bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic Activity of Inhaled Steroids in 1- to 3-Year-Old Children With Asthma
Authors: Anhøj Jacob , Bisgaard Anne Marie , Bisgaard Hans
Published: August 2004

Objective. To study the systemic activity of inhaled steroids in young children.

Methods. Forty children with mild asthma aged 1 to 3 years were studied in a 3-way crossover, randomized, placebo-controlled, double-blind trial. Treatment with inhaled fluticasone propionate, 200 μg twice daily delivered via pressurized metered-dose inhaler (pMDI) and Babyhaler (FP400), was compared with budesonide, 200 μg twice daily delivered via pMDI and NebuChamber (BUD400), and to placebo. The Babyhaler was primed before use. Knemometry was used to detect systemic steroid activity. It was performed with a hand-held knemometer after 1 and 4 weeks of treatment. The increase in lower-leg length within this 3-week period was used as the outcome measure. The intention-to-treat population was analyzed by analysis of variance.

Results. The increases in the lower-leg length during placebo, BUD400, and FP400 treatments were 85, 45, and 34 μm/d, respectively (adjusted mean). The growth in lower-leg length was significantly reduced from both steroid treatments. The difference between BUD400 and placebo was −40 μm/d (n = 25; 95% confidence interval [CI]: −8 to −72). The difference between FP400 and placebo was −51 μm/d (n = 26; 95% CI: −19 to −83). The difference between FP and BUD was −11 μm/d and was not statistically significant (n = 28; 95% CI: 20 to −42).

Conclusion. FP and BUD are both systemically active in children 1 to 3 years old when administered for 4 weeks from their dedicated spacer devices in daily doses of 400 μg with no difference between the 2 steroid regimens. These findings call for studies of clinical side effects from these treatments of preschool children.
Poisoning From a Dietary Supplement Administered During Hospitalization
Authors: Boyer Edward W. , Kearney Susan , Shannon Michael W. , Quang Lawrence , Woolf Alan , Kemper Kathi
Published: August 2004

Increasing numbers of persons use dietary supplements (DS). Patients who believe in the effectiveness of DS may continue to take them on admission to a health care facility. We present the case of a child who received a DS on a daily basis as an outpatient, continued its use after admission to the hospital, and became poisoned by it during his hospitalization.
Epidemiology of Pediatric Injury—Related Primary Care Office Visits in the United States
Authors: Hambidge Simon J. , Davidson Arthur J. , Gonzales Ralph , Steiner John F.
Published: August 2004

Objectives. Unintentional injuries are a major cause of childhood mortality and morbidity in the United States. However, there is little epidemiologic information about pediatric injuries seen in primary care settings. The objective of this study was to characterize types and external causes of childhood injuries seen by primary care physicians and to compare the demographic and visit characteristics of children with injury-related visits (IRVs) and non-IRVs.

Methods. A stratified random sample survey of office-based practicing physicians in the National Ambulatory Medical Care Survey (1997 and 1998) was conducted. Injury-related primary care office visits were measured for patients who were <19 years (number of patient visits = 6358).

Results. Visits for childhood injuries composed >10 million primary care office visits per year (a rate of 13.8 visits per 100 person-years). The most common diagnoses assigned to these injuries were open wounds, sprains and strains, contusions, and superficial injuries such as abrasions and splinters. Leading external causes of these injuries were sports and overexertion, accidental falls, natural factors such as bites and stings, and cutting instruments. The single most common cause of pediatric injuries was sports/overexertion. Children who had IRVs were more likely to be older (odds ratio [OR]: 1.10/year of age; 95% confidence interval [CI]: 1.08–1.12), to be male (OR: 1.5; 95% CI: 1.2–1.9), and to reside in the West (OR: 1.9; 95% CI: 1.4–2.6) or in a rural area (OR: 1.4; 95% CI: 1.1–1.9). They were less likely to be Asian (OR: 0.2; 95% CI: 0.1–0.5) or Hispanic (OR: 0.5; 95% CI: 0.3–0.8). At the visit, children with IRVs were more likely to see a physician who was not their primary care physician (OR: 1.8; 95% CI: 1.4–2.3) and to see a family physician rather than a pediatrician (OR: 2.3; 95% CI: 1.8–2.9).

Conclusions. IRVs account for a significant portion of primary care for children in the United States. Identifying potentially preventable external causes of injury and characteristics of children who are more likely to be injured is important both for injury prevention programs and for the education of physicians who care for children.
Behavior and Development of Preschool Children Born to Adolescent Mothers: Risk and 3-Generation Households
Authors: Black Maureen M. , Papas Mia A. , Hussey Jon M. , Hunter Wanda , Dubowitz Howard , Kotch Jonathan B. , English Diana , Schneider Mary
Published: August 2004

Objective. To investigate whether living in a 3-generation household (grandmother-mother-child) is associated with fewer behavior problems and better cognitive development among preschool children of mothers who gave birth during adolescence and whether it protects children from the behavior and developmental problems associated with maltreatment and maternal depression.

Design. Cohort study.

Setting. Participants included low-income families recruited from 4 sites: East, Northwest, Midwest, and South, who are part of LONGSCAN, a longitudinal study of children’s health, development, and maltreatment.

Participants. One hundred ninety-four mothers who were adolescents (less than age 19) at delivery. Data were gathered when children were 4 to 5 years of age. Twenty-six percent of the children lived in 3-generation households, 39% had a history of maltreatment, and 32% of the mothers had depression scores in the clinical range.

Main Outcome Measures. Child behavioral problems were measured with the Child Behavior Checklist, completed by the mother, and child developmental status was assessed with the Battelle Developmental Inventory Screening Test, administered by research assistants.

Results. Multiple regression analyses revealed that children who had been reported for maltreatment and had mothers with depressive symptoms had more externalizing behavior problems, compared with children who experienced neither risk or only 1 risk. However, when residential status was considered, children with the greatest number of externalizing behavior problems were those who experienced both maltreatment and maternal depressive symptoms and lived in 3-generation households. Children who had been reported for maltreatment or had mothers with depressive symptoms were more likely to have internalizing problems, compared with children with neither risk. Residential status was not related to children’s internalizing behavior problems or cognitive development.

Conclusions. Living in a 3-generation household did not protect preschool children from the behavior problems associated with maltreatment and depression. In contrast, living in a 3-generation household was associated with more behavior problems among the highest risk group of children—those who had been maltreated and had mothers with symptoms of depression. Although 3-generation families may provide an important source of support and stability for adolescent mothers and their infants early in the parenting process, it may not be advisable to rely on 3-generation households as young mothers enter adulthood, particularly among those with a history of maltreatment or depression. Children with the fewest number of behavior problems were living with their mothers in their own household (often with the father), had not been maltreated, and had mothers with few symptoms of depression.
Self-Esteem as a Predictor of Initiation of Coitus in Early Adolescents
Authors: Spencer Jennifer M. , Zimet Gregory D. , Aalsma Matthew C. , Orr Donald P.
Published: August 2004

Objective. To examine the role of self-esteem in predicting coitus initiation in a population of early adolescents.

Methods. Questionnaires assessing coital status, self-esteem, and pubertal maturation were collected from 188 participants who had not engaged in coitus by enrollment. Data were collected longitudinally while the participants were in the seventh and ninth grade. Ages ranged from 12 to 14 (mean: 12.50; standard deviation: 0.57) at Time 1 and from 14 to 16 (mean: 14.30; standard deviation: 0.49) at Time 2.

Results. Boys with higher self-esteem ratings at Time 1 were more likely to initiate intercourse by Time 2. Girls with higher self-esteem at Time 1 were more likely to remain virgins than girls with lower self-esteem. Pubertal status was unrelated to initiation of coitus in this sample.

Conclusions. Self-esteem, regardless of pubertal status, predicted coitus transition differentially in boys and girls. Results from this longitudinal study seem to fit within traditional problem behavior theory.
Household Composition and Risk of Fatal Child Maltreatment
Authors: Stiffman Michael N. , Schnitzer Patricia G. , Adam Patricia , Kruse Robin L. , Ewigman Bernard G.
Published: August 2004

Objective. Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment.

Methodology. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992–1994. Households were categorized based on adult residents’ relationship to the deceased child. Cases were all maltreatment injury deaths among children <5 years old. Controls were randomly selected from natural-cause deaths during the same period and frequency-matched to cases on age. The main outcome measure was maltreatment death.

Results. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6–21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6–12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1–4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8–2.0).

Conclusions. Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home.
Placental Features in Preterm Infants With Periventricular Leukomalacia
Authors: Kumazaki Kaori , Nakayama Masahiro , Sumida Yutaka , Ozono Keiichi , Mushiake Sotaro , Suehara Noriyuki , Wada Yoshinao , Fujimura Masanori
Published: August 2004

Objective. Evaluation of the placenta provides some important insights into pathophysiologic changes that take place during the prenatal and intrapartum process. We investigated the relationship between placental findings and periventricular leukomalacia (PVL) to obtain a better understanding of its cause.

Methods. Thirty-two preterm infants with PVL delivered before 34 weeks’ gestation, between 1990 and 1999, were classified into 4 groups according to the onset of brain injury assumed from ultrasonographic presentation and clinical course: 2 Antenatal, 22 Peripartum, 5 Postnatal, and 3 in an unknown time of onset group. We evaluated the gross and histopathologic features of the placentas of each group and compared them with those of a control group matched by birth weight and gestational age in terms of the frequency of major placental findings. Potential confounding factors were controlled in logistic regression analyses.

Results. Gross lesions with disturbance of uteroplacental circulation, including massive retroplacental hematoma, extensive infarction or thrombosis, and marked basal or perivillous fibrin deposition, were observed more frequently in the Antenatal + Peripartum combined subgroup than in the controls (41.7% vs 13.7%). Placentas from the Antenatal + Peripartum subgroup also demonstrated a significantly higher frequency of ischemic changes in villi, based on histopathologic examination, as compared with the control group (54.2% vs 13.7%). These associations remained after adjustment for confounding factors in logistic regression analyses (odds ratio: 4.04, 95% confidence interval: 1.40–11.67; and odds ratio: 7.28, 95% confidence interval: 2.50–21.20; respectively). Frequencies of chorioamnionitis and twin placentation tended to be higher in PVL cases than in the controls, although the differences were not statistically significant (46.9% vs 37.9%, 37.5% vs 20.0%, respectively).

Conclusions. These results suggest that disturbed placental circulation underlies the development of PVL in the majority of cases with prenatal and peripartum brain injury. In chorioamnionitis cases, certain additional factors were suggested in the genesis of PVL. Thus, placental examination is essential for elucidating the pathophysiologic changes leading to PVL in the perinatal process.
Poor Readability of Written Asthma Management Plans Found in National Guidelines
Authors: Forbis Shalini G. , Aligne C. Andrew
Published: August 2004

Objective. Written asthma management plans (WAMPs) for patients constitute a key component of current national asthma guidelines, but it is not known whether these plans meet the readability standards (of fifth-grade level or lower) recommended by health education experts. The objective of this study was to assess whether WAMPs presented in national guidelines are written at or below a fifth-grade reading level.

Methods. We used readability software to analyze 10 WAMPs. These included 7 from the national guidelines, 1 from the World Health Organization, and 2 local ones.

Results. The grade levels for the WAMPs ranged from 4.9 to 9.2. None of the national plans achieved a grade level equal to or below the fifth grade. However, the other plans had grade levels of 4.9, 5.7, and 5.9. The mean grade level for the national plans was 8.1, whereas the mean for the other 3 plans was 5.5. The difference between these 2 sets of WAMPs was significant.

Conclusion. WAMPs presented as part of the national guidelines are not written at or below a fifth-grade reading level. However, it is clear from this study that it is possible to achieve this level of readability. Increasing the availability and use of plans that meet recognized readability standards may help to improve asthma outcomes, especially in poor populations in which there is both low literacy and the greatest prevalence and severity of asthma.
Survival With Hypopituitarism From Congenital Syphilis
Authors: Nolt Dawn , Saad Rola , Kouatli Amjad , Moritz Michael L. , Menon Ram K. , Michaels Marian G.
Published: August 2004

Congenital syphilis continues to occur despite the advances in testing of pregnant women in many countries and the availability of penicillin since 1943. This is a report of a child with multiple systemic manifestations of congenital syphilis. This is one of the few cases of survival with pituitary involvement from congenital syphilis and the first noted case in which diabetes insipidus developed. Institution of routine testing in all countries might have prevented the severe manifestations of syphilis seen in this child.
Resistance to Recombinant Human Granulocyte Colony-Stimulating Factor in Neonatal Alloimmune Neutropenia Associated With Anti-Human Neutrophil Antigen-2a (NB1) Antibodies
Authors: Maheshwari Akhil , Christensen Robert D. , Calhoun Darlene A.
Published: August 2004

Neonatal alloimmune neutropenia is the neutrophil counterpart of the erythrocyte disorder of hemolytic disease of the newborn. Fetal neutrophil antigens, which are inherited from the father but foreign to the pregnant mother, provoke the formation of maternal antibodies, which, on transplacental passage, cause fetal/neonatal neutropenia. Because infants with this disorder are at a higher risk of infection, recombinant hematopoietic growth factors, such as recombinant human granulocyte colony-stimulating factor, have been tried, with generally good results, to treat those with severe and prolonged neutropenia. We report a neonate who had neonatal alloimmune neutropenia associated with antibodies directed against human neutrophil antigen-2a (NB1) and initially failed to respond to even very high doses of recombinant human granulocyte colony-stimulating factor but eventually had a therapeutic response.
Treatment of Plastic Bronchitis in a Fontan Patient With Tissue Plasminogen Activator: A Case Report and Review of the Literature
Authors: Costello John M. , Steinhorn David , McColley Susanna , Gerber Mark E. , Kumar Sulekha P.
Published: August 2004

Plastic bronchitis is a condition in which large, bronchial casts with rubber-like consistency develop in the tracheobronchial tree and cause airway obstruction. We describe a 4-year-old girl who had Fontan physiology and who developed plastic bronchitis and report for the first time the use of aerosolized tissue plasminogen activator for treatment of this condition. The literature is reviewed with emphasis placed on the occurrence of this disorder in patients with single ventricle physiology.
The Psychological Maltreatment of Children—Technical Report
Authors: Kairys Steven W. , Johnson Charles F. ,   Committee on Child Abuse and Neglect
Published: August 2004

Psychological maltreatment is a common consequence of physical and sexual abuse but also may occur as a distinct entity. Until recently, there has been controversy regarding the definition and consequences of psychological maltreatment. Sufficient research and consensus now exist about the incidence, definition, risk factors, and consequences of psychological maltreatment to bring this form of child maltreatment to the attention of pediatricians. This technical report provides practicing pediatricians with definitions and risk factors for psychological maltreatment and details how pediatricians can prevent, recognize, and report psychological maltreatment. Contemporary references and resources are provided for pediatricians and parents
Psychotropic Medication Use in a Population of Children Who Have Attention-Deficit/Hyperactivity Disorder
Authors: Guevara James , Lozano Paula , Wickizer Thomas , Mell Loren , Gephart Harlan
Published: August 2004

Objective. Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders.

Methods. A population-based retrospective matched cohort study was conducted of a large group model health maintenance organization located in western Washington State. Eligible patients were children who were ages 3 to 17 years and were continuously enrolled and used services from January 1 to December 31, 1997 (N = 57 216). Children with ADHD were identified by a diagnosis of ADHD or a pharmacy fill for a stimulant medication using automated patient files. Children without ADHD were randomly selected and matched 4:1 to children with ADHD on age and gender. Neurobehavioral disorders and pharmacy fills for psychotropic medications were measured.

Results. During 1997, 2992 children were identified as having ADHD (5.2%). These children were more likely to have a diagnosis of a non-ADHD neurobehavioral disorders (adjusted odds ratio: 6.3; 95% confidence interval: 5.4–7.3) than children without ADHD. Although most (78%) were treated with stimulant medications, children who were identified as having ADHD were also more likely to receive pharmacy fills for nonstimulant medications than were children without ADHD. Nonstimulant medications were more often used along with stimulant medications and were frequently prescribed in association with ADHD after controlling for other disorders.

Conclusions. Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed.
Reduced Risk of Sudden Death From Chest Wall Blows (Commotio Cordis) With Safety Baseballs
Authors: Link Mark S. , Maron Barry J. , Wang Paul J. , Pandian Natesa G. , VanderBrink Brian A. , Estes N. A. Mark
Published: August 2004

Objectives. In an experimental model of sudden death from baseball chest wall impact (commotio cordis), we sought to determine if sudden death by baseball impact could be reduced with safety baseballs.

Background. Sudden cardiac death can occur after chest wall impact with a baseball (commotio cordis). Whether softer-than-standard (safety) baseballs reduce the risk of sudden death is unresolved from the available human data. In a juvenile swine model, ventricular fibrillation (VF) has been shown to be induced reproducibly by precordial impact with a 30-mph baseball 10 to 30 ms before the T-wave peak, and this likelihood was reduced with the softest safety baseballs (T-balls). To further test whether safety baseballs would reduce the risk of sudden death at velocities more relevant to youth sports competition, we used our swine model of commotio cordis to test baseballs propelled at the 40-mph velocity commonly attained in that sport.

Methods. Forty animals received up to 3 chest wall impacts at 40 mph during the vulnerable period of repolarization for VF with 1 of 3 different safety baseballs of varying hardness, and also by a standard baseball.

Results. Safety baseballs propelled at 40 mph significantly reduced the risk for VF. The softest safety baseballs triggered VF in only 11% of impacts, compared with 19% and 22% with safety baseballs of intermediate hardness, and 69% with standard baseballs.

Conclusion. In this experimental model of low-energy chest wall impact, safety baseballs reduced (but did not abolish) the risk of sudden cardiac death. More universal use of these safety baseballs may decrease the risk of sudden death on the playing field for young athletes.
Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation
Authors: Fleenor Jonathan T. , Hoffman Timothy M. , Bush David M. , Paridon Stephen M. , Clark Bernard J. , Spray Thomas L. , Bridges Nancy D.
Published: August 2004

Objective. To review and describe pneumatosis intestinalis (PI) in children who have undergone thoracic organ transplantation and evaluate potential risk factors.

Methods. We retrospectively reviewed abdominal radiographs obtained from June 1992 through September 2000 in all pediatric (age <21 years) thoracic organ recipients who survived at least 1 week after transplantation. In this group, a case was defined as an episode of radiographically confirmed PI; those without PI were assigned as controls. Variables analyzed included demographic data, gastroenteritis history (stool cultures or symptoms of gastroenteritis), and transplant-related factors (ie, graft type, rejection history, immunosuppression regimen). Significance was defined as P < .05.

Results. Over this 8-year period, PI occurred in 8 (7%) of 116 patients (0.86% annual risk). No child had >1 diagnosed episode of PI. Of these 8 cases, 7 presented with 1 or more abdominal symptoms. Three of these children had rotavirus antigen isolated in their stool, 2 others were noted to have stool positive for Clostridium difficile toxin, and in the other 3, no pathogen was identified. All cases were treated with a regimen of intravenous antibiotics and total parenteral nutrition. There were no deaths; however, 1 patient developed an Aspergillus pulmonary infection during his course of antibiotic therapy, and another underwent an exploratory laparotomy without bowel resection. Significant risk factors included black race (unadjusted odds ratio: 16), younger age at presentation (age <5 years; unadjusted odds ratio: 9), higher steroid dose (steroid dose >0.5 mg/kg/d; unadjusted odds ratio: 7), and a higher tacrolimus level at presentation (tacrolimus level >1; unadjusted odds ratio: 6). PI did not occur with a steroid dose <0.4 mg/kg/d. Variables not associated with increased risk for developing PI included gender, graft type, total white blood cell count, recent antibiotic use, concurrent use of an antimetabolite, cytomegaloviral infection, past use of extracorporeal membrane oxygenation, and graft rejection history.

Conclusions. Significant risk factors for the development of PI in our pediatric thoracic organ transplantation population included black race, younger age, higher daily steroid dosing, and a high tacrolimus level at presentation. In the children diagnosed with PI, there were no related deaths, significant gastrointestinal sequelae, or complications. These findings suggest that in this population, PI will often have a benign course when treated aggressively, and that steroid dosing should be reduced to <0.5 mg/kg/d whenever possible.
Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979–1999
Authors: Wang Guijing , Dietz William H.
Published: August 2004

Objective. To examine the trend of obesity-associated diseases in youths and related economic costs.

Methods. Using a multiyear data file of the National Hospital Discharge Survey, 1979–1999, we analyzed the changes in obesity-associated diseases and economic costs in youths (6–17 years of age) over time. Diabetes, obesity, sleep apnea, and gallbladder disease were examined to explore the trend of the disease burden. Other obesity-associated diseases for which obesity was listed as a secondary diagnosis were also analyzed. Obesity-associated hospital costs were estimated from the discharges with obesity listed as a principal or secondary diagnosis.

Results. From 1979–1981 to 1997–1999, the percentage of discharges with obesity-associated diseases increased. The discharges of diabetes nearly doubled (from 1.43% to 2.36%), obesity and gallbladder diseases tripled (0.36% to 1.07% and 0.18% to 0.59%, respectively), and sleep apnea increased fivefold (0.14% to 0.75%). Ninety-six percent of discharges with a diagnosis of obesity listed obesity as a secondary diagnosis. Asthma and some mental disorders were the most common principal diagnoses when obesity was listed as a secondary diagnosis. Obesity-associated annual hospital costs (based on 2001 constant US dollar value) increased more than threefold; from $35 million (0.43% of total hospital costs) during 1979–1981 to $127 million (1.70% of total hospital costs) during 1997–1999.

Conclusions. Among all hospital discharges, the proportion of discharges with obesity-associated diseases has increased dramatically in the past 20 years. This increase has led to a significant growth in economic costs. These findings may reflect the impact of increasing prevalence and severity of obesity. Diet and physical activity interventions should be developed for weight loss and prevention of weight gain in youths.
Pediatrician Counseling About Preventive Health Topics: Results From the Physicians’ Practices Survey, 1998–1999
Authors: Galuska Deborah A. , Fulton Janet E. , Powell Kenneth E. , Burgeson Charlene R. , Pratt Michael , Elster Arthur , Griesemer Bernard A.
Published: August 2004

Objective. Government agencies and national organizations recommend that physicians counsel their child and adolescent patients about preventive health topics. Using data from a national survey, we describe the counseling patterns of pediatricians in regard to 9 recommended preventive health topics.

Methodology. Between October 1998 and April 1999, information was collected from 907 of 1760 primary care pediatricians randomly selected from a nationally representative sample. Through either a telephone interview or a mail survey, pediatricians were asked how frequently in the past month they counseled about 9 preventive health topics during the well-care visits or routine check-ups of their patients. Pediatricians answered questions regarding their patients aged 2 to 5, 6 to 12, and 13 to 18 years.

Results. Over 80% of the pediatricians counseled about 1 or more recommended preventive health topics during the well-care visits or routine check-ups of their patients. As compared with pediatricians who did not counsel about any topic, pediatricians who counseled were significantly more likely to be female and spend longer amounts of time with their patients during these visits. The frequency with which specific preventive health topics were discussed varied with the topic and the age of the patient.

Conclusion. Most pediatricians routinely counsel about some, but not all, recommended preventive health topics. An understanding of why pediatricians selectively counsel about specific topics is needed.
Use of Sunscreen, Sunburning Rates, and Tanning Bed Use Among More Than 10 000 US Children and Adolescents
Authors: Geller Alan C. , Colditz Graham , Oliveria Susan , Emmons Karen , Jorgensen Cynthia , Aweh Gideon N. , Frazier A. Lindsay
Published: August 2004

Objectives. To describe the association of sunscreen use, sunburning, and tanning bed use by age, sex, residence, and psychosocial variables associated with tan-seeking behaviors, and to compare these findings with sun protection recommendations from federal agencies and cancer organizations.

Methods. A cross-sectional study, from all 50 states, of 10 079 boys and girls 12 to 18 years of age in 1999. Data were collected from self-report questionnaires with the children of the participants from the Nurses Health Study (Growing Up Today Study).

Results. The prevalence of sunscreen use was 34.4% with girls more likely to use sunscreen than boys (40.0 vs 26.4, odds ratio: 1.86; 95% confidence interval: 1.70–2.03). Eighty-three percent of respondents had at least 1 sunburn during the previous summer, and 36% had 3 or more sunburns. Nearly 10% of respondents used a tanning bed during the previous year. Girls were far more likely than boys to report tanning bed use (14.4 vs 2.4), and older girls (ages 15–18) were far more likely than younger girls (ages 12–14) to report tanning bed use (24.6% vs 4.7). Tanning bed use increased from 7% among 14-year-old girls to 16% by age 15, and more than doubled again by age 17 (35%; N = 244). Multivariate analysis demonstrated that attitudes associated with tanning, such as the preference for tanned skin, having many friends who were tanned, and belief in the worth of burning to get a tan, were generally associated with sporadic sunscreen use, more frequent sunburns, and increased use of tanning beds.

Conclusions. Our findings suggest that many children are at subsequent risk of skin cancer because of suboptimal sunscreen use, high rates of sunburning, and tanning bed use. Recommendations in the United States for improved sun protection and avoidance of tanning beds and sunburning, which began in the early 1990s, have been primarily unheeded. Nationally coordinated campaigns with strong policy components must be developed and sustained to prevent skin cancer in a new generation of children and adolescents.
Tattoos and Body Piercings as Indicators of Adolescent Risk-Taking Behaviors
Authors: Carroll Sean T. , Riffenburgh Robert H. , Roberts Timothy A. , Myhre Elizabeth B.
Published: August 2004

Purpose. This study assessed tattoos and body piercings as markers of risk-taking behaviors in adolescents.

Methods. A 58-question survey, based on the 1997 Centers for Disease Control and Prevention Youth Risk Behavior Survey, was offered to all adolescent beneficiaries that came to the Adolescent Clinic. The survey contained standard Youth Risk Behavior Survey questions that inquire about eating behavior, violence, drug abuse, sexual behavior, and suicide. Questions about tattoos and body piercings were added for the purposes of this study.

Results. Participants with tattoos and/or body piercings were more likely to have engaged in risk-taking behaviors and at greater degrees of involvement than those without either. These included disordered eating behavior, gateway drug use, hard drug use, sexual activity, and suicide. Violence was associated with males having tattoos and with females having body piercings. Gateway drug use was associated with younger age of both tattooing and body piercing. Hard drug use was associated with number of body piercings. Suicide was associated with females having tattoos and younger age of both tattooing and body piercing. Tattoos and body piercings were found to be more common in females than males.

Conclusions. Tattoos and/or body piercings can alert practitioners to the possibility of other risk-taking behaviors in adolescents, leading to preventive measures, including counseling. Tattoo and body piercing discovery should be an important part of a health maintenance visit to best direct adolescent medical care.
Television Viewing and Television in Bedroom Associated With Overweight Risk Among Low-Income Preschool Children
Authors: Dennison Barbara A. , Erb Tara A. , Jenkins Paul L.
Published: August 2004

Context. Television (TV) viewing is associated with obesity among school-aged children, adolescents, and adults, but this relationship has not been evaluated in preschool-aged children.

Objective. To describe the TV/video viewing habits of a multiethnic, low-income preschool population of children and to determine whether TV/video viewing is related to their adiposity.

Design. Cross-sectional survey of parents/guardians with measurements of children’s height and weight.

Setting and Participants. Two thousand seven hundred sixty-one adults with children, 1 through <5 years, from 49 New York State agencies of the Supplemental Nutrition Program for Women, Infants, and Children.

Outcome Measures. Cross-sectional relationships between the amount of time the child spends viewing TV/video and the presence of a TV set in the child’s bedroom, with the prevalence of overweight children (body mass index [BMI] >85th percentile) after adjustment for potential confounders.

Results. Mean TV/video viewing times were higher among black children and Hispanic children than white children and increased with the child’s age. In multiple logistic regression, the odds ratio of children having a BMI >85th percentile was 1.06 (95% confidence interval [CI]: 1.004–1.11) for each additional hour per day of TV/video viewed, independent of child age, child sex, parental educational attainment, and race/ethnicity. Almost 40% of children had a TV set in their bedroom; they were more likely to be overweight and spent more time (4.6 hours per week) watching TV/video than children without a TV in their bedroom. In multiple logistic regression, the odds ratio of having a BMI >85th percentile was 1.31 (95% CI: 1.01–1.69) among those with a TV in their bedroom versus those without a TV, after statistical adjustment for child age, child sex, child TV/video viewing hours per week, maternal BMI, maternal education, and race/ethnicity.

Conclusions. This study extends the association between TV viewing and risk of being overweight to younger, preschool-aged children. A TV in the child’s bedroom is an even stronger marker of increased risk of being overweight. Because most children watch TV by age 2, educational efforts about limiting child TV/video viewing and keeping the TV out of the child’s bedroom need to begin before then.
Randomized Trial of Postpartum Care After Hospital Discharge
Authors: Gagnon Anita J. , Dougherty Geoffrey , Jimenez Vania , Leduc Nicole
Published: August 2004

Objective. Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants. These may be prevented by adequate breastfeeding frequency; however, rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent. This study addressed the question, “Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours’ postpartum who received either community nurse (home visit) or hospital nurse (clinic) follow-up?”

Methods. A randomized, controlled trial was conducted at a university teaching hospital (3700 births/y) and affiliated community health centers. A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge; 513 (87.5%) contributed data on 1 or more outcomes. Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home (experimental) or at the hospital (control) were provided. The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks’ postpartum by maternal diary and weight at home by research assistants, masked to group allocation.

Results. No clinically important or statistically significant group differences were found in daily breastfeeding frequency (mean difference experimental minus control = 0.1 feeds [95% confidence interval: −0.1–0.3]) or daily rate of infant weight gain (−1.1 g [−2.5–0.3]) based on intention-to-treat analyses.

Conclusions. Follow-up by nurses after short postpartum hospital stays, in either the home or a hospital-based clinic, of healthy infants discharged at <36 hours seems associated with satisfactory infant breastfeeding outcomes.
A Multicenter, Randomized, Controlled Trial Comparing Surfaxin (Lucinactant) Lavage With Standard Care for Treatment of Meconium Aspiration Syndrome
Authors: Wiswell Thomas E. , Knight Gail R. , Finer Neil N. , Donn Steven M. , Desai Hemant , Walsh William F. , Sekar Krishnamurthy C. , Bernstein Graham , Keszler Martin , Visser Valya E. , Merritt T. Allen , Mannino Frank L. , Mastrioianni Lisa , Marcy Brian , Revak Susan D. , Tsai Huei , Cochrane Charles G.
Published: August 2004

Objective. Infants with meconium aspiration syndrome (MAS) have marked surfactant dysfunction. Airways and alveoli of affected neonates contain meconium, inflammatory cells, inflammatory mediators, edema fluid, protein, and other debris. The objective of this study was to compare treatment with bronchoalveolar lavage using dilute Surfaxin with standard therapy in a population of newborn infants with MAS.

Methods. Inclusion criteria were 1) gestational age ≥35 weeks, 2) enrollment within 72 hours of birth, 3) diagnosis of MAS, 4) need for mechanical ventilation, and 5) an oxygenation index ≥8 and ≤25. Subjects were randomized to either lavage with Surfaxin or standard care (2:1 proportion). In lavaged infants, a volume of 8 mL/kg dilute Surfaxin (2.5 mg/mL) was instilled into each lung over approximately 20 seconds followed by suctioning after 5 ventilator breaths. The procedure was repeated twice. The third and final lavage was with a more concentrated solution (10 mg/mL) of Surfaxin.

Results. Twenty-two infants were enrolled (15 Surfaxin and 7 control). Demographic characteristics were similar. There were trends (not significant) for Surfaxin-lavaged infants to be weaned from mechanical ventilation earlier (mean of 6.3 vs 9.9 days, respectively), as well as to have a more rapid decline in their oxygenation indexes compared with control infants, the latter difference persisting for the 96-hour-long study period. The therapy was safe and generally well tolerated by the infants.

Conclusions. Dilute Surfaxin lavage seems to be a safe and potentially effective therapy in the treatment of MAS. Data from this investigation support future prospective, controlled clinical trials of bronchoalveolar lavage with Surfaxin in neonates with MAS.
Youth Access Interventions Do Not Affect Youth Smoking
Authors: Fichtenberg Caroline M. , Glantz Stanton A.
Published: August 2004

Objective. To determine the effectiveness of laws restricting youth access to cigarettes on prevalence of smoking among teens.

Methods. We conducted a systematic review of studies that reported changes in smoking associated with the presence of restrictions on the ability of teens to purchase cigarettes. We calculated the correlation between merchant compliance levels with youth access laws and prevalence (30-day and regular) prevalence of youth smoking, and between changes in compliance and prevalence associated with youth access interventions. We also conducted a random effects meta-analysis to determine the change in youth prevalence associated with youth access interventions from studies that included control communities.

Results. Based on data from 9 studies, there was no detectable relationship between the level of merchant compliance and 30-day (r = .116; n = 38 communities) or regular (r = .017) smoking prevalence. There was no evidence of a threshold effect. There was no evidence that an increase in compliance with youth access restrictions was associated with a decrease in 30-day (r = .294; n = 18 communities) or regular (r = .274) smoking prevalence. There was no significant difference in youth smoking in communities with youth access interventions compared with control communities; the pooled estimate of the effect of intervention on 30-day prevalence was −1.5% (95% confidence interval: −6.0% to +2.9%).

Conclusions. Given the limited resources available for tobacco control, as well as the expense of conducting youth access programs, tobacco control advocates should abandon this strategy and devote the limited resources that are available for tobacco control toward other interventions with proven effectiveness.
The Prevalence of Pain in Pediatric Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome as Reported by Participants in the Pediatric Late Outcomes Study (PACTG 219)
Authors: Gaughan Denise M. , Hughes Michael D. , Seage George R. , Selwyn Peter A. , Carey Vincent J. , Gortmaker Steven L. , Oleske James M. ,   PACTG 219 Team
Published: August 2004

Objectives. As the life expectancy of children with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increases, quality-of-life outcomes are of increasing concern. The prevalence of pain in adults with AIDS ranges from 40% to 60%, depending on stage of illness. There is limited research concerning pain in HIV-infected children and youth.

Design. The General Health Assessment for Children was administered to caregivers of HIV-infected children and youth enrolled in the Pediatric Late Outcomes Study (PACTG 219), a prospective cohort study. Pain is assessed over the previous month with 7 questions. For the purpose of this analysis, we defined pain as the presence of pain of at least moderate intensity. Participants were observed from January 1, 1996, to December 31, 1999.

Results. A total of 985 HIV-positive participants had a baseline pain evaluation in 1995. The prevalence of pain remained relatively constant during each year of observation, averaging 20%. Lower CD4+ T-lymphocyte percentage, female gender, and an HIV/AIDS-related diagnosis were highly associated with an increased risk of reported pain. Pain was also independently associated with increased risk of death. After adjusting for CD4 percentage, use of combination therapy including protease inhibitors, comorbid diagnoses, and other sociodemographic characteristics, individuals reporting pain were over 5 times more likely to die than those not reporting pain (hazard ratio = 5.07; 95% confidence interval = 3.23–7.95).

Conclusions. Pain is a frequently encountered symptom in children and youth with HIV disease and is also associated with increased mortality. These findings emphasize the importance of pain management in this population.
Pediatric Residents’ Clinical Diagnostic Accuracy of Otitis Media
Authors: Steinbach William J. , Sectish Theodore C. , Benjamin Daniel K. , Chang Kay W. , Messner Anna H.
Published: August 2004

Objective. Pediatric resident physicians’ clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry.

Methods. Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used κ statistics to calculate correlation of clinical findings and interpretation.

Results. A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a κ statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (κ statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (κ statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a κ statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a κ statistic of 0.32 (fair agreement).

Conclusions. Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.
Osteopetrosis, Lymphedema, Anhidrotic Ectodermal Dysplasia, and Immunodeficiency in a Boy and Incontinentia Pigmenti in His Mother
Authors: Dupuis-Girod Sophie , Corradini Nadège , Hadj-Rabia Smail , Fournet Jean-Christophe , Faivre Laurence , Le Deist Françoise , Durand Philippe , Döffinger Rainer , Smahi Asma , Israel Alain , Courtois Gilles , Brousse Nicole , Blanche Stéphane , Munnich Arnold , Fischer Alain , Casanova Jean-Laurent , Bodemer Christine
Published: August 2004

A child with X-linked osteopetrosis, lymphedema, anhidrotic ectodermal dysplasia, and immunodeficiency (OL-EDA-ID) was recently reported. We report the clinical features of a second boy with this novel syndrome and his mother, who presented with signs of incontinentia pigmenti (IP). The child had mild osteopetrosis without neurosensory complications, unilateral lymphedema of the left leg, and characteristic features of anhidrotic ectodermal dysplasia with sparse hair, facial dysmorphy, delayed eruption of teeth, and sweat gland abnormalities. He died at 18 months of severe immunodeficiency with multiple infections caused by Gram-negative (Salmonella enteritidis) and Gram-positive (Streptococcus pneumoniae) bacteria, nontuberculous mycobacteria (Mycobacterium kansasii), and fungi (Pneumocystis carinii). His 30-year-old mother’s medical history, together with residual cutaneous lesions, was highly suggestive of IP without neurologic impairment. In this patient with OL-EDA-ID, we detected the same NF-κB essential modulator stop codon hypomorphic mutation identified in the previous patient. The occurrence of the same clinical features in 2 unrelated patients with the same genotype demonstrates that OL-EDA-ID is a genuine clinical syndrome. The clinical and biological descriptions of the proband and his mother further corroborate the relationship between IP and EDA. Both syndromes are allelic and are associated with mutations in NF-κB essential modulator, with a genotype-phenotype correlation in hemizygous males. In contrast, loss-of-function mutations and hypomorphic mutations may cause IP in females.