bluuebunny/crossref_metadata_2025 huggingface dataset:
Presentation of Pediatric Celiac Disease in the United States: Prominent Effect of Breastfeeding
Authors: D’Amico Michael A. , Holmes Jessica , Stavropoulos Stavros N. , Frederick Marisa , Levy Joseph , DeFelice Amy R. , Kazlow Philip G. , Green Peter H. R.
Published: March 2006

Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p<0.05) and short stature (37% vs 62%, p<0.05), and had a higher rate of “atypical” symptoms (p<0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.
Meeting the Needs of Parents and Pediatric Patients: Results of a Survey on Primary Nocturnal Enuresis
Authors: Dunlop Amy
Published: March 2006

Primary nocturnal enuresis (PNE) affects about 7 million children and adolescents in the United States. A telephone survey of 745 parents/guardians of children aged 3 to 14 years was conducted to determine their knowledge and attitudes about PNE. Most did not know that PNE is a physical problem. Although 82% would want healthcare providers to discuss PNE with them if their child older than 6 years wet the bed, most would be uncomfortable initiating the dialogue. According to parents, healthcare providers either never or rarely discuss PNE. For the benefit of their young patients, healthcare providers must initiate discussion about PNE.
Community Physicians’ Attitudes Toward Electronic Follow-up After an Emergency Department Visit
Authors: Goldman Ran D.
Published: March 2006

Over 1-month, a survey was faxed to family primary care practitioners (PCPs) in the Greater Toronto area who referred patients to the Hospital for Sick Children (Toronto) emergency department (ED). Information about demographics, Internet access, and whether PCPs were interested in receiving e-mailed information about their patients. Of the 323 PCPs, 24% were excluded because they could not receive a fax or they had an office outside the hospital’s area code. One hundred fifty (61%) completed the survey—48% were family-physicians and 52% were pediatricians. Ninety-seven percent had Internet access and 9% had no personal e-mail. In total, 61% were interested in receiving electronic communication about their patients visiting the ED. Pediatricians were much more interested in the information compared to family physicians (p<0.0005). Having an e-mail account at home and at work, Internet access in the office, and reading e-mail once a day (or more) were the strongest indicators of being interested in receiving information. The main reason for disinterest however, was not enough time to read the e-mails (46% of non-interested PCPs).
Childhood Bathtub-Related Injuries: Slip and Fall Prevalence and Prevention
Authors: Spencer Sandra P. , Shields Brenda J. , Smith Gary A.
Published: March 2006

This study was conducted to describe the epidemiology of childhood bathtub-related injuries and to recommend methods for prevention of bathtub-related slips and falls. A consecutive series of 204 children, who were treated for bathtub-related injuries in a pediatric emergency department during a 3-year period were included in the study. The age range was 4 months to 16 years (mean 3.1, SD 2.8, median 2.8 years). Slips and falls accounted for 82.3% (168/204) of mechanisms of injuries. Lacerations, the most common injury type, accounted for 66.7% (136/204) of cases. The most frequent anatomic location of injury was the head or face (68.1%, 139/204). Adult supervision was present during 84.8% (67/79) of the injuries among children younger than 5 years. Parents changed the bathing environment after the patients’ injury in 82.3% (65/79) of cases. Injuries due to slips and falls are the most common type of childhood bathtub-related injury. Increased supervision alone will not be sufficient to prevent these injuries, given that adult supervision is already present in most cases. These injuries are most effectively prevented by passive methods, such as providing an effective slip-resistant bathtub surface. The large number of bathtub-related injuries associated with slips and falls argues for exploring a higher coefficient of friction standard for bathtubs, which may lead to fewer injuries.
Asking the Correct Questions to Assess Asthma Symptoms
Authors: Cabana Michael D. , Slish Kathryn K. , Nan Bin , Lin Xihong , Clark Noreen M.
Published: March 2006

A national survey of 896 parents of children with asthma was performed and responses to 2 types of inquiry were compared: global assessment versus specific assessment of symptoms. Almost all parents, 860 (96%), described their child’s asthma as under “good control” when asked a global assessment question. However, 306 (34%)—when asked specific questions—actually described poor asthma control with frequent symptoms. Medicaid insurance (OR: 1.59; 95% CI: 1.03, 2.44) and parental smoking (OR: 1.60; 95% CI: 1.06, 2.43) increased the likelihood that parents’ responses would be at risk for misinterpretation. Increased education (OR 0.41: 95% CI: 0.18, 0.91) and English as the primary language (OR 0.39; 95% CI 0.16, 0.96) were associated with decreased likelihood of misinterpretation. Vague, global assessment questions lead to incomplete clinical information and places the patient at risk for inadequate asthma therapy. A better approach is to use specific questions to determine the frequency of daytime or nighttime symptoms.
Parental Stress and Maladjustment in Children with Short Stature
Authors: Preston Andrew , Storch Eric A. , Lewin Adam , Geffken Gary R. , Baumeister Audrey L. , Strawser Melissa S. , Silverstein Janet H.
Published: March 2006

This study examined the psychometric properties of a measure of chronic disease-related parental stress, the Pediatric Inventory for Parents (PIP), in a sample of 22 children with short stature. Additionally, we investigated relations among disease-related parental stress, parental state anxiety, and children’s behavioral and psychological maladjustment. Results demonstrated acceptable internal consistency and convergent validity for the PIP. Significant and positive relations of medium to large effect sizes between parenting stress and internalizing and externalizing maladjustment were found. Recommendations for use of the PIP in clinical settings and future research directions are discussed.
Fragile X Syndrome: An Update and Review for the Primary Pediatrician
Authors: Visootsak Jeannie , Warren Stephen T. , Anido Aimee , Graham John M.
Published: March 2006

Fragile X syndrome (FXS) is the most common inherited cause of mental retardation. Since the initial identification of the responsible gene more than a decade ago, substantial progress has been made in both the clinical aspects of the disorder and its mechanistic basis; hence, it is important for primary care physicians to be familiar with these advances when providing anticipatory guidance. Timely diagnosis allows children to receive early intervention services and families to receive genetic counseling. Here the current state of knowledge is reviewed and a framework is provided for early recognition and diagnosis, along with counseling and treatment implications for the children and family members.
Disease Management in the Young Diabetic Patient: Glucose Monitoring, Coping Skills, and Treatment Strategies
Authors: Weinzimer Stuart A. , Doyle Elizabeth A. , Tamborlane William V.
Published: March 2006

Type 1 diabetes mellitus was thought to be the prevalent type of diabetes in children and adolescents; however, increasing numbers of juvenile patients appear to have type 2 diabetes. Management of all diabetes in young patients should include regular assessment, careful monitoring for glycemic control and the presence of hypoglycemia, and educational training on disease management. Hypoglycemic episodes, especially nocturnal events, are frequent in the young diabetic patient. Improvements in glycemic control and nocturnal hypoglycemia have been observed with continuous subcutaneous insulin infusion and insulin glargine. A continuous glucose-monitoring system can provide important insight into 24-hour glycemic control. Overall, careful management, monitoring, and education can improve glycemic control and yield positive treatment outcomes in the child or adolescent with diabetes.
Effects of Stimulant Medication on Cognitive Performance of Children with ADHD
Authors: Gimpel Gretchen A. , Collett Brent R. , Veeder Marietta A. , Gifford Julie A. , Sneddon Penny , Bushman Bryan , Hughes Kelly , Odell J. Dennis
Published: March 2006

The effect that treatment with stimulant medication has on the intellectual performance of children with attention deficit hyperactivity disorder (ADHD) was examined. Thirty-one children diagnosed with ADHD were given a WISC-III before any treatment was implemented. At least 1 year later, children were retested. At this time, 24 of the children were taking stimulant medications. Children receiving medications had significant increases in IQ scores, but no changes were found for those not taking medications. Changes in IQ scores were moderately related to parents’ perceived efficacy of the medication and parent-reported compliance with medication but were not strongly related to changes in parent-reported ADHD symptoms.
A Multimedia Violence Prevention Program Increases Pediatric Residents’ and Childcare Providers’ Knowledge About Responding to Childhood Aggression
Authors: Scholer Seth J. , Reich Stephanie M. , Boshers Robyn B. , Bickman Len
Published: March 2006

A pre-post knowledge test using alternate forms was used to determine if a multimedia violence prevention program can increase knowledge about management of childhood aggression. The participants were pediatric residents and childcare workers who attended lectures about aggression management in young children. The intervention was a presentation of a 30 minute CD-ROM program, Play Nicely, which teaches how to manage aggression in young children ages 1 to 7 years. A pretest and posttest multiple-choice knowledge assessment that focused on the program’s most important recommendations was administered. Childcare workers and pediatric residents had significantly increased knowledge scores after viewing the CD-ROM demonstration (F=6.8, p = 0.01). Childcare workers’ scores improved by 2.6 points (p< 0.001) and residents’ scores by 3.8 points (p< 0.001). A relatively short CD-ROM can improve knowledge about how to manage aggression in young children, indicating its usefulness as a violence prevention resource.
Lyme Arthritis in 20 Children Residing in a Non-Endemic Area
Authors: Saulsbury Frank T.
Published: March 2006

In non-endemic areas of the country, Lyme disease may not be considered in children who present with arthritis. This report details the clinical features of Lyme arthritis in 20 children residing in central Virginia. All patients presented with transient, often recurrent oligoarthritis of large joints, particularly the knee. Most patients were referred with a presumptive diagnosis of juvenile rheumatoid arthritis (JRA). This report reiterates the clinical presentation of Lyme arthritis in children and reminds physicians to consider the diagnosis of Lyme arthritis in children who present with acute arthritis even if they reside in a non-endemic area of the country. In addition, it differentiates the clinical presentation of Lyme arthritis from JRA.
Standard-dose and Short-term Corticosteroid Therapy in Immunoglobulin-resistant Kawasaki Disease
Authors: Takeshita Seiichiro , Kawamura Youichi , Nakatani Keigo , Tsujimoto Hiroshi , Tokutomi Tomoharu
Published: March 2006

Six patients with Kawasaki disease (KD) were treated with prednisolone (1 to 2 mg/kg/day) for 3 days (from days 10 to 12 after the onset of the illness) after apparently unsuccessful treatment with intravenous immunoglobulin (IVIG, 2 g/kg/dose and additional 1 g/kg/dose). Five patients responded immediately to the first course of prednisolone infusion. One patient failed to respond to the first course of prednisolone therapy, but he did respond to the second 3-day course of therapy. None of the patients demonstrated a further progression of coronary artery dilatation or any adverse effects. Standard-dose and short-term corticosteroid therapy therefore appears to be a safe and effective treatment for patients with IVIG-resistant KD.
Identifying Children with Pneumonia in the Emergency Department
Authors: Mahabee-Gittens E. Melinda , Grupp-Phelan Jacqueline , Brody Alan S. , Donnelly Lane F. , Bracey Sheryl E. Allen , Duma Elena M. , Mallory Mia L. , Slap Gail B.
Published: March 2006

Emergency physicians need to clinically differentiate children with and without radiographic evidence of pneumonia. In this prospective cohort study of 510 patients 2 to 59 months of age presenting with symptoms of lower respiratory tract infection, 100% were evaluated with chest radiography and 44 (8.6%) had pneumonia on chest radiography. With use of multivariate analysis, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) of the clinical findings significantly associated with focal infiltrates were age older than 12 months (AOR 1.4, CI 1.1-1.9), RR 50 or greater (AOR 3.5, CI 1.6-7.5), oxygen saturation 96% or less (AOR 4.6, CI 2.3-9.2), and nasal flaring (AOR 2.2 CI 1.2-4.0) in patients 12 months of age or younger. The combination of age older than 12 months, RR 50 or greater, oxygen saturation 96% or less, and in children under age 12 months, nasal flaring, can be used in determining which young children with lower respiratory tract infection symptoms have radiographic pneumonia.
Meningococcal Conjugate Vaccine in Adolescents and Children
Authors: Pichichero Michael E.
Published: March 2006

Disease caused by Neisseria meningitidis is associated with high mortality rates and significant sequelae. Quadrivalent (A, C, Y, W-135) polysaccharide meningococcal vaccine has been available for more than 20 years, and although used widely for adolescents entering college, it has a number of limitations, including short duration of immunity and lack of a herd effect. A quadrivalent meningococcal conjugate vaccine has recently been licensed and endorsed for use in adolescents 11 to 12 years of age, at age 15, or at college entry. Among the key features of the new meningococcal conjugate vaccine are stimulation of both B-cell-dependent and T-cell-dependent immune responses, induction of immunologic memory and booster effects, long-term protection, reduction of nasopharyngeal carriage of N. meningitidis, and herd immunity. Large randomized, double-blind studies in adolescents and 2- to 10-year olds have demonstrated the immunogenicity as well as the safety and tolerability of the new meningococcal conjugate vaccine formulation.
Healthcare Utilization for Acute and Chronic Diseases of Young, School-age Children in the Rural and Non-rural Setting
Authors: Cayce Kimberly A. , Krowchuk Daniel P. , Feldman Steven R. , Camacho Fabian T. , Balkrishnan Rajesh , Fleischer Alan B.
Published: March 2006

To determine the most frequently diagnosed conditions among rural and non-rural children age 5 to 9 and assess for environmental influences, data from the National Ambulatory Medical Care Survey (1996-2001) were used to examine frequencies of diagnoses in children age 5 to 9. Separately, we examined rural and non-rural outpatient physician visits in weighted multivariate logistic regression models. Overall, the most frequent diagnosis was routine health check, followed by several acute conditions. When analyzed separately, non-rural children were significantly more likely to visit a physician for routine health check (P = 0.002), asthma (P = 0.005), and acute upper respiratory infection (P = 0.037). Rural counterparts were significantly more likely to be seen for attention deficit disorder (P = 0.000), otitis media (P = 0.017), chronic rhinitis (P = 0.017) and influenza (P = 0.037). Children age 5 to 9 are healthy overall. When illness occurs, it is usually acute. Rural and non-rural, young, school-aged children exhibit many similarities in healthcare utilization, but differences occur. Most surprising is the difference in the diagnosis frequency of attention deficit disorder.
A 1999 Quality Improvement Initiative—Reassessment in 2004
Authors: Feinberg Arthur N. , Soyode Olufemi
Published: March 2006

We obtained a longitudinal overview of physician compliance with the American Academy of Pediatrics Policy RE9539 regarding early newborn discharge between 1999 and 2004. In previous studies we reported the results of a Quality Improvement/Feedback (QI/F) initiative at one community hospital (intervention) in 1999, during which time physician education occurred at a grand rounds and the hospital QI department reviewed all newborn charts for a 1-year period, notifying physicians of any deviations from the policy. We also assessed the very same physicians at another community hospital (control), which did not have this initiative and found significant changes in physician behavior only at the intervention hospital. In this study we reassessed the same physicians in the year 2004 and compared their performance with that in 2000, after the intervention was well established, once again at both the intervention and control hospitals. Physicians caring for newborns at the intervention hospital continued to demonstrate improvement in compliance with the Early Newborn Discharge Policy (p=0.0036), whereas there was no significant change in physician performance over time at the control hospital (p=0.6874). We conclude, similarly to the first study, that improvement in physician practice continued, but there was still no overall change in physician culture.
Adolescent Abuse of Dextromethorphan
Authors: Schwartz Richard H.
Published: March 2006

Dextromethorphan hydrobromide (DXM), a constituent of more than 125 patent cough/cold remedies, is the most popular antitussive medication in the United States. Cough syrups or capsules also contain additional ingredients such as acetaminophen, chlorpheniramine maleate, guaifenesin, and/or pseudoephedrine, and toxicity with overdosage is additive to that of dextromethorphan alone. An unknown number of adolescents in the United States and Europe intoxicate themselves with acute megadoses of dextromethorphan. A megadose of DXM is defined as 5 to 10 times the dose recommended for control of annoying nonproductive coughs. Although a moderate overdose of pure DXM hydrobromide is free of serious adverse effects, approximately 5% of persons of European ethnicity lack the ability to metabolize the drug normally, leading to rapid acute toxic levels. Variable quantities of pure dextromethorphan powder in multiples of 1 gram are easily available from the worldwide web, including e-Bay. Recipe-like extraction procedures are quickly available on the Internet for seemingly simple and inexpensive home manufacture of concentrated dextromethorphan powder from Coricidin HBP Cough & Cold™ tablets (street name triple C). Adolescents intoxicate themselves at parties and even before or after school since the drug is legal, relatively inexpensive, and easily purchased or shoplifted at drug or convenient stores. Acute megadoses of the drug have profound psychological and physiological effects similar to those of phencyclidine (PCP). Megadoses of dextromethorphan used to self-intoxicate, can produce a false-positive screening test for phencyclidine in a urine specimen.
Blood Lead Screening
Authors: Feinberg Arthur N. , Cummings C. Kim
Published: March 2006

To evaluate local procedures for and barriers to testing Medicaid patients for lead toxicity, a retrospective review of 675 charts of Medicaid patients’ age 12 to 36 months form the 7 practices who serve the vast majority of Medicaid children in Kalamazoo, Michigan was undertaken. We identified and tested a model for barriers to patients and physicians obtaining blood lead levels. Only 27.6% had blood lead levels substantially lower than the universal testing mandated by the Centers for Medicare and Medicaid Services. Physicians overestimated the number of children having blood lead tests, even with adjusting for patient non-compliance. Practices varied sharply in their approach to screening. Of 489 patients without findable lead test results, 139 (28.4%) were attributable to previous screening, 98 (20.0%) to patient failure, 181 (37.0%) to physician failure, 52 (10.6%) to patient + physician failure and 19 (3.9%) were indeterminate. There is need for improvement, standardization and unification of lead screening guidelines. Understanding barriers to blood lead testing is also necessary to develop credible data to promote shifts in public policy regarding lead abatement. Further studies should be done, such as interviews and questionnaires to determine why physicians fail to order blood lead tests, and patients fail to appear for a test that has been ordered.
Utility of Renal Imaging in the Diagnostic Evaluation of Obese Childhood Primary Hypertension
Authors: Tuli Sanjeev Y. , Dharnidharka Vikas R.
Published: March 2006

Although childhood primary hypertension (CP-HTN) associated with obesity is considered an earlier manifestation of typical adult-onset primary hypertension (adult-HTN), the recommendations for diagnostic evaluation are not identical in the two conditions. In particular, renal imaging is not recommended in adult-HTN, but is still currently recommended in CP-HTN. In this study, the clinical value of renal imaging in the initial diagnostic evaluation of CP-HTN was determined. A retrospective chart review was conducted of older and overweight children (> 7 years of age) evaluated in the pediatric nephrology clinic at the University of Florida from 1999 to 2004 for hypertension. The final highly selected study group was composed of obese or overweight children (body mass index > 85th percentile for age and gender) with otherwise unremarkable history, physical examination, and urinalysis. Renal imaging was performed (ultrasound in 49, computed tomography in one) in 50 patients (M:F = 28:22; age range, 7-20 years) with clinical features compatible with CP-HTN, and was normal in all patients. In this study, renal imaging did not add any clinical value to the initial evaluation of CP-HTN associated with obesity. Larger studies may confirm that the evaluation of CP-HTN in older obese children could be similar to guidelines for evaluation of adult-HTN.
Outcomes of Febrile Children Presumed to be Immunocompetent Who Present with Leukopenia or Neutropenia to an Ambulatory Setting
Authors: Serwint J. R. , Dias M. M. , Chang H. , Sharkey M. , Walker A. R.
Published: March 2006

To determine significant medical outcomes in febrile children presenting to an ambulatory setting with neutropenia and/or leukopenia. Methods: Retrospective medical record review conducted on febrile patients who had a blood culture drawn, with white blood cell counts less than 5,000/mm3 and/or an absolute neutrophil count less than 1000/mm3. Ninety-one patients were identified; 5 with positive blood culture results, 13 with significant non-oncologic disease, and 3 patients with leukemia who had involvement of 2 or more cell lines. Conclusions: In the majority of patients, clinical judgment, physical findings, and review of all cell lines of the complete blood cell count identified those with significant disease.
Parent’s Reports Predict their Child’s Developmental Problems
Authors: Tervo Raymond C.
Published: March 2006

To document parental reports about their child’s delayed development, 180 consecutive parents/guardians of children, ages ranging from 16 to 70 months, were surveyed. Parents reported a mean of 8.28 (SD 4.55) problems. Symptoms most reported were not talking well (79.5%), poor speech (59.8%), immaturity (58.0%), understands poorly (55.4%), bowel/bladder problems (50.9%), seldom plays with others (47.3%), attention (46.4%), eating (43.8%), clumsy-gross motor (40.2%), and clumsy-fine motor (40.2%). There was an association between delayed development and symptoms about eating, bowel-bladder, clumsy fine-motor, not talking well, understands poorly, immature, and seldom plays with others (p<0.05). The presence of language symptoms increased the odds of delayed development by 2.25. Relevant symptoms differed by developmental domains and different groups of items predicted specific delays. Parent reports indicated quantifiable difficulties requiring detailed assessments.
Impact of Childhood Epilepsy on Maternal Sleep and Socioemotional Functioning
Authors: Cottrell Lesley , Khan Atiya
Published: March 2006

Examinations of parental adjustment to their children’s chronic illness and parental sleep effects on their daily functioning have been conducted independently over the past 2 decades. As a result, very little is known about the association between parental sleep patterns and parental adjustment to their children’s illnesses. The goal of this study was multifaceted. Little is known about the sleep patterns of parents within a stressful situation such as having a child who experiences chronic health problems; therefore, more descriptives of parents’ sleep patterns needed to be identified. The second facet of this study was to examine the relationship between parental sleep problems and other measures of parental adjustment to their children’s chronic illness. Findings from 50 parents of children (5 years old and younger) who had been diagnosed with epilepsy revealed that parents spent an average of 4 hours sleeping during the night; awaking at least 3 times to check on their children. Parental awakening during the night was positively related to the number of seizures reported during a typical 24-hour period and parent perception of the seizure severity. Parental nighttime awakenings were inversely associated with parents’ perceptions of their own sleep quality, marital satisfaction, and maternal health. Findings from this study highlight the need for clinicians to investigate the current sleep patterns of parents whose children are receiving treatment for pediatric epilepsy.
Pseudoseizures in Children: A Profile of 50 Cases
Authors: Bhatia Manjeet S. , Sapra Savita
Published: March 2006

In contrast to adulthood hysterical disorders, childhood hysteria has not been accorded due recognition. Pseudoseizures are paroxysmal alterations in behavior that resemble epileptic seizures but are without any underlying organic cause. There is paucity of literature on pseudoseizures in children. In the present descriptive study of 2 years’ duration, a series of consecutively seen 50 children with pseudoseizures is reported. After detailed history from parents, various socio-demographic and clinical variables were noted. Of 110 children seen with conversion disorder, 50 had pseudoseizures (45.5%). The average age was 8.2 years in boys and 9.4 years in girls. There were 28 girls (56.0%) and 22 boys (44.0%), and the majority of patients had the pseudoseizures for 1 to 3 months. When the mode of referral was studied, 52% were referred from pediatric outpatient department and the majority were referred to rule out comorbid psychiatric disorder. The fits mimicking generalized tonic-clonic seizures were most common and the duration of fits ranged from 10 to 35 minutes. The most common frequency of fits was 5 to 6 per week. The average duration of symptoms was 2.6 months in boys and 3.2 months in girls. Only 14 patients (28%) gave the history of having seen the fits in a relative or schoolmate. School phobia and the fear of examinations were the most common precipitating factors. Separation anxiety disorder, school phobia, and mood disorders were common comorbid diagnoses. The patients were put on appropriate drug treatment and/or psychotherapy for 3 months. Of 50 cases, 36 (72.0%) remitted, 10 (20.0%) showed a decrease in frequency of pseudoseizures, and 4 (8.0%) did not improve. With correct diagnosis and treatment, the children with pseudoseizures have a good outcome.
Suppurative Complications of Frontal Sinusitis in Children
Authors: Kuczkowski Jerzy , Narozny Waldemar , Mikaszewski Boguslaw , Stankiewicz Czeslaw
Published: March 2006

A retrospective review of children diagnosed and treated for suppurative complications of paranasal sinusitis was undertaken to describe clinical presentation, microbiology, and treatment. This review includes children with subgaleal abscess and osteomyelitis of the frontal bone, subdural empyema, frontal lobe abscess, meningitis, and encephalitis. Staphylococcus aureus and group C β-hemolytic Streptococcus were isolated agents. All children were treated with intravenous antibiotics with drainage of both the sinus and extracranial and intracranial suppurations. Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.
Vitamin D Insufficiency in Preadolescent African-American Children
Authors: Rajakumar Kumaravel , Fernstrom John D. , Janosky Janine E. , Greenspan Susan L.
Published: March 2006

To determine the proportion of vitamin D insufficiency in 6- to 10-year-old preadolescent African-American children residing in Pittsburgh, Pennsylvania and to estimate their therapeutic response to vitamin D 400 IU/day for 1-month, an open-label pre- and post-comparison of vitamin D status following vitamin D 400 IU daily for 1 month during winter and early spring was conducted. Outcomes included serum calcium, phosphorus, albumin, 25 hydroxyvitamin D [25 (OH) D], 1, 25 dihydroxyvitamin D [1, 25 (OH) 2 D], parathyroid hormone (PTH), and markers of bone turnover (serum bone-specific alkaline phosphatase, osteocalcin, and urine n-telopeptide crosslinked collagen type 1 [NTX]). Dietary intake of vitamin D was assessed using a food frequency questionnaire. Forty-one of the 42 enrolled subjects (mean age: 8.9 ± 1.2 yrs [SD]) were analyzed, and 20/41 (49%) were vitamin D insufficient. Vitamin D insufficient group had a suggestive trend of being older (9.2 ± 1.0 years vs. 8.5 ± 1.3 years, p = 0.06) and more pubertally advanced (Tanner II: 7/20 vs. Tanner II: 1/21, p = 0.02). Mean dietary intake of vitamin D was 277 (146 IU/day (n = 41). Adequate intake for vitamin D (200 IU/day) was not met in 16/41 (39%); however, the dietary intake of vitamin D was not significantly different between the vitamin D insufficient and vitamin D sufficient groups.
Does Crying Turn Tympanic Membranes Red?
Authors: Yamamoto Loren G. , Sumida Ryan N. , Yano Stephen S. , Derauf D. Christian , Martin Paul E. , Eakin Paul J.
Published: March 2006

The diagnosis of acute otitis media is based on several clinical factors. One of these factors is the color of the tympanic membrane (TM). Crying can cause flushing and hyperemia of the face. The purpose of this study is to determine whether crying affects the color of tympanic membranes. Infants and toddlers (age 30 months or less) evaluated in an outpatient clinic or primary care pediatrician’s office for routine well-baby checks who received at least 2 parenteral immunizations were enrolled on a convenience basis. Ill children were excluded. The initial physician assessed crying and TM color/visibility. Following immunizations, a second physician assessed crying and the TM color/visibility. Color differences were stratified by the degree of crying. One hundred twenty-one study subjects received 2-5 parenteral immunizations. TM colors were most often in the pink range or less. Only 2 TMs were assessed as light red and none were assessed as red. Twenty-eight percent of the TMs with greater crying on the second exam were noted to be redder on the second exam compared to the first exam versus 11% for the comparison group (p=0.0007); 19% of the TMs with greater crying on the second exam were noted to be redder by 2 or more increment levels compared to the first exam versus 5% for the comparison group (p=0.0004); 31% of the TMs with greater crying on the second exam at the 3+ and 4+ level were noted to be redder on the second exam compared to the first exam versus 14% for the comparison group (p=0.003). Our data indicate that, in some instances, crying can result in an increase in pinkness of the TM. Crying in well children does not result in a red tympanic membrane.
Human Bites and Blood Exposures in New York City Schools
Authors: Stockheim Janet , Wilkinson Nadine , Ramos-Bonoan Carmen
Published: March 2006

The epidemiology of human bites and blood exposures in urban schools has not been described. The authors reviewed 734 human bite and blood exposure incidents in New York City schools from September 1999 to June 2001. School site, age, gender, body site, temporal distributions, and underlying health status of individuals were reviewed. Nine incidents involved children known or suspected to be HIV-infected. Medical interventions included EMS involvement, emergency room treatment, hospitalization, vaccine administration, laceration suturing, systemic antibiotic therapy, and serologic evaluation for transmission of blood-borne pathogens. These incidents occur with a high prevalence in NYC schools and have potential for serious outcomes.
Hepatitis A Immunization Strategies: Universal versus Targeted Approaches
Authors: Jacobs R. Jake , Meyerhoff Allen S. , Zink Thomas
Published: March 2006

The alternative to nationwide childhood hepatitis A vaccination is to continue targeting high-risk adults. To consider how many of today’s children will become vaccination candidates, the proportion of adults reporting a lifetime history of hepatitis A risk factors was examined. One thousand thirty-four US adults responded to a confidential postal survey, 49% of whom had met current Advisory Committee on Immunization Practices (ACIP) criteria for immunization and 72% had met an expanded set of criteria. Because adult vaccination is more costly per capita, targeted vaccination may provide modest financial savings with none of the benefits associated with reduced child-to-adult transmission.
Screening for Hypertension in High School
Authors: Nussinovitch Naomi , Elishkevitz Keren , Rosenthal Talma , Nussinovitch Moshe
Published: March 2006

Arterial hypertension is a major risk factor for atherosclerotic ischemic heart disease and cerebrovascular stroke. Blood pressure measurements were taken in the supine position in 6,282 healthy adolescents (3073 boys, 3209 girls) aged 13-17 years of both sexes. Forty-eight subjects were found to have hypertension: 35 idopathic and 13 secondary to reflux nephropathy, chronic glomerulonephritis, coarctation of the aorta, and hemolytic uremic syndrome. Systolic blood pressure was significantly higher among males than females at ages 15-17 years (p<0.001); diastolic blood pressure was higher among males at age 17 years only (p<0.05). Males with BMI>17 exhibited higher systolic blood pressure than females. Prevalence of hypertension, mostly primary, in a large cohort of students was 0.76%. Early screening is important for early interventions and reducing cardiovascular morbidity and mortality in adulthood.
Presenting Signs and Symptoms of Pheochromocytoma in Pediatric-aged Patients
Authors: Sullivan Janet , Groshong Ted , Tobias Joseph D.
Published: March 2006

To describe the varied presenting signs and symptoms in pediatric patients with pheochromocytoma, a retrospective chart review of the presenting signs and symptoms and subsequent clinical course of patients who presented to the Pediatric ICU following surgical excision of a pheochromocytoma was undertaken. The cohort of 7 patients (5 boys, 2 girls) ranged in age from 4 to 16 years. Two patients were hypertensive at initial presentation, and the other 5 developed hypertension after their initial presentation. The initial presenting signs and symptoms were related to the central nervous system (CNS) in 6 of the patients (5 with an acute alteration in mental status and 1 with visual disturbances). Two patients presented with congestive heart failure. Other signs and symptoms at the time of initial presentation included sweating, headache, weight loss, heat intolerance, increased thirst and urination, a decline in school activity, and red/puffy hands and feet. The time from the initial presentation until the diagnosis was confirmed was 5 months or more in 4 of the 7 patients. The diagnosis was confirmed by demonstration of elevated urinary catecholamines in all 7 patients, although 2 patients had initial negative urinary levels.
Hemangiomas of Infancy: Clinical and Biological Characteristics
Authors: Smolinski Kara N. , Yan Albert C.
Published: March 2006

Hemangiomas of infancy are common in the general pediatric population, are usually easily diagnosed, and generally do not require treatment. However, a small but significant percentage of hemangiomas of infancy may develop complications, including infection or ulceration. In addition, hemangiomas located in some anatomic regions may be associated with other anomalies and therefore require more careful monitoring and earlier intervention to prevent permanent sequelae. This review focuses on distinguishing hemangiomas from vascular malformations and delineates the natural history of hemangiomas of infancy, with an emphasis on identifying those hemangiomas that require additional evaluation and closer follow-up. Current treatment modalities, including the use of systemic steroids and the pulsed-dye laser, are discussed. In addition, several conditions that often present with cutaneous hemangiomas are described, including PHACES syndrome and neonatal hemangiomatosis. Finally, an assessment is made of the current understanding of the biology of hemangioma proliferation and involution, including the role of endothelial growth factors and GLUT1, a new marker for hemangiomas of infancy.
A Comparison of Buccal Midazolam and Rectal Diazepam for the Acute Treatment of Seizures
Authors: Baysun Şahika , Aydin Ömer Faruk , Atmaca Emel , Gürer Y. K. Yavuz
Published: March 2006

In this study, the authors aimed to evaluate buccal midazolam as a practical and safe alternative medication for children who suffer from seizures in the emergency setting and in home practice or anywhere. The effects and side effects of buccal midazolam and rectal diazepam were compared in the treatment of acute convulsions in 43 children, ranging in age from 2 months to 12 years who were seen at the emergency service of the children hospital. Midazolam was given on the even days of the month and diazepam was given on the odd days. In the midazolam group, the seizures of 18/23 (78%) patients terminated in 10 minutes; however 5/23 (22%) patients did not respond. In the diazepam group 17/20 (85%) patients responded in 10 minutes, but 3/20 (15%) did not respond. Midazolam was found to be as effective as diazepam and the difference was not statistically significant (p<0.05). Response periods of the 2 drugs showed no significant difference (p>0.05). The need for a second drug for seizures that did not stop with the first drug was equal, and the difference was not statistically significant (p>0.05). They did not observe any serious complications. In conclusion, buccal midazolam is safe and as effective as rectal diazepam for the treatment of seizures.
A Simple Approach to Improving Patient Satisfaction
Authors: Maisels M. Jeffrey , Kring Elizabeth A.
Published: March 2006

Improved communication with families may significantly increase their satisfaction with the care of their hospitalized child. The families of children admitted to a general pediatric service were randomly assigned to receive a daily visit from a communicator/facilitator whose purpose was to respond to any questions the family might have and, if necessary, to explain results of laboratory tests. Control families received routine care. At the time of discharge (study 1) or following discharge (study 2), the families were asked to complete a brief questionnaire regarding the quality of nursing care and physician care (both attending and resident physician). Responses were received from 76/83 (91.6%) in the study group and 75/83 (90.4%) in the control group. There was a highly significant improvement in parent satisfaction with all of the care delivered—nursing, attending physician, and resident care (p ≤.005 in all categories of care). The simple act of offering a sympathetic and understanding ear, and answering questions, many of which were unrelated to the medical problem at hand, had a salutary effect on overall patient and family satisfaction with both nursing and medical care. In the current era of intense competition to fill available beds and the important emphasis on quality of care, this approach deserves further evaluation by department managers and hospital administrators.
Decreased Regurgitation with a Soy Formula Containing Added Soy Fiber
Authors: Ostrom Karin M. , Jacobs Joan R. , Merritt Russell J. , Murray Robert D.
Published: March 2006

The objective of this randomized study was to determine if fiber-supplemented soy formula reduced regurgitation in young infants. We compared regurgitation in 179 infants randomly assigned cow’s milk-based (CM, 90) formula or soy formula with fiber (SF, 89). Initial daily incidence was similar (CM, 3.6; SF, 3.9 episodes), but significantly lower after 7 days on SF (CM, 3.4; SF, 2.3; p = 0.001). Less frequent regurgitation after 7 days on SF was sustained after 28 days (CM, 48%; SF, 31% of feedings; p = 0.001). Feeding SF effectively managed regurgitation while providing balanced nutrition without altering caloric distribution as occurs with adding rice cereal to formula.
Selective Mutism: Are Primary Care Physicians Missing the Silence?
Authors: Schwartz Richard H. , Freedy Alicia S. , Sheridan Michael J.
Published: March 2006

To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.
Storylines As a Neglected Cause of Crime
Authors: Agnew Robert
Published: March 2006

Researchers usually explain individual offending in terms of background factors like low self-control and association with delinquent peers. Such factors reflect the routine or typical aspects of the individual's life over an extended period of time and they influence the individual's predisposition for crime. Researchers also sometimes explain offending in terms of situational factors, which reflect the features of the situation immediately before a crime occurs and influence the commission of crime in that situation. But that temporal level between background and situational factors is largely ignored. The author refers to this level as “storylines.” Storylines begin with some event that is out of the ordinary, and this event temporarily alters the individual's characteristics, interactions, and/or settings for interaction inways that increase the likelihood of crime. This article draws on the qualitative research on crime and the leading crime theories to identify the major storylines conducive to crime, and it points to the important role that storylines can play in understanding the causes of crime and in efforts to control crime.
Are Violent Delinquents Worth Treating? A Cost–Benefit Analysis
Authors: Caldwell Michael F. , Vitacco Michael , Van Rybroek Gregory J.
Published: March 2006

This study reports on the cost benefits of an intensive treatment program for unmanageable juvenile delinquent boys, compared to the usual treatment in a secured juvenile corrections facility. A total of 101 boys who received the majority of their treatment services in a specialized program providing intensive mental health treatment were matched to a group of 101 juveniles who received treatment as usual (TAU) in a secured juvenile corrections setting on the basis of treatment propensity scores. Outcome data included the number and type of criminally charged offenses over an average follow-up period of 53 months (range 14 to 92 months). Borrowing from Cohen criminal justice processing costs for each offense was calculated in 2001 dollars. The initial costs of the program were offset by improved treatment progress and lowered recidivism, especially violent recidivism. The treatment group yielded a benefit-cost ratio of more than 7 to 1 over the TAU group. The results are discussed and compared to cost-benefit analyses of other juvenile treatment programs.
Individual differences in infant attention skills, joint attention, and emotion regulation behaviour
Authors: Morales Michael , Mundy Peter , Crowson Mary M. , Neal A. Rebecca , Delgado Christine E. F.
Published: March 2006

This study examined the concurrent and predictive relations between infant attention skills, joint attention, and emotion regulation. Infants' gaze following skills and duration of orienting were assessed at 6 months of age, and collaborative joint attention and emotion regulation skills were assessed at 24 months of age. The results indicated that infants' ability to follow direction of gaze at 6 months was significantly correlated with emotion regulation strategy use at 24 months of age, and that collaborative joint attention at 24 months was significantly correlated with emotion regulation strategy use at 24 months of age. The results of this study are consistent with previous research finding associations between collaborative joint attention and children's emotion regulation behaviour. These data also suggest that children's preexisting visual attention skills may contribute to their ability to regulate emotion.
Applications of multidimensional scaling profile analysis in developmental research: An example using adolescent irritability patterns
Authors: Ding Cody S.
Published: March 2006

Many statistical models have been used to study human development. The multidimensional scaling (MDS) method has been an under-utilised technique in psychological and educational research for studying such phenomena. In this paper, MDS profile analysis was used to examine adolescent mood change patterns over a 1-week period. This method is used to empirically determine different change profiles among adolescents, and to describe how they differ with respect to these change patterns. In addition, the associations between the change profiles and a set of background variables can be studied. Data on irritability–cheerfulness swing among adolescents were analysed to demonstrate the procedures. The results were discussed in the context of adolescent development.