bluuebunny/crossref_metadata_2025 huggingface dataset:
Resources and (in(ter))dependence
Authors: Lahelma Elina , Gordon Tuula
Published: May 2008

The lives of young people are lived in the context of social changes associated with neo-liberal politics. In neo-liberalism, individuals are considered autonomous units who steer their own futures, and the transition from youth into adulthood is understood as a change from dependence into independence from family ties. It has been assumed that autonomy is the endpoint of this development. Yet this approach has turned out to be too restricted. Several studies suggest that the family still remains a significant component in the social, educational, emotional and material lives of young people. Parents are important resources in young people's paths to adulthood.

In this article, we discuss changing reflections of young Finnish women and men on their relationships with their parents. We analyze parents as providers of material resources, as well as emotional and social ones, in order to facilitate the transition to adulthood. We suggest that whilst young people are willing to move from semi-dependence to independence in relation to material resources, in emotional and social terms they strive for interdependence. We came to know these young people in an ethnographic study when they began secondary school. This article draws from re-interviews with the same young people at the ages of 17–18 and 19–20.
On the Alert in an Unpredictable Environment
Authors: Golden Deborah , Mayseless Ofra
Published: May 2008

A fundamental tenet of much sociological, psychological and educational literature assumes that the creation of a predictable environment is crucial for nurturing a sense of well-being, as well as for generating a sense of trust in the wider social order. Still, the ways in which the environment is structured, and the very importance attached to the notion of predictability, will vary in different cultural contexts. Findings from an ethnography of daily life at an Israeli kindergarten over the 2001 school year show how the teacher, albeit unwittingly, shaped an environment that was inherently unpredictable . This unpredictability, in turn, served to mobilize personal resources and social practices among the children as a means not only of coping with the unpredictability, but of turning it to their advantage. Studies of Israeli Jewish youth reveal that the resources that are appropriate for successfully managing in an unpredictable environment are indeed salient and positively valued also at later stages in life. It is argued that socialization into an unpredictable environment at an early age reflects an enduring and characteristic facet of Israeli culture with regards to child-rearing.
Infantile colic, maternal smoking and infant feeding at 5 weeks of age
Authors: Canivet Catarina A. , Östergren Per-Olof , Jakobsson Iréne L. , Dejin-Karlsson Elisabeth , Hagander Barbro M.
Published: May 2008

Background: Many parents seek help from health professionals because of their infants' persistent crying in the early months. The aetiology of this condition, often labelled ``infantile colic'', is still unclear. Aims: To assess whether smoking during pregnancy, and/or smoking at infant age 5 weeks, is associated with infantile colic, and to describe how feeding at infant age 5 weeks and smoking are related to colic. Methods: This was a community-based study, with telephone interviews in late pregnancy, and at infant age 5 weeks, covering 1,625 mother—infant dyads, i.e. 86% of the eligible population. Results: Daily maternal smoking in pregnancy was related to subsequent colic, with an age-adjusted odds ratio (OR) of 1.74 (95% confidence interval 1.08—2.82). In the multivariate model, the OR was largely unaltered. The association between smoking at infant age 5 weeks and colic did not reach statistical significance. The subgroups based on smoking and infant feeding were small, but the results suggest that exclusive breast-feeding was protective against colic, including for infants of smoking mothers. Conclusions: This study presents yet another argument why smoking in pregnancy should be discouraged — some cases of infantile colic may be avoided. With regard to mothers who are not able to give up smoking, the results add some support for the conclusion that if a mother is worried about colic, she certainly should not refrain from breast-feeding even if she smokes.
Preventive home visits to older people are cost-effective
Authors: Sahlen Klas-Göran , Löfgren Curt , Mari Hellner Britt , Lindholm Lars
Published: May 2008

Aims: There is ongoing debate over the effectiveness of preventive home visits (PHVs) for the elderly. A municipality in the north of Sweden carried out a controlled trial of such visits. Healthy seniors aged 75 years and over received two PHVs per year over 2 years. The aim of this study was to do a cost utility analysis of the intervention. Methods: The intervention group (n=196) was compared with a control group (n=346), and a cost utility analysis was performed. The analysis was carried out with three different time perspectives. Data were sourced from official documents and medical and social records. Results: From a societal perspective, using a time period of 4 years, the analysis of PHVs to healthy seniors showed net savings. When including estimated future costs for health and elderly care during gained life years, the result changed from a net saving to a cost of Euro 200,000. A lifetime perspective also resulted in net savings if the costs of future health and elderly care were not included in the analysis. In this case, the total costs rose to approximately Euro 900,000. The cost could also be expressed as Euro 14,200 per quality-adjusted life year gained if future costs for elderly care and healthcare were included. Conclusions: PHVs represent a cost-effective intervention in this setting. The costs are justified by the outcomes.
Psy-knowledge, history and the sociology of law
Authors: McCallum David , Laurence Jennifer
Published: May 2008

This article examines the application of the psy-sciences to the conduct of juvenile justice in Victoria in the period 1940—80, in order to reassess assumptions in contemporary sociology of law concerning psy-knowledge and judicial administration, welfare and justice, and their relations to liberal or conservative political mandates. It seeks to understand the implications of shifts in the production of knowledge of the child in the justice system, by reporting on analysis of both clinical and administrative files of the Children's Court Clinic in this period. The article documents how particular kinds of offenders became known in order to be properly managed, and questions the extent of separation between science and juvenile justice administration.
Identification of Segments of Soccer Clubs in the Spanish League First Division With a Latent Class Model
Authors: Pestana Barros Carlos , del Corral Julio , Garcia-del-Barrio Pedro
Published: May 2008

This article identifies different groups in a cost function framework of soccer clubs in the Spanish Football League First Division. In particular, we have clustered the sample— comprising data for seasons 1994/1995 to 2004/2005—into three groups. To do so, we have implemented a stochastic frontier latent class model, a procedure that also permits us to analyze the efficiency of the clubs with respect to their own frontiers. The results reveal that some of the clubs could improve their efficiency levels substantially.
Risk Factors for Bile Duct Injury During Laparoscopic Cholecystectomy: A Case-Control Study
Authors: Kholdebarin Ramin , Boetto Jonathan , Harnish Julie L. , Urbach David R.
Published: May 2008

Common bile duct injury is a serious but uncommon complication of laparoscopic cholecystectomy. A case-control epidemiologic study of patients who had undergone cholecystectomy in Ontario, Canada, between 1991 and 1997 was performed. Four patients who had undergone a laparoscopic cholecystectomy at the same hospital 2 months prior to a case were selected as controls. The risk of bile duct injury associated with various exposures was estimated by unconditional logistic regression. There were 28 cases and 88 controls. Emergency operation (adjusted odds ratio = 5.0; 95% confidence interval, 1.4-17.8) and failure to identify the cystic duct (adjusted odds ratio = 13.7; 95% confidence interval, 2.5-76.3) were statistically significant risk factors for operative bile duct injury. No other characteristics were independent risk factors for bile duct injury. Failure to identify the cystic duct and the emergency surgery are independent risk factors for bile duct injury.
The Belly of the City
Authors: Carpentier Nico
Published: May 2008

In contrast to the informational city, the communicative city model is characterized by a normative stance on a series of social, political, ethical and spatial dimensions. Building on an expanded version of Kunzmann's description of the communicative city, this article emphasizes the importance of alternative media organizations for developing the (concept of the) communicative city, both at the discursive and the practice-based level. In other words, the existence of urban alternative media and their defining features (where the participatory and the translocal are highlighted) contribute to the development of the discourse of the communicative city, which is one of the representational regimes that aim to produce the city, its inhabitants and its communities. The material existence of these urban alternative media simultaneously bears evidence that the communicative city already exists, although some of its key practices remain hidden in the belly of the city, often ignored by the official city cultures. This article aims to revisit alternative media theory in order to show the importance of this belly of the city for the city. The article starts with an overview of four distinct approaches towards alternative media (the community media model, the model of alternativeness, the civil society media model and the rhizomatic media model), which show the importance of the participatory and the translocal for alternative media theory and for the communicative city.
The association between HIV and antituberculosis drug resistance
Authors: French C. E. , Glynn J. R. , Kruijshaar M. E. , Ditah I. C. , Delpech V. , Abubakar I.
Published: May 2008

In the UK, HIV is considered to be a risk factor for antituberculosis drug resistance. Evidence of the association is, however, inconclusive and there are few population-level data. The present study investigated the association in England and Wales during the period 1999–2005.

National tuberculosis surveillance data for adults were matched to HIV/AIDS reports. Unmatched cases were assumed to be HIV-negative. Separate analyses were conducted on new tuberculosis cases and those with a previous diagnosis. Logistic regression was used for univariable and multivariable analyses.

There were 1,657 previously diagnosed cases (80 HIV-positive) and 18,130 new cases (1,156 HIV-positive). Isoniazid resistance was found in 8.1% of previously diagnosed cases and 6.6% of new cases, and multidrug resistance in 2.8% and 0.7%, respectively. There was no evidence of an association between HIV and antituberculosis drug resistance among previously diagnosed cases. Among new cases, there was no overall association between HIV and isoniazid or multidrug resistance after adjusting for confounding factors. White HIV-positive patients were more likely to have multidrug resistance, but numbers were small.

In contrast to some previous studies, this large, up-to-date study provides little evidence that HIV co-infected tuberculosis patients in England and Wales are at increased risk of firstline antituberculosis drug resistance.
The impact on risk-factor analysis of different mortality outcomes in COPD patients
Authors: Faustini A. , Marino C. , D'Ippoliti D. , Forastiere F. , Belleudi V. , Perucci C. A.
Published: May 2008

The aim of the present study was to analyse the role of potential selection processes and their impact when evaluating risk factors for 30-day mortality among patients hospitalised for chronic obstructive pulmonary disease (COPD).

A cohort of 26,039 patients aged ≥35 yrs and hospitalised with COPD were enrolled. A 30-day follow-up was carried out using both the cause mortality register (CMR) and the hospital discharge register (HDR). Individual and hospital factors associated with 30-day mortality were studied using both mortality outcomes.

The 30-day mortality rate was 1.21·1,000 patient-days−1(95% confidence interval (CI) 1.14–1.29) using the CMR, and 1.06·1,000 patient-days−1(95% CI 0.98–1.13) using the HDR. Male patients, the most poorly educated, those who resided outside Rome and those who had more than one hospitalisation in the previous 2 yrs were more likely to die after discharge than when hospitalised. The most frequent cause of in-hospital death was respiratory disease and after discharge, heart disease. Older age, male sex, comorbidities, previous hospitalisations for respiratory failure, and admission to a ward not appropriate to treat respiratory diseases were the most important predictors of 30-day mortality.

Using in-hospital 30-day mortality provides a significantly different estimate of the role of specific risk factors.
Case volume and mortality in haematological patients with acute respiratory failure
Authors: Lecuyer L. , Chevret S. , Guidet B. , Aegerter P. , Martel P. , Schlemmer B. , Azoulay É.
Published: May 2008

High case volume is associated with improved survival in medical and surgical conditions. The present study sought to determine whether intensive care unit (ICU) case volume was associated with survival of critically ill patients with haematological malignancies and acute respiratory failure (ARF).

A regional database containing data from 1,753 haematological patients with ARF admitted to 28 medical ICUs from 1997 to 2004 was used. Multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors, including a propensity score that incorporates differences between ICUs with different case volumes.

The three case volume tertiles were: low volume (<12 admissions per year), intermediate volume (12–30 admissions per year), and high volume (>30 admissions per year). In univariate analyses, ICU case volume was not associated with ICU mortality. After adjusting for prognostic factors for ICU mortality and the propensity score, patients in high-volume ICUs had lower mortality than other patients. A case volume increase of one admission per year led to a significant mortality reduction with an odds ratio of 0.98 (95% confidence limits 0.97–0.99). Mortality was independently associated with severity of organ dysfunction.

In intensive care units admitting larger numbers of critically ill haematological patients with acute respiratory failure, mortality was lower than in other intensive care units. The mechanisms of the relationship between volume and outcome among haematological patients with acute respiratory deserve additional studies.
Upper airway collapse and reopening induce inflammation in a sleep apnoea model
Authors: Almendros I. , Carreras A. , Ramírez J. , Montserrat J. M. , Navajas D. , Farré R.
Published: May 2008

The upper airway of obstructive sleep apnoea patients is subjected to recurrent negative pressure swings promoting its collapse and reopening. The aim of the present study was to ascertain whether this mechanical stress induces upper airway inflammation in a rat model.

The upper airway of Sprague–Dawley rats was subjected to a periodic pattern of recurrent negative (-40 cmH2O, 1 s) and positive (4 cmH2O, 2 s) pressures inducing collapse and reopening for 5 h. Rats that were instrumented but not subjected to negative pressure swings were used as controls. The gene expression of the pro-inflammatory biomarkers macrophage inflammatory protein (MIP)-2, tumour necrosis factor (TNF)-α, interleukin (IL)-1β and P-selectin in the soft palate and larynx tissues was assessed by real-time PCR.

A marked overexpression of MIP-2, TNF-α, IL-1β and P-selectin (∼40-, 24-, 47- and 7-fold greater than controls, respectively) was observed in the larynx tissue; similar results were found in the soft palate tissue (∼14-, 7-, 35- and 11-fold greater than controls, respectively).

Recurrent upper airway collapse and reopening mimicking those experienced by obstructive sleep apnoea patients triggered an early local inflammatory process. These results could explain the inflammation observed in the upper airway of obstructive sleep apnoea patients.
Serial viral infections in infants with recurrent respiratory illnesses
Authors: Jartti T. , Lee W-M. , Pappas T. , Evans M. , Lemanske R. F. , Gern J. E.
Published: May 2008

To better understand the viral aetiology of recurrent and prolonged illnesses, nasal secretions were prospectively collected from 285 infants at increased risk of developing asthma. Of these, 27 infants had recurrent (at least five) moderate-to-severe respiratory illnesses (MSIs). The viral aetiology of the 150 MSIs and 86 scheduled visits was analysed by molecular diagnostics. The demographic and clinical data were compared with infants who had 0–4 MSIs.

Frequently ill infants had higher exposure to other children and more wheezing illnesses than less symptomatic children. Viruses were detected in 136 (91%) out of 150 MSIs, 14 (67%) out of 21 mild illnesses and 29 (45%) out of 65 asymptomatic visits. Human rhinovirus was the most common aetiological agent (61, 43 and 35% in MSIs, mild illnesses and asymptomatic visits, respectively). Mixed viral infections were generally associated with more severe illnesses (27, 0 and 5%, respectively). Among the 27 frequently ill infants, only eight (5.3%) out of 150 MSIs were prolonged (≥2 weeks duration). Considering all samples, detection of the same virus strain ≥2 weeks apart was unusual (5.3% of all 244 positive findings).

Human rhinovirus infections occur early, pervasively and repetitively in these high-risk infants. Infants with prolonged or recurrent respiratory illnesses most often have a series of infections rather than persistent infection with one virus strain.
Narrative and Emergent Behavior
Authors: Abbott H. Porter
Published: May 2008

The difficulty of understanding emergent behavior is usually attributed to our need to see in it the operation of some kind of centralized control where there is in fact none (Keller 1985, Resnick 1994). Yet as a species, we seem to have little difficulty with complex narratives in which there is no centralized control and in which chance often plays a major role (tragedies, comedies, most novels and films). I argue that the principal reason for the incompatibility of emergent behavior with narrative understanding is its massive distribution of causal agents—a complexity of causation so acute that it disallows any perceptible chain of causation that could serve as a narrative thread. Narrative can and does play a limited role in our understanding of emergent behavior but does so only at the micro level of individual agents (the horse ancestor) and the macro level of the whole (the evolution of the horse). The perils of our weakness for narrative templates in trying to understand emergent behavior arise when understanding the internal nature of the process of emergence is critical to our choice-making behavior. This is especially the case when our health and well-being depend on emergent behaviors to which we contribute. Notable examples are the common efforts to narrativize the behaviors of the stock market and human evolution.
Suture and the Narration of Subjectivity in Film
Authors: Butte George
Published: May 2008

To begin with, the essay identifies shortcomings in classical suture theory's approach to film's narration of consciousness. This approach, which has been widely influential in film theory, grew out of work by Jean-Pierre Oudart, Jacques-Alain Miller, Daniel Dayan, Stephen Heath, and Kaja Silverman and emphasizes a Lacanian drama of absence. This model of suture has also been the focus of important criticism by scholars like David Bordwell and Noel Carroll. My alternative paradigm of embodiment and multiple consciousnesses, what I call deep intersubjectivity, emerges from Maurice Merleau-Ponty's phenomenology, with contributions from Oudart's own phenomenological observations, and seeks to return the body (including its politics) to suture and to film narrative. The fundamental image drawn from Merleau-Ponty is the chiasmus, the film version of which is the shot/reverse shot sequence. I conclude with close readings of two moments from Michael Roemer's 1964 film about African American life, Nothing but a Man: they illustrate how suture enables the narration of intersubjectivity in film, in its embodiments (including the political) from violation and humiliation to evasion, opacity, and sometimes a recuperation, even if incomplete, of community, however temporary or partial.
Neurogenin 2 has an essential role in development of the dentate gyrus
Authors: Galichet Christophe , Guillemot François , Parras Carlos M.
Published: May 2008

The dentate gyrus (DG) of the hippocampus has a central role in learning and memory in adult rodents. The DG is generated soon after birth, although new neurons continue to be generated in the DG throughout life. The proneural factors Mash1 (Ascl1) and neurogenin 2 (Ngn2) are expressed during formation of the DG but their role in the development of this structure has not yet been addressed. Here, we show that Ngn2 is essential for the development of the DG. Ngn2 mutant mice have fewer DG progenitors and these cells present defects in neuronal differentiation. By contrast, the DG is normal in Mash1 mutant mice at birth, and loss of both Mash1 and Ngn2 does not aggravate the defect observed in Ngn2 single mutants. These data establish a unique role of Ngn2 in DG neurogenesis during development and raise the possibility that Ngn2has a similar function in adult neurogenesis.
Activation of Eklf expression during hematopoiesis by Gata2 and Smad5 prior to erythroid commitment
Authors: Lohmann Felix , Bieker James J.
Published: May 2008

The hierarchical progression of stem and progenitor cells to their more-committed progeny is mediated through cell-to-cell signaling pathways and intracellular transcription factor activity. However, the mechanisms that govern the genetic networks underlying lineage fate decisions and differentiation programs remain poorly understood. Here we show how integration of Bmp4 signaling and Gata factor activity controls the progression of hematopoiesis, as exemplified by the regulation of Eklf during establishment of the erythroid lineage. Utilizing transgenic reporter assays in differentiating mouse embryonic stem cells as well as in the murine fetal liver, we demonstrate that Eklf expression is initiated prior to erythroid commitment during hematopoiesis. Applying phylogenetic footprinting and in vivo binding studies in combination with newly developed loss-of-function technology in embryoid bodies, we find that Gata2 and Smad5 cooperate to induce Eklf in a progenitor population,followed by a switch to Gata1-controlled regulation of Eklftranscription upon erythroid commitment. This stage- and lineage-dependent control of Eklf expression defines a novel role for Eklf as a regulator of lineage fate decisions during hematopoiesis.
Biological Anthropology Section
Authors: Vitzthum Virginia J
Published: May 2008

•New Journal Focused on Teaching Evolutionary Sciences
 
•Harvard's Open Access Requirement
Culture and Agriculture
Authors: Rich Ronald
Published: May 2008

•Student Paper Award
 
•Pennsylvania Backs Off of Ban Labeling Milk as Monsanto Hormone‐Free
 Suzan Erem, E Paul Durrenberger
Society for Humanistic Anthropology
Authors: Gleach Frederic W , Santiago‐Irizarry Vilma
Published: May 2008

•Why Do We Exist?
Society for Medical Anthropology
Authors: Ragsdale Kathleen
Published: May 2008

•Mark Your Calendar! SMA 2008 Award Competition Deadlines
 
•Eileen Basker Memorial Prize
 
•Career Achievement Award
 
•New Millennium Book Award
 
•George Foster Practicing Medical Anthropology Award
 
•Steven Polgar Prize
 
•MASA Dissertation Award
 
•MASA Graduate Student Mentor Award
 
•Margaret Clark Graduate and Undergraduate Awards
 
•Hughes Graduate Prize and Rivers Undergraduate Prize
Community-Based Kangaroo Mother Care to Prevent Neonatal and Infant Mortality: A Randomized, Controlled Cluster Trial
Authors: Sloan Nancy L. , Ahmed Salahuddin , Mitra Satindra N. , Choudhury Nuzhat , Chowdhury Mushtaque , Rob Ubaider , Winikoff Beverly
Published: May 2008

OBJECTIVE. We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%.

METHODS. Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status.

RESULTS. Forty percent overall and ∼65% of newborns who died were not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study.

CONCLUSIONS. The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.
Needle-Free Powder Lidocaine Delivery System Provides Rapid Effective Analgesia for Venipuncture or Cannulation Pain in Children: Randomized, Double-Blind Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment Trial
Authors: Zempsky William T. , Bean-Lijewski Jolene , Kauffman Ralph E. , Koh Jeffrey L. , Malviya Shobha V. , Rose John B. , Richards Patricia T. , Gennevois Daniel J.
Published: May 2008

OBJECTIVE. The Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial was a randomized, single-dose, double-blind, phase 3 study investigating whether a needle-free powder lidocaine delivery system (a sterile, prefilled, disposable system that delivers lidocaine powder into the epidermis) produces effective local analgesia within 1 to 3 minutes for venipuncture and peripheral venous cannulation procedures in children.

METHODS. Pediatric patients (3–18 years of age) were randomly assigned to treatment with the needle-free powder lidocaine delivery system (0.5 mg of lidocaine and 21 ± 1 bar of pressure; n = 292) or a sham placebo system (n = 287) at the antecubital fossa or the back of the hand 1 to 3 minutes before venipuncture or cannulation. All patients rated the administration comfort of the needle-free systems and the pain of the subsequent venous access procedures with the Wong-Baker Faces Pain Rating Scale (from 0 to 5). Patients 8 to 18 years of age also provided self-reports with a visual analog scale, and parents provided observational visual analog scale scores for their child's venous access pain. Safety also was assessed.

RESULTS. Immediately after administration, mean Wong-Baker Faces scale scores were 0.54 and 0.24 in the active system and sham placebo system groups, respectively. After venipuncture or cannulation, mean Wong-Baker Faces scale scores were 1.77 ± 0.09 and 2.10 ± 0.09 and mean visual analog scale scores were 22.62 ± 1.80 mm and 31.97 ± 1.82 mm in the active system and sham placebo system groups, respectively. Parents' assessments of their child's procedural pain were also lower in the active system group (21.35 ± 1.43 vs 28.67 ± 1.66). Treatment-related adverse events were generally mild and resolved without sequelae. Erythema and petechiae were more frequent in the active system group.

CONCLUSIONS. The needle-free powder lidocaine delivery system was well tolerated and produced significant analgesia within 1 to 3 minutes.
Trends in Bacteremia in the Pre- and Post-Highly Active Antiretroviral Therapy Era Among HIV-Infected Children in the US Perinatal AIDS Collaborative Transmission Study (1986–2004)
Authors: Kapogiannis Bill G. , Soe Minn M. , Nesheim Steven R. , Sullivan Kevin M. , Abrams Elaine , Farley John , Palumbo Paul , Koenig Linda J. , Bulterys Marc
Published: May 2008

OBJECTIVE. HIV-infected children are at high risk for bacteremia. Highly active antiretroviral therapy has reduced rates of opportunistic infections; less is known about its effect on pediatric bacteremia rates. Thus, we sought to determine its impact on bacteremia incidence in HIV-infected children.

METHODS. Children born during 1986–1998 were followed until 2004 in the Perinatal AIDS Collaborative Transmission Study. We determined the pre–and post–highly active antiretroviral therapy (before and after January 1, 1997) incidence of bacteremia among HIV-infected children and characterized the CD4% temporal declines and mortality among patients with and those without incident bacteremias.

RESULTS. Among 364 children, 68 had 118 documented bacteremias, 97 before and 21 after January 1, 1997. Streptococcus pneumoniae constituted 56 (58%) pre–and 13 (62%) post–highly active antiretroviral therapy cases. The incidence rate ratio of bacteremias comparing post–versus pre–highly active antiretroviral therapy was 0.3 overall and 0.2, 0.2, and 0.4 among children aged 0 to 24, 25 to 48, and 49 to 72 months, respectively. Kaplan-Meier analysis for time to first bacteremia in children born during the pre–highly active antiretroviral therapy compared with the post–highly active antiretroviral therapy era revealed that 69% and 94%, respectively, remained bacteremia free at a median follow-up of 6 years. The Cox proportional hazards model also showed a significant reduction of bacteremias in the post–highly active antiretroviral therapy era, even after controlling for gender and race. Among children <6 years of age, those who experienced bacteremia had faster temporal CD4% decline than those who never had bacteremia. Survival analysis revealed that HIV-infected children with bacteremia experienced higher overall mortality when controlling for gender, race, and clinic site.

CONCLUSIONS. A significant decrease in bacteremia incidence and a prolongation in the time to first bacteremia incident were seen in the post–highly active antiretroviral therapy era. Children with a steeper decline of CD4 T cells were more likely to develop bacteremia. Children who experienced bacteremia had an associated higher mortality than their bacteremia-free counterparts.
Usefulness of Childhood Non–High Density Lipoprotein Cholesterol Levels Versus Other Lipoprotein Measures in Predicting Adult Subclinical Atherosclerosis: The Bogalusa Heart Study
Authors: Frontini Maria G. , Srinivasan Sathanur R. , Xu Jihua , Tang Rong , Bond M. Gene , Berenson Gerald S.
Published: May 2008

OBJECTIVE. This study sought to examine the usefulness of childhood non–high-density lipoprotein cholesterol level versus low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, triglyceride level, apolipoprotein B level, apolipoprotein A-I level, total cholesterol/high-density lipoprotein cholesterol ratio, and apolipoprotein B/apolipoprotein A-I ratio in predicting adult excess carotid intima-media thickness, an indicator of subclinical atherosclerosis.

METHODS. This retrospective cohort study included 437 black and white subjects (70% white and 40% male) who participated in the Bogalusa Heart Study as children 5 to 17 years of age and as adults 16 to 19 years later.

RESULTS. In analyses of each lipoprotein measure as a risk factor for predicting excess carotid intima-media thickness in adulthood, non–high-density lipoprotein cholesterol level, low-density lipoprotein cholesterol level, total cholesterol/high-density lipoprotein cholesterol ratio, apolipoprotein B level, and apolipoprotein B/apolipoprotein A-I ratio emerged as significant predictors, with respective odds ratios of 2.60, 2.95, 1.78, 1.44, and 1.69, after adjustment for childhood BMI, systolic blood pressure, other lipoprotein measures, and follow-up years; the odds ratios for high-density lipoprotein cholesterol, triglyceride, and apolipoprotein A-I levels were not significant. Regarding the discriminating value of different childhood lipoprotein measures in predicting excess carotid intima-media thickness in adulthood, analyses of the area under the receiver operating characteristic curve for each lipoprotein measure, adjusted for the aforementioned nonlipoprotein covariates, indicated that the value of 0.65 for the non–high-density lipoprotein cholesterol level was similar in magnitude to those for other lipoprotein measures, with values ranging from 0.62 to 0.66.

CONCLUSIONS. Childhood non–high-density lipoprotein cholesterol levels are as good as other lipoprotein measures in predicting subclinical atherosclerosis in adulthood, which has practical implications for coronary artery disease risk assessment and intervention in pediatric populations.
Accelerated Tooth Eruption in Children With Diabetes Mellitus
Authors: Lal Shantanu , Cheng Bin , Kaplan Selma , Softness Barney , Greenberg Ellen , Goland Robin S. , Lalla Evanthia , Lamster Ira B.
Published: May 2008

OBJECTIVE. The objective of this study was to evaluate tooth eruption in 6- to 14-year-old children with diabetes mellitus.

METHODS. Tooth eruption status was assessed for 270 children with diabetes and 320 control children without diabetes. Data on important diabetes-related variables were collected. Analyses were performed using logistic regression models.

RESULTS. Children with diabetes exhibited accelerated tooth eruption in the late mixed dentition period (10–14 years of age) compared to healthy children. For both case patients and control subjects the odds of a tooth being in an advanced eruptive stage were significantly higher among girls than boys. There was also a trend associating gingival inflammation with expedited tooth eruption in both groups. No association was found between the odds of a tooth being in an advanced stage of eruption and hemoglobin A1c or duration of diabetes. Patients with higher body mass index percentile demonstrated statistically higher odds for accelerated tooth eruption, but the association was not clinically significant.

CONCLUSIONS. Children with diabetes exhibit accelerated tooth eruption. Future studies need to ascertain the role of such aberrations in dental development and complications such as malocclusion, impaired oral hygiene, and periodontal disease. The standards of care for children with diabetes should include screening and referral programs aimed at oral health promotion and disease prevention.
Seating Patterns and Corresponding Risk of Injury Among 0- to 3-Year-Old Children in Child Safety Seats
Authors: Kallan Michael J. , Durbin Dennis R. , Arbogast Kristy B.
Published: May 2008

OBJECTIVE. Current guidelines for optimal restraint of children in motor vehicles recommend the center rear seating location for installing a child-restraint system. However, recent research on child occupants in child-restraint system has brought this into question. The objective of this study was to describe seating position patterns among appropriately restrained child occupants aged 0 to 3 years in the rear row of vehicles. In addition, we determined the association between rear row seating location and risk of injury.

METHODS. We studied data collected on child occupants from December 1, 1998, to December 31, 2006, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 3 years seated in a child-restraint system in the rear row of the vehicle, model year 1990 or newer, involved in a crash in 16 states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of ≥2.

RESULTS. Seating position distribution for child occupants was as follows: left outboard (31%), center (28%), and right outboard (41%). There was an inverse relationship between the center position and increasing child age (39% for occupants <1 year old versus 18% for occupants 3 years old), independent of the number of additional row occupants. Child occupants seated in the center had an injury risk 43% less than children seated in either of the rear outboard positions.

CONCLUSIONS. The most common seating position for appropriately restrained child occupants in a child-restraint system is the right rear outboard. The center rear seating position is used less often by children restrained by a child-restraint system as they get older. Children seated in the center rear have a 43% lower risk of injury compared with children in a rear outboard position.
Calcium Use During In-hospital Pediatric Cardiopulmonary Resuscitation: A Report From the National Registry of Cardiopulmonary Resuscitation
Authors: Srinivasan Vijay , Morris Marilyn C. , Helfaer Mark A. , Berg Robert A. , Nadkarni Vinay M. ,   the American Heart Association National Registry of CPR Investigators
Published: May 2008

OBJECTIVES. Specific patterns of calcium use during in-hospital pediatric cardiopulmonary resuscitation have not been reported since publication of pediatric advanced life support guidelines by the American Heart Association in 2000 recommended that calcium use during cardiopulmonary resuscitation be limited to select circumstances. We hypothesized that calcium is used frequently during in-hospital pediatric cardiopulmonary resuscitation and that its use is associated with worse survival to hospital discharge.

METHODS. We reviewed 1477 consecutive pediatric cardiopulmonary resuscitation index events (for patients younger than 18 years) submitted to the National Registry of Cardiopulmonary Resuscitation from January 2000 through July 2004. The primary outcome was survival to hospital discharge. Secondary outcomes included survival of event and neurologic outcome. Multivariable logistic regression was performed to analyze the association between calcium use and outcomes.

RESULTS. Calcium was used in 659 (45%) of 1477 events. Calcium was more likely to be used during cardiopulmonary resuscitation in the settings of pediatric facilities, ICUs, cardiac surgery, cardiopulmonary resuscitation duration of ≥15 minutes, asystole, and concurrently with other advanced life support medications: epinephrine, vasopressin, sodium bicarbonate, and magnesium sulfate. The use of calcium during cardiopulmonary resuscitation adjusted for confounding factors was associated with decreased survival to discharge and was not associated with favorable neurologic outcome.

CONCLUSIONS. Calcium is used frequently during in-hospital pediatric cardiopulmonary resuscitation. Although epidemiologic associations do not necessarily indicate causality, calcium use during cardiopulmonary resuscitation is associated with decreased survival to hospital discharge and unfavorable neurologic outcome.
Systematic Intervention to Reduce Central Line–Associated Bloodstream Infection Rates in a Pediatric Cardiac Intensive Care Unit
Authors: Costello John M. , Morrow Debra Forbes , Graham Dionne A. , Potter-Bynoe Gail , Sandora Thomas J. , Laussen Peter C.
Published: May 2008

OBJECTIVE. Our goal was to determine whether an intervention involving staff education, increased awareness, and practice changes would decrease central line–associated bloodstream infection rates in a pediatric cardiac ICU.

METHODS. A retrospective, interventional study using an interrupted time-series design was conducted to compare central line–associated bloodstream infection rates during 3 time periods for all patients admitted to our pediatric cardiac ICU between April 1, 2004, and December 31, 2006. During the preintervention period (April 2004 to December 2004), a committee was convened to track and prevent nosocomial infections. Pretesting demonstrated knowledge deficits regarding nosocomial infection prevention, and educational tools were developed. During the partial intervention period (January 2005 to March 2006), a comprehensive central line–associated bloodstream infection prevention initiative was implemented, including establishment of a unit-based infection control nurse position, education for physicians and nurses, real-time feedback on central line–associated bloodstream infection data, implementation of central venous line insertion, access, and maintenance bundles, and introduction of daily goal sheets on rounds that emphasized timely central venous line removal. Central line–associated bloodstream infection rates in the preintervention, partial intervention, and full intervention (April 2006 to December 2006) periods were compared.

RESULTS. The estimated mean preintervention central line–associated bloodstream infection rate was 7.8 infections per 1000 catheter-days, which decreased to 4.7 infections per 1000 catheter-days in the partial intervention period and 2.3 infections per 1000 catheter-days in the full intervention period. The preintervention central line–associated bloodstream infection rate was significantly higher than the median rate of 3.5 infections per 1000 catheter-days for multidisciplinary PICUs reporting to the National Healthcare Safety Network. During the full intervention period, our central line–associated bloodstream infection rate was lower than this pediatric benchmark, although statistical significance was not achieved.

CONCLUSIONS. A multidisciplinary, evidence-based initiative resulted in a significant reduction in central line–associated bloodstream infections in our pediatric cardiac ICU.
Trends in Intussusception Hospitalizations Among US Infants, 1993–2004: Implications for Monitoring the Safety of the New Rotavirus Vaccination Program
Authors: Tate Jacqueline E. , Simonsen Lone , Viboud Cecile , Steiner Claudia , Patel Manish M. , Curns Aaron T. , Parashar Umesh D.
Published: May 2008

OBJECTIVES. In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002–2004; and assess variations in background rates by age, race/ethnicity, and surgical management.

METHODS. By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993–2004 and from 35 states representing 85% of the birth cohort in 2002–2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data.

RESULTS. Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at ∼35 cases per 100000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100000) then increased rapidly, peaking at ∼62 per 100000 at 26 to 29 weeks, before declining gradually to 26 per 100000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100000), rates were greater among non-Hispanic black infants (37 per 100000) and Hispanic infants (45 per 100000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks.

CONCLUSIONS. This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination.
Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment
Authors: Bael An , Winkler Pauline , Lax Hildegard , Hirche Herbert , Gäbel Elisabeth , Vijverberg Marianne , van Zon Roelie , Van Hoecke Eline , van Gool Jan D.
Published: May 2008

OBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence.

METHODS. A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbach's Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems.

RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant.

CONCLUSION.More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding.
Tuberculosis Mimicking Ileocecal Intussusception in a 5-Month-Old Girl
Authors: de Steenwinkel Jurriaan E. M. , Driessen Gert-Jan A. , Kamphorst-Roemer Margreet H. , Zeegers Antoine G. M. , Ott Alewijn , van Westreenen Mireille
Published: May 2008

A 5-month-old girl was diagnosed with tuberculosis, mimicking ileocecal intussusception. The mother of the patient was later diagnosed with renal tuberculosis attributable to the same (unique) Mycobacterium tuberculosis strain. Possibly, that transmission occurred by aspiration or ingestion of infected amniotic fluid or urine, which could occur before or during birth. This case illustrates that tuberculosis can mimic other common diseases and, therefore, can be a difficult diagnosis to make. Because respiratory infection was very unlikely in this case, congenital tuberculosis or postnatal infection via infected urine or breast milk should be in the differential diagnosis. In this article, we focus on different (nonrespiratory) transmission routes of Mycobacterium tuberculosis and give a short review of the recent literature on congenital tuberculosis.