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Biomedical subjects

R Y Moon

Publications and source records attributed to R Y Moon.

11 recordsLinked to original sources
PubMed2001

Parental opinions regarding poliomyelitis immunizations.

The successful eradication of poliomyelitis in the United States has primarily been due to the use of oral poliovirus vaccine (OPV). However, because of the risk of vaccine-associated paralytic poliomyelitis with OPV, the use of inactivated poliovirus vaccine (IPV) has become the accepted option. We performed a cross-sectional survey of parents of children less than 18 months of age to determine parental preference regarding poliomyelitis vaccine options. Parents were asked questions about their knowledge regarding poliomyelitis and available vaccines. Parents were also given information about the risks and benefits of the 3 immunization options (all OPV, all IPV, and sequential IPV/OPV) and then asked to choose among the 3 schedules. We distributed 146 questionnaires, with an 88% response rate. Parents were, on average, 22 years old and had 12 years of education. Fifty-eight percent of parents thought that decisions regarding vaccine choices should be made by the physician and caregiver together. However, when given the choice, 41 % could not decide among the different vaccine options. One quarter (25%) chose the all OPV, 13% the all IPV, and 21% the sequential IPV/OPV schedule. Older parents were more likely to choose the all IPV schedule (p=0.042). There was no correlation with the parental level of education. More studies are required to determine if further education will empower urban parents to be more active participants in the medical decision process.

Administration, Oral↗
PubMed2001

Examination of state regulations regarding infants and sleep in licensed child care centers and family child care settings.

BACKGROUND: Twenty percent of sudden infant death syndrome (SIDS) occurs in child care settings. Although the incidence of SIDS in the United States has decreased with increased awareness of the risks of prone infant sleeping, smoke exposure, soft bedding, and unsafe sleep environments, avoidance of these risk factors is not universally practiced in child care settings. Advocacy through state child care regulatory agencies and legislative bodies may be effective in more widespread awareness and avoidance of risk factors. OBJECTIVE: To determine what individual state regulations for licensed child care centers and family child care settings exist regarding: 1) sleep positions for infants under 6 months old, 2) crib safety, 3) bedding safety, and 4) smoking in the facilities. DESIGN: A descriptive survey of regulations for licensed child care centers and family child care settings in the 50 states and the District of Columbia. RESULTS: Fifteen states use regulations adopted before publication of the first policy statement of the American Academy of Pediatrics on infant sleep position and SIDS in 1992. Six states require child care centers to place infants nonprone. Sixty-three percent of states require cribs in child care centers to meet at least 1 safety standard, and 45.1% require this in family child care homes. Six states have provisions limiting the use of soft bedding in child care centers, and 4 have such bans for family child care homes. Seventy-one percent of states prohibit smoking in child care centers during hours of operation; 17% of states have similar requirements for family child care homes. CONCLUSIONS: Many states use child care regulations that were written before the initial policy statements of the American Academy of Pediatrics regarding safe sleep environments for infants. Even those more recently adopted regulations do not adequately address sleep safety for infants. Pediatricians need to become more proactive in promoting safety regulations in child care. Adoption of new regulations can aid in education of child care providers and, thus, improve the safety for infants in child care.

Bedding and Linens↗
PubMed2000

Sudden infant death syndrome in child care settings.

BACKGROUND: The incidence of sudden infant death syndrome (SIDS) in the United States has decreased with decreased prone sleeping. Extrapolating from Census Bureau data, approximately 7% of SIDS should occur in organized child care settings (ie, child care centers or family child care homes). However, 2 states have reported higher rates of SIDS in child care. OBJECTIVES: To determine the percentage of SIDS deaths occurring in child care settings, and to ascertain associated factors. DESIGN: A retrospective study of SIDS deaths from January 1995 through June 1997 was conducted. Data were abstracted from SIDS databases in 11 states. Characteristics of SIDS cases occurring in child care settings, including sleep position, were compared with those occurring in the care of parents. Univariate and multiple logistic regression analyses were performed. RESULTS: A total of 1916 SIDS cases were analyzed for this study. Of these deaths, 20.4% occurred in child care settings. Compared with deaths in the care of parents, those occurring in child care settings were more likely to occur on weekdays between 8:00 AM and 4:00 PM; infants were older; not black; and their mothers were more educated. Infants in child care were more likely to be found prone in univariate analysis, but the association was not significant in multiple logistic regression analysis. However, in multiple regression analysis, infants in child care were more likely to be last placed prone or found prone, when the usual sleep position was side or supine. CONCLUSION: A large proportion (20.4%) of SIDS cases occur in child care settings. Factors associated with SIDS in child care settings include older age, race, and highly educated parents. Previous studies have reported that unaccustomed prone sleeping puts infants at high risk for SIDS; this characteristic was found to be associated with SIDS in child care and may partly explain the high proportion of SIDS cases in child care settings. Parents must discuss sleep position with any caretakers of their infants. In addition, further efforts to educate child care providers about the importance of supine sleep for infants must be ongoing.

Cause of Death↗
PubMed2000

Infant sleep position policies in licensed child care centers after back to sleep campaign.

BACKGROUND: Since the Back to Sleep (BTS) campaign was initiated in 1994, the rate of prone sleeping has decreased to approximately 20%. However, child care centers may have an increased rate of prone sleeping in infants. In 1996, a study of licensed child care centers demonstrated that 43% were unaware of the association between sudden infant death syndrome (SIDS) and prone sleeping and that 49% positioned infants prone. OBJECTIVE: To determine effectiveness of a mailing from the BTS campaign to licensed child care centers by assessing the following: 1) child care center awareness of the recommendations of the American Academy of Pediatrics regarding infant sleep position and 2) implementation of the recommendations of the American Academy of Pediatrics in child care center practice. DESIGN: A descriptive, cross-sectional survey of licensed child care centers in the metropolitan Washington, DC, region. All licensed child care centers caring for infants <6 months old in Washington, DC, and Montgomery, Prince Georges, Howard, Anne Arundel, Frederick, and Charles Counties in Maryland were recruited for the study. RESULTS: Out of 236 eligible centers, 172 completed the survey. Seventy-five percent (129) of the centers were aware of recommendations regarding infant sleep position. Infants were placed prone in 27.9% of centers, although only 2.9% placed infants exclusively in the prone position. The most common reasons for avoiding prone position entirely were SIDS risk reduction and licensing regulations. Half of the centers had a written policy regarding sleep position. Twenty centers who were aware of the dangers of prone sleeping continued to placed infants prone at least some of the time, largely because of parental request. Only 56.9% of centers had heard of the BTS campaign despite the mass mailing. The mailing resulted in policy change for 14 centers. CONCLUSIONS: Since 1996, the percentage of licensed child care centers in the greater Washington, DC, area that are aware of the association between SIDS and infant sleep position has increased from 57% to 75%. In addition, the rate of placing infants prone in these centers has declined from 49% in 1996 to 27.9% in this study. When child care centers are aware of the risk of prone sleeping, the most likely reason for continued prone placement is parental request. Although media and mailings have been largely effective in communicating BTS information to many child care centers, nonprone positioning is not universal among child care providers. Additional educational efforts toward child care providers and parents remain necessary.

Child Day Care Centers↗
PubMed1999

Prone infant sleeping despite the "Back to Sleep" campaign.

OBJECTIVES: To determine sleep position variation during the first 6 months of life and to identify risk factors for prone sleeping. DESIGN: Cohort study of healthy term newborns recruited from November 1995 to September 1996 and followed up to age 6 months. Pediatricians were surveyed about sleep position advice. At recruitment, all parents were instructed to avoid prone sleeping. Parents were telephoned at 1 week and then monthly to ensure that they recorded sleep position. Investigators were unaware of sleep position until the infant was 6 months of age, when sleep log data and reasons for sleep position choice were ascertained. SETTING: Practice-based study conducted by the Children's National Medical Center Pediatric Research Network, Washington, DC. PARTICIPANTS: A total of 402 consecutive healthy term newborns followed up by a Pediatric Research Network pediatrician were enrolled. Exclusion criteria were prematurity, a serious medical condition, and absence of a telephone. Of the 402 enrolled newborns, 348 (86.6%) completed the study. RESULTS: Only 34.0% of infants maintained a consistent sleep position. Prone sleeping increased from 12.2% at birth to 32.0% at 6 months. One third of pediatricians discussed sleep position beyond the newborn period. The following were associated (P<.05) with prone sleeping: male sex, lower maternal education level, single marital status, having siblings, and black race. Perceived infant comfort was the main reason for prone sleeping. CONCLUSIONS: Most newborns are placed by parents in nonprone sleep positions. Pediatricians need to consistently reinforce the "Back to Sleep" message when the infants are 2 to 4 months of age because this is the most likely time that they are switched to prone sleeping and the highest risk period of sudden infant death syndrome. Parents should not use prone sleeping as a means of comforting infants.

Cohort Studies↗
PubMed1999

Acute sinusitis.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1998

Parental literacy level and understanding of medical information.

OBJECTIVE: To ascertain the impact of literacy level on parents' understanding of medical information and ability to follow therapy prescribed for their children. DESIGN/METHODS: A prospective cohort of parents accompanying their children for acute care. Parents were interviewed about demographic status, their child's health, and use of pediatric preventive services. The Rapid Estimate of Adult Literacy in Medicine (REALM) test was used to assess parental literacy. The same parent was interviewed 48 to 96 hours later and asked to recall the child's diagnosis, any medication prescribed, and instructions. RESULTS: A total of 633 patients were enrolled. Follow-up was obtained in 543 patients (85.8%). Mean parental age was 32.43 years (SD = 9.07). Mean REALM score was 57.6 (SD = 10.9), corresponding to a 7th- to 8th-grade reading level, with a mean parental educational level of 13.43 years (SD = 2.09). Low REALM score was significantly correlated with young parental age and parental education. African-American race was associated with lower REALM scores. After controlling for these variables, REALM score significantly correlated with parental perception of how sick the child was, but not with use of preventive services, comprehension of diagnosis, medication name and instructions, or ability to obtain and administer prescribed medications. CONCLUSIONS: Parental literacy level did not correlate with use of preventive services or parental understanding of or ability to follow medical instructions for their children.

Adolescent↗
PubMed1998

Effects of sleep position on infant motor development.

BACKGROUND: As a result of the American Academy of Pediatrics' recommendation that healthy infants be placed on their side or back for sleep, the percentage of infants sleeping prone has decreased dramatically. With the increase in supine sleeping, pediatricians have questioned if there are differences in the rate of acquisition of early motor milestones between prone and supine sleeping infants. METHODS: To examine this question, we performed a prospective, practice-based study of healthy term infants. Infants were recruited before the age of 2 months. Parents were asked to record infant sleep position and awake time spent prone until 6 months of age. A developmental log was used to track milestones from birth until the infant was walking. Age of acquisition of eight motor milestones was determined, and the mean ages of milestone attainment of prone and supine sleepers were compared. RESULTS: Three hundred fifty-one infants completed the study. Prone sleepers acquired motor milestones at an earlier age than supine sleepers. There was a significant difference in the age of attainment of rolling prone to supine, tripod sitting, creeping, crawling, and pulling to stand. There was no significant difference in age when infants walked. CONCLUSIONS: The pattern of early motor development is affected by sleep position. Prone sleepers attain several motor milestones earlier than supine sleepers. However, all infants achieved all milestones within the accepted normal age range. Pediatricians can use this information to reassure parents. This difference in milestone attainment is not a reason to abandon the American Academy of Pediatrics' sleep position recommendations.

Child Development↗
PubMed1997

Infant sleep position in licensed child care centers.

OBJECTIVE: To determine 1) familiarity of child care centers with American Academy of Pediatrics (AAP) recommendations regarding infant sleep position, 2) predominant infant sleep positions in child care settings, and 3) child care policies pertaining to sleep position for infants less than 6 months of age. DESIGN: A descriptive, cross-sectional telephone survey including the age and number of infants cared for, infant sleep positions currently in use, and details regarding reasons for sleep position policies. PARTICIPANTS: All licensed child care centers caring for infants less than 6 months of age in Washington, DC, and Montgomery and Prince Georges Counties in Maryland. RESULTS: Out of 137 centers in these areas that accept infants less than 6 months of age, 131 completed the survey. Only 57% (75) of the centers were aware of recommendations regarding infant sleep position. Infants were placed prone in 49% (64) of the centers and 20% (26) of the centers positioned infants exclusively in the prone position. Of the centers, 75% (98) did not have a written policy regarding sleep position. Most common reasons for placing infants in the prone position included child comfort, fear of choking, and guidance by the parents of the infants. Centers that used the prone position exclusively cared for significantly fewer infants on average than centers that never or only sometimes placed infants prone. CONCLUSIONS: Almost half (43%) of licensed child care centers surveyed in the greater Washington, DC area were unaware of the association between sudden infant death syndrome (SIDS) and infant sleep position. Child care centers aware of prone positioning as a SIDS risk were less likely to place infants to sleep in this position, with many such centers avoiding prone positioning entirely. However, it was common for centers aware of the SIDS risk to still place infants prone if directed to do so by parents or if concerned about child comfort. Further educational efforts directed toward child care providers are needed.

Age Factors↗
PubMed1995

Poststreptococcal reactive arthritis in children: a potential predecessor of rheumatic heart disease.

OBJECTIVE: To report several cases of arthritis seen in children after infection with Group A beta-hemolytic Streptococcus (GABHS) which were not associated with carditis or other major manifestations of the Jones Criteria for acute rheumatic fever (ARF); and to analyze the literature to determine these patients' potential risks for the subsequent development of rheumatic heart disease. METHODS: A retrospective chart review was performed of all patients seen in a pediatric rheumatology clinic from January, 1990 to December, 1992. RESULTS: Four patients were identified with poststreptococcal reactive arthritis (PSReA) and no carditis. Their arthritis had an acute onset, tended to have a longer duration than the arthritis typically seen in ARF, and in most instances did not respond promptly to therapy with aspirin or nonsteroidal antiinflammatory agents. In some patients, there was no history of sore throat or fever. Diagnosis of PSReA was made by serologic testing. Cardiac evaluation in all 4 patients was negative. CONCLUSION: PSReA should be considered in the differential diagnosis for any pediatric patient with the acute onset of arthritis, whether the arthritis is the classic migratory polyarthritis typically seen in ARF or not. Throat culture and serologic testing for streptococcal infection should be performed on these patients. If recent GABHS infection is confirmed, cardiac evaluation, including echocardiogram, is warranted. Both ARF and PSReA occur after GABHS infection, but the precise relationship between these 2 entities is unclear. Longterm follow up of pediatric patients with PSReA in previous reports have shown that a certain percentage of them upon subsequent GABHS infection develop carditis. Until the specific risk factors (either host or bacterial characteristics) for developing subsequent carditis are better delineated, antibiotic prophylaxis similar to that used in ARF should be considered in patients with PSReA.

Arthritis, Reactive↗