bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Home Health Care in King County, Washington
Authors: Clemens Conrad J. , Davis Robert L. , Novack Alvin H. , Connell Frederick A.
Published: August 2004

Background. Pediatric home health care is one of the fastest growing segments of our health care system. However, our knowledge of the extent and quality of the services provided in this field is generally limited. Despite this shortcoming, pediatric health care providers are increasingly expected to participate in the home health care of their patients.

Objective. To describe the agencies and services that constitute pediatric home health care in a large metropolitan setting.

Methods. During the summer of 1995, home health care agencies in King County, WA, were surveyed if they had provided any pediatric services within the preceding 6 months. The agencies were queried about their characteristics and services provided, as well as referral and reimbursement sources. Survey data were supplemented by interviews with agency and state health personnel.

Results. Fourteen (88%) of the 16 agencies providing pediatric home health care services completed the survey. Agencies were predominantly for-profit, free-standing, and in business fewer than 10 years. Although there were uniform licensing requirements for agencies, no pediatric-specific regulations existed. In addition, many agencies lacked internal methods to ensure the provision of quality pediatric care. Eighty percent of all pediatric home health care services were provided by only 5 agencies. For intermittent (acute) services, agencies served approximately 450 children per month. The average number of visits per child was two, with 40% receiving only one visit. Services included skilled nursing (60%), infusion (27%), and respiratory therapy (9%). Maintenance (chronic) home health care services, for 156 chronically ill children, were provided almost exclusively by skilled nursing for an average of 9 hours per patient per day. The majority of referrals to agencies (75%) originated from health care providers, although a small number came from insurance companies or individual families. Reimbursement for intermittent care services was divided among commercial insurance (35%), captitated contracts (35%), and Medicaid (20%). In contrast, 90% of reimbursement for the chronically ill was from Medicaid.

Conclusions. In King County, WA, pediatric home health care is predominantly an unregulated, for-profit industry, with most agencies having little actual experience in pediatric home health care. In addition, the unique features of pediatric home health care necessitate both a greater understanding of this field and the consideration of more specific guidelines.
Prevalence of Overweight Among Preschool Children in the United States, 1971 Through 1994
Authors: Ogden Cynthia L. , Troiano Richard P. , Briefel Ronette R. , Kuczmarski Robert J. , Flegal Katherine M. , Johnson Clifford L.
Published: August 2004

Objective. To examine the prevalence of overweight among US preschool children 2 months through 5 years of age between the years 1971 through 1974 and 1988 through 1994.

Design. Nationally representative cross-sectional surveys with a physical examination, including measurement of stature, length, and weight. Between 1200 and 7500 children younger than 6 years were examined in each of four different surveys during 1971 through 1974 (first National Health and Nutrition Examination Survey [NHANES I]), 1976 through 1980 (NHANES II), 1982 through 1984 (Hispanic Health and Nutrition Examination Survey), and 1988 through 1994 (NHANES III).

Results. The prevalence of overweight increased among some sex and age groups of preschool children between 1971 through 1974 and 1988 through 1994. More than 10% of 4- and 5-year-old girls were overweight in 1988 through 1994 compared with 5.8% in 1971 through 1974. However, there was no change during this period in the prevalence of overweight among 1- and 2- to 3-year-old children. During 1988 through 1994, the prevalence of overweight among children 2 months through 5 years of age was consistently higher in girls than boys. Mexican-American children had a higher prevalence of overweight than non-Hispanic black and non-Hispanic white children. These results parallel what has been reported for older children and adults in the United States.

Conclusion. These results show that in the last 20 years the prevalence of overweight has increased among 4- and 5-year-old children but not among younger children. These findings suggest that efforts to prevent overweight, including encouragement of physical activity and improved diets, should begin in early childhood. overweight, anthropometry, preschool children.
Does Light-to-Moderate Alcohol Consumption During Pregnancy Increase the Risk for Renal Anomalies Among Offspring?
Authors: Moore Cynthia A. , Khoury Muin J. , Liu Yecai
Published: August 2004

Objective. To determine the association between light-to-moderate prenatal alcohol exposure and congenital renal anomalies.

Methods. Data from the population-based Atlanta Birth Defects Case-Control Study were used to examine the association between selected renal anomalies and self-reported maternal alcohol consumption during the period from 1 month before through 3 months after conception. Case infants were ascertained by a population-based birth defects registry with active case ascertainment; the case group consisted of 158 infants, born during 1968 through 1980 to metropolitan Atlanta residents, in whom these renal anomalies had been diagnosed. Two control groups were used. One had 3029 infants without birth defects, and the other had 4633 infants with birth defects exclusive of the urinary tract who were born during the same period.

Results. Overall, there was a moderate association between renal anomalies and moderate prenatal alcohol exposure (odds ratio, 1.5; 95% confidence interval, 1.0 to 2.3). When the renal anomalies were subclassified, moderate prenatal alcohol exposure was significantly associated only with renal agenesis or hypoplasia (odds ratio, 2.5; 95% confidence interval, 1.2 to 5.1), and within this group only infants with bilateral defects and other major anomalies in addition to renal agenesis or hypoplasia had significantly elevated risks. There were no significant associations between reported light consumption and any category of the selected renal anomalies. No conclusions could be reached for reported heavy consumption because of sparse data. Adjustments for potential confounding factors did not alter these results.

Conclusion. This study suggests that moderate alcohol consumption during pregnancy may increase a woman’s risk of giving birth to a child with renal agenesis or hypoplasia. renal anomalies, renal agenesis, prenatal ethanol exposure, multiple congenital anomalies.
A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors
Authors: Nielsen Karin , McSherry George , Petru Ann , Frederick Toni , Wara Diane , Bryson Yvonne , Martin Natasha , Hutto Cecelia , Ammann Arthur J. , Grubman Samuel , Oleske James , Scott Gwendolyn B.
Published: August 2004

Objective. To identify the population of human immunodeficiency virus–infected pediatric long- term survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.

Methods. A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients ≥8 years infected in the perinatal period with human immunodeficiency virus.

Results. A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts ≥500 cells/mm3(group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm3 (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm3 (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts ≥500 cells/mm3 and no immune deficiency syndrome-defining conditions.

Conclusions. Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression. HIV, pediatric long-term survivors, slow disease progression.
Morbidity and Mortality of Open Lung Biopsy in Children
Authors: Davies Lea , Dolgin Stephen , Kattan Meyer
Published: August 2004

Objective. In patients with diffuse pulmonary infiltrates, when empiric therapy or less-invasive diagnostic procedures fail, physicians frequently resort to open lung biopsy (OLB) to provide a definite diagnosis and to help redirect therapeutic treatment. OLB is still widely regarded as a safe diagnostic procedure, even in the critically ill child. The objective of this study is to evaluate the accuracy of this view with regard to children with acute respiratory failure (ARF) and, for this purpose, compares the mortality and morbidity of such patients with those without ARF.

Design. Retrospective chart review.

Setting. University hospital.

Patients. Forty-two patients (mean age, 6.6 years) underwent 47 OLBs for undiagnosed diffuse pulmonary infiltrates between July 1984 and December 1994. Twenty-six patients (55%) were in ARF. Fifteen of these patients were intubated and receiving mechanical ventilatory support before the OLB procedure.

Results. The overall incidence of serious complications associated with the OLB procedure was 51%. Of the patients with ARF, 17 (65%) had at least one major complication compared with 3 (14%) of the patients without ARF. Pleural air complications (62% of the total) occurred only in patients with ARF: pneumothoraces and/or prolonged air leaks developed in 10 (38%) after their OLBs; 9 of these patients died, and 7 had pneumothorax complicating their chest tube removal, which required replacement chest tubes. All patients with ARF preoperatively required prolonged ventilatory support after the OLB procedure, whereas 90% of the patients without ARF could be extubated within 24 hours. Overall, 10 patients (24%) died after the OLB procedure. All deaths occurred in patients with ARF. Both ARF preoperatively and the presence of postoperative complications were significantly associated with decreased survival.

Conclusions. The morbidity and mortality rates of children with ARF undergoing OLB for diffuse pulmonary infiltrates differ considerably from those of children without ARF. For children with ARF, OLB is associated with the risk of prolonged ventilatory support, recurrent pneumothoraces, and air leaks. These complications may be attributable to such patients' having diseased lungs with poor healing. Moreover, these complications may, in turn, contribute to the patients' poor outcomes.
Number and Activation of Circulating Polymorphonuclear Leukocytes and Platelets Are Associated with Neonatal Respiratory Distress Syndrome Severity
Authors: Brus Frank , van Oeveren Willem , Okken Albert , Oetomo Sidarto Bambang
Published: August 2004

Objective. To determine whether number and activation of circulating polymorphonuclear leukocytes (PMNs) and platelets are associated with disease severity in neonatal respiratory distress syndrome (RDS).

Design. Prospective study.

Setting. Tertiary neonatal intensive care unit.

Patients. Preterm infants with severe (n = 18) or mild to moderate (n = 18) RDS who were consecutively admitted.

Interventions. PMN and platelet counts and plasma concentrations of elastase-α1-proteinase inhibitor (E-α1-PI) and thromboxane B2(TxB2) were recorded each day during the first 5 days of life. E-α1-PI-to-PMN and TxB2-to-platelet ratios were calculated to correct for the influence of the PMN and platelet count on elastase and thromboxane release.

Results. From day 2, the severe RDS group had lower median PMN counts (1.5 vs 4.5 × 109/L), lower mean platelet counts (136 vs 230 × 109/L), and more elastase and thromboxane release, indicated by higher median E-α1-PI-to-PMN (39.2 vs 13.0 ng/106 PMNs on day 2) and TxB2-to-platelet (2.61 vs 0.52 pg/106 platelets on day 3) ratios than the mild-to-moderate group. Lower PMN and platelet counts and higher elastase and thromboxane release were correlated with birth asphyxia (lower 5-minute Apgar scores and umbilical arterial PH values), higher respiratory requirements (fraction of inspired oxygen and peak inspiratory pressure), and decreased values for continuous measures of RDS severity (ventilatory efficiency index and Pao2-to-alveolar oxygen tension ratio).

Conclusion. Decreased PMN and platelet counts and increased elastase and thromboxane release are correlated with increased RDS severity. Birth asphyxia (hypoxia and acidosis) and tissue injury caused by high-pressure ventilation and hyperoxia may promote this activation process.
Pain Management in the Emergency Department: Patterns of Analgesic Utilization
Authors: Petrack Emory M. , Christopher Norman C. , Kriwinsky Jan
Published: August 2004

Objective. To compare the use of analgesia in children to adults in 3 different emergency department (ED) settings.

Methods. Forty adult and 40 pediatric ED charts were randomly selected for review at each of 3 institutions: an academic medical center with separate pediatric and adult EDs (SEP ED), a community academic medical center with a combined adult and pediatric ED (COMB ED), and a community hospital with a combined ED (COMTY ED). All patients presenting to the EDs from July 1993 to June 1994 within 12 hours of an isolated long bone fracture were eligible for inclusion. Data were collected on demographics, training of providers, analgesic use and dosing in the ED and on discharge, and time from triage to analgesic use.

Results. The mean pediatric and adult ages were 8.7 and 38.3 years, respectively. Overall, 152/240 (63%) patients received some form of analgesia in the ED, with the COMTY ED (41/80; 51%) offering significantly less analgesia than the COMB ED (58/80; 73%), but not the SEP ED (53/80; 66%). Pediatric patients (64/120; 53%) received significantly less analgesia in the ED than adult patients (88/120; 73%). This difference was significant at the COMB ED (pediatric 23/40; 58% vs adult 35/40; 88%) and COMTY ED (pediatric 15/40; 38% vs adult 26/40; 65%), but not at the SEP ED (pediatric 26/40; 65% vs adult 27/40; 68%). 195/240 (81%) patients received discharge pain medication. There were no differences between pediatric (93/120; 78%) and adult (102/120; 85%) discharge analgesic prescribing practices. Although there was no difference in appropriateness of analgesic doses in the ED, pediatric patients (20/74; 27%) were more likely than adult patients (3/88; 3%) to receive inadequate doses of analgesics on discharge from the ED.

Conclusions. ED analgesia continues to be used less frequently in the pediatric compared with the adult population. Inadequate dosing of discharge analgesic medication in children is a significant problem. Patterns of analgesic utilization may differ in different types of ED settings.
Pediatrician's Responsibility for Infant Nutrition
Authors:   Committee on Practice and Ambulatory Medicine
Published: August 2004

The intent of this policy statement is to reaffirm the position of the American Academy of Pediatrics on four issues pertinent to infant nutrition: the promotion of breastfeeding, the importance of working to maintain and improve infant formulas for use when breastfeeding is not practical or desired, the recommendation against direct-to-consumer advertising of infant formulas, and the encouragement of the availability of a diversity of formulas.
Infant Sleep Position Instruction and Parental Practice: Comparison of a Private Pediatric Office and an Inner-city Clinic
Authors: Ray Brenda J. , Metcalf Sharon C. , Franco Sofia M. , Mitchell Charlene K.
Published: August 2004

Objective. To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning.

Design. Survey of mothers of infants ≤4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals.

Setting. A private practice (PP) serving predominantly white middle- and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky.

Patients. Fifty infants from each practice site.

Outcome Measure. The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS).

Results. Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice.

Conclusions. Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given. infant sleep position, SIDS, sleep instruction.
Children at Risk: Their Health Insurance Status by State
Authors: Yudkowsky Beth K. , Tang Suk-fong S.
Published: August 2004

Objective. To inform policymakers and child health advocates about children’s health insurance coverage in each state as Congress debates proposals to restructure the Medicaid program amidst declining employer-based dependent health insurance coverage.

Methods. Multiple years of data from the March supplement of the Current Population Surveys were pooled to yield more reliable estimates of changes in children’s health insurance coverage in each state from 1987 to 1993.

Results. Overall, the number of uninsured children grew by nearly 1 million between 1987 and 1993. The proportion of infants and children <7 years old without health insurance declined; the proportion of uninsured children between the ages of 7 and 22 increased. Between 1987–1990 and 1991–1993, six states experienced a significant increase in the number of uninsured children, only two states experienced a significant decrease in the number of uninsured children, although no progress was found in reducing the number of uninsured children in 43 states. Between 1987–1990 and 1991–1993, the proportion of children covered by employer-based private insurance decreased significantly in three-fourths of the states and the proportion of children with Medicaid coverage increased significantly in four-fifths of the states.

Conclusions. In a period of fast-declining employer-based health insurance coverage for dependents, Medicaid expansions have worked to moderate the surge in the number of children without health insurance. Of the 30 million children without private health insurance in 1993, nearly 18 million were insured by Medicaid. As policymakers debate the future of the Medicaid program, they must consider seriously its role as the country’s largest insurer of children’s health and its efficacy as a vital safety net for the nation’s children. children, insurance, Medicaid, access, state.
Maternal and Perinatal Risk Factors for Later Delinquency
Authors: Conseur Amy , Rivara Frederick P. , Barnoski Robert , Emanuel Irvin
Published: August 2004

Background. The early identification of risk factors for juvenile offending is one important step in preventing youth violence and offending. This cohort study examined whether perinatal circumstances predicted offending during adolescence.

Methods. Washington State birth certificates from 1974 to 1975 were linked to juvenile justice data to identify all individuals adjudicated between 10 and 17 years of age. Thirteen thousand five hundred seventy-three offenders were compared with a sample of 38 387 nonoffenders matched on gender and birth order.

Results. Both male and female children of mothers who were teenagers at the child's birth or at her first birth, or who were born to unmarried mothers, had significantly increased risk for any juvenile offending, and for being adjudicated for five or more crimes (chronic offending). Males born to unmarried mothers under 18 years old had an 11-fold increased risk of chronic offending compared with males born to married mothers ≥20 years old. Low birth weight and preterm gestational age carried no increased risk for juvenile offending.

Conclusions. Birth to teenage or unmarried mothers are strongly associated with later risk of juvenile delinquency. Although there are multiple, interrelated risk factors for juvenile delinquency, prevention of births to teenage and/or unmarried mothers may help to prevent subsequent juvenile delinquency.
The Utility of Body Mass Index as a Measure of Body Fatness in Children and Adolescents: Differences by Race and Gender
Authors: Daniels Stephen R. , Khoury Philip R. , Morrison John A.
Published: August 2004

Objective. To evaluate whether body mass index (BMI) is a representative equivalent measure of body fatness independent of age, race, gender, sexual maturation, and distribution of fat in children and adolescents.

Study Design. Cross-sectional study of 192 healthy subjects (100 boys and 92 girls, 103 white and 89 black) age 7 to 17 years.

Methods. Height and weight were measured in the standard fashion, and BMI (kg/m2) was calculated from these values. Fat mass and percent body fat were determined using dual-energy x-ray absorptiometry. Sexual maturation was evaluated by physical assessment. Distribution of fat was determined by the waist:hip ratio.

Results. There were no significant differences by gender and ethnic group for any of the demographic or anthropometric variables, except waist:hip ratio, which was higher in white compared with black boys. BMI was significantly and positively correlated with age, stage of maturation, and all of the anthropometric variables in each race-sex group. The correlation of maturation stage with BMI was stronger than the correlation between age and BMI. A multiple regression analysis showed that BMI, gender, race, sexual maturation, and distribution of fat were all significant independent correlates of the percent body fat (multiple R2 = .77). The percent body fat-BMI relationship was dependent on the stage of sexual maturation, gender (for an equivalent BMI, girls have greater amounts of body fat than boys), race (for equivalent BMI, whites have higher body fat than blacks), and waist:hip ratio (for equivalent BMI, those with central obesity have greater body fatness than those with peripheral obesity).

Conclusion. BMI is not an equivalent measure of the percent body fat for each race-sex group. When BMI is used as a measure of body fatness in a research or clinical setting, particularly when comparisons are made across race and gender, it may be important to consider the maturation stage, race, gender, and distribution of body fat in the interpretation of the results.
Inhaled Nitric Oxide and Hypoxic Respiratory Failure in Infants With Congenital Diaphragmatic Hernia
Authors:   The Neonatal Inhaled Nitric Oxide Study Group (NINOS)
Published: August 2004

Objective. We designed and conducted a randomized, double-masked, controlled multicenter study to determine whether inhaled nitric oxide (INO) in term and near-term infants with congenital diaphragmatic hernia (CDH) would reduce the occurrence of death and/or the initiation of extracorporeal membrane oxygenation (ECMO).

Patients and Methods. Infants of 34 weeks gestation or more, <14 days of age with CDH, without known structural heart disease, requiring assisted ventilation for hypoxemic respiratory failure with two oxygenation indices (OIs) of 25 or more at least 15 minutes apart, were eligible for this trial. Infants were centrally randomized and then received masked treatment with 20 ppm NO or 100% oxygen as control. Infants with less than a full response to 20 ppm NO (increase in Pao2 >20 Torr) after 30 minutes were evaluated at 80 ppm NO/control study gas.

Results. The 28 control and 25 treated infants enrolled by the 13 participating centers were not significantly different at randomization for any of the measured variables including prerandomization therapies and initial OIs (45.8 ± 16.3 for controls, 44.5 ± 14.5 for INO). Death at <120 days of age or the need for ECMO occurred in 82% of control infants compared with 96% of INO infants (ns). Death occurred in 43% of controls and 48% of the INO group (ns), and ECMO treatment was used for 54% of control and 80% of INO-treated infants. There was no significant improvement in Pao2 (Δ Pao2 7.8 ± 19.8 vs 1.1 ± 7.6 Torr, ns) nor significant reduction in OI (-2.7 ± 23.4 vs 4.0 ± 14.8, ns) associated with INO treatment. Mean peak nitrogen dioxide (NO2) concentration was 1.9 ± 1.3 ppm and the mean peak methemoglobin was 1.6 ± 0.8 mg/dL. No infant had study gas discontinued for toxicity. There were no differences between the control and INO groups for the occurrence of intracranial hemorrhage, specific grades of intracranial hemorrhage, periventricular leukomalacia, brain infarction, and pulmonary or gastrointestinal hemorrhages.

Conclusions. Although the immediate short-term improvements in oxygenation seen in some treated infants may be of benefit in stabilizing responding infants for transport and initiation of ECMO, we conclude that for term and near-term infants with CDH and hypoxemic respiratory failure unresponsive to conventional therapy, inhaled NO therapy as used in this trial did not reduce the need for ECMO or death.
Adolescents and Anabolic Steroids: A Subject Review
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was retired December 2009.

This revision of a previous statement by the American Academy of Pediatrics provides current information on anabolic steroid use by young athletes. It provides the information needed to enable pediatricians to discuss the benefits and risks of anabolic steroids in a well-informed, nonjudgmental fashion.
Echocardiography in Infants and Children
Authors:   Section on Cardiology
Published: August 2004

It is the intent of this statement to inform pediatric providers on the appropriate use of echocardiography. Although on-site consultation may be impossible, methods should be established to ensure timely review of echocardiograms by a pediatric cardiologist. With advances in data transmission, echocardiography information can be exchanged, in some cases eliminating the need for a costly patient transfer. By cooperating through training, education, and referral, complete and cost-effective echocardiographic services can be provided to all children.
Vaginal Gonococcal Cultures in Sexual Abuse Evaluations: Evaluation of Selective Criteria for Preteenaged Girls
Authors: Ingram David L. , Everett V. Denise , Flick Lauren A. R. , Russell Theresa A. , White-Sims Susanne T.
Published: August 2004

Objective. Accurate selective criteria could limit the number of vaginal cultures for Neisseria gonorrhoeae performed on preteenaged girls as part of their sexual abuse evaluations. This study was performed to determine whether the published selective criteria by the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect and by Siegel et al would have accurately detected all cases of vaginal gonococcal infections in our large study population.

Methods. We prospectively studied girls, ages 1 to 12 years, who were referred to our Child Sexual Abuse Team (CSAT) at Wake Medical Center in Raleigh, NC, between July 1, 1976 to July 1, 1996, for sexual abuse evaluations which were performed using a protocol that included collecting historical information, a sexual abuse interview, and a detailed genital examination which included a vaginal culture forN gonorrhoeae.

Results. Our study population consisted of 2898 girls of whom 2731 (94%) had vaginal cultures successfully performed forN gonorrhoeae. There were 84 girls with vaginal gonococcal infections, 80 of whom had a vaginal discharge. The four girls without a vaginal discharge included two with a history of having vaginal intercourse with an alleged perpetrator with gonorrhea, one withN gonorrhoeae isolated from a urine culture, and one whose preteenaged sister had gonorrhea. All of the 84 girls would have been identified using the selective culturing criteria of the AAP Committee on Child Abuse and Neglect: culturing when epidemiologically indicated (interpreted as the girl having another sexually transmitted disease [STD], a child sibling, child household member, a close child associate or a perpetrator with a known STD) or when the history and/or physical findings suggest the possibility of oral, genital, or rectal contact, or Siegel et al’s more selective criteria: only culturing prepubertal girls for N gonorrhoeae if there is a vaginal discharge at the time of presentation or if there is a high risk for STD acquisition, defined as having a STD diagnosed, a sibling with a STD, contact with a perpetrator known to have a STD, contact with multiple perpetrators, or Tanner stage III or above.

Conclusion. Both the selective criteria of the AAP Committee on Child Abuse and Neglect and the more selective criteria of Siegel et al as we interpreted them were accurate when applied to identifying girls with vaginal gonococcal infections in our study population. Neisseria gonorrhoeae, female children, sexual abuse evaluation, vaginal cultures.
Behaviour of cows at the feeding trough and when entering the milking parlour
Authors: Gere T. , Hamar G.
Published: August 2004

Observations were made during 2 × 3 days on the behaviour of 29 Holstein-Friesian cows when entering the milking parlour and at the feeding trough. The cows were identified by an electric apparatus on their necks, and by transmitters at the feeding trough in the milking parlour. Milking was done using Alfa-Laval milking apparatus with 2 × 4 milking stalls and an automatic cup-removing gadget. Rank correlation coefficients were calculated between the entrance order and the most important production characteristics. There was no correlation between the entrance order to the milking parlour and the dominance order at the feeding trough. The younger cows were dominant when entering the milking parlour, and the older, heavier cows at the feeding trough.
Development of crop production technologies for multifunctional agriculture
Authors: Bedő Z.
Published: August 2004

The concept of the sustainable development of agricultural production marked the beginning of a new era in agriculture worldwide. The term sustainability was first interpreted primarily as the sustainability of the environment, due to the ever more serious problems experienced in this connection on a global scale. In searching for a solution, however, focus shifted to a complex approach to sustainable development. It became clear that in addition to the sustainability of the environment, a long-term solution could only be achieved if economic and social sustainability was also ensured. This is particularly true of agriculture, since the existing problems cannot be solved purely on the basis of environmental considerations. Only the comprehensive handling of ecological, economic and social challenges can produce a satisfactory answer to the questions involved in sustainable development. This will necessarily mean a change in the tasks facing agriculture, which will be responsible for more numerous, more varied functions than previously. If these new tasks are to be successfully performed, new technological systems will need to be elaborated, requiring an acceleration of research and development throughout the world.
Crop production research in multifunctional agriculture
Authors: Berzsenyi Z.
Published: August 2004

The research agenda for crop science in the 21st century will depend largely on whether the present conditions regarding the global food surplus continue, or whether a food scarcity recurs. Crop production research is based chiefly on small-plot field experiments, the majority of which are either long-term experiments or experiments set up to investigate the specific agronomic responses of Martonvásár maize hybrids and wheat varieties. The sustainability of crop production is examined in long-term experiments. The agronomic responses of maize hybrids and wheat varieties are studied at various levels of biological organisation. Growth analysis facilitates the exact characterisation of agronomic responses and the grouping of response effects and types using multivariable methods. Continued experimentation coupled with crop simulation models and decision support systems are an ever more useful framework for analysing the complexity of agricultural systems.
Role of Soil Multifunctionality in Future Sustainable Agricultural Development
Authors: Várallyay G.
Published: August 2004

Soils represent a considerable part of the natural resources of Hungary. Consequently, rational land use and proper soil management - to guarantee normal soil functions - are important elements of sustainable (agricultural) development, having special importance both in the national economy and in environment protection. The main soil functions in the biosphere are as follows: -conditionally renewable natural resource; -reactor, transformer and integrator of the combined influences of other natural resources (solar -radiation, atmosphere, surface and subsurface waters, biological resources), site of “sphereinteractions”; -medium for biomass production, primary food-source of the biosphere; -storage of heat, water, plant nutrients and - in some special cases - wastes; -high capacity buffer medium, which may prevent or moderate the unfavourable consequences of various environmental stresses; -natural filter and detoxication system, which may protect the deeper geological formations and the subsurface waters from various pollutants; -significant gene reservoir, an important element of biodiversity; -conservator of natural and human heritages. Society has utilized these functions in different ways (rate, method, efficiency) throughout history, depending on the given natural conditions and socio-economic circumstances. In many cases the character of the particular functions has not been properly taken into consideration during the utilization of soil resources, and misguided management has resulted in their over-exploitation, in the decreasing efficiency of one or more soil functions, and - above a certain limit - in serious environmental deterioration. The scientifically based planning and implementation of sustainable land use and rational soil management to ensure desirable soil functions, without any undesirable environmental side-effects, require the efficient control of soil processes.
Contribution of population improvement to the development of maize lines with commercial value
Authors: Hadi G
Published: August 2004

The grain yield was increased by 8.2% per cycle (32.8% overall) in a population of Mindszentpusztai Yellow Dent (MYD), by 8.9% per cycle (35.6% overall) in a population of Mv Syn. I and by 4.9% per cycle (19.7% overall) in a population of Westigua when tested on the closed pedigree line HMv 124-2. Averaged over the three populations the rise in grain yield was 7.5% per cycle, giving a total of around 30% after four cycles. The grain moisture at harvest showed a slight but significant decrease, while there was no change in the percentage stalk lodging. It seems probable that this increase in grain yield was achieved not at the expense of other correlated characters, but as the result of a greater frequency of gene combinations having a positive effect on grain yield, since recurrent selection was combined with selection for multiple ears at high plant density. The hybrid performance of the improved populations was extremely good, reaching 87.9% of that of commercial hybrids. Over the last 25 years around 11,500 S1 families have been tested from a total of 115 populations (including the three discussed above) and the inbreeding of the selected families was continued until the homozygous state was reached. Despite careful selection, it has not proved possible to breed inbred lines suitable for the development of hybrids with commercial value. Further research will be required to discover the reasons for this failure.
Effects of cassava genotype, climate and the Bemisia tabaci vector population on the development of African cassava mosaic geminivirus (ACMV)
Authors: Abdullahi Ismail , Atiri G. A. I. , Dixon G. O. ,   et al.
Published: August 2004

A survey was carried out in the 1996/97 and 1997/98 growing seasons on a field planted in three replicates with five clones of cassava at the International Institute of Tropical Agriculture, Ibadan, located in a transition forest, to determine the effects of cassava genotype and climate on the development of African cassava mosaic geminivirus (ACMV) and changes in the Bemisiatabaci population. Cassava genotype, climate and their interactions have significant (P<0.01) effects on the population of B. tabaci and the development of ACMV. The incidence of ACMV was significantly (P<0.01) higher in clones 81/01635 and 92/0520 than in TMS 30572 and 94/0239, while 91/02327 showed the greatest resistance. A positive correlation between the incidence and severity of ACMV was observed, but this did not correlate with the whitefly population density.
Coating of prilled urea with ecofriendly neem (Azadirachta indica A. Juss.) formulations for efficient nitrogen use in hybrid rice
Authors: Singh S. , Shivay Y. S.
Published: August 2004

A field experiment was carried out during the rainy season (June-October) of 1998 at the Research Farm of the Indian Agricultural Research Institute, New Delhi, India to study the effect of coating prilled urea with eco-friendly neem (Azadirachta indica A. Juss.) formulations in improving the efficiency of nitrogen use in hybrid rice. The experiment was laid out in a split-plot design with three replications. Two rice cultivars, hybrid rice (NDHR-3) and Pusa Basmati-1, formed the main plots, with the levels of nitrogen (0, 60, 120 and 180 kg N ha-1) and various forms of urea at 120 kg N ha-1 in the sub-plots. The results obtained in this study showed that the rice hybrid NDHR-3 performed significantly better than the scented variety Pusa Basmati-1 for almost all the agronomic traits tested (growth, yield attributes, grain and straw yields, nitrogen uptake and apparent N recovery) The advantage of grain yield in hybrid NDHR-3 was nearly 16 q/ha over Pusa Basmati-1. Increasing levels of nitrogen significantly increased the number of effective tillers hill-1, panicle length, panicle weight, grain and straw yields and nitrogen uptake, thereby revealing a significant decline in agronomic nitrogen use efficiency (NUE). Among the sources of N, Pusa Neem Golden Urea proved to be significantly superior to other sources with regards to panicle length, grain yield, N uptake, agronomic nitrogen use efficiency and apparent N recovery (%), indicating that coating urea with neem formulations not only increased the grain yield, NUE and apparent N recovery, but also helped to reduce the environmental hazards associated with the use of large amounts of urea.
Effect of continuous application of manures and fertilizers on productivity of cotton-sorghum rotation
Authors: Blaise D. , Singh J. V. , Venugopalan M. V. ,   et al.
Published: August 2004

Field experiments were conducted from 1985 through 2001 on medium deep vertisol to determine the effect of the continuous application of manure and fertilizers on a two-year cotton-sorghum rotation. The results indicate that the response to N was greatest during the initial years, while after five to six rotation cycles the yield levels declined to the zero level in the N and NK plots. The application of P along with N prevented the decline in seed cotton and sorghum grain yields. The effect was more pronounced at the higher level. K application did not result in any yield increase. Balanced fertilizer at the higher level (N90P19K37) resulted in a significant yield increase over the recommended dose (N60P13K25); however, the percentage increase declined with duration, indicating a decline in factor productivity. Seed cotton yields were the highest when part of the fertilizer N was applied from an organic source (farmyard manure: FYM). Of the eight years, a significant response was observed in four years at the lower level (N30P13K25 + 5 t FYM ha-1) and six years at the higher level (N45P19K37 + 7.5 t FYM ha-1), while in sorghum a response was only observed in two years. The cotton crop should, therefore, be preferred to sorghum for the application of organic manure. In areas where no organic manure is available, N60P13K25 is sufficient for cotton, while sorghum needs to be fertilized at 1.5 times the recommended dose (N90P19K37).
Preliminary notes regarding early 10th century cereal production by the first Hungarian settlers
Authors: Gyulai F.
Published: August 2004

Archaeobotany, the study of plant macrofossils (seeds and fruits) obtained from archaeological excavations, becomes particularly important when there is very little or no archaeological, written or iconographical material available about the cultivation of the plants found. This is particularly the case in relation to the early Hungarian settlers.  The most significant event of the 10th century in the Carpathian Basin was the Hungarian conquest, yet this is the most fiercely debated period of Hungarian history, and the subject, in some cases, of extreme views. The information available on the way of life of the early Hungarians is very sparse, especially as regards farming and crop production skills. The conquering Hungarians were “semi-nomadic”. This may equally include mobile pastoralism and a limited extent of tillage and plant cultivation. Other archaeobotanical evidence suggests that the early Hungarians were not nomadic. There are very few seed remains directly relevant to the period of the Hungarian Conquest: the leading strata of early Hungarian society probably practised mobile pastoralism of a fundamentally Turkish character. It can be presumed that plant cultivation was the occupation assigned to common people who pursued a more sedentary way of life. It was probably these people whose plant remains were found in Lébény-Billedomb (near Gyor) in 1993 and are presented in this paper. This is the first evidence of plant cultivation by the early Hungarians. The finds from the 10th century settlement are rich in cereal species such as common wheat, barley, rye and millet.
Book review
Authors: Vida G.
Published: August 2004

D. Pimentel (Ed.): Encyclopedia of Pest Management. Marcel Dekker, Inc., New York, Basel, 2002. 929 pp. ISBN 0-8247-0632-0
Photosynthetic attributes and seed yield of sunflower (Helianthus annuus L.) as influenced by different levels and ratios of nitrogen and phosphorus fertilizers
Authors: Thavaprakash N. , Senthilkumar G. , Sivakumar S. D. , Raju M.
Published: August 2004

A field experiment was conducted at the Main Research Station, University of Agricultural Sciences, Dharwad, India, on medium black soils during the kharif (wet) season of 1999. The experiment was laid out in a randomized complete block design with varying N/P ratios (0.67 to 2.00) along with a control with a constant level of potassium (60 kg ha-1). The results revealed that the number of green leaves plant-1, the dry matter accumulation in the leaves, leaf area (dm2 plant-1) and leaf area index (LAI) increased up to the flowering stage (65 DAS) and thereafter declined. In the early stages (seedling and button stages) there was no significant variation with respect to the number of green leaves plant-1 among the treatments except in the control. Similarly, leaf area and LAI did not vary at the seedling stage. Treatments receiving N/P ratios of ?1.0 or 1.0 with higher doses of nitrogen (120 kg N ha-1) gave a significantly higher number of green leaves plant-1, leaf area and LAI as compared to N/P ratios of <1.0 and the control in later stages. The dry matter accumulation in the leaves (g plant-1) differed in all the stages, but higher values were recorded in these same treatments. Thus, due to the higher number of green leaves, higher LAI and greater dry matter accumulation in the leaves, the treatments with an N/P ratio of ?1.0 or 1.0 with 120 kg N ha-1 produced higher seed yields (3188 to 3554 kg ha-1) than other N/P ratios (2761 to 3009 kg ha-1). The highest yield (3554 kg ha-1) was recorded with an N/P ratio of 1.0 in the treatment receiving 120 kg N and 120 kg P2O5 ha-1. The correlation coefficients between these photosynthetic attributes and seed yield were also positive and significant.
Protein composition in different phases obtained by the ultracentrifugation of dough
Authors: Kuktaite R. , Larsson H. , Johansson E.
Published: August 2004

Ultracentrifugation was used as a non-destructive method to separate dough into liquid, gel, gluten, starch and bottom phases. The protein composition in the different phases was investigated for dough prepared from spring wheat (Triticum aestivum L.). The SDS-PAGE, SE-HPLC and RP-HPLC methods were used for the analysis. The wheat protein composition of the liquid and gel phases consisted of albumins, globulins and traces of gliadins and glutenins. The gluten phase contained proteins extractable with all the extraction buffers used. A similar protein composition was found in the starch and bottom phases, but in considerably lower amounts. Specific LMW glutenin subunits were identified in the gluten phase by RP-HPLC. The albumin composition differed in the gel phase compared to the gluten and bottom phases.  Differences in protein composition due to mixing methods were detected only for the albumin composition in the liquid phases.
Physiological responses of groundnut (Arachis hypogaea L.) to drought stress and its amelioration: A review
Authors: Reddy T. Y. , Reddy V. R. , Anbumozhi V.
Published: August 2004

Groundnut (Arachis hypogaeaL.) is an important cash crop for tropical farmers. It is an annual legume and its seeds contain high amounts of edible oil (43-55%) and protein (25-28%). Even though it is fairly drought-tolerant, production fluctuates considerably as a result of rainfall variability. To develop a water stress response function in groundnut, research has been done to improve the performance under varying degrees of stress at various physiological stages of crop growth. This review summarizes recent information on the drought resistance characteristics of groundnut with a view to developing appropriate genetic enhancement strategies for water-limited environments. It is suggested that there are considerable gains to be made in increasing yield and stabilizing the yield in environments characterized by terminal drought stress and further exploiting drought escape strategy, by shortening crop duration. Many traits conferring dehydration avoidance and dehydration tolerance are available, but integrated traits, expressed at a high level of organization, are likely to be more useful in crop improvement programs. Possible genetic improvement strategies are outlined, ranging from empirical selection for yield in drought environments to a physiological-genetic approach. It is also suggested that in view of recent advances in understanding drought resistance mechanisms, the latter strategy is becoming more feasible. It is concluded that the use of this recently derived knowledge in a systematic manner could lead to significant gains in yield and yield stability in the world's groundnut production. Research is needed to develop transferable technologies to help farmers in arid and semi-arid regions. Increasing soil moisture storage by soil profile management and nutrient management for quick recovery from drought are some of the areas which need to be explored.