Providence, RI, United States
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Dennehy P.H.,Hasbro Childrens Hospital
Infectious Disease Clinics of North America | Year: 2015

Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide. Vaccination is the only control measure likely to have a significant impact on the incidence of severe disease. Rotavirus vaccines have reduced the burden of disease in the United States and Europe and vaccine programs are being introduced in Asia and Africa where it is hoped that vaccine will have significant impact on severe infection. Long-term monitoring and strain surveillance are needed to assess the effects of rotavirus immunization programs and to determine whether changes in strain ecology will affect rotavirus vaccine effectiveness. © 2015 Elsevier Inc..


Owens J.A.,Hasbro Childrens Hospital | Belon K.,Hasbro Childrens Hospital | Moss P.,St. Georges School
Archives of Pediatrics and Adolescent Medicine | Year: 2010

Objective: To examine the impact of a 30-minute delay in school start time on adolescents' sleep, mood, and behavior. Design: Participants completed the online retrospective Sleep Habits Survey before and after a change in school start time. Setting: An independent high school in Rhode Island. Participants: Students (n=201) in grades 9 through 12. Intervention: Institution of a delay in school start time from 8 to 8:30 AM. Main Outcome Measures: Sleep patterns and behavior, daytime sleepiness, mood, data from the Health Center, and absences/tardies. Results: After the start time delay, mean school night sleep duration increased by 45 minutes, and average bedtime advanced by 18 minutes (95% confidence interval, 7-29 minutes [t423=3.36; P<.001]); the percentage of students getting less than 7 hours of sleep decreased by 79.4%, and those reporting at least 8 hours of sleep increased from 16.4% to 54.7%. Students reported significantly more satisfaction with sleep and experienced improved motivation. Daytime sleepiness, fatigue, and depressed mood were all reduced. Most health-related variables, including Health Center visits for fatigue-related complaints, and class attendance also improved. Conclusions: A modest delay in school start time was associated with significant improvements in measures of adolescent alertness, mood, and health. The results of this study support the potential benefits of adjusting school schedules to adolescents' sleep needs, circadian rhythm, and developmental stage. ©2010 American Medical Association. All rights reserved.


Owens J.A.,Hasbro Childrens Hospital | Jones C.,Durham University | Nash R.,Hasbro Childrens Hospital
Journal of Clinical Sleep Medicine | Year: 2011

Study Objectives: To examine sleep health knowledge and beliefs and their relationship to sleep practices in a community sample of caregivers of young children. Methods: A convenience sample of caregivers visiting a museum on one of 2 consecutive weekend days completed a brief parent-report survey on child sleep habits and parental basic sleep knowledge and beliefs and attitudes regarding sleep as a health behavior. Results: Of the 253 analyzable surveys (response rate 80%; mean age of index child 3.4 ± 2.0 years), 23% of children did not have a consistent bedtime, 25% had a bedtime later than 9 pm, 23% had at least one electronic device in the bedroom, and 56% frequently fell asleep with an adult present. Both positive and negative sleep habits tended to cluster together. Children who had irregular and late bedtimes were more than twice as likely to obtain insuffi cient sleep that those with regular and early bedtimes (OR 2.30, 2.45). While 25% of children were getting less than the recommended sleep amount for age, just 13% of parents believed that their child was getting insuffi cient sleep. Lack of knowledge regarding the potential negative impact of specifi c sleep practices was associated with an increased likelihood of engaging in those practices. Conclusions: The results of this survey study of a generally well-educated sample of caregivers suggest that there are clear parental knowledge gaps regarding healthy sleep in young children and supports the need for increased sleep health education.


Owens J.A.,Hasbro Childrens Hospital | Jones C.,Durham University
Journal of Developmental and Behavioral Pediatrics | Year: 2011

OBJECTIVE:: The purpose of this study was to examine the associations among parental knowledge and beliefs about healthy sleep, sleep practices, and insufficient sleep in a pediatric primary care clinic sample. METHODS:: A convenience sample of caregivers of patients between 3 months and 12 years attending a hospital-based pediatric primary care clinic in an academic center completed a brief survey on (1) child sleep habits, (2) basic sleep knowledge, and (3) beliefs and attitudes regarding sleep as a health behavior. RESULTS:: Of the 184 analyzable surveys (response rate 72%; mean age of index child 4.0 ± 3.2 years), 42% of children did not have a consistent bedtime, 43% had a bedtime later than 9 pm, 76% had a television in the bedroom, 69% frequently fell asleep with an adult present, and 18% had daily caffeine intake. Although 76% of parents underestimated their child's sleep needs compared to recommended amounts, just 8% reported that their child was not getting adequate sleep. More than half of parents believed that inadequate sleep increases the risk of being underweight and endorsed snoring as a sign of healthy sleep. An increased level of sleep knowledge was associated with a number of positive sleep practices and inversely correlated with sleep duration. CONCLUSION:: The results of this study document the need for increased targeted caregiver education regarding healthy sleep practices, the importance of adequate sleep, the impact of insufficient sleep on health, and recognition of potential signs of sleep problems in young children, especially in high-risk populations. Copyright © 2011 Lippincott Williams & Wilkins.


Biondi E.,University of Rochester | McCulloh R.,Childrens Mercy Hospitals and Clinics | Alverson B.,Hasbro Childrens Hospital | Klein A.,University of Rochester | And 2 more authors.
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVE: Children with community-acquired lower respiratory tract infection (CA-LRTI) commonly receive antibiotics for Mycoplasma pneumoniae. The objective was to evaluate the effect of treating M. pneumoniae in children with CA-LRTI. METHODS: PubMed, Cochrane Central Register of Controlled Trials, and bibliography review. A search was conducted by using Medical Subject Headings terms related to CA-LRTI and M. pneumoniae and was not restricted by language. Eligible studies included randomized controlled trials (RCTs) and observational studies of children ≤17 years old with confirmed M. pneumoniae and a diagnosis of CA-LRTI; each must have also compared treatment regimens with and without spectrum of activity against M. pneumoniae. Data extraction and quality assessment were completed independently by multiple reviewers before arriving at a consensus. Data were pooled using a random effects model. RESULTS: Sixteen articles detailing 17 studies were included. The most commonly selected primary outcome was symptomatic improvement. Nine studies examined M. pneumoniae treatment in CA-LRTI secondary to M. pneumoniae, and 5 RCTs met criteria for meta-analysis. The suggested pooled risk difference of 0.12 (95% confidence interval, -0.04 to 0.20) favoring treatment was not significantly different and demonstrated significant heterogeneity. Limitations included substantial bias and subjective outcomes within the individual studies, difficulty interpreting testing modalities, and the inability to correct for mixed infections or timing of intervention. CONCLUSIONS: We identified insufficient evidence to support or refute treatment of M. pneumoniae in CA-LRTI. These data highlight the need for well-designed, prospective RCTs assessing the effect of treating M. pneumoniae in CA-LRTI. Copyright © 2014 by the American Academy of Pediatrics.


Lee K.C.,University of Rhode Island | Lee K.C.,Hasbro Childrens Hospital | Bercovitch L.,University of Rhode Island | Bercovitch L.,Hasbro Childrens Hospital
Seminars in Perinatology | Year: 2013

Infantile hemangiomas are the most common tumors of infancy. The serendipitous discovery of the therapeutic efficacy of propranolol in the management of infantile hemangiomas has revolutionized the care and understanding of these lesions, and greatly improved the prognosis for a good cosmetic outcome. In addition, there has been an expansion of indications for treatment of hemangiomas, taking into account not only those hemangiomas that can cause airway compromise, amblyopia, and cardiac overload, but also those lesions that can lead to unsatisfactory cosmetic outcome or deformity after involution. Current concepts of pathogenesis of infantile hemangiomas, of segmental hemangiomas with systemic associations, of hepatic hemangiomas, and of the use of systemic and topical beta-blockers for the management of IH are all reviewed. © 2013 Elsevier Inc.


Ventetuolo C.E.,Rhode Island Hospital | Muratore C.S.,Hasbro Childrens Hospital
American Journal of Respiratory and Critical Care Medicine | Year: 2014

Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome that characterized the 2009 influenza A(H1N1) pandemic have stimulated renewed interest in the use of venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to support the respiratory system. Theoretical advantages of ECLS for respiratory failure include the ability to rest the lungs by avoiding injurious mechanical ventilator settings and the potential to facilitate early mobilization, which may be advantageous for bridging to recovery or to lung transplantation. The use of venoarterial ECMO has been expanded and applied to critically ill adults with hemodynamic compromise from a variety of etiologies, beyond postcardiotomy failure. Although technology and general care of the ECLS patient have evolved, ECLS is not without potentially serious complications and remains unproven as a treatment modality. The therapy is now being tested in clinical trials, although numerous questions remain about the application of ECLS and its impact on outcomes in critically ill adults. Copyright © 2014 by the American Thoracic Society.


Jenny C.,Brown University | Jenny C.,Hasbro Childrens Hospital
Child Abuse and Neglect | Year: 2011

Carole Jenny's Child Abuse and Neglect: Diagnosis, Treatment and Evidence focuses attention on the clinical evidence of child abuse to help you correctly diagnose and treat such cases in your own practice. In print and online, this unique, well-illustrated clinical reference provides new insights into the presentation and differential diagnosis of physical abuse and looks at shaken baby syndrome, sex offenders and abuse in religious organizations, information on the biomechanics of injury, and other factors. It's also an ideal board-review tool for those taking the American Board of Pediatrics' subspecialty exam in Child Abuse Pediatrics. Identify an abusive injury and treat it effectively by reviewing evidence and critical analyses from leading authorities in the field.Recognize the signs of shaken baby syndrome, sex offenders and abuse in religious organizations.Understand the biomechanics of injury to determine whether abuse was truly the cause of a child's injury.View illustrations that show first-hand examples of child abuse or neglect.Search the complete contents online and download the illustrations at www.expertconsult.com.Expert clinical evidence to recognize, diagnose and treat child abuse. © 2010 Elsevier Inc. All rights reserved.


Dennehy P.H.,Hasbro Childrens Hospital | Dennehy P.H.,Brown University
Current Infectious Disease Reports | Year: 2013

Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and continues to have a major global impact on childhood morbidity and mortality. No antiviral therapy is available. Treatment of rotavirus gastroenteritis is limited to rehydration therapy. Recently, therapies, such as probiotics, have been developed as adjuncts to rehydration therapy. Two effective rotavirus vaccines are available and recommended for routine immunization of all infants. These vaccines have been introduced in both developed and developing countries. As rotavirus vaccines are implemented, studies that assess health impact, indirect benefits, and strain changes after the introduction of rotavirus vaccine have been reported. In the United States, rotavirus vaccination has led to dramatic drops in severe rotavirus-related hospitalizations and has reduced emergency room visits. Herd immunity has also been noted after routine rotavirus immunization. There have been no significant strain shifts or escape mutants noted since the introduction of rotavirus vaccines. © 2013 Springer Science+Business Media New York.


Diamond D.A.,Childrens Hospital | Gargollo P.C.,Children's Medical Center Dallas | Caldamone A.A.,Hasbro Childrens Hospital
Fertility and Sterility | Year: 2011

The authors review the current approach to management of the adolescent varicocele which has evolved over the past two decades. Principles of observational, surgical and adjunctive management are discussed relative to significant clinical findings. A selective approach to surgical intervention is advocated with the goal of preserving fertility potential. Copyright © 2011 American Society for Reproductive Medicine.

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