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PubMed2000

Driving outcomes of young people with attentional difficulties in adolescence.

OBJECTIVE: To examine associations between attentional difficulties at age 13 and a range of adverse driving outcomes measured at 21 years. METHOD: Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Data collection included the following: (1) parent and teacher report measures of attentional difficulties (13 years); (2) measures of driving behavior, including involvement in an accident, drinking and driving, and traffic violations (18-21 years); and (3) measures of a range of potentially confounding individual, sociofamilial, and driving-related factors. RESULTS: Young people with high levels of attentional difficulties were at greater risk of involvement in a motor vehicle accident, drinking and driving, and traffic violations. These associations were largely explained by the personal characteristics (gender, conduct problems) and driving experience (length of time respondent held a license, distance driven) of young people with attentional difficulties. Even after adjustment for the effects of confounding factors, adolescent attentional difficulties placed young people at increased risk of an injury accident, driving without a license, and other traffic violations. CONCLUSIONS: Associations between adolescent attentional difficulties and subsequent driving risks largely reflect the effects of confounding factors correlated with attentional difficulties and driving outcomes. However, even after adjustment for confounding, adolescent attentional difficulties contributed to later injury accident risk and possibly also to risky driving behavior.

Accidents, Traffic↗
PubMed1987

Effects of child restraint laws on traffic fatalities in eleven states.

Mandatory child restraint laws in 11 states were evaluated for their effect on motor vehicle fatality rates among young children. Data from 1976 through 1983 were analyzed using a monthly time-series design involving 54 months' pre-law and 12 months' post-law data. The 11 states collectively had a mean of 8.8 and a standard deviation of 3.6 fatalities per month among young children. Such small frequency counts resulted in a large proportion of the variation being random. Statistical power analyses found fatality reductions of 20% to 25% following the child restraint laws would be statistically significant. Reductions of such a magnitude were not found for young children. Based on these findings, we recommend that evaluations of highway safety policies focusing on a specific age group within a single state not be limited to analyses of traffic fatalities alone. Studies employing analyses of the larger numbers of crash-induced injuries have identified modest but important casualty reductions not found when analyzing fatalities alone.

Accidents, Traffic↗
PubMed1989

[Acute traumatic intracranial hematoma in children].

The data on 25 children patients with acute traumatic intracranial hematomas are presented. This accounts for 2.9% of a total of intracranial hematomas and 0.6% of a total of children with craniocerebral trauma. Correct diagnosis and early surgical intervention combined with therapeutic measures ensured favorable outcome in 76% of the cases.

Acute Disease↗
PubMed1995

Patterns of care received by Medicaid recipients with urinary tract infections.

BACKGROUND: Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs. PURPOSE: The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations. METHODS: The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition). RESULTS: We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound. CONCLUSIONS: Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.

Alabama↗
PubMed1982

Junior medical students and satisfaction of patients' parents in a pediatric clerkship.

This study reports an evaluation of the impact of junior medical students on patient satisfaction, as expressed by the patients' parents, and on visit length in a hospital-based general pediatric clinic. Data were collected on a group of consecutive visits. One month later a random sample of the parents of these patients were interviewed to ascertain their attitudes toward the care of their children. Data gathered by these two methodologies were combined to yield an operational and attitudinal data set. Although patient visits with medical students were significantly longer than nonstudent encounters, the proportion of parents who expressed overall satisfaction with their child's visit was greater for visits involving medical students. Dissatisfaction with the amount of time spent generally increased with the length of the visit in both groups. A pattern emerged, however, which indicated that a larger proportion of parents whose children were involved in teaching encounters were satisfied with the visit overall than those not involved regardless of the visit length. The data suggest willingness on the part of parents to accept time costs associated with teaching in the program.

Child↗
PubMed2000

Anthelmintic drugs for treating worms in children: effects on growth and cognitive performance.

BACKGROUND: Helminth (worm) infections are widespread and are thought to contribute to poor nutritional status, anaemia, and impaired growth and learning in children. OBJECTIVES: To summarise the effects of anthelmintic drug treatment in children in relation to their growth and cognitive performance. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase and the reference lists of articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of drug treatment compared with placebo or no drug treatment for intestinal helminths in children. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for additional information. MAIN RESULTS: Thirty trials involving more than 1500 children were included. There was potential for bias from inadequate concealment of allocation. Studies varied in relation to target groups, drugs administered and treatment regimens. Compared to placebo or no drug treatment, drug treatment for helminths was associated with some positive effects on change in weight, height and skinfold thickness. However there was significant heterogeneity between the results of the trials. There were some positive effects on mean weight change in the trials reporting this outcome; after a single dose (any anthelminth) the pooled estimate was 0.24 kg, (95% CI 0.15 to 0.32; fixed effects model assumed); and 0.38 kg (95% CI 0.00 to 0.77; random effects model assumed). Results from trials giving multiple doses showed mean weight change under one year of follow up of 0.10 kg (95% CI 0.04 to 0.17; fixed effects assumed); or 0.15 (95% CI 0.00 to 0.30; random effects assumed). At more than one year of follow up, mean weight change was 0.12 kg (95% CI -0.02 to 0.26; fixed effects assumed) and 0.43 (95% CI -0.61 to 1.47; random effects model assumed). Results from studies of cognitive performance were mixed and inconclusive. REVIEWER'S CONCLUSIONS: There is some limited evidence that routine treatment of children in areas where helminths are common has small effects on weight gain, but this is not consistent between trials. There is insufficient evidence to know whether this intervention improves cognitive performance. Our interpretation of these results is that the current public health programme investments in this intervention, based on the expectation that there will be an improvement in growth and learning, are not based on consistent or reliable evidence.

Adolescent↗
PubMed1996

Invasive pneumococcal infections in human immunodeficiency virus-infected children.

Invasive pneumococcal infection (IPI) is the most common serious bacterial infection in human immunodeficiency virus (HIV)-infected children. Data from a population-based pediatric HIV surveillance project were used to determine the incidence of IPI in HIV-infected children and to conduct a case-control study assessing potential risk factors for IPI in HIV-infected children. There were 50 episodes of IPI and a cumulative incidence of 6.1 cases/100 patient-years through age 7 years. Children with IPI were more likely to have a prior AIDS diagnosis (odds ratio, 4.2; 95% confidence interval, 1.2-15.1) and higher levels of IgG and IgM (P=.01) than were controls. In a separate case-control study, the manifestations of IPI in HIV-infected children were compared with those in HIV-negative controls. Focal complication rates in the 2 groups did not differ; however, HIV-infected children were less likely than controls to have leukocytosis (P<.001) and more likely to have isolates with penicillin resistance (P=.03).

Age Factors↗
PubMed2001

Rear seating and risk of injury to child occupants by vehicle type.

The safety of rear-seated child passengers was evaluated across vehicle types. 113,887 children under age 16 in crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children in the second row suffered less significant injuries than those in the front in all vehicle types except compact extended cab pickup trucks in which the risk for children in the rear was 13% as compared to 2.8% for front-seated occupants. Further research is needed to identify the child and vehicle characteristics which might explain this increased injury risk.

Abbreviated Injury Scale↗
PubMed2003

The effects of varying exposure to malaria transmission on development of antimalarial antibody responses in preschool children. XVI. Asembo Bay Cohort Project.

In areas of intense malaria transmission, malaria morbidity and mortality is highest in children 3-18 months old. Interventions that reduce malaria exposure early in life reduce morbidity but may also delay development of clinical immunity. We assessed the relationship between intensity of malaria exposure and development of antibody responses. Thirty-nine children were monitored monthly, from birth to > or =2.5 years old (1238 observations), and were divided into 3 exposure categories, on the basis of parasitemic episodes or entomological data. Children with low exposure during the first 2 years of life had higher subsequent levels of antibody to merozoite surface protein-1(19-kDa) (a marker of blood-stage responses) by months 24-35 (P<.05). This inverse relationship decreased as children aged. There was no consistent relationship between exposure early in life and subsequent levels of antibody to circumsporozoite protein (a marker of sporozoite-stage responses). These data suggest that, in areas of intense malaria transmission, during the first 3 years of life, interventions that either reduce the number of asexual parasitemic episodes or lower entomological exposure do not delay the development of antibody responses to blood-stage malarial antigens.

Animals↗
PubMed2000

Chest radiograph in acute respiratory infections in children.

BACKGROUND: Chest radiography is widely used in acute lower respiratory infection in children, but the benefits are unknown. OBJECTIVES: To assess the effects of chest radiography for children with acute lower respiratory infections. SEARCH STRATEGY: We searched the Cochrane Respiratory Infections Group trials register, the Cochrane Controlled Trials Register and MEDLINE up to December 1999. We contacted experts in the fields of acute respiratory infections and paediatric radiology to locate additional studies. SELECTION CRITERIA: Randomised or quasi-randomised trials of chest radiography in acute respiratory infections in children. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and assessed trial quality. MAIN RESULTS: We identified only one trial of 522 participants, performed by the reviewers. The participants were ambulatory children aged two months to five years. Forty six percent of both radiography and control participants had recovered by seven days - odds ratio (1.03, 95% confidence interval 0.64 to 1.64). Thirty three percent of radiography participants and 32% of control participants made a subsequent hospital visit within four weeks - odds ratio 1.02 (95% confidence interval 0.71 to 1.48). Three percent of both radiography and control participants were subsequently admitted to hospital within four weeks - odds ratio 1.02 (95% confidence interval 0.40 to 2.60). There were no deaths in either group. REVIEWER'S CONCLUSIONS: There is no evidence that chest radiography improves outcome in ambulatory children with acute lower respiratory infection. The findings do not exclude a potential effect of radiography, but the potential benefit needs to be balanced against the hazards and expense of chest radiography. The findings apply to ambulatory children only.

Acute Disease↗
PubMed1999

Factors related to adiposity among children aged 3 to 7 years.

OBJECTIVE: To compare diet and physical activity between a group of children aged 4 to 7 years who had increased their sum of 7 skinfolds by 1.5 standard deviations or more since the previous year and those who had not. SUBJECTS/DESIGN: A longitudinal design was used wherein children had their body composition assessed at 4 annual intervals. Fifteen study subjects were identified from a larger study on the development of cardiovascular risk factors in children. Three matched control subjects were identified for all but 4 study subjects. Children were included if they were 3 or 4 years old at the time of the first of 4 annual clinics to collect data. Children were volunteers from a mid-sized city. MEASURES: Seven skinfold sites were assessed, each 3 times. An average was taken of the mean at each site. Diet and physical activity were assessed using observational methods for up to 4 days for each of 3 years between the 4 annual clinics (held in the summers of 1986, 1987, 1988, and 1989). RESULTS: Children consumed significantly (P = .02) more fat grams and suggestively higher percentages of energy from fat (P = .06), total energy (P = .08), and percentage energy from protein (P = .10). No differences were detected for percent energy from carbohydrate, physical activity, or height. CONCLUSIONS: Programs to prevent childhood obesity might have success by targeting dietary fat consumption among children as young as 4 years old, but further research is needed.

Adipose Tissue↗
PubMed1987

A comparison of five anthropometric indices for identifying factors of malnutrition.

Five anthropometric indices--weight-for-age, height-for-age, weight-for-height, weight velocity, and height velocity--are compared for identifying factors of nutritional status of children. Data come from Matlab, the field station of the International Centre for Diarrhoeal Disease Research, Bangladesh. Weights and heights on approximately 1,400 children aged 12-60 months were taken 11 times at two-month intervals. Dwelling floor space, a proxy for socioeconomic status, is considered a long-term factor; the 1974-1975 Bangladesh famine, a medium-term factor; and season, a short-term factor of nutritional status. The figures of the indices by socioeconomic status at different times show their power to identify the factors visually; the regression analyses test statistical significance of the factors; and the standardized regression coefficients provide relative power of the indices to identify the factors. Weight-for-age and height-for-age appear best for identifying long- and medium-term factors; weight velocity, for identifying short-term factors. Weight-for-height is third in identifying long- and medium-term factors, second for identifying short-term factors. Height velocity identifies short-term factors only. The effect of short-term factors on height velocity appears approximately four months later than it appears on weight velocity. This study clarifies why certain indices do not predict mortality in this study population and others.

Anthropometry↗
PubMedDate not supplied

Dentists' ranking of Medicaid reimbursement rates as a measure of their pediatric Medicaid participation.

The objective of the study was to determine the usefulness of dentists' ranking of Medicaid reimbursement rates as a measure of their participation in the Medicaid program for children. Data were obtained from two mail-in questionnaire surveys of Connecticut dentists, before and after an increase in Medicaid reimbursement rates for children. Dentists ranked acceptability of Medicaid reimbursement rates on a seven-point index, while their participation in the Medicaid program was assessed by whether they acknowledged treating Medicaid children and were currently accepting new Medicaid children into their practices. There was a significant difference (p < 0.0001) in the dentists' ranking of Medicaid reimbursement rates following the rate increase indicating that the index was responsive. Acceptance of new Medicaid children into dental practices was a better measure of active participation in the Medicaid program. Following the increase in Medicaid reimbursement rates, dentists ranking it as acceptable/equivocal were more likely (p < 0.02) to accept new Medicaid children into their practices. In conclusion, the index of dentists' ranking of Medicaid reimbursement rates was a responsive and valid measure of their participation in the Medicaid program.

Attitude of Health Personnel↗
PubMed1984

Play assessment in the differential diagnosis of autism and other causes of severe language disorder.

The autistic child's problems with language may be an impairment in symbolic functioning that affects all forms of communication, including representational thought and the ability to play creatively. The hypothesis that autistic children specifically do not project symbolic meaning onto toys (which is not associated with other conditions causing severe language disorder) was tested in a group of 15 severely language-impaired children. Data were obtained from a parent interview/questionnaire and analysis of a video-taped play session. The findings suggest that language-disordered children who meet DSM III criteria for autism most consistently show absence of symbolic play, and those who do have symbolic play fall into a wide range of diagnostic categories excluding autism. The report presents valuable observational and interpretational clinical factors, useful in the assessment and differential diagnosis of a language-impaired child.

Adolescent↗
PubMed2001

The effect of seating position on risk of injury for children in side impact collisions.

The objective of this study was to evaluate the effect of seating position on risk of injury to children in side impact crashes. 5,632 children under age 16 in side impact crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children seated in the front seat were at higher risk of significant injury than children seated in the rear (OR = 2.2 95% CI (1.2-3.8)). After adjusting for age, restraint use, and vehicle damage, children in the front seat were more likely to be injured (OR 2.6 95% CI (1.1-6.2)) than children seated in the rear when the child was sitting near the side of the impact. These results highlight the importance of evaluating the safety performance of both vehicles and restraint systems for children in side impact crashes.

Accidents, Traffic↗
PubMed2004

Are inhaled corticosteroids associated with an increased risk of fracture in children?

Inhaled corticosteroids are widely used in the long-term management of asthma in children. Data on the relationship between inhaled corticosteroid therapy and osteoporotic fracture are inconsistent. We address this issue in a large population-based cohort of children aged 4-17 years in the UK (the General Practice Research Database). The incidence rates of fracture among children aged 4-17 years taking inhaled corticosteroids (n=97,387), taking bronchodilators only (n=70 984) and a reference group (n=345,758) were estimated. Each child with a non-vertebral fracture (n=23,984) was subsequently matched by age, sex, practice, and calendar time to one child without a fracture. Fracture incidence was increased in children using inhaled corticosteroids, as well as in those receiving bronchodilators alone. With an average daily beclomethasone dose of 200 microg or less, the crude fracture risk relative to nonusers was 1.10 [95% confidence interval (CI), 0.96-1.26]; with dosage of 201-400 microg, it was 1.23 (95% CI, 1.08-1.39); and with dosages over 400 microg, it was 1.36 (95% CI, 1.11-1.67). This excess risk disappeared after adjustment for indicators of asthma severity. The increased risk of fracture associated with use of inhaled corticosteroids is likely to be the result of the underlying illness, rather than being directly attributable to inhaled corticosteroid therapy.

Administration, Inhalation↗
PubMed2003

Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children.

OBJECTIVE: To study the effects of excessive sweetened drink consumption on daily energy balance and nutrient intake in a longitudinal study of children. SUBJECTS AND METHODS: Daily dietary intakes of 30 children aged 6 to 13 years old were collected over 4 to 8 weeks. Weights and heights of children were measured at the beginning and end of the study in 21 children. Data were analyzed by analysis of variance (ANOVA) (PROC MIXED in SAS) and multiple regression. RESULTS: Excessive sweetened drink consumption (>12 oz/day) displaced milk from children's diets (122-147 g/day less milk drank, P <.0001) because caregivers served less milk and the children consumed smaller amounts of milk. The consequences were lower daily protein, calcium, magnesium, phosphorus, and vitamin A intakes. Because children failed to reduce consumption of solid foods to compensate for the caloric contribution of sweetened drinks, higher daily energy intakes were observed. Consequently, the greater the sweetened drink consumption the greater the weight gain (1.12 +/- 0.7 kg) compared with children who consumed <12 oz per day (0.32-0.48 +/- 0.4 kg). CONCLUSIONS: Excessive sweetened drink consumption is associated with the displacement of milk from children's diets, higher daily energy intake, and greater weight gain.

Adolescent↗