bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal carriage of a single clone of community-acquired methicillin-resistant Staphylococcus aureus among kindergarten attendees in northern Taiwan
Authors: Lo Wen-Tsung , Lin Wei-Jen , Tseng Min-Hua , Lu Jang-Jih , Lee Shih-Yi , Chu Mong-Ling , Wang Chih-Chien
Published: June 2007

Background:

To evaluate the prevalence and microbiological characterization of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in a kindergarten.

Methods:

Point prevalence study. Nasal swabs were collected from healthy children younger than 7 years of age who were attending a kindergarten in Taipei, Taiwan. A parent questionnaire regarding MRSA risk factors was administered simultaneously. All CA-MRSA colonization isolates were archived for subsequent antimicrobial susceptibility and molecular typing.

Results:

Of the 68 children who participated in the study, 17 (25%) had S. aureus isolated from nasal swabs. Nine (13.2%) of the 68 children had CA-MRSA carriage, and none of them had any identified risk factors. Antimicrobial susceptibility testing revealed all of the 9 CA-MRSA colonization isolates had uniformly high resistance (100%) to both clindamycin and erythromycin, the macrolide-lincosamide-streptogramin-constitutive phenotype and the ermB gene. Pulsed-field gel electrophoresis revealed 8 (88.9%) of 9 CA-MRSA colonization isolates were genetically related and multilocus sequence typing revealed all isolates had sequence type 59. All of the colonization isolates carried the staphylococcal cassette chromosome mec type IV, but none were positive for the Panton-Valentine leukocidin genes.

Conclusion:

The results of this study suggest that a single predominant CA-MRSA colonization strain featuring high clindamycin resistance circulated in this kindergarten. Additionally, due to the established transmissibility of colonization isolates, the high prevalence of nasal carriage of CA-MRSA among healthy attendees in kindergartens may indicate the accelerated spread of CA-MRSA in the community.
Protein kinase C and human uterine contractility
Authors: Eude-Le Parco Isabelle , Dallot Emmanuelle , Breuiller-Fouché Michelle
Published: June 2007

Abnormalities in uterine contractility are thought to contribute to several clinical problems, including preterm labor. A better understanding of the mechanisms controlling uterine activity would make it possible to propose more appropriate and effective management practices than those currently in use. Recent advances point to a role of the protein kinase C (PRKC) family in the regulation of uterine smooth muscle contraction at the end of pregnancy. In this review, we highlight recent work that explores the involvement of individual PRKC isoforms in cellular process, with an emphasis on the properties of PRKCZ isoform.
Disclosing conflicts of interest in German publications concerning health services research
Authors: Schneider Nils , Lingner Heidrun , Schwartz Friedrich W
Published: June 2007

Background

The influence of the pharmaceutical industry and other stakeholders on medical science has been increasingly criticised. When dealing with conflicts of interest in scientific publications it is important to ensure the best possible transparency. The objective of this work is to examine the disclosure practice of financial and non-financial conflicts of interest in German language publications concerning health services research for the first time.

Methods

We performed a systematic literature search in the PubMed data base using the MeSH term "health services research". The review was conducted on July 10, 2006, setting the limits "dates: published in the last 2 years" and "languages: German" (only articles with abstracts). 124 articles in 31 magazines were found. In the magazines the instructions for authors were examined as to whether a statement on conflicts of interest is expected – and if, in which form. Regarding the articles in the journals which require a statement, we examined whether the statement is explicitly published. The results are descriptively represented.

Results

13 magazines (42%) do not require any statement on conflicts of interest, whereas 18 journals (58%) expect a statement. Two of these 18 magazines refer explicitly to the uniform requirements of the International Committee of the Medical Journal Editors (ICMJE); the remaining 16 magazines give differently accentuated instructions on how to disclose conflicts of interest, whereby the focus is primarily on financial issues. A statement on conflicts of interest is explicitly published in 11 of the 71 articles (15%) which are found in the magazines that require a statement with the submission of a manuscript. Related to the total number of included articles, this means that the reader explicitly receives information on potential conflicts of interest in 9% of the cases (11 of 124 articles). Statements of others that are involved in the publication process (reviewers, editors) are not available in any of the articles examined.

Conclusion

A better sensitization for possible conflicts of interest in German publications concerning health services research is necessary. We suggest tightening the criteria for disclosure in the instructions for authors in the scientific journals. Among other things the equivalent consideration of financial and non-financial conflicts of interest as well as the obligatory publication of the statements should be part of good practice.
Mortality and nutrition surveys by Non-Governmental organisations. Perspectives from the CE-DAT database
Authors: Degomme Olivier , Guha-Sapir Debarati
Published: June 2007

In this paper we explore the strengths and gaps among NGO surveys based on an analysis of the records held in the CE-DAT database at CRED. We conclude by recommending the priority areas for strengthening NGO capacity to undertake surveys and ways to improve data quality in general.
Methods for health surveys in difficult settings: charting progress, moving forward
Authors: Bostoen Kristof , Bilukha Oleg O , Fenn Bridget , Morgan Oliver W , Tam Clarence C , ter Veen Annemarie , Checchi Francesco
Published: June 2007

Health surveys are a very important component of the epidemiology toolbox, and play a critical role in gauging population health, especially in developing countries. Research on health survey methods, however, is sparse. In particular, current sampling methods are not well adapted for certain 'difficult' settings, such as emergencies, remote regions without easily available sampling frames, hidden and vulnerable population groups, urban slums and populations living under strong political pressure. This special issue of Emerging Themes in Epidemiology is entirely devoted to survey methods in such settings, and builds upon a successful conference in London highlighting problems with current approaches and possible ways forward. Greater investment in research on health survey methods is needed and will have beneficial effects for populations in need.
Assessing household wealth in health studies in developing countries: a comparison of participatory wealth ranking and survey techniques from rural South Africa
Authors: Hargreaves James R , Morison Linda A , Gear John SS , Kim Julia C , Makhubele Mzamani B , Porter John DH , Watts Charlotte , Pronyk Paul M
Published: June 2007

Background

Accurate tools for assessing household wealth are essential for many health studies in developing countries. Household survey and participatory wealth ranking (PWR) are two approaches to generate data for this purpose.

Methods

A household survey and PWR were conducted among eight villages in rural South Africa. We developed three indicators of household wealth using the data. One indicator used PWR data only, one used principal components analysis to combine data from the survey, while the final indicator used survey data combined in a manner informed by the PWR. We assessed internal consistency of the indices and assessed their level of agreement in ranking household wealth.

Results

Food security, asset ownership, housing quality and employment were important indicators of household wealth. PWR, consisting of three independent rankings of 9671 households, showed a high level of internal consistency (intraclass correlation coefficient 0.81, 95% CI 0.79–0.82). Data on 1429 households were available from all three techniques. There was moderate agreement in ranking households into wealth tertiles between the two indicators based on survey data (spearman rho = 0.69, kappa = 0.43), but only limited agreement between these techniques and the PWR data (spearman rho = 0.38 and 0.31, kappa = 0.20 and 0.17).

Conclusion

Both PWR and household survey can provide a rapid assessment of household wealth. Each technique had strengths and weaknesses. Reasons for differences might include data inaccuracies or limitations in the methods by which information was weighted. Alternatively, the techniques may measure different things. More research is needed to increase the validity of measures of socioeconomic position used in health studies in developing countries.
Wanted: studies on mortality estimation methods for humanitarian emergencies, suggestions for future research
Authors:   Working Group for Mortality Estimation in Emergencies
Published: June 2007

Measuring rates and circumstances of population mortality (in particular crude and under-5 year mortality rates) is essential to evidence-based humanitarian relief interventions. Because prospective vital event registration is absent or deteriorates in nearly all crisis-affected populations, retrospective household surveys are often used to estimate and describe patterns of mortality. Originally designed for measuring vaccination coverage, the two-stage cluster survey methodology is frequently employed to measure mortality retrospectively due to limited time and resources during humanitarian emergencies. The method tends to be followed without considering alternatives, and there is a need for expert advice to guide health workers measuring mortality in the field.

In a workshop in France in June 2006, we deliberated the problems inherent in this method when applied to measure outcomes other than vaccine coverage and acute malnutrition (specifically, mortality), and considered recommendations for improvement. Here we describe these recommendations and outline outstanding issues in three main problem areas in emergency mortality assessment discussed during the workshop: sampling, household data collection issues, and cause of death ascertainment. We urge greater research on these issues. As humanitarian emergencies become ever more complex, all agencies should benefit from the most recently tried and tested survey tools.
Allelic and genotypic associations of DRD2 Taq I A polymorphism with heroin dependence in Spanish subjects: a case control study
Authors: Perez de los Cobos Jose , Baiget Montserrat , Trujols Joan , Sinol Nuria , Volpini Victor , Banuls Enrique , Calafell Francesc , Luquero Elena , del Rio Elisabeth , Alvarez Enric
Published: June 2007

Background

Conflicting associations with heroin dependence have been found involving the A1 allele of dopamine D2 receptor gene (DRD2) Taq I A polymorphism.

Methods

We compared two samples of unrelated Spanish individuals, all of European origin: 281 methadone-maintained heroin-dependent patients (207 males and 74 females) who frequently used non-opioid substances, and 145 control subjects (98 males and 47 females).

Results

The A1-A1 genotype was detected in 7.1% of patients and 1.4% of controls (P = 0.011, odds ratio = 5.48, 95% CI 1.26–23.78). Although the A1 allele was not associated with heroin dependence in the entire sample, the frequency of A1 allele was higher in male patients than in male controls (24.4% vs. 16.3%, P = 0.024, odds ratio = 1.65, 95% CI 1.07–2.57). A logistic regression analysis showed an interaction between DRD2 alleles and gender (odds ratio = 1.77, 95% CI 1.15–2.70).

Conclusion

Our results indicate that, in Spanish individuals, genotypes of the DRD2 Taq I A polymorphism contribute to variations in the risk of heroin dependence, while single alleles contribute only in males.
Preferential chemotaxis of activated human CD4+ T cells by extracellular cyclophilin A
Authors: Damsker Jesse M , Bukrinsky Michael I , Constant Stephanie L
Published: June 2007

The recruitment and trafficking of leukocytes are essential aspects of the inflammatory process. Although chemokines are thought to be the main regulators of cell trafficking, extracellular cyclophilins have been shown recently to have potent chemoattracting properties for human leukocytes. Cyclophilins are secreted by a variety of cell types and are detected at high levels in tissues with ongoing inflammation. CD147 has been identified as the main signaling receptor for cyclophilin A (CypA) on human leukocytes. It is interesting that the expression of CD147 is elevated on leukocytes from inflamed tissue, suggesting a correlation among the presence of extracellular cyclophilins, CD147 expression, and inflammatory responses. Thus, cyclophilin-CD147 interactions may contribute directly to the recruitment of leukocytes into inflamed tissues. In the current studies, we show that activatd human T lymphocytes express elevated levels of CD147, compared with resting T cells and that these activated T cells migrate more readily to CypA than resting cells. Furthermore, we show that unlike resting CD4+ T cells, the cyclophilin-mediated migration of activated T cells does not require interaction with heparan sulfate receptors but instead, is dependent on CD147 interaction alone. Such findings suggest that cyclophilin-CD147 interactions will be most potent when leukocytes are in an activated state, for example, during inflammatory responses. Thus, targeting cyclophilin-CD147 interactions may provide a novel approach for alleviating tissue inflammation.
Toll-like receptor 4 (TLR4)-dependent proinflammatory and immunomodulatory properties of the glycoinositolphospholipid (GIPL) fromTrypanosoma cruzi
Authors: Medeiros Monica M , Peixoto Jaqueline R , Oliveira Ana-Carolina , Cardilo-Reis Larissa , Koatz Vera L G , Van Kaer Luc , Previato José O , Mendonça-Previato Lúcia , Nobrega Alberto , Bellio Maria
Published: June 2007

We have demonstrated recently that the glycoinositolphospholipid (GIPL) molecule from the protozoan Trypanosoma cruzi is a TLR4 agonist with proinflammatory effects. Here, we show that GIPL-induced neutrophil recruitment into the peritoneal cavity is mediated by at least two pathways: one, where IL-1β acts downstream of TNF-α, and a second, which is IL-1β- and TNFRI-independent. Moreover, NKT cells participate in this proinflammatory cascade, as in GIPL-treated CD1d−/− mice, TNF-α and MIP-2 levels are reduced significantly. As a consequence of this inflammatory response, spleen and lymph nodes of GIPL-treated mice have an increase in the percentage of T and B cells expressing the CD69 activation marker. Cell-transfer experiments demonstrate that T and B cell activation by GIPL is an indirect effect, which relies on the expression of TLR4 by other cell types. Moreover, although signaling through TNFRI contributes to the activation of B and γδ+ T cells, it is not required for increasing CD69 expression on αβ+ T lymphocytes. It is interesting that T cells are also functionally affected by GIPL treatment, as spleen cells from GIPL-injected mice show enhanced production of IL-4 following in vitro stimulation by anti-CD3. Together, these results contribute to the understanding of the inflammatory properties of the GIPL molecule, pointing to its potential role as a parasite-derived modulator of the immune response during T. cruzi infection.
Involvement of Glyceraldehyde-3-Phosphate Dehydrogenase in Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand-Mediated Death of Thyroid Cancer Cells
Authors: Du Zhen-Xian , Wang Hua-Qin , Zhang Hai-Yan , Gao Da-Xin
Published: June 2007

TNF-related apoptosis-inducing ligand (TRAIL) is cytotoxic to most thyroid cancer cell lines, including those originating from anaplastic carcinomas, implying TRAIL as a promising therapeutic agent against thyroid cancers. However, signal transduction in TRAIL-mediated apoptosis is not clearly understood. In addition to its well-known glycolytic functions, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is a multifunctional protein, including its surprising role as a mediator for cell death. In this study we explored the involvement of GAPDH in TRAIL-mediated thyroid cancer cell death. In follicular undifferentiated thyroid cells, S-nitrosylation and nuclear translocation of GAPDH appear to mediate TRAIL-induced cell death at least partially, as evidenced by pretreatment with N-nitro-L-arginine methyl ester, a competitive nitric oxide synthase inhibitor that partially but significantly attenuated TRAIL-induced apoptosis through the reduction of S-nitrosylation and nuclear translocation of GAPDH. In addition, GAPDH small interfering RNA partially prevented the apoptotic effect of TRAIL, although TRAIL-induced nitric oxide synthase stimulation and production of nitric oxide were not attenuated. Furthermore, nuclear localization of GAPDH was observed in another thyroid cancer cell line, KTC2, which is also sensitive to TRAIL, but not in those TRAIL insensitive cell lines: ARO, KTC1, and KTC3. These data indicate that nitric oxide-mediated S-nitrosylation of GAPDH and subsequent nuclear translocation of GAPDH might function as a mediator of TRAIL-induced cell death in thyroid cancer cells.
Glial Cell Line-Derived Neurotrophic Factor: An Intraovarian Factor that Enhances Oocyte Developmental Competence in Vitro
Authors: Linher Katja , Wu De , Li Julang
Published: June 2007

The success of early embryonic development depends on oocyte nuclear and cytoplasmic maturation. We have investigated whether glial cell line-derived neurotrophic factor (GDNF) affects the in vitro maturation (IVM) of porcine oocytes and their subsequent ability to sustain preimplantation embryo development. GDNF and both its coreceptors, GDNF family receptor α-1 (GFRα-1) and the rearranged during transformation (RET) receptor, were expressed in oocytes and their surrounding cumulus cells derived from small and large follicles. When included in IVM medium, GDNF significantly enhanced cumulus cell expansion of both small and large cumulus-oocyte complexes and increased the percentage of small follicle-derived oocytes maturing to the metaphase II stage, although nuclear maturation of large oocytes was not significantly affected. Examination of cyclin B1 protein expression as a measure of cytoplasmic maturation revealed that in the presence of GDNF, cyclin B1 levels were significantly increased in large follicle-derived oocytes, as well as in oocytes from small follicles to a level comparable to the untreated large group. After activation, a significantly higher percentage of both small and large oocytes that were matured in the presence of GDNF developed to the blastocyst stage compared with untreated controls. Indeed, GDNF enhanced the blastocyst rate of small oocytes to levels comparable to those obtained for large oocytes matured without GDNF. The effect of GDNF was specific; this was evident because its enhancement of nuclear maturation and embryo developmental potential was blocked by an antibody against GFRα-1. Our study provides the first functional evidence that GDNF affects oocyte maturation and preimplantation embryo developmental competence in a follicular stage-dependent manner. This finding may provide insights for improving the formulation of IVM culture systems, especially for oocytes from small follicles.
Rising Follicle-Stimulating Hormone Levels with Age Accelerate Female Reproductive Failure
Authors: McTavish Kirsten J. , Jimenez Mark , Walters Kirsty A. , Spaliviero Jennifer , Groome Nigel P. , Themmen Axel P. , Visser Jenny A. , Handelsman David J. , Allan Charles M.
Published: June 2007

Rising serum FSH levels is one of the earliest signs of human female reproductive aging. Whether or not elevated FSH remains a passive reflection of a diminishing ovarian follicle pool or actively contributes to declining female fertility with age has not been established. We therefore investigated female reproduction in mice expressing progressively rising serum levels of transgenic human FSH (Tg-FSH, 2.5–10 IU/liter) independently of follicle depletion. We show that serum LH and estradiol levels and uterine size remained normal in Tg-FSH females, whereas ovarian weight and corpora lutea number were significantly increased up to 1.3- and 5-fold, respectively. Furthermore, the monotrophic FSH rise produced a striking biphasic effect on female fertility. Tg-FSH females less than 22 wk old delivered increased litter sizes, then beyond 23 wk, litter sizes decreased rapidly culminating in premature infertility despite continued ovary follicle development, and increased ovulation and uterine embryo implantation sites as well as normal serum levels of anti-Mullerian hormone, a marker of ovarian follicle reserve. We found that rising circulating Tg-FSH produced premature infertility by increasing embryo-fetal resorption and parturition failure with age. Thus, our Tg-FSH mice present a novel paradigm to investigate selective contributions of elevated FSH to age-related female infertility, which revealed that rising FSH levels, despite no exhaustion of ovarian reserve, actively accelerates female reproductive aging primarily by postimplantation reduction of embryo-fetal survival.
Temporal Dynamics of Type 2 Deiodinase Expression after Melatonin Injections in Syrian Hamsters
Authors: Yasuo Shinobu , Yoshimura Takashi , Ebihara Shizufumi , Korf Horst-Werner
Published: June 2007

In many species living in temperate zones, reproduction is controlled by the photoperiod. Recent findings have clarified that type 2 iodothyronine deiodinase (Dio2) plays a significant role in the photoperiodic response of gonads in the mediobasal hypothalamus, converting the prohormone T4 into bioactive T3. In mammals, Dio2 expression is suppressed by long-term melatonin injections, although the signal transduction pathways that link the melatonin signal to Dio2 expression are unknown. As a first step to approach the problem, we have here investigated the temporal dynamics of the melatonin effect on Dio2 expression using male Syrian hamsters. Dio2 mRNA levels were found to show diurnal rhythms under long-day conditions in an area adjacent to the tuberoinfundibular sulcus and in the ependymal cell layer lining the ventrobasal walls of the third ventricle. Daily sc melatonin injections given in the late afternoon under long-day condition suppressed the Dio2 mRNA levels already at the first day after the onset of the treatment in the ependymal cell layer lining the ventrobasal walls of the third ventricle, and 1 d later in an area adjacent to the tuberoinfundibular sulcus. These suppressive effects were sustained for at least 2 d after a single injection. Furthermore, we examined the temporal changes of the Dio2 expression after the onset of the treatment, showing that the suppression did not occur until midday of the next day. These data suggest that melatonin is involved in the signal transduction mechanisms controlling the photoperiodic response of gonads by acting on Dio2 expression rather rapidly through indirect pathways.
A Note on Recent Trends in Suicide in Fiji
Authors: Forster Peter M. , Kuruleca Selina C. , Auxier C.R.
Published: June 2007

The incidence of suicides and attempted suicides is one indicator of mental health and life satisfaction within the population. The trends in suicidal behaviour vary with sex and ethnicity within the population, and underscore the impact of culture on people's lives and wellbeing. Although incidence of suicide provides important information, there has been no systematic reporting of data within the country. The only source of national data is the statistics unit of Fiji's police force, who record all deaths that were not caused by disease, along with such data as the sex and ethnicity of the deceased. The police are willing to provide information on suicide to researchers and government bodies, within the constraints of having the staff and other resources needed to provide such information. The present article explores what we know about this important social issue, and investigates some potential ways forward for dealing with it at individual and group levels.
Overseas Development Workers: ‘Big Five’ Personality Scores
Authors: Hudson Sheena , Inkson Kerr
Published: June 2007

To test hypotheses formulated by Ones and Viswesvaran (1997), a cohort of 47 selected volunteer overseas development workers from New Zealand completed the NEO PI-R ‘Big Five’ personality inventory. In line with hypotheses, these workers were significantly higher than population norms on openness and its six subfacets, and on agreeableness and the subfacet of tender-mindedness, but contrary to hypotheses, they were not significantly different on either neuroticism or conscientiousness. The article argues for further research in this field.
Families' Health-Related Social Problems and Missed Referral Opportunities
Authors: Fleegler Eric W. , Lieu Tracy A. , Wise Paul H. , Muret-Wagstaff Sharon
Published: June 2007

OBJECTIVES. The objectives of this study were to characterize (1) families' cumulative burden of health-related social problems regarding access to health care, housing, food security, income security, and intimate partner violence; (2) families' experiences regarding screening and referral for social problems; and (3) parental acceptability of screening and referral.

METHODS. We surveyed 205 parents of children who were 0 to 6 years of age and attended 2 urban pediatric clinics for a well-child visit using a self-administered, computer-based questionnaire. The questionnaire included previously validated questions about health-related social problems and new questions about screening and referral in the past 12 months.

RESULTS. A total of 205 (79%) of 260 eligible families participated. Eighty-two percent of families reported ≥1 health-related social problem; 54% experienced problems in ≥2 social domains. Families experienced similar types and frequencies of problems despite demographic differences between clinics. One third of families reported no screening in any domain in the previous 12 months. Of 205 families, 143 (70%) identified at least 1 need for a referral; 101 (49%) expressed ≥1 unmet referral need. Of families who reported receiving referrals, 115 referrals were received by 79 families; of the referrals made, 63% (73 of 115) led to contact with the referral agency, and 82% (60 of 73) of the referral agencies were considered helpful. A computer-based system in a pediatrician's office for future screening and referral for health-related social problems was deemed acceptable by 92% of parents.

CONCLUSIONS. Urban children and families reported a significant burden of health-related social problems yet infrequent pediatric screening or referral for these problems. Of families who reported receiving referrals, a majority contacted the recommended agencies and found them helpful. This study also demonstrates the feasibility of using a computer-based questionnaire to identify health-related social problems in a routine outpatient clinic setting.
Laboratory Values for Children With Newly Diagnosed Inflammatory Bowel Disease
Authors: Mack David R. , Langton Christine , Markowitz James , LeLeiko Neal , Griffiths Anne , Bousvaros Athos , Evans Jonathan , Kugathasan Subra , Otley Anthony , Pfefferkorn Mariann , Rosh Joel , Mezoff Adam , Moyer Susan , Oliva-Hemker Maria , Rothbaum Robert , Wyllie Robert , delRosario J. Fernando , Keljo David , Lerer Trudy , Hyams Jeffrey ,   for the Pediatric Inflammatory Bowel Disease Collaborative Research Group
Published: June 2007

OBJECTIVE. The goal was to determine how often common laboratory tests yield normal results at the time of diagnosis for children with inflammatory bowel disease.

METHODS. Data were obtained from a registry of children with newly diagnosed inflammatory bowel disease who were enrolled prospectively in 18 US/Canadian centers. Laboratory values investigated included hemoglobin level, platelet count, albumin level, and erythrocyte sedimentation rate. Disease severity was categorized by physician global assessment.

RESULTS. A total of 526 children (mean age: 11.6 years; 58% male; 392 with Crohn disease and 134 with ulcerative colitis) were studied. All 4 values were normal for 21% of patients with mild Crohn disease and 54% with mild ulcerative colitis. In contrast, only 3.8% of children with moderate/severe Crohn disease and 4.3% with moderate/severe ulcerative colitis had normal results for all 4 tests. The erythrocyte sedimentation rate was least likely to be normal; overall, 26% of patients with inflammatory bowel disease had a normal erythrocyte sedimentation rate, including 18% with moderate/severe disease. Hemoglobin levels were normal for 32%, platelet counts for 50%, and albumin levels for 60%. There was no clear association between Crohn disease location and either severity or number of normal laboratory values. In contrast, there were direct correlations between ulcerative colitis disease severity and both the extent of bowel inflammation and the number of abnormal laboratory tests.

CONCLUSION. The presence of normal screening laboratory studies should not dissuade clinicians from considering a diagnosis of inflammatory bowel disease.
The Host Hospital 24-Hour Underreferral Rate: An Automated Measure of Call-Center Safety
Authors: Hirsh Daniel A. , Simon Harold K. , Massey Robert , Thornton Lisa , Simon Joseph E.
Published: June 2007

OBJECTIVES. The goals were to (1) define and illustrate an automated method of monitoring the safety of telephone triage, (2) demonstrate that this method approximates reasonably a more-global safety measure, and (3) describe the month-to-month variability of this automated measure for the call center studied.

METHODS. From October 2005 through March 2006, hospitalizations at a tertiary care pediatric hospital after calls to its call center were matched with their respective call-center dispositions. The host hospital 24-hour underreferral rate was defined as the percentage of total admissions to the study institution within 24 hours after a call to the call center for treatment of the same illness or injury that had been assigned a nonurgent disposition by the call center. A convenience sample of call-center calls was surveyed for admissions to other facilities. This sample was then combined with admissions to the pediatric hospital to estimate a true 24-hour underreferral rate. Underreferrals were subjected to clinical and statistical analyses.

RESULTS. The host hospital 24-hour underreferral rate was 5.2%. The estimated true 24-hour underreferral rate was 5.95% ± 2.75%. Diagnoses frequently associated with underreferral were gastroenteritis, croup, asthma, and bronchiolitis. Underreferred patients admitted to the study institution were hospitalized for an average of 1.6 ± 1.1 days, compared with 2.8 ± 3.1 days for patients referred by the call center to a higher level of care. The monthly SD of the host hospital 24-hour underreferral rate was 1.56%.

CONCLUSIONS. For the call center studied, the host hospital 24-hour underreferral rate could be determined easily and objectively and approximated reasonably the true 24-hour underreferral rate. The month-to-month variability of the host hospital 24-hour underreferral rate was sufficiently small to allow for meaningful internal trending analyses.
Inhaled Nitric Oxide Therapy Decreases the Risk of Cerebral Palsy in Preterm Infants With Persistent Pulmonary Hypertension of the Newborn
Authors: Tanaka Yuko , Hayashi Tomoshige , Kitajima Hiroyuki , Sumi Kiyoaki , Fujimura Masanori
Published: June 2007

OBJECTIVE. The aim was to determine whether inhaled nitric oxide therapy improves neurodevelopmental outcomes for infants with preterm persistent pulmonary hypertension of the newborn.

METHODS. We conducted a historical cohort study to compare the 3-year incidence of cerebral palsy in preterm singleton infants (<34 gestational weeks) with hypoxemic respiratory failure caused by persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (16 patients) or 100% oxygen (15 patients) therapy. All neonates had clinical and echocardiographic evidence of pulmonary hypertension without structural heart disease.

RESULTS. The incidence of cerebral palsy among patients treated with inhaled nitric oxide was 12.5%, whereas that among patients treated with 100% oxygen was 46.7%. After adjustment for maternal fever (≥38°C) during delivery, birth weight, Apgar score at 5 minutes, high-frequency oscillatory ventilation, and surfactant therapy, inhaled nitric oxide therapy, compared with 100% oxygen therapy, was associated with a decreased risk of cerebral palsy in preterm infants with persistent pulmonary hypertension of the newborn.

CONCLUSION. Inhaled nitric oxide therapy decreases the risk of cerebral palsy in preterm infants with persistent pulmonary hypertension of the newborn.
Differences in Severity-Adjusted Pediatric Hospitalization Rates Are Associated With Race/Ethnicity
Authors: Chamberlain James M. , Joseph Jill G. , Patel Kantilal M. , Pollack Murray M.
Published: June 2007

OBJECTIVE. Racial/ethnic disparities in health care delivery have been well described, but little is known about such disparities for children who seek emergency care. The objective of this study was to test the hypothesis that severity-adjusted emergency department pediatric admission rates are associated with race/ethnicity.

METHODS. Secondary analyses were conducted of an established database of 16 emergency departments that participated in a national study to validate the Pediatric Risk of Admission II score, which is used to measure severity of illness. Patients were randomly selected by the coordinating center from daily emergency department visit logs. Crude and severity-adjusted admission rates were compared among the 3 most common races/ethnicities: white, black, and Hispanic. Adjusted admission rates were calculated by using the standardized admission ratio, which was calculated by dividing the observed admissions by the predicted admissions, when predicted was calculated from the Pediatric Risk of Admission II score.

RESULTS. After exclusion of 3 sites that recorded race/ethnicity in <10% of patients, there were 13 sites with 8952 patients in the 3 major race/ethnicity groups. Black and Hispanic patients were similar to each other and different from white patients; therefore, these 2 groups were combined for analyses. Both crude (8.2% vs 5.3%) and severity-adjusted (standardized admission ratio: 1.71 vs 1.1) admission rates were higher in white than in nonwhite patients. Standardized admission ratios were close to 1.0 in both race/ethnicity groups in the higher quintiles of illness severity. In contrast, white patients were admitted at 1.5 to 2 times the expected rate in the lowest 2 quintiles of severity.

CONCLUSIONS. There are differences in both crude and adjusted admission rates between white and black/Hispanic patients. The results are more consistent with high rates of discretionary admissions for white patients with low illness severity than with underadmitting severely ill black or Hispanic patients.
Endothelial Function in Newborn Infants Is Related to Folate Levels and Birth Weight
Authors: Martin Helena , Lindblad Bo , Norman Mikael
Published: June 2007

OBJECTIVE. Low maternal folate levels during pregnancy correlate with low birth weight, a perinatal risk factor for later cardiovascular disease. We studied relationships between red blood cell folate levels, birth weight, and vascular endothelial function (a key factor in the early pathophysiologic processes of heart disease) in newborn infants.

METHODS. We included 82 infants (30 low birth weight) and their mothers. A laser Doppler technique was used to measure skin perfusion during transdermal iontophoresis of acetylcholine (an endothelium-dependent vasodilator). Red blood cell folate, vitamin B12, and homocysteine levels were determined.

RESULTS. The perfusion response to acetylcholine was lower in low birth weight infants than in normal birth weight control subjects (mean: 35 vs 76 perfusion units). The neonatal acetylcholine response correlated with red blood cell folate levels in both infants and their mothers. The folate levels of low birth weight and control infants did not differ significantly (mean: 1603 vs 1795 nmol/L), but mothers of low birth weight infants had lower folate levels than did mothers of control infants (mean: 805 vs 1109 nmol/L). In multivariate analysis, low birth weight and red blood cell folate levels contributed independently to endothelial function in newborn infants. The levels of vitamin B12 and homocysteine were similar in the 2 groups and did not correlate with endothelial function.

CONCLUSION. The data presented here provide the first evidence for a relationship between folate levels and vascular endothelial function in newborn infants.
Use of Sleep Medications in Hospitalized Pediatric Patients
Authors: Meltzer Lisa J. , Mindell Jodi A. , Owens Judith A. , Byars Kelly C.
Published: June 2007

OBJECTIVE. Little is known about the medications prescribed for sleep in hospitalized children. The aims of this study were to (1) determine the percentage of hospitalized children who receive medication for sleep disturbances, (2) determine what medications are prescribed for sleep difficulties, and (3) examine medical and demographic variables related to medications prescribed during hospitalization.

PATIENTS AND METHODS. A chart review was conducted for all inpatients at 3 pediatric hospitals across 26 randomly selected days in 2004. Demographic, medical, and medication data were collected on 9440 patients. The sample was 54.5% male, had a mean age of 7.0 years, and was 63% white. Almost 19% of the patients had at least 1 psychiatric diagnosis.

RESULTS. Overall, 6.0% of all hospitalized children (3% of all medically hospitalized children, excluding children with a psychiatric diagnosis) were prescribed medications for sleep, with antihistamines the most frequently prescribed medication (36.6%), followed by benzodiazepines (19.4%); hypnotic agents were the least frequently prescribed (2.2%). Significant differences were found in both the frequency of sleep-medication prescriptions and the types of medications used across hospitals, as well as for age, length of hospitalization, and service that the child was discharged from. Children with a psychiatric diagnosis were more likely to receive a sleep medication, with 22% of children on a psychiatric service receiving a sleep-related medication.

CONCLUSIONS. Approximately 3% to 6% of children are treated pharmacologically with a broad array of sleep medications in hospital settings. Prescription practices vary by hospital, medical service, child age, and diagnosis. The results from this study indicate that medications are being prescribed for sleep in hospitalized children, especially in children with psychiatric diagnoses. However, given that there are neither Food and Drug Administration–approved sleep medications for children nor clinical consensus guidelines regarding their use, clinical trials, practice guidelines, and additional research are clearly needed.
A Randomized, Controlled Trial of a Removable Brace Versus Casting in Children With Low-Risk Ankle Fractures
Authors: Boutis Kathy , Willan Andrew R. , Babyn Paul , Narayanan Unni G. , Alman Benjamin , Schuh Suzanne
Published: June 2007

OBJECTIVES. Isolated distal fibular ankle fractures in children are very common and at very low risk for future complications. Nevertheless, standard therapy for these fractures still consists of casting, a practice that carries risks, inconveniences, and use of subspecialty health care resources. Therefore, the main objective of this study was to determine whether children who have these low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.

METHODS. This was a noninferiority, randomized, single-blind trial in which children who were 5 to 18 years of age and treated in a pediatric emergency department for low-risk ankle fractures were randomly assigned to a removable ankle brace or a below-knee walking cast. The primary outcome at 4 weeks was physical function, measured by using the modified Activities Scale for Kids. Additional outcomes included patient preferences and costs.

RESULTS. The mean activity score at 4 weeks was 91.3% in the brace group (n = 54), and this was significantly higher than the mean of 85.3% in the cast group (n = 50). Significantly more children who were treated with a brace had returned to baseline activities by 4 weeks compared with those who were casted (80.8% vs 59.5%). Fifty-four percent of the casted children would have preferred the brace, but only 5.7% of children who received the brace would have preferred the cast. The cost-effectiveness acceptability curve was always >80%; therefore, the brace was cost-effective compared with the cast.

CONCLUSIONS. The removable ankle brace is more effective than the cast with respect to recovery of physical function, is associated with a faster return to baseline activities, is superior with respect to patient preferences, and is also cost-effective.
Patent Ductus Arteriosus and Its Treatment as Risk Factors for Neonatal and Neurodevelopmental Morbidity
Authors: Chorne Nancy , Leonard Carol , Piecuch Robert , Clyman Ronald I.
Published: June 2007

OBJECTIVES. The purpose of this work was to determine whether the reported association between neonatal morbidities and a patent ductus arteriosus is because of the left-to-right patent ductus arteriosus shunt itself, the therapies used to treat it, or the immaturity of the infants who are likely to develop a patent ductus arteriosus.

METHODS. A total of 446 infants (<28 weeks' gestation) were treated with the same patent ductus arteriosus care–oriented protocol, and logistic regression analysis was used to examine the effects of several patent ductus arteriosus–related variables (presence of a symptomatic patent ductus arteriosus, the number of indomethacin doses used, the ductus response to indomethacin, and the use of surgical ligation) on the incidence of retinopathy of prematurity, necrotizing enterocolitis, chronic lung disease, death, and neurodevelopmental impairment.

RESULTS. Most of the predictive effects that the presence of a patent ductus arteriosus and its treatment had on neonatal morbidity could be accounted for by the infants' immature gestation. Use of surgical ligation, however, was significantly associated with the development of chronic lung disease and was independent of immature gestation, other patent ductus arteriosus–related variables, or other perinatal and neonatal risk factors known to be associated with chronic lung disease.

CONCLUSIONS. These findings add to the growing uncertainty about the benefits and risks of surgical ligation during the neonatal period.
Immunogenicity and Safety of Intradermal Influenza Immunization at a Reduced Dose in Healthy Children
Authors: Chiu Susan S. , Peiris J.S. Malik , Chan Kwok H. , Wong Wilfred Hing Sang , Lau Yu Lung
Published: June 2007

OBJECTIVES. We conducted this study to test the hypothesis that intradermal influenza vaccination at one fifth of a standard dose elicits comparable immunogenicity to full-dose intramuscular vaccination in children.

PATIENTS AND METHODS. We conducted a randomized, open-label study in 112 healthy children aged 3 to <18 years to compare the immunogenicity and safety of intradermal vaccination at one fifth of a dose with standard intramuscular vaccination. Analyses of hemagglutination inhibition antibody titers to each antigen in each group included geometric mean titers before and 21 days after vaccination, fold increase in geometric mean titers after vaccination, seroprotection rate, and seroconversion rate.

RESULTS. The mean age of the subjects was 10.11 ± 4.04 years in the intradermal vaccination group and 10.57 ± 3.91 years in the intramuscular group. Intradermal vaccination was safe. Induration and mild erythema at the injection site were reported at 25% and 57%, respectively, in the intradermal group. Fold increase of geometric mean titers against influenza A/Caledonia was robust in both groups (11.1-fold and 12.9-fold increase in the intramuscular and intradermal groups, respectively), whereas that for B/Shandong was more modest (4.3–4.4). Both approaches elicited very high geometric mean titers against influenza A/Panama: 1360.5 and 893.9 for the intramuscular and intradermal groups, respectively, but because the prevaccination antibody titers were high, the fold increase of geometric mean titers was only 4.5 and 2.6, respectively.

CONCLUSION. The immunogenicity of one fifth of a dose of influenza vaccine delivered by the intradermal route is comparable to the standard-dose intramuscular vaccination in children as young as 3 years of age.
Relationship Between Angiotensin-Converting Enzyme Gene Insertion or Deletion Polymorphism and Insulin Sensitivity in Healthy Newborns
Authors: Han Tongyan , Wang Xinli , Cui Yunpu , Ye Hongmao , Tong Xiaomei , Piao Meihua
Published: June 2007

CONTEXT. It was proposed that the association between low birth weight and adult insulin resistance is principally genetically mediated. The insertion/deletion polymorphism of the angiotensin-converting enzyme gene was associated with insulin sensitivity in adults.

OBJECTIVE. Our goal was to investigate the relationship between angiotensin-converting enzyme gene insertion/deletion polymorphism and the insulin sensitivity in healthy newborns.

PATIENTS AND METHODS. One hundred eighty healthy newborns, all of whom had a 1-minute Apgar score of >7 and gestational age >33 weeks, were enrolled in the study. Fasting glucose and insulin levels were measured on day 2 or 3 after birth, and angiotensin-converting enzyme genotype was determined.

RESULTS. The observed frequency distribution of angiotensin-converting enzyme genotypes did not deviate from that predicted by Hardy-Weinberg equilibrium in this group. There were no statistically significant differences in birth size and shape in different angiotensin-converting enzyme genotypes. Those carriers of the genotype homozygous for the deletion allele had the highest logarithmically transformed homeostasis model assessment compared with those who were heterozygous or homozygous for the insertion polymorphism. When compared with those with ≥1 insertion allele, those of the genotype homozygous for the deletion allele had significantly higher logarithmically transformed fasting insulin and logarithmically transformed homeostasis model assessment results. Regarding birth weight, birth length, ponderal index, and fasting glucose concentration, there were no significant differences between the genotype homozygous for the deletion allele and the genotypes heterozygous or homozygous for the insertion allele.

CONCLUSIONS. In this study, the deletion allele was associated with relatively impaired insulin sensitivity in healthy neonates. It may be a clue to explain the association between the deletion allele and insulin resistance in the long-term.