bluuebunny/crossref_metadata_2025 huggingface dataset:
Pubic Bone Age Estimation in Adult Women*
Authors: Berg Gregory E.
Published: May 2008

Abstract: In recent years, numerous physical anthropologists have pointed out the need for regional standards for estimating age in various world populations. While investigating aging methods for East European populations, dramatic changes were noted in the pubic symphyseal morphology and structure of older adult female individuals. These changes were not captured in the typically used pubic symphysis aging methods. This paper defines and tests the need for a new phase, phase VII, that follows the Suchey‐Brooks phase VI. In addition, Suchey‐Brooks phases V and VI are redefined. Phase definitions, decision‐making rules, and comparison graphics for the new method are presented. Balkan (n = 85) and Eastern Tennessee (n = 104) samples, totaling 189 individuals, were used in the analysis. Pearson correlation coefficients between four observers and a control seriation were strong, indicating ease of replicability between investigators. No statistically significant intra‐observer error was detected. Summary statistics show that individuals in phase V were on average in the early 50s, while individuals in phase VI were in their mid 50s to mid 60s, and individuals in phase VII were in their mid 70s. Since linear regression models tend to under‐age the elderly and over‐age the young, transition analysis, using an unrestricted cumulative probit model, was undertaken to evaluate the phases and to produce point estimates for the ages‐at‐transition for the Balkan sample. The highest posterior density region point estimates with their associated upper and lower bounds can be used for predicting age for unknown forensic cases related to the Balkan sample. Further, the mean ages and standard deviations for phases V–VII for the Tennessee sample are presented for use in American forensic cases.
Detection of Explosives in Hair Using Ion Mobility Spectrometry
Authors: Oxley Jimmie C. , Smith James L. , Kirschenbaum Louis J. , Marimganti Suvarna , Vadlamannati Sravanthi
Published: May 2008

Abstract:  Conventional explosives 2,4,6‐trinitrotoluene (TNT), nitroglycerin (NG), and ethylene glycol dinitrate (EGDN) sorbed to hair can be directly detected by an ion mobility spectrometer (IMS) in E‐mode (for explosives). Terrorist explosive, triacetone triperoxide (TATP), difficult to detect by IMS in E‐mode, was detected in N‐mode (for narcotics). Three modes of sample introduction to IMS vapor desorption unit were used: (i) placement of hair directly into the unit, (ii) swabbing of hair and placement of swabs (i.e., paper GE‐IMS sample traps) into the unit, and (iii) acetonitrile extracts of hair positioned on sample traps and placed into the unit. TNT, NG, and EGDN were detected in E‐mode by all three sample introduction methods. TATP could only be detected by the acetonitrile extraction method after exposure of the hair to vapor for 16 days because of lower sensitivity. With standard solutions, TATP detection in E‐mode required about 10 times as much sample as EGDN (3.9 μg compared with 0.3 μg). IMS in N‐mode detected TATP from hair by all three modes of sample introduction.
Differentiating between Physically Violent and Nonviolent Stalkers: An Examination of Canadian Cases
Authors: Morrison Kimberley A.
Published: May 2008

Abstract: This study is one of a few that empirically investigated factors that differentiated the physically violent stalker from the nonviolent stalker. Using discriminant analysis, 103 Canadian cases of “simple obsessional” stalking were examined. Overall, the success of the model for classifying cases into one of two groups was 81%. Results revealed that the physically violent stalker is more likely to: (a) have a stronger previous emotional attachment toward their victim; (b) be more highly fixated/obsessed with their victim; (c) have a higher degree of perceived negative affect towards their victim; (d) engage in more verbal threats toward the victim; and (e) have a history of battering/domestic abuse towards the victim. Overall, the variables that best differentiate the physically violent stalker from the nonviolent one appear to characterize underlying themes of anger, vengeance, emotional arousal, humiliation, projection of blame, and insecure attachment pathology.
Discrimination of Falls and Blows in Blunt Head Trauma: Systematic Study of the Hat Brim Line Rule in Relation to Skull Fractures
Authors: Kremer Célia , Racette Stéphanie , Dionne Charles‐Antoine , Sauvageau Anny
Published: May 2008

Abstract:  In the discrimination of falls from blows in blunt head trauma, the hat brim line rule is one of the most often used criteria. The present study assesses the validity of the hat brim line rule for skull fractures and looks at other possible criteria. All autopsy cases were retrospectively analyzed on a 5‐year period. Cases selected consisted of downstairs falls (n = 13), falls from one’s own height (n = 23), and homicidal blows (n = 44). Results show that fractures above the hat brim line are more in favor of blows, while fractures in the hat brim line zone are more difficult to distinguish. The majority of fractures were located on the left side for homicidal blows and on the right side for falls. A higher average number of lacerations was revealed for homicidal blows. In conclusion, this study establishes three criteria in favor of blows: (i) localization of a wound above the hat brim line; (ii) left side lateralization; and (iii) a high number of lacerations.
Pig‐mentation: Postmortem Iris Color Change in the Eyes of Sus scrofa*
Authors: Abraham Elizabeth , Cox Margaret , Quincey David
Published: May 2008

Abstract:  Experienced forensic pathologists and examiners may be familiar with the phenomenon of postmortem iris color change; however, only Knight, Simpson’s forensic medicine, Arnold, London, 1997; Ref. 1 and Saukko and Knight, Knight’s forensic pathology, 3rd ed., Arnold, London, 2004; Ref. 2 have referred to it in the literature, and to date, there have been no published scientific research studies on this taphonomic artifact. A controlled experiment was conducted of postmortem changes to isolated Sus scrofa eyes. The eyes (n = 137) were separated into three groups and each sample was observed for 3‐day postmortem at a different temperature. In addition, a Sus scrofa head was obtained to observe postmortem changes of eyes in situ. All isolated blue eyes in the experiment, at room temperature and higher, changed to brown/black within 48 h. The in situ blue eye, at room temperature, turned brown/black within 72 h. If iris color consistently changes postmortem in humans, then this taphonomic artifact must be incorporated into victim identification protocol, including disaster victim identification software, and autopsy reports to prevent inaccurate victim identification and inappropriate exclusion from the identification process.
Immunofluorescence confocal laser scanning microscopy and immuno‐electron microscopic identification of keratins in human materno‐foetal interaction zone
Authors: Ahenkorah J. , Hottor B. , Byrne S. , Bosio P. , Ockleford C. D.
Published: May 2008

We show here that at least 5 keratin proteins are present in villous trophoblast and the same 5 in extravillous trophoblast. A further 14 tested were undetectable in these tissues. In contrast, 10 of the 19 keratins tested were present in amniotic epithelium. The marking of amniotic epithelium on the one hand, as distinct from villous and extravillous trophoblast on the other, can be achieved using 5 keratins (K4, 6, 13, 14 and 17) with a mixture of positive and negative discrimination that is expected, in combination, to be highly sensitive. All the specific keratins identified in trophoblast were apparently up‐regulated on the pathway to extravillous trophoblast. Co‐ordinated differentiation at the molecular expression level is indicated by this finding. The relevant keratins are K5, 7, 8, 18 and 19. Specific keratins have been identified that are down‐regulated in villous trophoblast in pre‐eclamptic pregnancy. This difference between healthy and pre‐eclamptic chorionic villous trophoblast keratin expression was statistically significant in 4 out of the 5 keratins. This was not the case for the extravillous trophoblast at the immunofluorescence confocal level but significant differences were obtained using immunogold electron microscopy. We suggest that the villous trophoblast in pre‐eclamptic placentae is cytoskeletally weaker with respect to the filaments made from these specific proteins and that this is one reason why, in pre‐eclampsia, trophoblast is deported in greater quantity than in healthy placentae.
Injectable calcium phosphate cement as a graft material for maxillary sinus augmentation: an experimental pilot study
Authors: Aral Ali , Yalçιn Serdar , Karabuda Zihni Cuneyt , Anιl Ata , Jansen John A. , Mutlu Zihni
Published: May 2008

Objectives: The aim of the present study was to evaluate the efficiency of injectable CaP cement as a graft material around dental implants in the maxillary sinus augmentation procedure.

Material and methods: Bilateral sinus augmentation process was carried out in three sheep and two implants were inserted during the same session. Out of a total of 12 installed implants, eight belonged to the so‐called experimental group. In the experimental group, injectable CaP cement was used as augmentation material while autologous bone served as control.

Results: Histological examination revealed that newly formed bone surrounded the cement completely without an intervening fibrous tissue layer. Following a healing period of 12 weeks, mean bone‐to‐implant contact (BIC) values in the experimental and control groups were 36±5 and 37±3, respectively. The percentage of BIC was comparable with other experimental sinus augmentation studies. Further, it appeared that the thickness of the cortical bone that covered the outer surface of the maxillary sinus was <2–3 mm, which affected the primary stability of the implants negatively.

Conclusion: CaP cement is indeed effective to stimulate bone formation in the sinus elevation procedure. Nevertheless, additional improvements in the cement composition are required to allow final clinical utilization of the material.
Evaluation of soft‐tissue alteration around implant‐supported single‐tooth restoration in the anterior maxilla: the pink esthetic score
Authors: Lai Hong‐Chang , Zhang Zhi‐Yong , Wang Feng , Zhuang Long‐Fei , Liu Xin , Pu Yi‐Ping
Published: May 2008

Purpose: To evaluate the alterations of soft tissue around a single‐tooth implant in the anterior maxilla with a new defined pink esthetic score (PES) at the time of crown placement and 6 months post‐loading.

Material and methods: According to the case inclusion criteria, 29 patients subjected to single‐tooth replacement with ITI implant‐supported restoration in the anterior maxilla were included. Assessments of soft tissue after crown placement (baseline) and at 6 months (follow‐up) were performed by two orthodontists with PES.

Results: No statistically significant difference was found between the two observers. PES for the single‐tooth implant varied from 6.90 to 9.55 at 6‐month follow‐up. The scores of the mesial and distal papilla, level of soft‐tissue margin, soft‐tissue contour, soft‐tissue color and soft‐tissue texture increased significantly at follow‐up. The highest percentage of improvement in PES was found in the cases scoring 0–4 at the baseline.

Conclusions: The esthetic outcome of soft tissue around the single‐tooth implant had improved significantly at follow‐up compared with baseline according to PES assessment. The results suggested that the potential for significant changes in soft‐tissue levels after restorative therapy needs to be considered for single‐implant therapy in the anterior maxilla.
Effects of bisphosphonates on tooth eruption in children with osteogenesis imperfecta
Authors: Kamoun‐Goldrat Agnès , Ginisty Danielle , Merrer Martine Le
Published: May 2008

Bisphosphonates are currently used in the therapy of osteogenesis imperfecta (OI) to decrease the bone fragility observed in OI patients. Bisphosphonate therapy delays tooth eruption in rats. The aim of this study was to determine whether or not bisphosphonate therapy delays tooth eruption in children. The clinical emergence of teeth was observed and the calculated dental age and the number of delayed teeth were determined for 33 OI patients treated with bisphosphonates and for strictly gender‐ and age‐matched controls. There were significant differences between bisphosphonate‐treated patients and controls for calculated dental age and number of delayed teeth. Bisphosphonate therapy was associated with a mean delay of 1.67 yr in tooth eruption in children with OI.
Bite force and electromyograpy during maximum unilateral and bilateral clenching
Authors: Van Der Bilt Andries , Tekamp Anneke , Van Der Glas Hilbert , Abbink Jan
Published: May 2008

Maximum voluntary bite force has often been studied as an indicator of the functional state of the masticatory system. Bilateral, as well as unilateral, methods have been used to determine bite force. Only a few studies have compared the outcomes of both methods. The aim of this study was to measure bite force and jaw‐muscle activity during bilateral as well as unilateral maximum clenching in a large number of healthy subjects, so that the results could be compared. In a group of 81 dentate subjects we observed an average bilateral bite force of 569 N. The average unilateral bite force was significantly lower, being 430 N (right) and 429 N (left). Masseter and anterior temporal muscle activities were also significantly lower during unilateral clenching as compared with bilateral clenching. The masseter muscles showed no difference in activity between the ipsilateral side and the contralateral side during unilateral clenching. In contrast, the activity of the anterior temporal muscle on the ipsilateral side was significantly higher than on the contralateral side. Thus, the change in the forces acting on the jaw during unilateral clenching compared with bilateral clenching leads to a different response in the temporal muscles than in the masseter muscles.
Motor behavior of the jaw muscles during different clenching levels
Authors: Rues Stefan , Schindler Hans J. , Türp Jens C. , Schweizerhof Karl , Lenz Jürgen
Published: May 2008

The goals of this study were to investigate whether (i) muscle activities are affected by different feedback strategies, (ii) the balancing behavior of the neuromuscular system is influenced by different force levels, and (iii) axial loading of the posterior teeth is a realistic biomechanical conception. In 10 healthy subjects, all jaw muscles were recorded bilaterally. Intra‐oral force transfer and force measurement were achieved by using a measuring device simulating natural maximum intercuspation. Under visual feedback‐control, the subjects generated pure vertical and directionally unrestricted force vectors with identical force magnitude at different force levels. The force transmission characteristics under experimental occlusion were investigated by calculating the reduction point (RP) of the resultant bite force. Directionally unrestricted clenching revealed a higher activation of the musculature than pure vertical clenching and was also characterized by a distinct anterior force component. Under both test conditions, the RP moved towards a posterior position with increasing clenching forces. The results indicate an essential recruitment difference of the jaw muscles between the two clenching conditions. Pure axial loading of teeth seems to be impeded by the anterior force component during bilateral clenching. The posterior movement of the RP might prevent overloading of the temporomandibular joints and anterior teeth.
Applicability of action planning and coping planning to dental flossing among Norwegian adults: a confirmatory factor analysis approach
Authors: Åstrøm Anne Nordrehaug
Published: May 2008

Using a prospective design and a representative sample of 25‐yr‐old Norwegians, this study hypothesized that action planning and coping planning will add to the prediction of flossing at 4 wk of follow‐up over and above the effect of intention and previous flossing. This study tested the validity of a proposed 3‐factor structure of the measurement model of intention, action planning, and coping planning and for its invariance across gender. A survey was conducted in three Norwegian counties, and 1,509 out of 8,000 randomly selected individuals completed questionnaires assessing the constructs of action planning and coping planning related to daily flossing. A random subsample of 500 participants was followed up at 4 wk with a telephone interview to assess flossing. Confirmatory factor analysis (CFA) confirmed the proposed 3‐factor model after respecification. Although the chi‐square test was statistically significant [χ2 = 58.501, degrees of freedom (d.f.) = 17), complementary fit indices were satisfactory [goodness‐of‐fit index (GFI) = 0.99, root mean squared error of approximation (RMSEA) = 0.04]. Multigroup CFA provided evidence of complete invariance of the measurement model across gender. After controlling for previous flossing, intention (β = 0.08) and action planning (β = 0.11) emerged as independent predictors of subsequent flossing, accounting for 2.3% of its variance. Factorial validity of intention, action planning and coping planning, and the validity of action planning in predicting flossing prospectively, was confirmed by the present study.
Oral health impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures
Authors: Lahti Satu , Suominen‐Taipale Liisa , Hausen Hannu
Published: May 2008

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data (n = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14‐item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects ≥ 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3–0.8) and 0.7 (0.5–0.9) for 30–34‐yr‐old and 34–74‐yr‐old subjects, respectively. The odds ratios for those with 1–9 teeth and for those who were edentate were 3.4 (2.4–4.9) and 4.0 (2.6–6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.
An algorithm for the automatic detection of seizures in neonatal amplitude‐integrated EEG
Authors: Lommen CML , Pasman JW , Van Kranen VHJM , Andriessen P , Cluitmans PJM , Van Rooij LGM , Bambang Oetomo S
Published: May 2008

Aim: To develop and evaluate an algorithm for the automatic screening of electrographic neonatal seizures (ENS) in amplitude‐integrated electroencephalography (aEEG) signals.

Methods: CFM recordings were recorded in asphyxiated (near)term newborns. ENS of at least 60 sec were detected based on their characteristic pattern in the aEEG signal, an increase of its lower boundary. The algorithm was trained using five CFM recordings (training set) annotated by a neurophysiologist, observer1. The evaluation of the algorithm was based on eight different CFM recordings annotated by observer1 (test set observer 1) and an independent neurophysiologist, observer2 (test set observer 2).

Results: The interobserver agreement between observer1 and 2 in interpreting ENS from the CFM recordings was high (G coefficient: 0.82). After dividing the eight CFM recordings into 1‐min segments and classification in ENS or non‐ENS, the intraclass correlation coefficient showed high correlations of the algorithm with both test sets (respectively, 0.95 and 0.85 with observer1 and 2). The algorithm showed in five recordings a sensitivity ≥ 90% and approximately 1 false positive ENS per hour. However, the algorithm showed in three recordings much lower sensitivities: one recording showed ENSs of extremely high amplitude that were incorrectly classified by the algorithm as artefacts and two recordings suffered from low interobserver agreement.

Conclusion: This study shows the feasibility of automatic ENS screening based on aEEG signals and may facilitate in the bed‐side interpretation of aEEG signals in clinical practice.
PGE2/TXB2 imbalance in neonatal hypoxemic respiratory failure
Authors: Sood BG , Delaney‐Black V , Glibetic M , Aranda JV , Chen X , Shankaran S
Published: May 2008

Background: An imbalance of vaso‐constrictor and ‐dilator mediators has been implicated in the pathogenesis of the pulmonary hypertension accompanying neonatal hypoxemic respiratory failure (NHRF).

Aim: To characterize plasma PGE2, TXB2 and their ratio in normal newborns and in those with NHRF.

Methods: Twenty newborns with NHRF received inhaled PGE1 (IPGE1) by jet nebulizer in doses of 25, 50, 150 and 300 ng/kg/min followed by weaning. Blood for PGE2 and TXB2 assay using EIA was available in 8 neonates with NHRF prior to IPGE1. Umbilical cord arterial samples were also obtained at delivery from 10 normal newborns to serve as controls.

Results: Compared to normal newborns, those with NHRF had significantly lower PGE2/TXB2 ratios after controlling for preterm gestation (<37 weeks) and postnatal age (p < 0.05). Notably, all subjects except one in the NHRF group had a value of <1.0 (range 0.1–1.2) compared to a value of > 1.0 in all subjects in the Control group (range 1.1–5.2).

Conclusions: Lower PGE2/TXB2 ratio in subjects with NHRF compared with controls reflects a predominance of vaso‐constrictor activity in these patients as the basis of pulmonary hypertension. Plasma PGE2/TXB2 ratio may have important implications for the diagnosis and treatment of NHRF.
Cryptorchidism: classification, prevalence and long‐term consequences
Authors: Virtanen Helena E , Bjerknes Robert , Cortes Dina , Jørgensen Niels , Rajpert‐De Meyts Ewa , Thorsson Arni V , Thorup Jørgen , Main Katharina M
Published: May 2008

Undescended testis is a common finding in boys, and the majority of cases have no discernible aetiology. There are unexplained geographical differences and temporal trends in its prevalence. Cryptorchidism, especially bilateral, is associated with impaired spermatogenesis and endocrine function and increases the risk of testicular cancer. There is an urgent need to identify factors that adversely affect testicular development and optimize treatment.

Conclusion: Cryptorchidism may reflect a primary testicular maldevelopment with long‐term consequences.
Blood glucose level in preterm infants after antenatal exposure to glucocorticoid
Authors: Koivisto M , Peltoniemi OM , Saarela T , Tammela O , Jouppila P , Hallman M
Published: May 2008

Aim: To determine the impact of antenatal glucocorticoid on neonatal glucose homeostasis.

Methods: This is a retrospective gestationally paired survey followed by a randomized study. On the basis of the interval between last antenatal dexamethasone and birth, 228 preterm infants born before 34 weeks were divided into Short (<24 h), Intermediate (1–6 days), and Long (≥7days) exposure groups and compared their gestationally paired controls. After a single course of betamethasone, the parturients remaining undelivered for one week were randomized to receive either one dose of betamethasone (n = 52) or placebo (n = 53). Glucose values were recorded at 11 time points in the first 3 days of life. Hypoglycaemic and hyperglycaemic values were counted.

Results: There were no overall differences in mean glucose levels between the antenatal glucocorticoid and the control groups. However, the long exposure time to antenatal glucocorticoid was associated with increased risk of hyperglycaemia (OR 4.1; 2.2–7.6).

Conclusion: Antenatal glucocorticoid administration was associated with subtle disturbances of glucose homeostasis in preterm infants. These differences were dependent on the length of drug‐delivery interval so that long exposition time seemed to increase the incidence of hyperglycaemia during the first days of life.
Development and descent of the testis in relation to cryptorchidism
Authors: Virtanen Helena E , Cortes Dina , Rajpert‐De Meyts Ewa , Ritzén E Martin , Nordenskjöld Agneta , Skakkebaek Niels E , Toppari Jorma
Published: May 2008

The testis descends in two phases. Animal studies suggest, that the transabdominal descent of the testis depends on the insulin‐like hormone 3 (INSL3). Androgens are important in the inguinoscrotal testicular descent in animals and humans. In general, the cause of cryptorchidism is unknown and the aetiology is possibly multifactorial. Histological changes in cryptorchid testes demonstrate disturbed development.

Conclusion: Since testicular descent is regulated by testis‐derived hormones, cryptorchidism may reflect a functional defect of the testis.
Therapeutic effect of turquoise versus blue light with equal irradiance in preterm infants with jaundice
Authors: Ebbesen Finn , Madsen Poul , Støvring Søren , Hundborg Heidi , Agati Giovanni
Published: May 2008

Aim: To compare the efficiency of turquoise light with that of TL52 blue in treatment of preterm infants with jaundice at the same level of body irradiance.

Methods: Infants with gestational age 28–37 weeks and non‐haemolytic hyperbilirubinemia were treated for 24 h with either turquoise light (OSRAM L18W/860 fluorescent lamps) or blue light (Philips TL20W/52 fluorescent lamps). The concentrations of serum total bilirubin and bilirubin isomers were measured by the Vitros routine method and by HPLC, respectively.

Results: The decrease in serum concentrations of total bilirubin, total bilirubin isomers and the toxic Z,Z‐bilirubin was greatest for infants treated with turquoise light. Further, the increase in Z,E‐bilirubin was smaller and there was a trend towards a higher rise in E,Z‐bilirubin.

Conclusions: Turquoise light has a greater bilirubin reducing effect than TL52 blue light with equal irradiance, expressed both by serum total bilirubin, total bilirubin isomers and Z,Z‐bilirubin, i.e. the turquoise spectral range is more efficient than the blue. This is in accordance with deeper penetration into the skin, lower production of the Z,E‐bilirubin and greater production of E,Z‐bilirubin and lumirubin, in infants under turquoise light. This suggests, given equal irradiances, that light in the turquoise spectral range is preferable to the TL52 blue in treatment of newborn jaundiced infants.
Seeing through the blind! Ability of hospital staff to differentiate morphine from placebo, in neonates at a placebo controlled trial
Authors: Bergqvist LL , Eriksson M , Kronsberg SS , Schollin J , Barton B , Anand KJS
Published: May 2008

Aim: To investigate whether professional training and/or clinical experience affect the ability of caregiver to assess clinical signs of pre‐emptive morphine analgesia.

Methods: In the Neurological Outcomes & Pre‐emptive Analgesia In Neonates trial preterm infants undergoing mechanical ventilation were randomized to receive continuous infusion, either of morphine or placebo blinded. Staff from centres in Sweden (Stockholm and Örebro) completed an assessment form.

Results: A total of 360 assessment forms were collected from 52 neonates. In 59% of the cases, caregivers correctly identified patients group. Comparable proportion of answers were correct between physicians, nurses and assistant nurses (63, 60 and 54%, respectively, p = 0.60). Staff with Neonatal intensive care unit experience <1 year identified 63%, as compared to 65% for working 1–5 year, and 55% that has been working >5 years (p = 0.28). Staff's ability to correctly identify group assignment was reduced by amount of additional morphine (p < 0.01) and severity of illness (p = 0.01).

Conclusions: Clinical medical staffs, including neonatologists, have great difficulties in assessing the presence and severity of pain. Further studies should focus on the methods for assessment of prolonged pain in preterm neonates, define the effects of adequate analgesia, and investigate the clinical factors that may alter neonatal responses to acute and prolonged pain.
Kostmann syndrome or infantile genetic agranulocytosis, part two: understanding the underlying genetic defects in severe congenital neutropenia
Authors: Carlsson Göran , Melin Malin , Dahl Niklas , Ramme Kim Göransdotter , Nordenskjöld Magnus , Palmblad Jan , Henter Jan‐Inge , Fadeel Bengt
Published: May 2008

Congenital neutropenia in man was first reported 50 years ago by the Swedish paediatrician Rolf Kostmann. He coined the term ‘infantile genetic agranulocytosis’ for this condition, which is now known as Kostmann syndrome. Recent studies have revealed mutations in ELA‐2, encoding the neutrophil granule protease, neutrophil elastase, in autosomal dominant neutropenia, and mutations in HAX‐1, encoding an anti‐apoptotic protein, in autosomal recessive neutropenia.

Conclusion: Future studies should aim to clarify the mechanisms underlying the evolution of secondary malignancies in these patients.
Immediate maternal thermal response to skin‐to‐skin care of newborn
Authors: Bergström A , Okong P , Ransjö‐Arvidson A‐B
Published: May 2008

Aim: To elucidate the immediate maternal thermal skin response when placing the neonate on the mothers' chest, skin‐to‐skin (STS).

Methods: Ugandan mothers with non‐asphyxiated newborns after vaginal delivery (n = 39) were studied. Maternal skin and axillary temperatures were measured immediately before STS contact, then every 2 min for 20 min and finally 10 min after removing the neonate. Neonatal axillary/forehead temperatures were measured immediately before STS contact, and twice after initiating STS, followed by a measurement 10 min after the newborn had been removed.

Results: A rapid thermal response was demonstrated in maternal breast skin immediately after STS contact. It rose by 0.5°C (p < 0.0001) on average the first 2 min after STS contact and fell by 0.5°C 10 min after we had removed the neonate (p < 0.0001). Maternal axillary temperature also rose 2 min after initiation of STS (p < 0.0001) but stayed constant 10 min after removal of the newborn from the STS position.

Conclusion: The findings indicate that there is a rapid maternal, thermal response to the positioning of the newborn STS. The tactile contact may elicit a maternal adaptation enhancing the warming of the newborn. Possible mechanisms include maternal autonomic nerve‐mediated skin vasodilatation.
Oxygen as a neonatal health hazard: call for détente in clinical practice
Authors: Sola Augusto , Rogido Marta R , Deulofeut Richard
Published: May 2008

Education in oxygenation and in how oxygen is given to newborns needs to increase. Treatment with oxygen should no longer be considered proverbial and customary, regardless of our ‘past experience’ or consensus recommendations in clinical guidelines, since oxygen may lead to acute or chronic health effects.

Conclusion: Inappropriate oxygen use is a neonatal health hazard associated with aging, DNA damage and cancer, retinopathy of prematurity, injury to the developing brain, infection and others. Neonatal exposure to pure O2, even if brief, or to pulse oximetry >95% when breathing supplemental O2 must be avoided as much as possible.
Shed some light on darkness: will Tanzania reach the millennium development goals?
Authors: Janson Annika
Published: May 2008

The overall picture of health in sub‐Saharan Africa can easily be painted in dark colours. The aim of this viewpoint is to discuss epidemiological data from Tanzania on overall health indicators and the burden of malaria and HIV. Is the situation in Tanzania improving or deteriorating? Are the health‐related millennium development goals (MDG) on reducing under‐five mortality, reducing maternal mortality and halting HIV and malaria within reach?

Conclusion: Child mortality and infant mortality rates are decreasing quite dramatically. Malaria prevention strategies and new effective treatment are being launched. The MDG 4 on child mortality is clearly within reach, and the same optimism may apply to MDG 6 on combating malaria.
Screening Copenhagen school children at risk of type 2 diabetes mellitus using random capillary blood glucose
Authors: Pearson Seija , Broløs Elisabeth J. , Herner Eva B. , Hansen Bente , Olsen Birthe S.
Published: May 2008

Aim: To screen adolescents at risk of type 2 diabetes mellitus (T2DM) using random capillary blood glucose (RCBG).

Methods: Ninth grade pupils who were overweight and/or had a family history of T2DM were offered to have RCBG measured and were referred for further investigation if the value was ≥7.8 mmol/L.

Results: Two thousand four hundred and eleven pupils were examined, 19% were overweight, 4% being obese. 589 met inclusion criteria and 384 participated. Ethnic minorities and pupils in low socio‐economic school‐areas (SESA) were significantly more overweight than ethnic Danes and pupils in high SESA. Compared to ethnic Danish pupils, the relative risk of having a positive parent history of T2DM was increased five‐fold for ethnic Turkish and Arab pupils and 13‐fold for ethnic Pakistani pupils. One pupil had a diagnosed T2DM. Two had elevated RCBG values. One of these had an undiagnosed T2DM.

Conclusion: Our study shows a high prevalence of overweight adolescents in Copenhagen, especially in school areas with low socio‐economic standard and in pupils with Turkish, Pakistani and Arab ethnicity. Only three out of the 10 pupils with the highest risk participated. New strategies to reach and motivate risk groups to follow health recommendations and new methods of screening should be developed.
Physicians' use of guidelines and attitudes to withholding and withdrawing treatment for extremely premature neonates in Norway
Authors: Miljeteig Ingrid , Markestad Trond , Norheim Ole Frithjof
Published: May 2008

Objectives: To examine if explicit written guidelines for withholding and withdrawing treatment for extremely premature infants exist and are used in obstetric and paediatric units in Norway, and to explore changes in attitudes and which factors are considered important when making decisions regarding life support.

Methods: Cross‐sectional postal survey addressed to the medical directors of all the 46 obstetric and the 28 paediatric units in Norway.

Results: The response rate was 84%. Half the units had guidelines for withholding and one quarter for withdrawing life support. Most of them were non‐written informal guidelines. The most important factors for withholding treatment were gestational age and vitality while risk of severe disability and future quality of life were the major concerns for withdrawing treatment. The mean reported gestational age threshold for resuscitating infants decreased from 23.6 weeks (SD ± 0.6) in a study from 1998 to 23.0 weeks (SD ± 0.8) in 2005 (p = 0.001). Physicians did not perceive this change in threshold, but 1/3 felt that decisions regarding provision of life support had become more difficult. Almost half of the responding physicians agreed with the statement that Norway is too liberal in its provision of life support to extremely premature infants.

Conclusion: The criteria for whom to provide life support or not are imprecise and may be subject to unperceived changes. Explicit local guidelines for the decision‐making process may secure legitimacy and fair treatment options.
Nasal carriage of Staphylococcus aureus in 4–6 age groups in healthy children in Afyonkarahisar, Turkey
Authors: Ciftci Ihsan Hakki , Koken Resit , Bukulmez Aysegul , Ozdemir Mehmet , Safak Birol , Cetinkaya Zafer
Published: May 2008

Aim: Staphylococcus aureus is a common cause of disease, particularly for colonized persons. Although methicillin‐resistant S. aureus (MRSA) infection has frequently reported, population‐based S. aureus and MRSA colonisation estimates are lacking. Our objective in this report is to present the prevalance of S. aureus carriage among 4–6 age groups healthy children in our region.

Methods: Nasal samples for S. aureus culture were obtained from healthy children. Sociodemographic features and the data related with risk factors were obtained from the parents of the children. Nasal swabs were inoculated on to a variety of bacteriological culture media, which were then incubated at 35 ± 1°C for 16–18 h. Antimicrobial susceptibility testing of the isolates was determined according to Clinical and Laboratory Standard Institute (CLSI, 2005) guidelines.

Results: In this study 1134 children between 4 and 6 years old age were evaluated; 607 (53.5%) of the subjects were boys and 527 (46.5%) were girls. S. aureus was isolated in 322 (28.4%) subjects and MRSA was isolated in 3 (0.3%) subjects of them. All of the MRSA isolates were found in healthcare workers' children.

Conclusions: This first assessment of this study is that nearly one third of the 4–6 age group healthy children population present nasal carriage of S. aureus in Turkey. However, it also shows that the rate of MRSA carriage remains low. In addition, it is considered that MRSA colonization may be a risk factor for healthcare workers' children.
Look‐back study of Hepatitis C in teenagers after blood transfusions as neonates
Authors: Kori Michal , Flidel‐Rimon Orna , Sigler Erica , Shinwell Eric , Granot Esther
Published: May 2008

Aim: To conduct a single‐centre “look‐back” study of the prevalence of hepatitis C in teenagers who had received blood products as newborns, prior to hepatitis C virus (HCV) blood donor screening.

Methods: Using blood bank records, we identified 732 surviving teenagers aged 14–18 years who had received blood products as neonates during 1986–1990. Letters recommending HCV antibody testing were sent to 732 surviving teenagers; 581 recipients were contacted and invited to undergo testing, and, of these, 429 consented (59% of the survivors). HCV antibody testing was performed on all and HCV‐RNA was tested on those who were antibody positive.

Results: Three teenagers (0.7%, 95% CI 0.54–0.86) tested positive for HCV antibodies and all three were HCV‐RNA positive. There were no cases in which antibodies were detected and polymerase chain reaction (PCR) was negative. Two of the three had mildly elevated liver enzymes and all three had mild inflammatory activity and low fibrosis scores on liver biopsy.

Conclusions: The look‐back process, even in a single centre with a stable urban population, is relatively inefficient in screening at‐risk populations. Although the prevalence of hepatitis C in this sample was relatively low, paediatricians should offer screening to teenagers and young adults who received blood products in the neonatal period.
A population based 10‐year study of neonatal air transport in North Norway
Authors: Lang Astri , Brun Henrik , Kaaresen Per Ivar , Klingenberg Claus
Published: May 2008

Aim: This study audits the activity of the neonatal air transport team in Norway's two northernmost counties.

Methods: Data on all air transports to or from the regional Neonatal Intensive Care (NICU) Unit within a 10‐year period were collected.

Results: Two hundred and thirty‐eight acute transports were conducted during the study period; 169 referrals to the NICU and 69 transfers to national surgical and cardiac centres. Only 13 very low birth weight infants were transported; the in utero transport rate was 95% for this patient population. The adjusted risk of death and/or intracranial haemorrhage for outborn very low birth weight infants was five‐fold increased compared to those not transported postnatally. Babies with congenital heart disease comprised the one‐fourth of all transports. The long‐term mortality was 14% for the whole study population, and 29% for infants with congenital heart disease. Only seven deaths (3.2%) were defined as being transport‐related; death during or within 24 h after transport. However, preventable complications like temperature instability, hypoglycaemia and hypo‐/hypercapnia occurred in 10–20% of all transports.

Conclusion: The transport related mortality was low in this study, however very low birth weight infants and infants with major congenital heart disease showed a relatively poor outcome.
Physician consultation and antibiotic prescription in Swedish infants: population‐based comparison of group daycare and home care
Authors: Hedin Katarina , Andre Malin , Håkansson Anders , Mölstad Sigvard , Rodhe Nils , Petersson Christer
Published: May 2008

Background: Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants.

Aim: To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account.

Methods: For a cohort of Swedish 18‐month‐old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month.

Results: 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63–3.82) and for antibiotic prescription 2.43 (1.34–4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account.

Conclusion: When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants
Growth factors gene expression in the developing lung
Authors: Mager Edward M. , Renzetti Gabriele , Auais Alexander , Piedimonte Giovanni
Published: May 2008

Aim: This is the first systematic study using quantitative real‐time PCR to analyze and compare the expression profiles for critical members of the epidermal growth factor (EGF), transforming growth factor β (TGFβ), and vascular endothelial growth factor (VEGF) families in developing rat lungs.

Methods: mRNA expression was quantified at embryonic (E) day 15, 17, 19, 21, and postnatal age 1 day, 2 weeks, 12 weeks.

Results: EGF and EGFR increased during gestation and development, then decreased in adulthood, whereas TGFα was highest at birth and remained unchanged afterwards. All TGFβ isoforms increased slightly during pregnancy, reached highest expression during development, and returned to neonatal levels in adulthood. TGFβRI and TGFβRII patterns were similar to TGFβ2 and TGFβ1 respectively, whereas TGFβRIII expression was lowest at the postnatal time points. VEGF164 and VEGF120 showed a steady increase up to 2 weeks and declined at 12 weeks, whereas highest VEGF188 expression occurred at 12 weeks. VEGF‐A receptors expression paralleled the summation of all three isoforms, increasing steadily with age.

Conclusion: Expression of growth factors in the developing lung is characterized by highly regulated distinctive patterns that may be critical to understand the early origin and progression of pulmonary diseases in childhood as well as in adulthood. Quantitative real‐time PCR analysis revealed several differences compared to previously reported expression patterns defined with older methodologies.
Trends in neonatology and pediatrics publications over the past 12 years
Authors: Tov Amir Ben , Lubetzky Ronit , Mimouni Francis B , Alper Arik , Mandel Dror
Published: May 2008

Objective: To test the hypothesis that the number of publications in Neonatology and Pediatrics increases over time, and to verify whether the categories of publications all follow the same pattern over time.

Design and setting: We evaluated all Medline articles during 1994–2005. Search was limited to humans, English and to ‘newborn’ or ‘all‐child’. We used regression analysis to determine the effect of year‐of‐publication upon the number‐of‐publications of each type.

Results: Medline reported 36,141 publications in Neonatology and 169,823 in Pediatrics during the evaluation period. There was a significant linear increase in the number of publications in Neonatology and Pediatrics. There was a steady increase over time in Neonatology and in Pediatrics in meta‐analyses, reviews and editorials. There was a steady decrease over time in letters in Neonatology, but no significant change in letters in Pediatrics. While there was no significant change in clinical trials (CTs), randomized control trials (RCTs) in Neonatology, there was a significant increase in CTs and RCTs in Pediatrics.

Conclusions: The field of neonatology has not had a significant yearly increase of original studies, but has seen an increase of reviews, meta‐analyses and editorials. This contrasts with Pediatrics, which shows a similar increase in reviews, meta‐analyses and editorials, but also an increase in the number of CTs and RCTs and guidelines.
Literature Names for Pediatric Medical Conditions
Authors: Bilavsky Efraim , Yarden‐Bilavsky Havatzelet , Ashkenazi Shai
Published: May 2008

From the Grimm Brothers to Charles Dickens, from Gulliver's Travels to Alice's Adventures in Wonderland, great writers and stories have been a source for names of paediatric medical conditions, sometimes preceding the medical description by many years. This article describes the circumstances that led to the creation of some of these fascinating names, the physicians who coined them, and their link to the actual medical conditions.

Conclusion: Literary names for medical conditions add warmth and humanity to the field of paediatrics.
Fathers and their children's health: a telephone interview study
Authors: Hallberg A‐C , Kristiansson R , Beckman A , Petersson K , Råstam L , Håkansson A
Published: May 2008

Objective: To study fathers' perception of, and involvement in, their children's health.

Design: Telephone interviews according to a structured guide.

Setting: County of Skåne, Sweden.

Main outcome measures: Answers regarding care and upbringing of child, child's health and ill health, and role of father.

Subjects: 237 fathers of small children.

Results: Fathers seem to be involved in their children to a large extent, both in caring and playing activities with their children. Most of them (82%) think that the child's health is good, and half of them (55%) have, at some time, contacted a doctor. The fathers mention security, love and commitment as important factors for being a good father, and almost all (97%) think that they are good fathers. Yet, only slightly more than half of them (54%) state that they have sufficient time for the child.

Conclusions: Today, fathers are subject to quite different expectations to participate actively in their children's everyday life than was the case for previous generations. Therefore, more studies of fathers' involvement in their children are needed, as well as a new approach within the health care system to fathers' participation.