bluuebunny/crossref_metadata_2025 huggingface dataset:
Stunting of Growth as a Major Feature of Anorexia Nervosa in Male Adolescents
Authors: Modan-Moses Dalit , Yaroslavsky Amit , Novikov Ilia , Segev Sharon , Toledano Anat , Miterany Edith , Stein Daniel
Published: August 2004

Objective. To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth.

Methods. Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical Center from January 1, 1994, to December 31, 1998, were reviewed. Height and weight measurements were obtained before the onset of AN, at admission, and thereafter routinely during hospitalization and follow-up.

Results. Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (−0.81 ± 0.93) was significantly lower than the premorbid SDS (−0.21 ± 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate >1 kg/y) was associated with a mean height gain of 6.97 ± 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate ≤1 kg/y) was associated with a mean of 2.7 ± 3.9 cm/y. This between-group difference was highly significant. Complete catch-up growth was not achieved in 9 of 12 patients. There was a trend for the mean adult final height SDS (−0.52 ± 0.84) to be higher than the admission height SDS but lower than both the premorbid height SDS and the midparental target height SDS (−0.21 ± 0.79).

Conclusions. Linear growth retardation was a prominent feature of AN in our sample of male adolescent patients, preceding, in some cases, the reported detection of the eating disorder. Weight restoration, particularly when target weight is based on the premorbid height percentile, may be associated with significant catch-up growth, but complete catch-up growth may not be achieved.
Effect of Newborn Hospitalization on Family and Child Behavior: A 12-Year Follow-up Study
Authors: Rautava Päivi , Lehtonen Liisa , Helenius Hans , Sillanpää Matti
Published: August 2004

Objective. To study the effects of a critical illness and hospitalization of a newborn on family functioning and child behavior during the subsequent 12 years.

Methods. With the use of a randomized stratified cluster sampling, a follow-up of 1443 pregnant women was started at early pregnancy. These pregnancies resulted in 1294 deliveries. A total of 170 infants were admitted to neonatal units and were classified according to their medical risk, and 1112 healthy-born infants were eligible for the control group. After excluding the children with disabilities at 3 years of age, 134 remained in the risk groups and 952 children remained in the control group. The follow-up examinations were performed at the ages of 3 and 9 months and at 3 and 12 years. The main outcome measures were parents’ subjective well-being and adjustment to the child, family functioning, and child’s behavioral problems.

Results. The families with a critically ill newborn experienced more need for support and maladaptation during the first year after delivery. They reported more child behavior problems at 3 years, but no differences were found at 12 years of age. The families with a hospitalized, low-risk infant coped as well as the controls.

Conclusions. A critical illness of a newborn had long-lasting effects on the family and child behavior. The hospitalization of a newborn with a low medical risk did not have any negative consequences on family or child behavior. This is encouraging for a large group of families that experience early separation from their newborn infant as a result of hospitalization.
Infant Susceptibility of Mortality to Air Pollution in Seoul, South Korea
Authors: Ha Eun-Hee , Lee Jong-Tae , Kim Ho , Hong Yun-Chul , Lee Bo-Eun , Park Hye-Sook , Christiani David C.
Published: August 2004

Objective. Susceptibility of target populations to air pollution is an important issue, because air pollution policies and standards should be based on the susceptibilities of those at particular risk. To evaluate which age group is more susceptible to the adverse health effects of air pollution, we compared the effects of air pollution on mortality among postneonates, those aged 2 to 64 years, and those over 65 years of age.

Design. Daily counts of total and respiratory death along with daily levels of meteorological variables and air pollutants were analyzed using generalized additive Poisson regression. The relative risks (RR) of mortality for interquartile changes of the levels of particulate matter <10 μm (PM10) were calculated on the same day.

Results. For postneonates, the RR of total mortality for an interquartile change (42.9 μg/m3) in PM10 (RR: 1.142; 95% confidence interval [CI]: 1.096–1.190) was greatest among age groups. Next were the elderly over 65 years of age (RR: 1.023; 95% CI: 1.022–1.024). Regarding respiratory mortality, RR for an interquartile change of PM10 in postneonates (RR: 2.018; 95% CI: 1.784–2.283) was also greater than those in the other groups.

Conclusions. These results agree with the hypothesis that infants are most susceptible to PM10 in terms of mortality, particularly respiratory mortality.
Polio Extraimmunization in Children Younger Than 2 Years After Changes in Immunization Recommendations
Authors: Mell Loren K. , Davis Robert L. , Mullooly John P. , Black Steven B. , Shinefield Henry R. , Zangwill Kenneth M. , Ward Joel I. , Marcy S. Michael , Chen Robert T. ,   for the CDC Vaccine Safety Datalink Project
Published: August 2004

Objective. To investigate trends over time in polio extraimmunization among children in 4 large health maintenance organizations and to study the association with recent changes in polio immunization policy.

Methods. Using 176 169 children who were born after 1994 and enrolled for their first 2 years of life, we assessed rates and trends of polio extraimmunization in the Vaccine Safety Datalink project. We used logistic regression to test the association of extraimmunization with different polio immunization schedules and with sociodemographic characteristics and used Poisson regression to test changes in rates over time.

Results. Overall, 10.5% were extraimmunized for poliovirus; children on the all inactivated polio virus or sequential schedule were one half as likely as those on the all oral polio virus schedule to be extraimmunized by 2 years of age. There was a significant decrease in extraimmunization over time, with <5% of children born at the end of 1997 being extraimmunized, compared with >15% at the beginning of 1994.

Conclusions. Poliovirus extraimmunization rates have fallen dramatically in association with the change-over to the all inactivated polio virus schedule.
Sleep Duration From Infancy to Adolescence: Reference Values and Generational Trends
Authors: Iglowstein Ivo , Jenni Oskar G. , Molinari Luciano , Largo Remo H.
Published: August 2004

Objective. The main purpose of the present study was to calculate percentile curves for total sleep duration per 24 hours, for nighttime and for daytime sleep duration from early infancy to late adolescence to illustrate the developmental course and age-specific variability of these variables among subjects.

Methods. A total of 493 subjects from the Zurich Longitudinal Studies were followed using structured sleep-related questionnaires at 1, 3, 6, 9, 12, 18, and 24 months after birth and then at annual intervals until 16 years of age. Gaussian percentiles for ages 3 months to 16 years were calculated for total sleep duration (time in bed) and nighttime and daytime sleep duration. The mean sleep duration for ages 1 to 16 years was estimated by generalized additive models based on the loess smoother; a cohort effect also had to be included. The standard deviation (SD) was estimated from the loess smoothed absolute residuals from the mean curve. For ages 3, 6, and 9 months, an alternative approach with a simple model linear in age was used. For age 1 month, empirical percentiles were calculated.

Results. Total sleep duration decreased from an average of 14.2 hours (SD: 1.9 hours) at 6 months of age to an average of 8.1 hours (SD: 0.8 hours) at 16 years of age. The variance showed the same declining trend: the interquartile range at 6 months after birth was 2.5 hours, whereas at 16 years of age, it was only 1.0 hours. Total sleep duration decreased across the studied cohorts (1974–1993) because of increasingly later bedtime but unchanged wake time across decades. Consolidation of nocturnal sleep occurred during the first 12 months after birth with a decreasing trend of daytime sleep. This resulted in a small increase of nighttime sleep duration by 1 year of age (mean 11.0 ± 1.1 hours at 1 month to 11.7 ± 1.0 hours at 1 year of age). The most prominent decline in napping habits occurred between 1.5 years of age (96.4% of all children) and 4 years of age (35.4%).

Conclusions. Percentile curves provide valuable information on developmental course and age-specific variability of sleep duration for the health care professional who deals with sleep problems in pediatric practice.
Parental Factors, Mass Media Influences, and the Onset of Eating Disorders in a Prospective Population-Based Cohort
Authors: Martínez-González Miguel Angel , Gual Pilar , Lahortiga Francisca , Alonso Yolanda , Irala-Estévez Jokin de , Cervera Salvador
Published: August 2004

Objective. To identify risk factors for eating disorders.

Methods. A community cohort study was conducted in Navarra, Spain. A region-wide representative sample of 2862 girls who were 12 to 21 years of age completed the Eating Attitudes Test (40-item version) and other questionnaires in 1997. Girls who scored high in the Eating Attitudes Test-40 were interviewed by a psychiatrist who applied Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria to diagnose prevalent cases of eating disorders. Girls who were free of any eating disorder in 1997 were reassessed after 18 months of follow-up using the same methods.

Results. Ninety new cases of eating disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were identified during the follow-up. In the multivariate logistic analysis, a higher risk of incident eating disorder was found for several exposures assessed at the beginning of follow-up, such as younger age, usually eating alone (odds ratio [OR]: 2.9; 95% confidence interval: 1.9–4.6), and frequently reading girls’ magazines or listening to radio programs (OR: 2.1; 1.2–3.8 for those most frequently using both media). No independent association was found for television viewing or socioeconomic status. A marital status of parents different from “being married” was associated with a significantly higher risk in the multivariate analysis (OR: 2.0; 1.1–3.5).

Conclusions. Our results support the role of mass media influences and parental marital status in the onset of eating disorders. The habit of eating alone should be considered as a warning sign of eating disorders.
Genome Scan for Childhood and Adolescent Obesity in German Families
Authors: Saar Kathrin , Geller Frank , Rüschendorf Franz , Reis André , Friedel Susann , Schäuble Nadine , Nürnberg Peter , Siegfried Wolfgang , Goldschmidt Hans-Peter , Schäfer Helmut , Ziegler Andreas , Remschmidt Helmut , Hinney Anke , Hebebrand Johannes
Published: August 2004

Objective. Several genome scans have been performed for adult obesity. Because single formal genetic studies suggest a higher heritability of body weight in adolescence and because genes that influence body weight in adulthood might not be the same as those that are relevant in childhood and adolescence, we performed a whole genome scan.

Methods. The genome scan was based on 89 families with 2 or more obese children (sample 1). The mean age of the index patients was 13.63 ± 2.75 years. A total of 369 individuals were initially genotyped for 437 microsatellite markers. A second sample of 76 families was genotyped using microsatellite markers that localize to regions for which maximum likelihood binomial logarithm of the odd (MLB LOD) scores on use of the concordant sibling pair approach exceeded 0.7 in sample 1.

Results. The regions with MLB LOD scores >0.7 were on chromosomes 1p32.3-p33, 2q37.1-q37.3, 4q21, 8p22, 9p21.3, 10p11.23, 11q11-q13.1, 14q24-ter, and 19p13-q12 in sample 1; MLB LOD scores on chromosomes 8p and 19q exceeded 1.5. In sample 2, MLB LOD scores of 0.68 and 0.71 were observed for chromosomes 10p11.23 and 11q13, respectively.

Conclusion. We consider that several of the peaks identified in other scans also gave a signal in this scan as promising for ongoing pursuits to identify relevant genes. The genetic basis of childhood and adolescent obesity might not differ that much from adult obesity.
Physical Fitness and C-Reactive Protein Level in Children and Young Adults: The Columbia University BioMarkers Study
Authors: Isasi Carmen R. , Deckelbaum Richard J. , Tracy Russell P. , Starc Thomas J. , Berglund Lars , Shea Steven
Published: August 2004

Objective. To examine the association of physical fitness with C-reactive protein (CRP) level in children and young adults.

Methods. Subjects (N = 205) aged 6 to 24 years were enrolled in the Columbia University BioMarkers Study (1994–1998). Physical fitness was assessed using a non-effort-dependent treadmill testing protocol (physical work capacity at heart rate of 170 beats per minute). CRP level was measured using a high-sensitivity assay.

Results. Subjects were 54% female and 65% of Hispanic origin. Mean fitness level was higher in boys than in girls, but CRP levels did not differ by gender. Fitness level was inversely correlated with CRP (r = −0.22). This relationship was significant in boys (r = −0.32) but not in girls (r = −0.15). After multivariate regression adjustment for age, race/ethnicity, body mass index, and family history of early-onset ischemic heart disease, physical fitness remained inversely associated with CRP level in boys (β = −0.02; standard error = 0.01).

Conclusions. These findings indicate that physical fitness is inversely related to CRP level in children and that this relationship is more pronounced in boys than in girls.
Early Versus Late Diagnosis: Psychological Impact on Parents of Children With Cystic Fibrosis
Authors: Mérelle Maria E. , Huisman Jaap , Alderden-van der Vecht Angélika , Taat Froukje , Bezemer Dick , Griffioen Rupino W. , Brinkhorst Govert , Dankert-Roelse Jeannette E.
Published: August 2004

Objectives. To explore the relationship between the period preceding diagnosis and the way parents of children with cystic fibrosis (CF) experience and handle their child’s disease.

Design. A retrospective study.

Setting. CF Center “Noordwest Nederland,” the Netherlands.

Participants. Participants were the parents of children <13 years old with CF who were treated at the CF Center “Noordwest Nederland.” The participants were divided into 2 groups according to the duration of prediagnostic period: <3 months (defined as early diagnosis) and ≥3 months (defined as late diagnosis).

Main Outcome Measures. Experience of the prediagnostic period, contact with the medical profession, coping, future perspective, and attitudes toward neonatal screening for CF.

Results. Parents of 55 children were eligible for study participation; 45 were enrolled. Retrospectively, the period preceding an early diagnosis was less negatively experienced by parents than the period preceding a late diagnosis. Parents of children with an early diagnosis had retrospectively more confidence in the medical profession before confirmation of diagnosis. In general, parents in this study used adaptive coping styles. Duration of prediagnostic period was not significantly related to future perspective. Hopelessness seemed to be mainly determined by a severe course of disease as experienced by the parents. Ninety-eight percent of all parents were in favor of neonatal screening for CF.

Conclusions. A short prediagnostic period is associated with less negative feelings and increased confidence in the medical profession among parents of children with CF. Neonatal screening for CF may be of benefit to parents by removing the stress of a delayed diagnosis.
Amplitude-Integrated Electroencephalography Coupled With an Early Neurologic Examination Enhances Prediction of Term Infants at Risk for Persistent Encephalopathy
Authors: Shalak Lina F. , Laptook Abbot R. , Velaphi Sithembiso C. , Perlman Jeffrey M.
Published: August 2004

Objectives. The objectives of this study were to determine, first, whether an early neurologic examination could predict a persistent abnormal neonatal neurologic state comparable to the amplitude-integrated electroencephalography (a-EEG) and, second, whether a combination of the 2 methods would further enhance early identification of high-risk infants.

Methods. Fifty term infants were enrolled prospectively when they had evidence of intrapartum distress, Apgar score ≤5 at 5 minutes, or cord arterial pH ≤7.00 and were admitted to intensive care. Each enrolled infant underwent an early neurologic examination using a modified Sarnat staging system (stages 2 and 3 were regarded as abnormal) and a blinded simultaneous a-EEG measurement. Predictive values were calculated for a short-term abnormal outcome defined as persistent moderate to severe encephalopathy beyond 5 days.

Results. An abnormal short-term outcome was present in 14 (28%) of 50 infants. The neurologic examination was performed at 5 ± 3 hours after delivery. A short-term abnormal outcome occurred in 9 (53%) of 17 infants with initial stage 2 and in both infants with initial stage 3 encephalopathy. In addition, 13 infants manifested features of both stage 1s and 2 and post hoc were classified (S1–2). Three of the latter infants (23%) developed an abnormal short-term outcome. The a-EEG was abnormal in 15 (30%) infants, 11 (73%) of whom developed an abnormal outcome. An abnormal a-EEG was more specific (89% vs 78%), had a greater positive predictive value (73% vs 58%), and had similar sensitivity (79% vs 78%) and negative predictive value (90% vs 91%) when compared with an abnormal early neurologic examination. A combination of abnormalities had the highest specificity (94%) and positive predictive value (85%).

Conclusion. The combination of the a-EEG and the neurologic examination shortly after birth enhances the ability to identify high-risk infants and limits the number of infants who would be falsely identified compared with either evaluation alone.
Vascular Endothelial Growth Factor in the Cerebrospinal Fluid of Infants Who Died of Sudden Infant Death Syndrome: Evidence for Antecedent Hypoxia
Authors: Jones Kimberly L. , Krous Henry F. , Nadeau Julie , Blackbourne Brian , Zielke H. Ronald , Gozal David
Published: August 2004

Objectives. Recurrent hypoxemia has been proposed as an important pathophysiological mechanism underlying sudden infant death syndrome (SIDS). However, conflicting results emerged when xanthines were used as markers for hypoxia. The vascular endothelial growth factor (VEGF) gene is highly sensitive to changes in tissue partial oxygen tension, and changes in genomic and protein expression occur even after changes in oxygenation within the physiologic range.

Methods. For determining whether hypoxia precedes SIDS, VEGF levels were measured using an enzyme-linked immunosorbent assay in the cerebrospinal fluid (CSF) of 51 SIDS infants and in 33 additional control infants who died of an identifiable cause. In addition, 6 rats that had a chronically implanted catheter in the lateral ventricle were exposed to a short hypoxic challenge, and VEGF concentrations were measured in CSF at various time points for 24 hours. Another set of 6 rats were killed with a pentobarbital overdose, and VEGF CSF levels were obtained at different time points after death.

Results. Mean VEGF concentrations in CSF were 308.2 ± 299.1 pg/dL in the SIDS group and 85.1 ± 82.9 pg/dL in those who died of known causes. Mean postmortem delay averaged 22 hours for both groups. In rat experiments, hypoxic exposures induced time-dependent increases in VEGF, peaking at 12 hours and returning to baseline at 24 hours. Postmortem duration in the animals was associated with gradual increases in VEGF that reached significance only at 36 hours.

Conclusions. We conclude that VEGF CSF concentrations are significantly higher in infants who die of SIDS. We postulate that hypoxia is a frequent event that precedes the sudden and unexpected death of these infants.
Newborn Early Discharge Revisited: Are California Newborns Receiving Recommended Postnatal Services?
Authors: Galbraith Alison A. , Egerter Susan A. , Marchi Kristen S. , Chavez Gilberto , Braveman Paula A.
Published: August 2004

Context. Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving.

Objective. To describe rates of early discharge and of timely follow-up for early-discharged newborns.

Design and Setting. Retrospective, population-based cohort study using a 1999 postpartum survey in California.

Participants. A total of 2828 infants of mothers with medically low-risk singleton births.

Main Outcome Measures. Rates of early discharge (≤1-night stay after vaginal delivery and ≤3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge).

Results. Overall, 49.4% of newborns were discharged early. Of these, 67.5% had untimely follow-up. The odds of early discharge were greater with lower incomes: the adjusted odds ratios (AORs) (with 95% confidence intervals) were 2.06 (1.50–2.83) for incomes ≤100% of poverty, 2.20 (1.65–2.93) for incomes from 101%–200% of poverty, and 2.24 (1.63–3.08) for incomes from 201%–300% of poverty. Untimely follow-up was more likely for infants of women with incomes ≤100% of poverty (AOR = 1.89 [1.13–3.17]) and 201%–300% of poverty (AOR = 1.78 [1.09–2.91]), Medicaid coverage (AOR = 1.73 [1.20–2.47]), Latina ethnicity (AOR = 1.47 [1.02–2.14]), and non-English language (AOR = 1.72 [1.16–2.55]).

Conclusions. Despite an apparent decline in short stays after legislation, many newborns—particularly from lower-income families—continue to be discharged early. Most newborns discharged early—particularly those with Medicaid and those from low-income, Latina, and non–English-speaking homes—do not receive recommended follow-up. The most socioeconomically vulnerable newborns are receiving fewer postnatal services.
Prescribing of Psychotropic Medications for Children by Australian Pediatricians and Child Psychiatrists
Authors: Efron Daryl , Hiscock Harriet , Sewell Jillian R. , Cranswick Noel E. , Vance Alasdair L. A. , Tyl Yvonne , Luk Ernest S. L.
Published: August 2004

Objective. To describe the pattern of prescribing of psychotropic medications for Australian children.

Design. Australia-wide cross-sectional postal survey conducted in 2000.

Participants. All registered general pediatricians and child and adolescent psychiatrists.

Results. The survey was completed by 435 general pediatricians and 187 child and adolescent psychiatrists (response rates 72% and 70%, respectively). Stimulants and clonidine were the most frequently prescribed medications. Seventy-two percent of practitioners reported that they had prescribed a combination of medications. Frequent combinations included a stimulant and clonidine (64% of pediatricians, 51% of child psychiatrists) and a stimulant and a selective serotonin reuptake inhibitor (SSRI; 29% of pediatricians, 36% of child psychiatrists).

Pediatricians were more likely than child psychiatrists to report prescribing clonidine for sleep problems (67% vs 36%). Child psychiatrists were more likely than pediatricians to report prescribing SSRIs (93% vs 75%) and mood stabilizers (45% vs 11%) for depression, and SSRIs (74% vs 50%) and tricyclic antidepressants (37% vs 12%) for obsessive compulsive disorder.

Off-label prescribing (indication or age not included in the product information) was reported by 40%. Over 5% of practitioners in this study had prescribed clonidine, methylphenidate, dexamphetamine, and typical neuroleptics for children under 3 years of age.

Conclusions. A broad range of psychotropic medications are being prescribed for Australian children, with some medication groups being prescribed frequently. Combinations of psychotropic medications are used regularly, and there is some prescribing for very young children. The safety and efficacy of several of the agents prescribed have not been adequately researched in children. There is an urgent need for pediatric psychopharmacology research to inform current prescribing practice.
Availability of Adolescent Health Services and Confidentiality in Primary Care Practices
Authors: Akinbami Lara J. , Gandhi Hiren , Cheng Tina L.
Published: August 2004

Background. Little is known about availability of services and confidential care for adolescents in primary care practices or how availability among pediatric practices compares to that among other primary care practices. The objective of this study was to assess self-reported availability of services for medically emancipated conditions and confidential care in primary care practices, to compare physician responses to those from office staff who answer appointment lines, and to compare availability in pediatric practices to other primary care practice types.

Methods. We conducted a telephone survey of randomly selected practices from the Washington, DC, metropolitan area in pediatrics (Peds), internal medicine (IM), and family medicine (FM). We asked staff who answer appointment lines about availability of services for medically emancipated conditions and confidential appointments for adolescents. Physicians received the same questions via a mail survey. Responses from office staff and physicians in the same practice were linked for comparison.

Results. Of 434 practices contacted by telephone, 372 (86%) responded. Of the 615 physicians surveyed from these 372 practices, 264 (43%) from 170 practices responded to the mail survey. Peds practices were less likely than FM and IM practices to offer services for medically emancipated conditions and were less likely than FM practices to offer confidential services to adolescents. Office staff and physicians from FM and IM had higher agreement compared with Peds about availability of services for medically emancipated conditions. Agreement between office staff and physicians about provision of confidential appointments to adolescents was low among all practice types. However, having a written office policy on adolescent confidentiality was significantly associated with agreement between office staff and physicians about availability of confidential services.

Conclusions. Care for medically emancipated conditions and confidential services for adolescents are limited among primary care practices, especially among pediatric practices. All primary care practice types had significant disagreement between office staff and physicians about availability of confidential services to adolescents. Adolescents who call appointment lines are likely to receive inaccurate information about confidentiality policies. Establishing written office policies on adolescent confidentiality may help to improve access to confidential care for adolescents.
Adolescent Participation in Tobacco Promotions: The Role of Psychosocial Factors
Authors: Burke Albers Alison , Biener Lois
Published: August 2004

Objectives. To identify psychosocial factors that place adolescents at risk for participation in tobacco promotions, and to further investigate the hypothesis that psychosocial vulnerabilities have an indirect effect on smoking initiation among youth by way of involvement with tobacco promotions.

Methods. Data were from a follow-up telephone survey of youth in Massachusetts. A subset of adolescents who were not established smokers, had not smoked cigarettes in the past 30 days, and did not own a promotional item at baseline in 1993 was used for the analyses (n = 468). Bivariate analyses were used to evaluate the association between psychosocial vulnerabilities and subsequent acquisition of cigarette promotional items. Logistic regression was conducted to identify the set of factors that best predict attainment of tobacco promotional items, and to examine the mediating influence of item acquisition on the relation of between psychosocial vulnerabilities and smoking initiation.

Results. Adolescents who were academically disengaged at baseline were more likely to acquire a tobacco promotional item at follow-up. Academic disengagement was significantly associated with item acquisition, above and beyond the other psychosocial vulnerabilities. The direct effect of academic disengagement changed from marginally significant to nonsignificant when item acquisition was introduced.

Conclusions. This study provides evidence that receptivity to tobacco promotional items is greatest among youth who are disengaged from school.
Discovering Fragile X Syndrome: Family Experiences and Perceptions
Authors: Bailey Donald B. , Skinner Debra , Sparkman Karen L.
Published: August 2004

We used surveys from 274 families who had at least 1 child with fragile X syndrome (FXS) to determine their experiences in discovering FXS, factors associated with the timeliness of discovery, and the perceived consequences of obtaining this information. For families of male children who were born in the last decade, someone first became concerned about the child’s development at an average age of 13 months. Professional confirmation of a developmental delay did not occur until an average age of 21 months, and a FXS diagnosis occurred at an average age of nearly 32 months. Families reported several barriers to discovering FXS and frustration with the process. Many families had additional children with FXS without knowing reproductive risk. A range of perceived benefits and challenges associated with the discovery were reported. We conclude that selected pediatric practices could promote earlier identification but in only a limited way and predict that disorders such as FXS will continue to challenge current criteria for determining viable candidate disorders for newborn screening.
Scope of Practice Issues in the Delivery of Pediatric Health Care
Authors:   Committee on Pediatric Workforce
Published: August 2004

In recent years, there has been an increase in the number of nonphysician pediatric clinicians and an expansion in their respective scopes of practice. This raises critical public policy and child health advocacy concerns. The American Academy of Pediatrics (AAP) believes that optimal pediatric health care depends on a team-based approach with coordination by a physician leader, preferably a pediatrician. The pediatrician is uniquely suited to manage, coordinate, and supervise the entire spectrum of pediatric care, from diagnosis through all stages of treatment, in all practice settings. The AAP recognizes the valuable contributions of nonphysician clinicians, including nurse practitioners and physician assistants, in delivering optimal pediatric care. The AAP also believes that nonphysician clinicians who provide health care services in underserved areas should be supported by consulting pediatricians and other physicians using technologies including telemedicine. Pediatricians should serve as advocates for optimal pediatric care in state legislatures, public policy forums, and the media and should pursue opportunities to resolve scope of practice conflicts outside state legislatures. The AAP affirms that as nonphysician clinicians seek to expand their scopes of practice as providers of pediatric care, standards of education, training, examination, regulation, and patient care are needed to ensure patient safety and quality health care for all infants, children, adolescents, and young adults.
Childhood Drowning: Barriers Surrounding Private Swimming Pools
Authors: Stevenson Mark R. , Rimajova Miroslava , Edgecombe Dean , Vickery Ken
Published: August 2004

Objective. To investigate the causes of child drowning and determine the need for changes in the legislation as well as improvements to the inspection and enforcement of current legislation related to barriers surrounding private swimming pools.

Methods. There were 3 stages to the study: a retrospective review of coroner’s data, an audit of swimming pool inspections, and in-depth interviews with swimming pool inspectors in Western Australia. The incidence of childhood drowning (per population) and compliance rates of swimming pools (per 1000 swimming pools) to the legislation were measured.

Results. During the 12-year observational period (1988–2000) 50 children younger than 5 years drowned in private swimming pools in Western Australia with an overall incidence of drowning of 4.4 per 100 000 children per year. Sixty-eight percent of drownings occurred in pools that did not have 4-sided fencing with an almost 2-fold increased risk (incidence rate ratio: 1.78; 95% confidence interval: 1.40–1.79) of a child’s drowning in a swimming pool with 3-sided versus 4-sided fencing. The compliance rate of swimming pools (compliance to the current legislation) at first inspection was approximately 400 per 1000 swimming pools.

Conclusions. Almost two thirds of the swimming pools in which children drowned had only 3-sided fencing. With a combination of a change in legislation, enhanced inspection processes, and public education, the incidence of drowning in private swimming pools in Western Australia could be reduced in the coming years.
Expression of CD40 Ligand on CD4+ T-Cells and Platelets Correlated to the Coronary Artery Lesion and Disease Progress in Kawasaki Disease
Authors: Wang Chih-Lu , Wu Yu-Tsun , Liu Chieh-An , Lin Mei-Wei , Lee Chia-Jung , Huang Li-Tung , Yang Kuender D.
Published: August 2004

Objective.Kawasaki disease (KD) is an acute febrile vasculitic syndrome in children. CD40 ligand (CD40L) has been implicated in certain types of vasculitis. We proposed that CD40L expression might be correlated with coronary artery lesions in KD.

Methods.Blood samples were collected from 43 patients with KD before intravenous immunoglobulin (IVIG) treatment and 3 days afterward. Forty-three age-matched febrile children with various diseases were studied in parallel as controls. CD40L expression on T-cells and platelets were detected by flow cytometry, and soluble CD40L (sCD40L) levels were measured by enzyme-linked immunosorbent assay.

Results.We found that CD40L expression on CD4+ T-cells was significantly higher in patients with KD than in the febrile control (FC) group (28.69 ± 1.17% vs 4.37 ± 0.36%). CD40L expression decreased significantly 3 days after IVIG administration (28.69 ± 1.17% vs 13.53 ± 0.55%). CD40L expression on platelets from patients with KD was also significantly higher than in the FC group (8.20 ± 0.41% vs 1.26 ± 0.12%) and decreased after IVIG therapy. sCD40L levels were also significantly higher in KD patients with those of FC (9.69 ± 0.45 ng/mL vs 2.25 ± 0.19 ng/mL) but were not affected by IVIG treatment 3 days afterward (9.69 ± 0.45 ng/mL vs 9.03 ± 0.32 ng/mL). More interesting, we found that in KD patients, CD40L expression on CD4+ T-cells and platelets but not on CD8+ T-cells or sCD40L was correlated with the occurrence of coronary artery lesions.

Conclusions.CD40L might play a role in the immunopathogenesis of KD. IVIG therapy might downregulate CD40L expression, resulting in decrease of CD40L-mediated vascular damage in KD. This implicates that modulation of CD40L expression may benefit to treat KD vasculitis.
Effect of Exercise on Immunologic Factors in Breast Milk
Authors: Lovelady Cheryl A. , Hunter Christie P. , Geigerman Cissy
Published: August 2004

Objective. Although it is well documented that breast milk provides optimal nutrition and immune benefits to the infant, factors that influence the immunologic composition of breast milk are less understood. A recent study reported that immunoglobulin A (IgA) levels in breast milk are lower after exercise compared with resting concentrations. However, the women exercised until exhaustion. The effect of moderate exercise on immunologic components in breast milk has not been reported. Therefore, the purpose of this study was to 1) compare the levels of immunologic compounds in breast milk of exercising women with the milk of sedentary women and 2) determine whether 30 minutes of moderate exercise affects immunologic properties of breast milk.

Methods. Exclusively lactating women were studied at 3 months’ postpartum. Women in the exercise group (EG; n = 29) reported exercising aerobically at least 30 minutes/d for 3 days/wk, and women in the sedentary group (SG; n = 24) had exercised once a week or less during the previous 6 weeks. Cardiovascular fitness levels and concentrations of IgA, lactoferrin, and lysozyme in milk were measured. A subsample of the EG (n = 17) participated in a 30-minute exercise session at 75% of maximum heart rate and a rest session of 30 minutes of sitting rest on 2 separate days. Breast milk samples were collected before and 10 and 60 minutes after exercise and rest sessions. IgA, lactoferrin, and lysozyme concentrations were measured.

Results. Women in the EG had a higher level of cardiovascular fitness than women in the SG (39.7 ± 1.0 vs 32.4 ± 1.0 mL O2/kg/min). Milk concentrations of IgA, lactoferrin, or lysozyme were not significantly different between groups. In addition, there were no significant differences in the concentrations of IgA, lactoferrin, or lysozyme after moderate exercise compared with sitting rest.

Conclusion. Moderate exercise during lactation improves cardiovascular fitness without affecting levels of IgA, lactoferrin, or lysozyme in breast milk.
Temperament and Physical Performance in Children With Osteogenesis Imperfecta
Authors: Suskauer Stacy J. , Cintas Holly L. , Marini Joan C. , Gerber Lynn H.
Published: August 2004

Objective.Children with osteogenesis imperfecta (OI) must participate in therapy to achieve motor performance objectives. Their behavioral style may influence motor performance. For this reason, the temperament of children with types III or IV OI was assessed prospectively to 1) compare their temperament with that of nondisabled children, 2) investigate the relationship between temperament and gross motor performance, and 3) examine relationships among temperament, parental overprotection and coping, physical activity, muscle strength, and motor performance.

Methods.Age-appropriate Carey Temperament Scales, Brief Assessment of Motor Function (BAMF), and the Vulnerable Child/Overprotecting Parents Scale were completed for 35 children 1 to 12 years old. Additional measures included the Childhood Health Assessment Questionnaire, Parent Daily Hassles Scale, manual muscle testing, Pediatric Activity Record, and a Summed Severity Score. Spearman correlations and multiple regression were used to identify and predict significant relationships.

Results.Temperament of children with OI differed from age-based norms in only 1 domain: activity. Motor performance (BAMF) correlated significantly with 3 domains of temperament: persistence (r = −.48), approach (r = −.34), and activity (r = .40). Activity was also related to the ratio of head circumference to body length (r = −.45) and the number of fractures in the preceding year (r = −.35). Parents’ reports of their daily hassles significantly correlated with several domains of the child’s temperament. No significant relationships were identified between parental overprotection and temperament or motor performance.

Conclusions.The temperament of children with types III and IV OI does not differ from that of their nondisabled peers, with the exception of lower activity scores. Although it is considered a biological attribute, the expression of temperament, specifically activity, may be influenced by learned behaviors. Because gross motor performance is related to activity, persistence, and approach/avoidance, knowledge of an individual’s temperament may enhance the child’s ability to benefit from interventions to improve motor skill and activity levels.
Tobacco Counseling at Well-Child and Tobacco-Influenced Illness Visits: Opportunities for Improvement
Authors: Tanski Susanne E. , Klein Jonathan D. , Winickoff Jonathan P. , Auinger Peggy , Weitzman Michael
Published: August 2004

Objective. To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM).

Methods. Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (≤18 years) that included clinician-reported counseling for tobacco use/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed.

Results. Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13–18 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5–33.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician’s assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002–2.50; and odds ratio: 3.0; 95% confidence interval: 1.5–6.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty.

Conclusions. Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.
Infectious Disease Hospitalizations Among American Indian and Alaska Native Infants
Authors: Holman Robert C. , Curns Aaron T. , Cheek James E. , Singleton Rosalyn J. , Anderson Larry J. , Pinner Robert W.
Published: August 2004

Objective. To describe the burden and trends in hospitalizations associated with infectious diseases among American Indian and Alaska Native (AI/AN) infants.

Methods. First-listed infectious disease hospitalizations and hospitalization rates among AI/AN infants and infants in the general US population from 1988–1999 were analyzed by using Indian Health Service/tribal hospital discharge data and the National Hospital Discharge Survey data, respectively.

Results. Infectious disease hospitalizations accounted for 53% of all AI/AN infant hospitalizations and approximately 43% of all US infant hospitalizations during 1988–1999. The annual hospitalization rate for infectious diseases among AI/AN infants declined from 27 486 per 100 000 infants in 1988 to 14 178 per 100 000 infants in 1999. However, the rates for AI/AN infants within the Alaska, Southwest, and Northern Plains regions remained higher than that for the general US infant population at the end of the study period. Lower respiratory tract infection hospitalizations accounted for almost 75% of AI/AN infant infectious disease hospitalizations, and the lower respiratory tract infection hospitalization rate for AI/AN infants was twice that for US infants.

Conclusions. Although infectious disease hospitalization rates for AI/AN infants have declined, AI/AN infants continue to have a higher infectious disease burden than the general US infant population.
Alteplase in the Treatment of Complicated Parapneumonic Effusion: A Case Report
Authors: Bishop Naomi B. , Pon Steven , Ushay H. Michael , Greenwald Bruce M.
Published: August 2004

The treatment of complex parapneumonic effusions in children remains controversial, with some advocating less invasive, strictly medical management and others supporting a more aggressive approach of thoracotomy with or without decortication. Recent advances, including video-assisted thoracoscopic surgery and intrapleural fibrinolytic therapy, offer new options for effective treatment. We report the first case of successful resolution of a complex parapneumonic effusion in a 16-month-old girl with the use of tissue plasminogen activator (alteplase), infused via a catheter in the pleural space.
Accidental Scald Burns in Sinks
Authors: Titus M. Olivia , Baxter Amy L. , Starling Suzanne P.
Published: August 2004

Scald burns to the feet and lower extremities in children are described in the literature as often resulting from forced immersions. This report illustrates 3 cases of burns whose distribution and historical factors identify them as accidental. The location of these accidental burns is similar to those found in inflicted injury, but the patterns were indicative of flowing water burns, not forced immersions. Burns in these locations may be confused with abuse. Medical providers need to be aware of information that may enable them to distinguish the 2 causes. Effective caregiver education regarding the importance of lowering the temperature of water heaters and discouraging play in household sinks is critical to prevent additional tap water scald burn injuries.
Effectiveness of Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Newborns
Authors: Koppel Robert I. , Druschel Charlotte M. , Carter Tonia , Goldberg Barry E. , Mehta Prabhu N. , Talwar Rohit , Bierman Fredrick Z.
Published: August 2004

Objective. To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM).

Methods. Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation ≤95% at >24 hours). Data regarding true and false positives as well as negatives were collected and analyzed.

Results. Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return ×2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%).

Conclusions. This screening test is simple, noninvasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.