bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomic nervous system dysfunction predicts poor prognosis in patients with mild to moderate tetanus
Authors: Wasay Mohammad , Khealani Bhojo A , Talati Naasha , Shamsi Rohmah , Syed Nadir A , Salahuddin Naseem
Published: February 2005

Background

Autonomic nervous system (ANS) dysfunction is present in up to one third of patients with tetanus. The prognostic value of ANS dysfunction is known in severe tetanus but its value is not well established in mild to moderate tetanus.

Methods

Medical records of all patients admitted with tetanus at two academic tertiary care centers in Karachi, Pakistan were reviewed. The demographic, clinical and laboratory data was recorded and analyzed. ANS dysfunction was defined as presence of labile or persistent hypertension or hypotension and sinus tachycardia, tachyarrythmia or bradycardia on EKG. Patients were divided into two groups based on presence of ANS dysfunction (ANS group and non ANS group). Tetanus severity was classified on the basis of Ablett criteria.

Results

Ninety six (64 males; 32 females) patients were admitted with the diagnosis over a period of 10 years. ANS group had 31 (32%) patients while non ANS group comprised of 65 (68%) patients. Both groups matched for age, gender, symptom severity, use of tetanus immunoglobulin and antibiotics. Twelve patients in ANS group had mild to moderate tetanus (Ablett I and II) and 19 patients had severe/very severe tetanus (Ablett III and IV). Fifteen (50%) patients in ANS group required ventilation as compared to 28 (45%) in non-ANS group (p = 0.09). Fourteen (47%) patients died in ANS group as compared to 10 (15%) in non ANS group (p= 0.002). Out of those 14 patients died in ANS group, six patients had mild to moderate tetanus and eight patients had severe/ very severe tetanus. Major cause of death was cardiac arrhythmias (13/14; 93%) in ANS group and respiratory arrest (7/10; 70%) in non ANS group. Ten (33%) patients had complete recovery in ANS group while in non ANS group 35(48%) patients had complete recovery (p= 0.05).

Conclusions

ANS dysfunction was present in one third of our tetanus population. 40% patients with ANS dysfunction had only mild to moderate tetanus. ANS dysfunction, irrespective of the need of mechanical ventilation or severity of tetanus, predicted poor outcome.
Long-term survival rates of laryngeal cancer patients treated by radiation and surgery, radiation alone, and surgery alone : studied by lognormal and Kaplan-Meier survival methods
Authors: Tai Patricia , Yu Edward , Shiels Ross , Tonita Jon
Published: February 2005

Background

Validation of the use of the lognormal model for predicting long-term survival rates using short-term follow-up data.

Methods

907 cases of laryngeal cancer were treated from 1973–1977 by radiation and surgery (248), radiation alone (345), and surgery alone (314), in registries of Connecticut and Metropolitan Detroit of the SEER database, with known survival status up to 1999. Phase 1 of this study used the minimum chi-square test to assess the goodness of fit of the survival times of those who died with disease to a lognormal distribution. Phase 2 used the maximum likelihood method to estimate long-term survival rates using short-term follow-up data. In order to validate the lognormal model, the estimated long-term cancer-specific survival rates (CSSR) were compared with the values calculated by the Kaplan-Meier (KM) method using long-term data.

Results

The 25-year CSSR were predicted to be 72%, 68% and 65% for treatments by radiation and surgery, by radiation alone, and by surgery alone respectively, using short-term follow-up data by the lognormal model. Corresponding results calculated by the KM method were: 72+/-3%, 68+/-3% and 66+/-4% respectively.

Conclusions

The lognormal model was validated for the prediction of the long-term survival rates of laryngeal cancer patients treated by these different methods. The lognormal model may become a useful tool in research on outcomes.
An interactive course to enhance self-efficacy of family practitioners to treat obesity
Authors: Katz Sara , Feigenbaum Amiel , Pasternak Shmuel , Vinker Shlomo
Published: February 2005

Background

Physicians' awareness of their important role in defusing the obesity epidemic has increased. However, the number of family practitioners who treat obesity problems continues to be low. Self-efficacy refers to the belief in one's ability to organize and execute the courses of action required to produce given attainments. Thus, practitioners who judge themselves incapable of managing obesity do not even try. We hypothesized that practitioners' self-efficacy and motivation would be enhanced as a result of participating in an interactive course designed to enrich their knowledge of obesity management.

Methods

Twenty-nine family practitioners participated in the course, which was accompanied by qualitative interviews. The difference between the physicians' pre-course and post-course appraisals was tested by paired t-test. The interviews were analyzed by qualitative methods.

Results

Post-course efficacy appraisals were significantly higher than pre-course appraisals (p < 0.0005). A deeper insight on the practitioners' self-efficacy processes was gained through reflection of the practitioners on their self-efficacy during the interviews.

Conclusions

Up-to-date information and workshops where skills, attitudes and social support were addressed were important in making the program effective.
Claudin-1, -3 and -4 proteins and mRNA expression in benign and malignant breast lesions: a research study
Authors: Tőkés Anna-Mária , Kulka Janina , Paku Sándor , Szik Ágnes , Páska Csilla , Novák Pál Kaposi , Szilák László , Kiss András , Bögi Krisztina , Schaff Zsuzsa
Published: February 2005

Introduction

We compared levels of protein and mRNA expression of three members of the claudin (CLDN) family in malignant breast tumours and benign lesions.

Methods

Altogether, 56 sections from 52 surgically resected breast specimens were analyzed for CLDN1, CLDN3 and CLDN4 expression by immunohistochemistry. mRNA was also analyzed using real-time PCR in 17 of the 52 cases.

Results

CLDNs were rarely observed exclusively at tight junction structures. CLDN1 was present in the membrane of normal duct cells and in some of the cell membranes from ductal carcinoma in situ, and was frequently observed in eight out of nine areas of apocrine metaplasia, whereas invasive tumours were negative for CLDN1 or it was present in a scattered distribution among such tumour cells (in 36/39 malignant tumours). CLDN3 was present in 49 of the 56 sections and CLDN4 was present in all 56 tissue sections. However, CLDN4 was highly positive in normal epithelial cells and was decreased or absent in 17 out of 21 ductal carcinoma grade 1, in special types of breast carcinoma (mucinous, papillary, tubular) and in areas of apocrine metaplasia. CLDN1 mRNA was downregulated by 12-fold in the sample (tumour) group as compared with the control group using GAPDH as the reference gene. CLDN3 and CLDN4 mRNA exhibited no difference in expression between invasive tumours and surrounding tissue.

Conclusions

The significant loss of CLDN1 protein in breast cancer cells suggests that CLDN1 may play a role in invasion and metastasis. The loss of CLDN4 expression in areas of apocrine metaplasia and in the majority of grade 1 invasive carcinomas also suggests a particular role for this protein in mammary glandular cell differentiation and carcinogenesis.
Comparison of the oxidative phosphorylation (OXPHOS) nuclear genes in the genomes of Drosophila melanogaster, Drosophila pseudoobscura and Anopheles gambiae
Authors: Tripoli Gaetano , D'Elia Domenica , Barsanti Paolo , Caggese Corrado
Published: February 2005

Background

In eukaryotic cells, oxidative phosphorylation (OXPHOS) uses the products of both nuclear and mitochondrial genes to generate cellular ATP. Interspecies comparative analysis of these genes, which appear to be under strong functional constraints, may shed light on the evolutionary mechanisms that act on a set of genes correlated by function and subcellular localization of their products.

Results

We have identified and annotated the Drosophila melanogaster, D. pseudoobscura and Anopheles gambiae orthologs of 78 nuclear genes encoding mitochondrial proteins involved in oxidative phosphorylation by a comparative analysis of their genomic sequences and organization. We have also identified 47 genes in these three dipteran species each of which shares significant sequence homology with one of the above-mentioned OXPHOS orthologs, and which are likely to have originated by duplication during evolution. Gene structure and intron length are essentially conserved in the three species, although gain or loss of introns is common in A. gambiae. In most tissues of D. melanogaster and A. gambiae the expression level of the duplicate gene is much lower than that of the original gene, and in D. melanogaster at least, its expression is almost always strongly testis-biased, in contrast to the soma-biased expression of the parent gene.

Conclusions

Quickly achieving an expression pattern different from the parent genes may be required for new OXPHOS gene duplicates to be maintained in the genome. This may be a general evolutionary mechanism for originating phenotypic changes that could lead to species differentiation.
Predictors of Survival After Radiofrequency Thermal Ablation of Colorectal Cancer Metastases to the Liver: A Prospective Study
Authors: Berber Eren , Pelley Robert , Siperstein Allan E.
Published: February 2005

Purpose

The aim of this study was to determine the predictors of survival at the time of radiofrequency thermal ablation (RFA) in patients with colorectal liver metastasis.

Patients and Methods

One hundred thirty-five patients with colorectal liver metastases who were not candidates for resection underwent laparoscopic RFA.

Results

The median Kaplan-Meier survival for all patients was 28.9 months after RFA treatment. Patients with a carcinoembryonic antigen (CEA) less than 200 ng/mL had improved survival compared with those with a CEA more than 200 (34 v 16 months; P = .01). Patients with the dominant lesion less than 3 cm in diameter had a median survival of 38 v 34 months for lesions 3 to 5 cm, and 21 months for lesions greater than 5 cm (P = .03). Survival approached significance for patients with one to three tumors versus more than three tumors (29 v 22 months; P = .09). The presence of extrahepatic disease did not affect survival. Only the largest liver tumor size more than 5 cm was found to be a significant predictor of mortality by Cox proportional hazards model, with a 2.5-fold increased risk of death versus the largest liver tumor size less than 3 cm (P = .05).

Conclusion

This study determines which patients do best after RFA. Historical survival with chemotherapy alone is 11 to 14 months, suggesting RFA has a positive impact on overall survival. Limited amounts of extrahepatic disease do not appear to affect survival adversely. RFA is a useful adjunct to chemotherapy in those patients with liver-predominant disease.
Thermochromatographic studies of mercury and radon on transition metal surfaces
Authors: Soverna S. , Dressler R. , Düllmann Ch. E. , Eichler B. , Eichler R. , Gäggeler H. W. , Haenssler F. , Niklaus J.-P. , Piguet D. , Qin Z. , Türler A. , Yakushev Alexander B.
Published: February 2005

In preparation for the experimental investigation of chemical properties of element 112 model studies were conducted based on the assumed similarity of element 112 to either the noble gas Rn or the transition metal Hg, its supposed lighter homologue in group 12. The adsorption behavior of elemental Hg on the transition metals Ag, Au, Ni, Pd, and Pt were investigated experimentally by off-line gas thermochromatography. The deduced adsorption data of Hg were compared with new values calculated using the Eichler–Miedema model. The observed sequence of increasing Hg-metal-interactions for Ag < Ni < Au < Pd < Pt confirms the predicted trend. The only exception was Pd, on which Hg was calculated to adsorb at a higher temperature than on Pt. Difficulties to obtain reproducible clean surfaces of Ag, Ni, Pd, and Pt led to the choice of Au as the best metal surface suitable to adsorb Hg.

For fast on-line gas thermochromatography studies on metallic surfaces a new set-up was developed based on the In-situ Volatilization and On-line detection technique (IVO). This set-up was tested in on-line thermochromatographic investigations with short-lived Hg isotopes and 219Rn, using Au or Pd as stationary surfaces. An overall efficiency of about 60% and a transportation time less than 25 s was determined for this newly designed IVO. A separation factor of more than 106 was estimated for non-volatile species.
EXAFS study on the neptunium(V) complexation by various humic acids under neutral pH conditions
Authors: Sachs S. , Schmeide K. , Reich T. , Brendler V. , Heise K. H. , Bernhard G.
Published: February 2005

The structure of Np(V) humic acid (HA) complexes at pH 7 was studied by extended X-ray absorption fine structure analysis (EXAFS). For the first time, the influence of phenolic OH groups on the complexation of HA and Np(V) in the neutral pH range was investigated using modified HAs with blocked phenolic OH groups and Bio-Rex70, a cation exchange resin having only carboxyl groups as proton exchanging sites.

The formation of Np(V) humate complexes was verified by near-infrared (NIR) spectroscopy. Axial Np-O bond distances of 1.84–1.85 Å were determined for the studied Np(V) humate complexes and the Np(V)-Bio-Rex70 sorbate. In the equatorial plane Np(V) is surrounded by about 3 oxygen atoms with bond lengths of 2.48–2.49 Å. The comparison of the structural parameters of the Np(V) humates with those of Np(V)-Bio-Rex70 points to the fact that the interaction between HA and Np(V) in the neutral pH range is dominated by carboxylate groups. However, up to now a contribution of phenolic OH groups to the interaction process cannot be excluded completely. The comparison of the obtained structural data for the Np(V) humates to those of Np(V) carboxylates and Np(V) aquo ions reported in the literature indicates that humic acid carboxylate groups predominantly act as monodentate ligands. A differentiation between equatorial coordinated carboxylate groups and water molecules using EXAFS spectroscopy is impossible.
Genetic Diversity and Population Structure of Teosinte
Authors: Fukunaga Kenji , Hill Jason , Vigouroux Yves , Matsuoka Yoshihiro , Sanchez G. Jesus , Liu Kejun , Buckler Edward S , Doebley John
Published: February 2005

The teosintes, the closest wild relatives of maize, are important resources for the study of maize genetics and evolution and for plant breeding. We genotyped 237 individual teosinte plants for 93 microsatellites. Phylogenetic relationships among species and subspecific taxa were largely consistent with prior analyses for other types of molecular markers. Plants of all species formed monophyletic clades, although relationships among species were not fully resolved. Phylogenetic analysis indicated that the Mexican annual teosintes divide into two clusters that largely correspond to the previously defined subspecies, Z. mays ssp. parviglumis and ssp. mexicana, although there are a few samples that represent either evolutionary intermediates or hybrids between these two subspecies. The Mexican annual teosintes show genetic substructuring along geographic lines. Hybridization or introgression between some teosintes and maize occurs at a low level and appears most common with Z. mays ssp. mexicana. Phylogeographic and phylogenetic analyses of the Mexican annual teosintes indicated that ssp. parviglumis diversified in the eastern part of its distribution and spread from east to west and that ssp. mexicana diversified in the Central Plateau of Mexico and spread along multiple paths to the north and east. We defined core sets of collections of Z. mays ssp. mexicana and ssp. parviglumis that attempt to capture the maximum number of microsatellite alleles for given sample sizes.
Chromosomal Inversion Polymorphism Leads to Extensive Genetic Structure
Authors: Munté Agustí , Rozas Julio , Aguadé Montserrat , Segarra Carmen
Published: February 2005

The adaptive character of inversion polymorphism in Drosophila subobscura is well established. The OST and O3+4 chromosomal arrangements of this species differ by two overlapping inversions that arose independently on O3 chromosomes. Nucleotide variation in eight gene regions distributed along inversion O3 was analyzed in 14 OST and 14 O3+4 lines. Levels of variation within arrangements were quite similar along the inversion. In addition, we detected (i) extensive genetic differentiation between arrangements in all regions, regardless of their distance to the inversion breakpoints; (ii) strong association between nucleotide variants and chromosomal arrangements; and (iii) high levels of linkage disequilibrium in intralocus and also in interlocus comparisons, extending over distances as great as ∼4 Mb. These results are not consistent with the higher genetic exchange between chromosomal arrangements expected in the central part of an inversion from double-crossover events. Hence, double crossovers were not produced or, alternatively, recombinant chromosomes were eliminated by natural selection to maintain coadapted gene complexes. If the strong genetic differentiation detected along O3 extends to other inversions, nucleotide variation would be highly structured not only in D. subobscura, but also in the genome of other species with a rich chromosomal polymorphism.
Replication of an Egfr-Wing Shape Association in a Wild-Caught Cohort of Drosophila melanogaster
Authors: Dworkin Ian , Palsson Arnar , Gibson Greg
Published: February 2005

Linkage disequilibrium mapping has been used extensively in medical and evolutionary genetics to map causal polymorphisms within genes associated with disease status or phenotypic variation for a trait. However, the initial findings of most nonhuman studies have not been replicated in subsequent studies, due in part to false positives, as well as additional factors that can render true positives unreplicable. These factors may be more severe when the initial study is performed using an experimental population of organisms reared under controlled lab conditions. We demonstrate that despite considerable phenotypic differences for wing shape between a lab-reared experimental population and a wild-caught cohort of Drosophila melanogaster, an association between a putative regulatory polymorphism in Egfr and wing shape can be replicated. These results are discussed both within the framework of future association-mapping studies and within the context of the evolutionary dynamics of alleles in populations.
The Evolution of the SEPALLATA Subfamily of MADS-Box GenesSequence data from this article have been deposited with the EMBL/GenBank Data Libraries under accession nos. AY850178, AY850179, AY850180, AY850181, AY850182, AY850183, AY850184, AY850185, AY850186.
Authors: Zahn Laura M , Kong Hongzhi , Leebens-Mack James H , Kim Sangtae , Soltis Pamela S , Landherr Lena L , Soltis Douglas E , dePamphilis Claude W , Ma Hong
Published: February 2005

Members of the SEPALLATA (SEP) MADS-box subfamily are required for specifying the “floral state” by contributing to floral organ and meristem identity. SEP genes have not been detected in gymnosperms and seem to have originated since the lineage leading to extant angiosperms diverged from extant gymnosperms. Therefore, both functional and evolutionary studies suggest that SEP genes may have been critical for the origin of the flower. To gain insights into the evolution of SEP genes, we isolated nine genes from plants that occupy phylogenetically important positions. Phylogenetic analyses of SEP sequences show that several gene duplications occurred during the evolution of this subfamily, providing potential opportunities for functional divergence. The first duplication occurred prior to the origin of the extant angiosperms, resulting in the AGL2/3/4 and AGL9 clades. Subsequent duplications occurred within these clades in the eudicots and monocots. The timing of the first SEP duplication approximately coincides with duplications in the DEFICIENS/GLOBOSA and AGAMOUS MADS-box subfamilies, which may have resulted from either a proposed genome-wide duplication in the ancestor of extant angiosperms or multiple independent duplication events. Regardless of the mechanism of gene duplication, these pairs of duplicate transcription factors provided new possibilities of genetic interactions that may have been important in the origin of the flower.
Costly Resistance to Parasitism
Authors: Zhong Daibin , Pai Aditi , Yan Guiyun
Published: February 2005

Information on the molecular basis of resistance and the evolution of resistance is crucial to an understanding of the appearance, spread, and distribution of resistance genes and of the mechanisms of host adaptation in natural populations. One potential important genetic constraint for the evolution of resistance is fitness cost associated with resistance. To determine whether host resistance to parasite infection is associated with fitness costs, we conducted simultaneous quantitative trait loci (QTL) mapping of resistance to parasite infection and fitness traits using the red flour beetle (Tribolium castaneum) and the tapeworm parasite (Hymenolepis diminuta) system in two independent segregating populations. A genome-wide QTL scan using amplified fragment length polymorphism (AFLP) markers revealed three QTL for beetle resistance to tapeworm infection. These three QTL account for 44–58% variance in beetle infection intensity. We identified five QTL for fecundity and five QTL for egg-to-adult viability, which accounted for 36–57% and 36–49%, respectively, of the phenotypic variance in fecundity and egg-to-adult viability. The three QTL conferring resistance were colocalized with the QTL affecting beetle fitness. The genome regions that contain the QTL for parasite resistance explained the majority of the variance in fecundity and egg-to-adult viability in the mapping populations. Colocalization of QTL conferring resistance to parasite infection and beetle fitness may result from the pleiotropic effects of the resistance genes on host fitness or from tight linkages between resistance genes and adverse deleterious mutations. Therefore, our results provide evidence that the genome regions conferring resistance to tapeworm infection are partially responsible for fitness costs in the resistant beetle populations.
Magnetic Resonance Image Correlates of Hemiparesis After Neonatal and Childhood Middle Cerebral Artery Stroke
Authors: Boardman James P. , Ganesan Vijeya , Rutherford Mary A. , Saunders Dawn E. , Mercuri Eugenio , Cowan Frances
Published: February 2005

Objective. Motor impairment after neonatal and childhood-onset ischemic stroke (IS) is common, although the prevalence and type of hemiparesis differs between the 2 age groups. Lesion topography is an important predictor of hemiparesis after neonatal IS, but it is not known if the same topographic predictors of adverse motor outcome apply to childhood-onset IS. We used a consistent approach to define lesion topography and evaluate motor outcome in both age groups to (1) investigate whether early topographic predictors of hemiparesis after unilateral middle cerebral artery–territory stroke are the same in neonates and older children and (2) compare the prevalence of dystonia and loss of independent finger movements between the 2 age groups.

Design. Twenty-eight patients with neonatal-onset IS (Hammersmith Hospital, London, United Kingdom) were studied together with 43 patients with childhood-onset IS (Great Ormond Street Hospital, London, United Kingdom). All patients had exclusive unilateral middle cerebral artery–territory IS. Lesion topography was studied by using the first magnetic resonance image acquired after the onset of symptoms and was coded for involvement of cerebral cortex (CC), posterior limb of the internal capsule (PLIC), basal ganglia (BG), and white matter. The primary outcome was hemiparesis, and secondary outcomes were dystonia and loss of age-appropriate independent finger movements.

Results. Hemiparesis was more common after childhood-onset IS (56%) than neonatal-onset IS (24%). In neonatal-onset IS, concomitant involvement of BG, CC, and PLIC predicts the development of hemiparesis (odds ratio: 99; 95% confidence interval: 5.2-1883.8), and no child with 1 or 2 of these structures involved developed hemiparesis. In contrast, in childhood-onset IS, concomitant BG, CC, and PLIC lesions tended to be associated with hemiparesis (9 of 11), but this adverse outcome was seen also among patients with 1- or 2-site involvement. However, hemiparesis was less likely if the infarction involved BG only (odds ratio: 0.162; 95% confidence interval: 0.036-0.729). Dystonia was present in 15 of 24 in the childhood-onset group with hemiparesis but was not seen after neonatal-onset IS. In both age groups upper-limb impairment was more severe than lower-limb impairment, with frequent loss of independent hand function among hemiparetic patients.

Conclusions. In neonatal and childhood-onset IS, early magnetic resonance imaging provides useful prognostic information about subsequent motor outcome. There are differences in the functional response of the neuromotor system to injury between the 2 age groups that cannot be attributed to methodological differences alone.
Changes in Access, Utilization, and Quality of Care After Enrollment Into a State Child Health Insurance Plan
Authors: Kempe Allison , Beaty Brenda L. , Crane Lori A. , Stokstad Johan , Barrow Jennifer , Belman Shira , Steiner John F.
Published: February 2005

Background. There currently are few published data evaluating the effect of State Children's Health Insurance Programs on health care outcome measures in children. Colorado's Child Health Plan Plus (CHP+) is a non-Medicaid State Children's Health Insurance Program that began enrollment in April 1998. The objectives of this study were to compare reported (1) access to care, (2) utilization of health care, and (3) quality of care during the year before and the first year after enrollment into CHP+.

Methods. We interviewed 480 randomly selected families by telephone 2 months after their first enrollment into CHP+ (September 1999 to January 2000) and, again, 1 year later. We used generalized linear models to examine the effect of enrollment on health care access, utilization, and quality while controlling for type of previous insurance, length of time uninsured before enrollment, race/ethnicity, and age.

Results. Regarding access to care, the percentage of families who reported a usual site of preventive care did not change significantly, but families reported more often being able to see providers as soon as desired for routine care (incidence ratio [IR]: 2.03; 95% confidence interval [CI]: 1.37–3.02]), for care when sick or injured (IR: 2.77; 95% CI: 1.85–4.16), for specialty care (IR: 1.96; 95% CI: 1.16–3.32), and for all health care (IR: 2.35; 95% CI: 1.81–3.07). Unmet medical needs decreased after versus before enrollment for prescription medications (IR: 0.38; 95% CI: 0.26–0.55), mental health care (IR: 0.63; 95% CI: 0.40–0.97), prescription glasses (IR: 0.44; 95% CI: 0.29–0.65), and dental care (IR: 0.59; 95% CI: 0.47–0.76). Regarding utilization, the proportion who saw a provider for routine care in the past year increased (IR: 1.39; 95% CI: 1.06–1.83), but reported visits for sick, specialty, and emergency department care and hospitalizations did not increase. Regarding quality of care, the proportion who rated their health care as “best” increased (RI: 1.31; 95% CI: 1.04–1.66) after versus before enrollment.

Conclusions. Families who were newly enrolled into CHP+ perceived dramatic increases in access to all types of care and decreases in unmet medical needs, no increase in utilization of emergency department or hospitalization services, and improved overall quality of care in the year after enrollment into CHP+.
Critical Gaps in Child Passenger Safety Practices, Surveillance, and Legislation: Georgia, 2001
Authors: Staunton Catherine , Davidson Steve , Kegler Scott , Dawson Lisa , Powell Kenneth , Dellinger Ann
Published: February 2005

Objective. Motor vehicle crashes remain the leading cause of death among US children 1 year of age and older. Although age-appropriate child passenger restraint use and back seating position are effective injury prevention strategies, many children 12 years of age and younger ride inappropriately restrained and seated in the front seat. In Georgia and in most states, surveillance of child passenger restraint use is less than optimal. Although child safety seat legislation is 1 of the most effective mechanisms for increasing correct restraint use and back seating position, Georgia's child occupant restraint law, like the laws in most states, falls short of practices recommended by government and child advocacy safety groups. The objective of this study was to document child passenger restraint use and seating position among children aged 0 to 12 years in Georgia and to use these study results to evaluate the efficacy of Georgia’s child restraint surveillance and legislation.

Methods. In May and June 2001, police roadblocks were used to collect information about child passenger age, restraint use, and seating position.

Results. Data were collected on 1858 children who were riding in 1221 vehicles in 24 different Georgia counties. Results showed that 56% of children were inappropriately restrained and/or in the front seat. The most problematic age groups included infants who were in forward-facing child safety seats (28%) and/or in the front seat (22%); children who were 5 to 8 years of age in car seat belts alone (88%), rather than age- and size-appropriate child safety seats (6%); and children who were 9 to 12 years of age and riding in the front seat (39%). We compared our results with the existing Georgia passenger restraint surveillance system and found that it would have missed 77% of the children in our study who were inappropriately restrained and/or riding in the front seat. In a similar comparison, Georgia's restraint law did not cover over 74% of the children in our study who were riding at risk.

Conclusion. The results of this study highlight 3 important areas for improving child passenger safety: targeted interventions to promote booster seat use and riding in the back seat, expanded child passenger restraint and seating position surveillance, and expanded legislation to mandate booster seat use and back seating position.
The Pediatric Risk of Hospital Admission Score: A Second-Generation Severity-of-Illness Score for Pediatric Emergency Patients
Authors: Chamberlain James M. , Patel Kantilal M. , Pollack Murray M.
Published: February 2005

Objective. To develop and validate a second-generation severity-of-illness score that is applicable to pediatric emergency patients. The Pediatric Risk of Admission (PRISA) score was developed in a single hospital and was recalibrated and validated in 2, previous, small studies from academic pediatric hospitals. This study was performed to develop and validate a score in a larger sample of diverse hospitals.

Methods. Emergency departments (EDs) were block randomly selected as part of a study on ED quality on the basis of 3 care characteristics: annual patient volume (high or low compared with national median), presence or absence of a pediatric emergency medicine subspecialist, and presence or absence of residents. Patients were selected randomly on the basis of daily arrival logs. Medical records were photocopied, and abstracted data included demographic, historical, physiologic, and therapeutic information. The total sample was randomly divided into a 75% development sample and a 25% validation sample. Univariate and multivariate analyses were used to model the risk of mandatory admission, admissions for which preidentified, inpatient medical resources were used. The resulting multiple logistic regression model coefficients were converted to integer scores. Calibration (Hosmer-Lemeshow goodness of fit) and discrimination (area under the ROC curve) were used to measure performance. As a measure of construct validity, proportions of patients in ordered risk intervals were correlated with the outcomes of admission, mandatory admission, and ICU admission.

Results. Sixteen EDs enrolled 11664 patients. Mean patient age (±SD) was 6.8 ± 5.8 years, and 53% were male. Nine percent arrived by emergency medical services, and 6.9% were admitted. The most common diagnoses were minor injuries, otitis media, and fever. The multivariate analysis yielded a score with 7 historical variables, 8 physiologic variables, 1 therapy (oxygen) term, and 1 interaction term. Calibration was excellent. In the development sample, 442 mandatory admissions were predicted and 442 were observed (total χ2 = 2.275), and in the validation sample, 136.6 were predicted and 145 were observed (χ2 = 8.575). The area under the receiver operator characteristic curve was 0.82 ± 0.01 (SE) in the development sample and 0.77 ± 0.02 in the validation sample. In ordered predicted risk intervals, the proportion of patients with admissions, mandatory admissions, and ICU admissions increased in a linear manner.

Conclusions. The second-generation PRISA II score for pediatric ED patients has been developed and validated in a large sample of diverse hospitals. Performance characteristics indicate that PRISA II will be useful for institutional comparisons, benchmarking, and controlling for severity of illness when enrolling patients in clinical trials.
Overweight, Obesity, and Health-Related Quality of Life Among Adolescents: The National Longitudinal Study of Adolescent Health
Authors: Swallen Karen C. , Reither Eric N. , Haas Steven A. , Meier Ann M.
Published: February 2005

Objective. Childhood and adolescent overweight and obesity have increased substantially in the past 2 decades, raising concerns about the physical and psychosocial consequences of childhood obesity. We investigated the association between obesity and health-related quality of life in a nationally representative sample of adolescents.

Methods. A cross-sectional analysis was conducted using the 1996 National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7 to 12 during the 1994–1995 school year, and 4743 adolescents with direct measures of height and weight. Using Centers for Disease Control and Prevention growth charts to determine percentiles, we used 5 body mass categories. Underweight was at or below the 5th percentile, normal BMI was between the 5th and 85th percentiles, at risk for overweight was between the 85th and 95th percentiles, overweight was between the 95th and 97th percentiles + 2 BMI units, and obese was at or above the 97th percentile + 2 BMI units. Four dimensions of health-related quality of life were measured: general health (self-reported general health), physical health (absence or presence of functional limitations and illness symptoms), emotional health (the Center for Epidemiologic Studies Depression Scale and Rosenberg's self-esteem scale), and a school and social functioning scale.

Results. We found a statistically significant relationship between BMI and general and physical health but not psychosocial outcomes. Adolescents who were overweight had significantly worse self-reported health (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.34–3.51), as did obese adolescents (OR: 4.49; 95% CI: 2.87–7.03). Overweight (OR: 1.81; 95% CI: 1.22–2.68) and obese (OR: 1.91; 95% CI: 1.24–1.95) adolescents were also more likely to have a functional limitation. Only among the youngest adolescents (ages 12–14) did we find a significant deleterious impact of overweight and obesity on depression, self-esteem, and school/social functioning.

Conclusions. Using a nationally representative sample, we found that obesity in adolescence is linked with poor physical quality of life. However, in the general population, adolescents with above normal body mass did not report poorer emotional, school, or social functioning.
Effect of Pneumococcal Vaccination on Quality of Life in Children With Recurrent Acute Otitis Media: A Randomized, Controlled Trial
Authors: Brouwer Carole N. M. , Maillé A. Rianne , Rovers Maroeska M. , Veenhoven Reinier H. , Grobbee Diederick E. , Sanders Elisabeth A. M. , Schilder Anne G. M.
Published: February 2005

Background. Limited effectiveness of current treatment strategies for recurrent acute otitis media (RAOM) and increasing antibiotic resistance have diverted attention to prevention of AOM by vaccination. Pneumococcal vaccination for AOM seems to have only modest clinical efficacy. Thus far, the effects on health-related quality of life (HRQoL) or functional health status (FHS) have not been studied.

Objective. To assess the effect of vaccination on HRQoL or FHS.

Methods. In a double-blind, randomized, controlled trial, 383 children 1 to 7 years old with RAOM were vaccinated with either heptavalent pneumococcal conjugate vaccine followed by pneumococcal polysaccharide vaccine (pneumococcal group: n = 190) or with hepatitis A or B vaccines (control group: n = 193). Parents completed validated Dutch versions of 8 HRQoL and FHS instruments assessing generic FHS (Rand, Functional Status Questionnaire specific, and Functional Status Questionnaire generic), otitis media–specific FHS (OM-6), otitis media–specific child HRQoL (Numerical Rating Scale for Child), family functioning (Family Functioning Questionnaire), and otitis media–specific caregiver HRQoL (Numerical Rating Scale for Caregiver). Scores were compared at baseline and at 14 and 26 months' follow-up.

Results. At baseline, the average AOM incidence in the pneumococcal and control group was 5.0 (SD: 2.8) and 4.9 (SD: 2.6) episodes per year, respectively, with 38.4% and 36.8% having suffered from ≥6 episodes per year. AOM frequency decreased 4.4 episodes per year in both groups, with a considerable and comparable improvement in HRQoL and FHS. No substantial differences in HRQoL or FHS were found between the pneumococcal and the control group at baseline or at 14 or 26 months' follow-up.

Conclusion. Pneumococcal vaccination has no beneficial effect compared with control vaccination on either HRQoL or FHS in children 1 to 7 years old with RAOM.
Does a Triplet Birth Pose a Special Risk for Infant Development? Assessing Cognitive Development in Relation to Intrauterine Growth and Mother-Infant Interaction Across the First 2 Years
Authors: Feldman Ruth , Eidelman Arthur I.
Published: February 2005

Objective. To examine whether a triplet birth per se poses a risk to the development of infants' cognitive competencies and to the mother-infant relationship.

Methods. Twenty-three sets of triplets were matched with 23 sets of twins and 23 singleton infants (n = 138) with respect to gestational age, birth weight, and medical and demographic features. Infants with perinatal asphyxia, intraventricular hemorrhage of grade 3 or 4, periventricular leukomalacia, or central nervous system infection were excluded from the study. At 6, 12, and 24 months of age, mother-infant interaction was observed and infants' cognitive development was tested with the Bayley II test.

Results. Mothers of triplets displayed lower levels of sensitivity at 6, 12, and 24 months and infants were less socially involved at 6 and 24 months, compared with singletons and twins. Triplets scored lower than singletons and twins on the Bayley Mental Developmental Index at 6, 12, and 24 months. A weight discordance of >15% was found for 15 triplet sets (65.2%). The discordant triplets showed decreased cognitive skills at 12 and 24 months, compared with their siblings, and received the lowest scores for maternal sensitivity. Hierarchical multivariate regression analysis revealed that greater medical risk at birth, multiple-birth status, lower maternal sensitivity, and reduced infant social involvement in the first 2 years were each predictive of lower cognitive outcomes at 2 years (R2 = 0.33).

Conclusions. Triplets appear to be at higher risk for cognitive delays in the first 2 years of life, and discordant infants are at especially high risk. This delay is related in part to the difficulty of providing sensitive mothering to 3 infants at the same time. The findings may assist practitioners in guiding prenatal and postpartum parental care and management.
Overweight Among Low-Income Preschool Children Associated With the Consumption of Sweet Drinks: Missouri, 1999–2002
Authors: Welsh Jean A. , Cogswell Mary E. , Rogers Sharmini , Rockett Helaine , Mei Zuguo , Grummer-Strawn Laurence M.
Published: February 2005

Objective. To examine the association between sweet drink consumption and overweight among preschool children.

Methods. A retrospective cohort design was used to examine the association between sweet drink consumption and overweight at follow-up among 10904 children who were aged 2 and 3 years and had height, weight, and Harvard Service Food Frequency Questionnaire data collected between January 1999 and December 2001 and height and weight data collected 1 year later. Sweet drinks included vitamin C-containing juices, other juices, fruit drinks, and sodas as listed on the Harvard Service Food Frequency Questionnaire. Logistic regression was used to adjust for age; gender; race/ethnicity; birth weight; and intake of high-fat foods, sweet foods, and total calories. Results were stratified by baseline BMI.

Results. Among children who were normal or underweight at baseline (BMI <85th percentile), the association between sweet drink consumption and development of overweight was positive but not statistically significant. Children who were at risk for overweight at baseline (BMI 85th–<95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and ≥3 drinks/day were, respectively, 2.0 (95% confidence interval [CI]: 1.3–3.2), 2.0 (95% CI: 1.2–3.2), and 1.8 (95% CI: 1.1–2.8) times as likely to become overweight as the referent (<1 drink/day). Children who were overweight at baseline (BMI ≥95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and ≥3 drinks/day were, respectively, 2.1, 2.2, and 1.8 times as likely to remain overweight as the referent.

Conclusions. Reducing sweet drink consumption might be 1 strategy to manage the weight of preschool children. Additional studies are needed to understand the mechanism by which such consumption contributes to overweight.
Changes in Neonatology: Comparison of Two Cohorts of Very Preterm Infants (Gestational Age <32 Weeks): The Project on Preterm and Small for Gestational Age Infants 1983 and The Leiden Follow-Up Project on Prematurity 1996-1997
Authors: Stoelhorst Gerlinde M. S. J. , Rijken Monique , Martens Shirley E. , Brand Ronald , den Ouden A. Lya , Wit Jan-Maarten , Veen Sylvia ,   on behalf of the Leiden Follow-up Project on Prematurity
Published: February 2005

Objective. To determine changes in peri- and neonatal care concerning neonatal mortality and morbidity by comparing 2 cohorts of very prematurely born infants (gestational age [GA] <32 weeks), 1 from the 1980s and 1 from the 1990s.

Methods. The Leiden Follow-Up Project on Prematurity (LFUPP-1996/97), a regional, prospective study, includes all infants who were born alive after a GA <32 weeks in 1996 and 1997 in the Dutch health regions Leiden, The Hague, and Delft. The Project On Preterm and Small for Gestational Age Infants (POPS-1983), a national, prospective study from the presurfactant era, includes all liveborn infants <32 weeks' GA and/or <1500 g from 1983 (n = 1338). For comparison, infants from the POPS-1983 cohort with a GA <32 weeks from the same Dutch health regions were selected (n = 102).

Results. The absolute number of preterm births in the study region increased by 30%: 102 in 1983 to on average of 133 in 1996–1997. Centralization of perinatal care improved: the percentage of extrauterinely transported infants decreased from 61% in 1983 to 35% in 1996–1997. A total of 182 (73%) of the LFUPP-1996/97 infants were treated antenatally with glucocorticosteroids compared with 6 (6%) of the POPS-1983 infants. A total of 112 (42%) of the LFUPP-1996/97 infants received surfactant. In-hospital mortality decreased from 30% in the 1980s to 11% in the 1990s. Mortality of the extremely preterm infants (<27 weeks) decreased from 76% to 33%. The incidence of respiratory distress syndrome remained the same: ∼60% in both groups. Mortality from respiratory distress syndrome, however, decreased from 29% to 8%. The incidence of bronchopulmonary dysplasia increased from 6% to 19%. For the surviving infants, the average length of stay in the hospital and the mean number of NICU days stayed approximately the same (∼67 days total admission time and 44 NICU days in both groups); including the infants who died, the mean NICU admission time increased from 27 days in the 1980s to 41 days in the 1990s. Equal percentages of adverse outcome (dead or an abnormal general condition) at the moment of discharge from hospital were found (±40% in both groups).

Conclusions. An increase in the absolute number of very preterm births in this study region was found, leading to a greater burden on the regional NICUs. Improvements in peri- and neonatal care have led to an increased survival of especially extremely preterm infants. However, increased survival has resulted in more morbidity, mainly bronchopulmonary dysplasia, at the moment of discharge from the hospital.
Research in Neonatology for the 21st Century: Executive Summary of the National Institute of Child Health and Human Development–American Academy of Pediatrics Workshop. Part I: Academic Issues
Authors: Raju Tonse N.K. , Ariagno Ronald L. , Higgins Rosemary , Marter Linda J. Van
Published: February 2005

This article presents the executive summary of the presentations and discussions at the Workshop on Research in Neonatology sponsored by the National Institute of Child Health and Human Development and the American Academy of Pediatrics Section on Perinatal Pediatrics convened in January 2004. In this article, the scientific aspects are summarized, highlighting the current knowledge gaps and identifying research priorities with a focus on emerging technologies. In a separate article, issues concerning workforce needs and shortages and board-certification requirements are presented. Full-length articles on the presented topics will be published in the Journal of Perinatology.
Patterns of Molecular Diversity in Naturally Occurring and Refugial Populations of the Least Chub
Authors: Mock K. E. , Miller M. P.
Published: February 2005

The least chub Iotichthys phlegethontis is a small, rare cyprinid fish endemic to the Bonneville basin, Utah. Although it was once widely distributed within the basin, naturally occurring populations are now known to exist only in four isolated geographical regions. We used nuclear (amplified fragment length polymorphism) and mitochondrial genetic markers to describe the patterns of genetic divergence and diversity within and among populations from these regions and to assess genetic diversity in two refugial populations. We found that a large proportion of the diversity in this species was attributable to population structuring (FST = 0.52). Given that a high proportion of the genetic variation is accounted for by population differentiation and that three of the existing populations have been discovered in the last 10 years, we suggest that surveys to discover additional populations be a high management priority. We also recommend that existing populations be studied for evidence of adaptive divergence. The refugial populations that we studied closely resembled their source populations with respect to both genetic divergence and diversity, indicating that the current policy of founding these populations with large numbers of fish is effective.