bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity and Psychiatric Disorder: Developmental Trajectories
Authors: Mustillo Sarah , Worthman Carol , Erkanli Alaattin , Keeler Gordon , Angold Adrian , Costello E. Jane 
Published: August 2004

Objectives. To identify age-related trajectories of obesity from childhood into adolescence, and to test the association of these trajectories with the development of psychiatric disorders (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse, depression, and anxiety).
Methods. White children (N = 991) 9 to 16 years old from the Great Smoky Mountains Study, a representative sample of rural youth, were evaluated annually over an 8-year period for height, weight, psychiatric disorder, and vulnerabilities for psychiatric disorder. Longitudinal analyses on the repeated measures data were conducted using developmental trajectory models and generalized estimating equation models.
Results. Obesity was 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. Four developmental trajectories of obesity were found: no obesity (73%), chronic obesity (15%), childhood obesity (5%), and adolescent obesity (7%). Only chronic obesity was associated with psychiatric disorder: oppositional defiant disorder in boys and girls and depressive disorders in boys.
Conclusions. In a general population sample studied longitudinally, chronic obesity was associated with psychopathology.
Apnea, Sudden Infant Death Syndrome, and Home Monitoring
Authors:   Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was retired May 2012.
More than 25 years have elapsed since continuous cardiorespiratory monitoring at home was suggested to decrease the risk of sudden infant death syndrome (SIDS). In the ensuing interval, multiple studies have been unable to establish the alleged efficacy of its use. In this statement, the most recent research information concerning extreme limits for a prolonged course of apnea of prematurity is reviewed. Recommendations regarding the appropriate use of home cardiorespiratory monitoring after hospital discharge emphasize limiting use to specific clinical indications for a predetermined period, using only monitors equipped with an event recorder, and counseling parents that monitor use does not prevent sudden, unexpected death in all circumstances. The continued implementation of proven SIDS prevention measures is encouraged.
Hearing Deficits in Young Adults Who Had a History of Otitis Media in Childhood: Use of Personal Stereos Had No Effect on Hearing
Authors: de Beer Brechtje A. , Graamans Kees , Snik Ad F. M. , Ingels Koen , Zielhuis Gerhard A. 
Published: August 2004

Objective. To test the hypothesis proposed in a recent French study that a history of recurrent otitis media (OM) in childhood increases susceptibility to hearing loss from frequent exposure to a personal stereo (PS) during development to early adulthood.
Methods. A subcohort of 358 young adults selected from a historic cohort study, all 18 years old and with a well-documented OM history (secretory and acute), provided data on the sound level and length of exposure to PSs. Four contrasting groups were formed: those with the highest or lowest PS exposure combined with a positive or negative history of OM (n = 238). The main outcome measure was hearing thresholds from pure-tone audiometry (0.5–8 kHz).
Results. Young adults with a history of recurrent OM in childhood did not show greater susceptibility to hearing loss from PS use than their peers without a history of OM. However, a history of recurrent OM was associated with significant mean air-conduction hearing loss of 4 dB and a mean bone-conduction hearing loss of 2 dB compared with the participants without a history of OM (Fig 1).
Conclusions. Recurrent OM in childhood may have an irreversible effect on the middle ear and the cochlea and may lead to hearing deficits in later life. No interaction with PS exposure is seen.
Tuberculin Testing and Risk of Tuberculosis Infection Among New York City Schoolchildren
Authors: Gounder Celine R. , Driver Cynthia R. , Scholten Jerod N. , Shen Huimin , Munsiff Sonal S. 
Published: August 2004

Objectives. To assess adherence to a 1996 health policy change, which discontinued mandatory tuberculin skin testing (TST) of new entrants to NYC primary schools and continued mandatory testing of new entrants to secondary schools.
Methods. The proportion tested before (1991–1995) and after (1996–1998) the change in health policy was determined. Factors associated with TST positivity and the cost of continued testing were assessed.
Results. A total of 76.6% of 551 636 new entrants to primary schools were tested in 1991–1995; slightly fewer, 71.1% of 339 958, were tested in 1996- 1998. Among new entrants to secondary schools, 31.0% of 106 463 were tested in 1991–1995 and 51.4% of 53 762 were tested in 1996–1998. The proportion who were TST-positive continued to decrease after 1996 to 1.2% among primary and 9.7% among secondary schoolchildren in 1998. Older age and birth outside the United States were associated with TST positivity. The estimated minimum cost of continued testing in primary schools was $123 152 per tuberculosis case prevented.
Conclusion. An approach aimed at reducing testing of children at low risk for latent tuberculosis infection did not decrease testing of younger children. More important, older children who were more likely to be born in countries of high tuberculosis incidence were not tested. Additional efforts are needed to increase awareness among medical and school personnel to decrease testing among children who do not have risk factors for latent tuberculosis infection and to increase tuberculin testing of children who are entering school for the first time at the secondary level and do have risk factors for tuberculosis infection.
Postpartum Length of Stay and Newborn Health: A Cost-Effectiveness Analysis
Authors: Malkin Jesse D. , Keeler Emmett , Broder Michael S. , Garber Steven 
Published: August 2004

Objective. To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations.Methods. A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113 147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured.Results. Estimated lower-bound cost per newborn life-year saved was $19 800 (95% confidence interval: $11 600–$61 300) when only neonatal deaths were considered. The corresponding upper-bound estimate was $94 800 (95% confidence interval: $55 200–$286 800). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths).Conclusions. At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of $100 000 per quality-adjusted life-year suggested by the literature.
Too Small for a Seatbelt: Predictors of Booster Seat Use by Child Passengers
Authors: Ebel Beth E. , Koepsell Thomas D. , Bennett Elizabeth E. , Rivara Frederick P. 
Published: August 2004

Objectives. Motor vehicle injury is the leading cause of injury death for children 4 to 8 years of age. Although booster seat use in this age group substantially reduces the risk of injury, most children are currently restrained by seatbelts designed for adults. The objective of this study was to measure booster seat use directly, determine factors predictive of proper child restraint, and assess parental reasons for booster use and nonuse.Methods. We conducted a cross-sectional, observational study in Seattle, Washington, Spokane, Washington, and Portland, Oregon, from February to April 2000. Drivers were surveyed in their vehicles after picking up children from schools and child care centers. Trained observers recorded child age, weight, and height and directly observed restraint use. Observed restraint use was compared with the recommended restraint method based on the child’s weight and age. Data were analyzed using multivariate logistic regression, adjusted for clustering by car and site.Results. We observed 2880 children traveling in cars, 1539 of whom were eligible for booster seat use. Eighty-eight percent of drivers agreed to respond to our survey. Only 16.5% of children for whom a booster seat was recommended were properly restrained, compared with 80% of younger children for whom a child safety seat was recommended and 55% of children for whom an adult seatbelt was recommended. Relative to a 4-year-old booster-eligible child, a 6-year-old was only half as likely to use a booster seat (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.31–0.71) and an 8-year-old almost never used a booster seat (OR: 0.04; 95% CI: 0.01–0.19). Booster use was more common when the driver wore a seatbelt (OR: 3.1; 95% CI: 1.8–5.4). Parents whose children were using booster seat cited “safety” (61%) and “child comfort and visibility” (12%) as their primary concerns. When a child was not using a booster seat, parents most often believed that their child was “too big for a car seat” (56%), reported that the seat was in another vehicle (9%), or stated that they “had not heard” of booster seats (8%).Conclusions. Many parents still incorrectly believe that children are safe in a seatbelt and have outgrown the need for a car seat. These results demonstrate the need for public education campaigns to educate parents about booster seat use.
Occurrence and Mechanisms of Sudden Oxygen Desaturation in Infants Who Sleep Face Down
Authors: Patel Aloka L. , Paluszynska Dorota , Harris Kathleen A. , Thach Bradley T. 
Published: August 2004

Objective. Infants who sleep prone and face down on soft bedding are particularly vulnerable for sudden infant death syndrome. It has been suggested that 1 mechanism of death in this situation involves rebreathing of expired air. Many infants tolerate rebreathing while lying prone face down for long periods with stable saturations. Others occasionally have rapid desaturations and may require intervention to terminate rebreathing. The present study had 3 objectives: 1) to determine the frequency of rapid desaturations in a large group of healthy infants, 2) to elucidate the mechanism of these desaturations, and 3) to determine the timing of these events during periods of rebreathing.Methods. We studied respiratory tracings and videotapes of 56 healthy 1- to 6-month-old infants who were sleeping face down and rebreathing on soft bedding in our laboratory. We compared the frequency of desaturations during rebreathing and nonrebreathing periods. We measured respiratory frequency and apnea occurrence before desaturation and nonrebreathing control episodes. We also measured minute ventilation during steady state before desaturation and just before desaturation.Results. There were 25 desaturation episodes in infants while rebreathing, occurring in 11 (19.6%) of the 56 infants. Episodes were significantly more frequent during rebreathing than during nonrebreathing periods. Three desaturation episodes reached &lt;85%; 2 required intervention to terminate rebreathing. The respiratory frequency was not different between nonrebreathing control and desaturation episodes. Brief apneas were significantly more frequent preceding desaturation than control episodes (44% vs 4%). Just before episodes, there was a transient decrease in minute volume despite increasing inspired carbon dioxide in 3 episodes. There was evidence of partial or complete pharyngeal airway obstruction in 3 episodes. Thirty-six percent of all episodes were immediately preceded by behavioral arousal.Conclusions. Rebreathing in prone sleeping infants is associated with an increased frequency of episodic desaturations. Desaturation may result from respiratory pattern changes such as brief apneas often associated with evidence of behavioral arousal or failure to increase ventilation in the face of rising inspired carbon dioxide, also associated with behavioral arousal.
Median Household Income and Mortality Rate in Cystic Fibrosis
Authors: O’Connor Gerald T. , Quinton Hebe B. , Kneeland Terry , Kahn Richard , Lever Thomas , Maddock Joanne , Robichaud Priscilla , Detzer Mark , Swartz Donald R. 
Published: August 2004

Context. Poverty has been shown to be a determinant of health outcomes in many epidemiologic studies.Objective. The goal of this study was to assess the association between household income and the mortality rate in cystic fibrosis (CF) patients.Design, Setting, and Patients. We selected white patients diagnosed before 18 years old and having 1 or more records in the Cystic Fibrosis Foundation Patient Registry since 1991. These 23 817 patients were linked to the 1990 US Census by their zip code of residence. The median household income was adjusted for state level differences in cost of living using the 1998 Consumer Price Index.Interventions. None.Main Outcome Measures. We examined the association between categories of the median household income and the mortality rate. We examined the association between income categories and age-related changes in pulmonary function and body weight as well as specific nutritional and pulmonary therapies.Results. We found a strong monotonic association between the median household income and the mortality rate. The test of trend was significant, and this effect was maintained after adjustment for a variety of patient and disease characteristics. When the lowest income category (&lt;$20 000) is compared with the highest (≥$50 000), the adjusted incidence rates were 90.3 and 62.6 per 10 000 person years, respectively; this represents a 44% increased risk of death in the lowest income category. Patients living in areas with lower median household income also had consistently lower pulmonary function and body weight than did those living in higher income areas. The differences in weight percentiles and forced expiratory volume in 1 second are substantial in magnitude, they appear at an early age, and they persist into adulthood for these CF patients. Prescribed nutritional treatments and screening for CF-related diabetes were significantly higher among patients living in areas with lower median household income. Prescription of deoxyribonuclease and inhaled tobramycin was not significantly associated with median household income.Conclusion. There was a strong association between lower household income and increased mortality rate among CF patients. Additional understanding of this effect will require more complete and direct measurement of socioeconomic status and a better understanding of treatment adherence, local environmental conditions, and especially the care of CF patients during the early years of life.
Effects of Thickened Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using Intraluminal Impedance
Authors: Wenzl Tobias G. , Schneider Sabine , Scheele Frank , Silny Jiri , Heimann Gerhard , Skopnik Heino 
Published: August 2004

Objective. Thickening of formula feedings is part of the therapeutic approach for gastroesophageal reflux (GER) in infants. However, its mechanism of action, especially regarding the occurrence of nonacid (pH &gt;4) GER, has not yet been clearly described. The aim of this randomized, placebo-controlled crossover study was to examine the influence of formula thickened with carob (St. John’s bread) bean gum on acid and nonacid GER.Methods. Infants with recurrent regurgitation and without other symptoms were fed alternately (A-B-A-B-A-B) with thickened (A) and nonthickened (B) but otherwise identical formula. Documentation of GER episodes during the study was performed by simultaneous intraesophageal impedance measurement (intraluminal electrical impedance; IMP) and pH monitoring. The IMP technique is able to detect bolus movements inside a luminal organ. The use of multiple measuring segments on a single catheter allowed the analysis of direction, height, and duration of the bolus transport. Continuous videorecording and visual surveillance of regurgitation frequency and amount resulted in a severity score.Results. Fourteen infants (42 ± 32 days old) were examined during 6 feeding intervals each for a total measuring time of 342 hours. A total of 1183 GER episodes and 83 episodes of regurgitation were registered. Regurgitation frequency (15 vs 68 episodes) and amount (severity score 0.6 vs 1.8) were significantly lower after feedings with thickened formula. The difference regarding the occurrence of GER documented by IMP was also pronounced (536 vs 647 episodes). Although not statistically significant, maximal height reached by the refluxate in the esophagus was decreased after thickened feedings. Mean GER duration and the frequency of acid (pH &lt;4) GER were not altered.Conclusions. Thickened feeding has a significant effect on the reduction of regurgitation frequency and amount in otherwise healthy infants. This effect is caused by a reduction in the number of nonacid (pH &gt;4) GER episodes, but also because of a decrease of mean reflux height reached in the esophagus. However, the occurrence of acid GER is not reduced. The combination of IMP and pH monitoring allows the complete registration and description of these GER episodes. Thickening of formula feedings with carob bean gum is an efficient therapy for uncomplicated GER in infants.
Injuries Experienced by Infant Children: A Population-Based Epidemiological Analysis
Authors: Pickett William , Streight Susan , Simpson Kelly , Brison Robert J. 
Published: August 2004

Objective. Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern Ontario.Methods. Epidemiologic analysis of emergency-based surveillance data (1994–2000) for infants (&lt;12 months old) from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program.Results. A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries).Conclusion. The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.
Health Care Utilization and Expenditures Associated With Child Care Attendance: A Nationally Representative Sample
Authors: Silverstein Michael , Sales Anne E. , Koepsell Thomas D. 
Published: August 2004

Objective. Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children.Methods. A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data.Results. A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0–7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1–3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2–6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be $642 (95% CI: 508–813), versus $985 (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends.Conclusion. In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.