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1.  Effectiveness of a Statewide Abusive Head Trauma Prevention Program in North Carolina 
JAMA pediatrics  2015;169(12):1126-1131.
IMPORTANCE
Abusive head trauma (AHT) is a serious condition, with an incidence of approximately 30 cases per 100 000 person-years in the first year of life.
OBJECTIVE
To assess the effectiveness of a statewide universal AHT prevention program.
DESIGN, SETTING, AND PARTICIPANTS
In total, 88.29% of parents of newborns (n = 405 060) in North Carolina received the intervention (June 1, 2009, to September 30, 2012). A comparison of preintervention and postintervention was performed using nurse advice line telephone calls regarding infant crying (January 1, 2005, to December 31, 2010). A difference-in-difference analysis compared AHT rates in the prevention program state with those of other states before and after the implementation of the program (January 1, 2000, to December 31, 2011).
INTERVENTION
The Period of PURPLE Crying intervention, developed by the National Center on Shaken Baby Syndrome, was delivered by nurse-provided education, a DVD, and a booklet, with reinforcement by primary care practices and a media campaign.
MAIN OUTCOMES AND MEASURES
Changes in proportions of telephone calls for crying concerns to a nurse advice line and in AHT rates per 100 000 infants after the intervention (June 1, 2009, to September 30, 2011) in the first year of life using hospital discharge data for January 1, 2000, to December 31, 2011.
RESULTS
In the 2 years after implementation of the intervention, parental telephone calls to the nurse advice line for crying declined by 20%for children younger than 3 months (rate ratio, 0.80; 95%CI, 0.73–0.87; P < .001) and by 12%for children 3 to 12 months old (rate ratio, 0.88; 95%CI, 0.78–0.99; P = .03). No reduction in state-level AHT rates was observed, with mean rates of 34.01 person-years before the intervention and 36.04 person-years after the intervention. A difference-in-difference analysis from January 1, 2000, to December 31, 2011, controlling for economic indicators, indicated that the intervention did not have a statistically significant effect on AHT rates (β coefficient, −1.42; 95%CI, −13.31 to 10.45).
CONCLUSIONS AND RELEVANCE
The Period of PURPLE Crying intervention was associated with a reduction in telephone calls to a nurse advice line. The study found no reduction in AHT rates over time in North Carolina relative to other states. Consequently, while this observational study was feasible and supported the program effectiveness in part, further programmatic efforts and evaluation are needed to demonstrate an effect on AHT rates.
doi:10.1001/jamapediatrics.2015.2690
PMCID: PMC4687484  PMID: 26501945
2.  The Medical Cost of Abusive Head Trauma in the United States 
Pediatrics  2014;134(1):91-99.
OBJECTIVES
Health consequences of shaken baby syndrome, or pediatric abusive head trauma (AHT), can be severe and long-lasting. We aimed to estimate the multiyear medical cost attributable to AHT.
METHODS
Using Truven Health MarketScan data, 2003–2011, we identified children 0 to 4 years old with commercial or Medicaid insurance and AHT diagnoses. We used exact case–control matching based on demographic and insurance characteristics such as age and health plan type to compare medical care between patients with and without AHT diagnoses. Using regression models, we assessed service use (ie, average annual number of inpatient visits per patient) and inpatient, outpatient (including emergency department), drug, and total medical costs attributable to an AHT diagnosis during the 4-year period after AHT diagnosis.
RESULTS
We assessed 1209 patients with AHT and 5895 matched controls. Approximately 48% of patients with AHT received inpatient care within 2 days of initial diagnosis, and 25% were treated in emergency departments. AHT diagnosis was associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after the diagnosis. The estimated total medical cost attributable to AHT in the 4 years after diagnosis was $47 952 (95% confidence interval [CI], $40 219–$55 685) per patient with AHT (2012 US dollars) and differed for commercially insured ($38 231 [95% CI, $29 898–$46 564]) and Medicaid ($56 691 [95% CI, $44290–$69 092]) patients.
CONCLUSIONS
Children continue to have substantial excess medical costs for years after AHT. These estimates exclude related nonmedical costs such as special education and disability that also are attributable to AHT.
doi:10.1542/peds.2014-0117
PMCID: PMC4676400  PMID: 24936000
child abuse; shaken baby syndrome; economic analysis
3.  Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial 
Background
Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking.
Methods
We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour.
Results
The mean score (range 0–100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6).
Interpretation
The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking. (ClinicalTrials.gov trial register no. NCT00175422.)
doi:10.1503/cmaj.081419
PMCID: PMC2659818  PMID: 19255065

Results 1-3 (3)