavioral Assessment Scale. The costs of 3 different groups of developmental and behavioral screening are estimated. The estimated per-member per-month cost per 0- to 3-year-old child ranges from $4 to &gt;$7 in our 3 examples.Conclusions.Cost remains a significant barrier to greater provision of formal developmental and behavioral screening. Our scaleable cost model may be adjusted for a given practice to account for the overall level of developmental risk. The model also provides an estimate of the time and cost of providing new screening services. This model allows pediatric practices to select the mix of developmental screens most appropriate for their particular patient population at an acceptable cost.
Association Between Sudden Infant Death Syndrome and Prone Sleep Position, Bed Sharing, and Sleeping Outside an Infant Crib in Alaska
Authors: Gessner Bradford D. , Ives George C. , Perham-Hester Katherine A. 
Published: August 2004

Objective.
To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS).

Methods.
We conducted a retrospective descriptive study of all SIDS cases in Alaska from January 1, 1992, through December 31, 1997. Reviewed data sources included maternal and infant medical records, autopsy reports, birth and death certificates, police and state trooper death scene investigations, and occasionally home interviews.

Results.
The death certificate identified SIDS as a cause of death for 130 infants (cause-specific infant mortality rate: 2.0 per 1000 live births). Among infants for whom this information was known, 113 (98%) of 115 were found in the prone position, sleeping outside an infant crib, or sleeping with another person. By contrast, 2 (1.7%) were found alone and supine in their crib (1 of whom was found with a blanket wrapped around his face). Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non–drug-using parent on an adult nonwater mattress was identified.

Conclusion.
Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.
Effects of Early Erythropoietin Therapy on the Transfusion Requirements of Preterm Infants Below 1250 Grams Birth Weight: A Multicenter, Randomized, Controlled Trial
Authors: Ohls Robin K. , Ehrenkranz Richard A. , Wright Linda L. , Lemons James A. , Korones Sheldon B. , Stoll Barbara J. , Stark Ann R. , Shankaran Seetha , Donovan Edward F. , Close Nicole C. , Das Abhik ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: August 2004

Objectives.Infants of ≤1250 g birth weight receive multiple erythrocyte transfusions during their hospitalization. We hypothesized that early erythropoietin (Epo) and iron therapy would 1) decrease the number of transfusions received (infants 401-1000 g birth weight; trial 1) and 2) decrease the percentage of infants who received any transfusions (1001–1250 g birth weight; trial 2).Methods.A total of 172 infants in trial 1 and 118 infants in trial 2 were randomized to treatment (Epo, 400 U/kg 3 times weekly) or placebo/control. Therapy was initiated by 4 days after birth and continued through the 35th postmenstrual week. All infants received supplemental parenteral and enteral iron. Complete blood and reticulocyte counts were measured weekly, and ferritin concentrations were measured monthly. Transfusions were administered according to protocol. Phlebotomy losses and transfusion data were recorded.Results.Treated and placebo/control infants in trial 1 received a similar number of transfusions (4.3 ± 3.6 vs 5.2 ± 4.2, respectively). A similar percentage of treated and control infants in trial 2 received at least 1 transfusion (37% vs 46%). Reticulocyte counts were higher in treated infants during each week of the study in both trials. Hematocrits were higher among treated infants from week 2 on in both trials. Ferritin concentrations were higher in placebo/controls than in treated infants at weeks 4 and 8 in trial 1 and at week 4 in trial 2. No adverse effects of Epo or supplemental iron occurred.Conclusion.The combination of early Epo and iron as administered in this study stimulated erythropoiesis in infants who were ≤1250 g at birth. However, the lack of impact on transfusion requirements fails to support routine use of early Epo.neonate, intravenous iron, donor exposure.
Respiratory Infections in Infants: Interaction of Parental Allergy, Child Care, and Siblings—The PIAMA Study
Authors: Koopman Laurens P. , Smit Henriette A. , Heijnen Marie-Louise A. , Wijga Alet , van Strien Rob T. , Kerkhof Marjan , Gerritsen Jorrit , Brunekreef Bert , de Jongste Johan C. , Neijens Herman J. 
Published: August 2004

Objective.To investigate the association between contacts with other children and the development of respiratory infections in the first year of life in children with or without genetic predisposition for allergy.Methods.Children (n = 4146) who participate in a prospective birth cohort study (Prevention and Incidence of Asthma and Mite Allergy study) were investigated. Questionnaires were used to obtain information on doctor-diagnosed upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI), child care attendance, having siblings, family history of allergic disease, and various potential confounders.Results.Child care attendance in the first year of life was associated with doctor-diagnosed URTI (adjusted odds ratio [AOR]: 2.7; 95% confidence interval [CI]: 2.1–3.4 for large child care facility vs no child care) and doctor-diagnosed LRTI (AOR: 5.6; 95% CI: 3.9–7.9). Having siblings was associated with doctor-diagnosed LRTI (AOR: 2.6; 95% CI: 2.0–3.4). In addition, children who have allergic parents and attend child care or have older siblings have a higher risk of developing doctor-diagnosed LRTI than do children who have nonallergic parents.Conclusions.Child care attendance or having siblings increases the risk of developing doctor-diagnosed LRTI in the first year of life to a greater extent in allergy-prone children than in children who are not allergy prone.