bluuebunny/crossref_metadata_2025 huggingface dataset:
The direct effects of the angiotensin-converting enzyme inhibitors, zofenoprilat and enalaprilat, on isolated human pancreatic islets
Authors: Lupi Roberto , Guerra Silvia Del , Bugliani Marco , Boggi Ugo , Mosca Franco , Torri Scilla , Prato Stefano Del , Marchetti Piero
Published: February 2006

Objective: Data from prospective studies suggest a significant reduction in the risk of new diabetes from drug therapies containing angiotensin-converting enzyme (ACE) inhibitors. Since the renin–angiotensin system (RAS) has been found locally in several tissues and cells, including pancreatic islets, we hypothesized that the positive metabolic effects of ACE inhibitors may be due to a beneficial action of these compounds on insulin-secreting β-cells.

Design and methods: Isolated human pancreatic islets were studied after 24 h of incubation with 22.2 mmol/l glucose, with or without the presence in the incubation medium of 0.5–6.0 mmol/l zofenoprilat or enalaprilat, ACE inhibitor drugs which differ by the presence of a sulphydryl or a carboxyl group in their structural formula. Functional and molecular studies were then performed to assess insulin secretion, redox balance, mRNA and protein expression.

Results: Angiotensinogen, ACE and angiotensin type 1 receptor mRNA expression increased in islets cultured in high glucose; this was similarly prevented by the presence of either ACE inhibitor. As expected, preculture of human islets in high glucose determined a marked reduction in insulin secretion which was associated with enhanced oxidative stress, as shown by increased nitrotyrosine concentrations, and enhanced expression of protein kinase C β and NADPH oxidase. The presence of either of the ACE inhibitors counteracted several of the deleterious effects of high glucose exposure, including reduction of insulin secretion and increased oxidative stress; zofenoprilat showed significantly more marked effects.

Conclusions: These results showed that: (a) RAS molecules are present in human islets and their expression is sensitive to glucose concentration, (b) ACE inhibitors, and in particular zofenoprilat, protect human islets from glucotoxicity and (c) the effects of ACE inhibition are associated with decreased oxidative stress. Together, these findings provide evidence that the possible beneficial effects of ACE inhibitors in human diabetes are due, at least in part, to a protective action on pancreatic β-cells.
Treatment of tall stature in boys with somatostatin analogue 201–995: effect on final height
Authors: Noordam C , van Daalen S , Otten BJ
Published: February 2006

Background: An optimal treatment for tall stature in boys in terms of efficacy and safety is not available. Treatment with somatostatin analogue 201–995 (SMS) has been tried with positive short-term results.

Methods: We evaluated the effect of SMS treatment on reducing adult height. Over 2 years, 16 boys presenting to our university hospital with tall stature (constitutional tall stature (n = 13), Marfan syndrome (n = 2) and tethered spinal cord (n = 1)) with a predicted final height above 197 cm were included in the study and prospectively followed until final height was reached. As one boy was lost to follow-up we have reported on 15 boys. Treatment with SMS as a single subcutaneous dose was started and continued until final height was reached. In eight boys androgens were given to induce puberty after the start of SMS and five boys were on treatment with androgens prior to SMS treatment. Effect on reduction of final height prediction, calculated with the index of potential height based on the bone age of Greulich and Pyle, was the main outcome measure. Standard anthropometric assessments were performed a year before and every 3 months during treatment. Bone age was assessed by the method of Greulich and Pyle at the start and after 6 and 12 months.

Results: Mean reduction in final height prediction (predicted adult height minus achieved adult height) was −0.1 cm (range −6.4 to +5.7). In three boys, asymptomatic microlithiasis of the gall bladder was diagnosed.

Conclusions: We have concluded that, in spite of encouraging short-term results, long-term treatment with SMS does not reduce final height in a manner sufficient to justify SMS treatment in tall stature.
Osteoporosis and male age-related hypogonadism: role of sex steroids on bone (patho)physiology
Authors: Rochira V , Balestrieri A , Madeo B , Zirilli L , Granata A R M , Carani C
Published: February 2006

Male age-related bone loss is caused, at least in part, by hypogonadism that occurs with advancing age. The study of the effects of sex steroids on bone physiology in men has recently highlighted the central role of estrogens on bone pathophysiology. This review focuses on particular aspects of bone physiology and pathophysiology in aging men, noting both the similarities to and the differences from female counterparts. In particular, the role of sex steroids on bone sexual dimorphism in health and disease has been analyzed.
Celiac disease in North Italian patients with autoimmune Addison’s disease
Authors: Betterle Corrado , Lazzarotto Francesca , Spadaccino Aglaura Cinzia , Basso Daniela , Plebani Mario , Pedini Beniamino , Chiarelli Silvia , Albergoni Mariapaola
Published: February 2006

Objective: Patients with autoimmune Addison’s disease (AAD) are prone to develop other autoimmune manifestations. An increased prevalence of celiac disease (CD) has recently been demonstrated in Northern European patients with AAD. IgA deficiency is the most frequent type of immunodeficiency among humans and is present in about one in every 600 individuals in the population. IgA deficiency is frequent in patients with other autoimmune diseases, but data concerning AAD are still unavailable.

Design: The aim was to define the prevalence of CD and of IgA deficiency in a group of Italian patients with AAD.

Methods: One hundred and nine patients with AAD were enrolled and examined for tissue transglutaminase autoantibodies of the IgA class, circulating levels of IgA and adrenal cortex antibodies.

Results: Two (1.8%) of the patients were affected by already diagnosed CD and were already on a gluten-free diet. Out of the remaining 107 patients, four (3.7%) were found to be positive for IgA antibodies to human tissue transglutaminase. Three of the four patients who were positive for tissue transglutaminase autoantibodies agreed to undergo endoscopy and duodenal biopsies and, in one, a latent form of CD was identified. The clinical, silent or latent form of CD was present in six out of 109 (5.4%). This prevalence was significantly higher (P = 0.0001) than that reported for the Northern Italian population which was equal to 0.063%. Specifically, CD was present in 12.5% of the autoimmune polyglandular syndrome (APS) type 1 cases, in four out of 60 (6.7%) of the APS type 2 cases and in one out of 40 (2.5%) of the isolated AAD cases. IgA deficiency was present in two out of 109 patients (1.8%), all of whom had normal IgG anti-gliadin. Autoantibodies to the adrenal cortex were detected in 81 out of 109 patients (74.3%).

Conclusions: In patients with AAD there is a high prevalence of both CD and IgA deficiency. Consequently, it is important to screen for CD with tissue transglutaminase autoantibodies of the IgA class and for IgA levels.
Systemic monocyte chemoattractant protein-1 concentrations are independent of type 2 diabetes or parameters of obesity: results from the Cooperative Health Research in the Region of Augsburg Survey S4 (KORA S4)
Authors: Herder Christian , Müller-Scholze Sylvia , Rating Philipp , Koenig Wolfgang , Thorand Barbara , Haastert Burkhard , Holle Rolf , Illig Thomas , Rathmann Wolfgang , Seissler Jochen , Wichmann H-Erich , Kolb Hubert
Published: February 2006

Objective: Data on the relevance of monocyte chemoattractant protein (MCP)-1 in the pathophysiology of type 2 diabetes (T2D) and obesity are inconsistent. Since MCP-1 is produced by adipocytes and has been postulated to be involved in macrophage infiltration into adipose tissue, we wanted to test whether serum MCP-1 levels were correlated with T2D or obesity.

Design and methods: Out of 1653 individuals aged 55 to 74 years participating in the population-based KORA Survey S4 (KORA/Cooperative Health Research in the Region of Augsburg) in Southern Germany, 236 patients with T2D, 242 subjects with impaired glucose tolerance and 244 normoglycaemic controls matched for age and sex were analysed for circulating MCP-1 concentrations.

Results: MCP-1 serum concentrations were not associated with impaired glucose tolerance, type 2 diabetes or several parameters of obesity. Moreover, systemic MCP-1 levels were not significantly correlated with all but one (fasting triglycerides) of the biochemical markers tested.

Conclusions: Our data indicate that MCP-1 levels are not associated with T2D and that the contribution of fat mass to systemic MCP-1 protein might be low, suggesting that the possible local pathogenic role of MCP-1 may not be reflected by increased systemic levels of MCP-1.
Maternal plasma corticotrophin-releasing factor and urocortin levels in post-term pregnancies
Authors: Torricelli Michela , Ignacchiti Erika , Giovannelli Alessia , Merola Angelica , Scarpetti Elisa , Calonaci Giulia , Picciolini Enrico , Florio Pasquale , Reis Fernando M , Linton Elizabeth A , Petraglia Felice
Published: February 2006

Objective: Corticotrophin-releasing factor (CRF) and urocortin are two placental neuropeptides that are involved in the mechanisms of labour by modulating myometrial activity. Maternal plasma levels of both CRF and urocortin are increased at term and preterm labour, whilst those of CRF are reduced in women who are destined to experience post-term delivery. The present study evaluated maternal plasma levels in term and post-term pregnancies out of labour.

Design: A group of healthy pregnant women was enrolled and subdivided as follows: (i) at term out of labour (n = 19; 276 ± 0.7 days of gestation; samples collected at the time of elective caesarean section due to previous uterine surgery); (ii) post-term (n = 19; 291 ± 1.4 days of gestation), from whom samples were collected before induction of labour.

Methods: Urocortin and CRF measurements by radioimmunoassay; digital palpatory cervical examination and Bishop score computation; cervical length and funnelling presence assessment by transvaginal ultrasonography.

Results: Maternal plasma CRF concentrations were significantly (P < 0.05) lower whilst those of urocortin were unchanged in post-term compared with term pregnancy. However, CRF and urocortin levels were both significantly (P < 0.05 and P < 0.001 respectively) higher in pregnancies delivered within 12 h of labour induction than in those that remained undelivered, and were significantly correlated with the induction-delivery interval (CRF: r = −0.676, P = 0.0015; urocortin: r = −0.783, P < 0.0001).

Conclusions: CRF and urocortin levels are decreased and unchanged, respectively, in post-term pregnancy when compared with term pregnancy. Both CRF and urocortin correlate with the time of labour onset after induction. Since CRF derives from the placenta, and urocortin from the fetus, the concerted expression of these neuropeptides appears to be relevant in determining the length of human gestation.
Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia
Authors: Jarfelt M , Fors H , Lannering B , Bjarnason R
Published: February 2006

Objective: Treatment for childhood leukaemia induces many risk factors for development of decreased bone mineral density (BMD). Physical activity is also known to affect BMD. The aim was to study BMD and markers of bone turnover in a well-defined group of survivors of acute lymphoblastic leukaemia (ALL) who had all reached final height as well as peak bone mass, taking both previous treatment and physical activity into consideration.

Design: All patients treated for ALL before the onset of puberty in the region of western Sweden, between 1973 and 1985, in first remission were included. Thirty-five out of forty-seven patients aged 20–32 years participated. Nineteen patients had received cranial radiotherapy, and the median follow-up time was 20 years.

Methods: BMD was assessed using dual-energy X-ray absorbtiometry (DEXA). Serum concentrations of markers of bone turnover were analysed. Physical performance was measured using a performance exercise capacity stress test.

Results: BMD was slightly reduced in lumbar spine (−0.4 SD), but not in femoral neck or total body. BMD in femoral neck was correlated to physical performance and dose of corticosteroid, but no correlation was found with spontaneous growth hormone (GH) secretion. Markers of bone turnover were also correlated to physical performance, but not to GH secretion.

Conclusions: Physical fitness seems to be the most important factor in developing and preserving normal bone mineral density in ALL patients. We propose that lifestyle education promoting physical activity is encouraged from an early point in time for these patients.
Vascular and renal function in experimental thyroid disorders
Authors: Vargas Félix , Moreno Juan Manuel , Rodríguez-Gómez Isabel , Wangensteen Rosemary , Osuna Antonio , Álvarez-Guerra Miriam , García-Estañ Joaquín
Published: February 2006

This review focuses on the effects of thyroid hormones in vascular and renal systems. Special emphasis is given to the mechanisms by which thyroid hormones affect the regulation of body fluids, vascular resistance and, ultimately, blood pressure. Vascular function is markedly affected by thyroid hormones that produce changes in vascular reactivity and endothelial function in hyper- and hypothyroidism. The hypothyroid state is accompanied by a marked decrease in sensitivity to vasoconstrictors, especially to sympathetic agonists, alteration that may play a role in the reduced blood pressure of hypothyroid rats, as well as in the preventive effects of hypothyroidism on experimental hypertension. Moreover, in hypothyroid rats, the endothelium-dependent and nitric oxide donors vasodilation is reduced. Conversely, the vessels from hyperthyroid rats showed an increased endothelium-dependent responsiveness that may be secondary to the shear-stress induced by the hyperdynamic circulation, and that may contribute to the reduced vascular resistance characteristic of this disease. Thyroid hormones also have important effects in the kidney, affecting renal growth, renal haemodynamics, and salt and water metabolism. In hyperthyroidism, there is a resetting of the pressure-natriuresis relationship related to hyperactivity of the reninangiotensin system, which contributes to the arterial hypertension associated with this endocrine disease. Moreover, thyroid hormones affect the development and/or maintenance of various forms of arterial hypertension. This review also describes recent advances in our understanding of thyroid hormone action on nitric oxide and oxidative stress in the regulation of cardiovascular and renal function and in the long-term control of blood pressure.
Predictors of abnormal glucose metabolism in women with polycystic ovary syndrome
Authors: Möhlig Matthias , Spranger Joachim , Ristow Michael , Pfeiffer Andreas F H , Schill Thilo , Schlösser Hans W , Moltz Lothar , Brabant Georg , Schöfl Christof
Published: February 2006

Objective: Polycystic ovary syndrome (PCOS) is a risk factor for type 2 diabetes mellitus and screening for abnormal glucose metabolism has been recommended by an oral glucose tolerance test (OGTT). This procedure is time-consuming and inconvenient, limiting its general use. Therefore, an easy method is wanted to separate PCOS women with normal from those with potentially abnormal glucose metabolism.

Design: Simple parameters obtained from 101 consecutive PCOS patients were assessed by receiver operating curve analysis for their ability to predict abnormal glucose metabolism.

Results: Comparing discriminating parameters at defined sensitivities revealed that, assessed by homeostasis model assessment (HOMA), insulin resistance (HOMA%S) had the highest specificitiy. At a cut-off point of 73.1%, HOMA%S had a sensitivity of 95.5% and a specificity of 51.9%. Applying this cut-off separated 59 women who had a high probability of abnormal glucose metabolism from 42 women who were at low risk (less than 2.5%). Fasting insulin was the second-best parameter and had a similar specificity. A screening strategy which applies HOMA%S or fasting insulin could almost halve the number of OGTTs by directing them to those PCOS women most likely to be suffering from abnormal glucose metabolism. The negative predictive value of this strategy was 97%. The strategy was tested and confirmed in a second and independent cohort of 264 PCOS women.

Conclusions: HOMA%S, or to a lesser extent fasting insulin, appears to allow for stratified metabolic screening of PCOS women with OGTT.
Timing of Solid Food Introduction in Relation to Atopic Dermatitis and Atopic Sensitization: Results From a Prospective Birth Cohort Study
Authors: Zutavern Anne , Brockow Inken , Schaaf Beate , Bolte Gabriele , von Berg Andrea , Diez Ulrike , Borte Michael , Herbarth Olf , Wichmann H-Erich , Heinrich Joachim ,   the LISA Study Group
Published: February 2006

OBJECTIVE. Prophylactic feeding guidelines recommend a delayed introduction of solid foods for the prevention of atopic diseases. Scientific evidence for this is scarce. This study investigates whether a delayed introduction of solids (past 4 months or 6 months) is protective against the development of atopic dermatitis (AD) and atopic sensitization when considering reverse causality.

METHODS. Data from 2612 infants in an ongoing birth cohort study were analyzed at 2 years of age. Information on diet and on symptoms and diagnoses of AD was collected semiannually, and information on specific immunoglobulin E levels was collected at 2 years of age.

RESULTS. Solid food introduction past the first 4 months of life decreased the odds of symptomatic AD but not for doctor-diagnosed AD, combined doctor-diagnosed and symptomatic AD, or atopic sensitization. Postponing the introduction beyond the sixth month of life was not protective in relation to either definition of AD or atopic sensitization. There was also no evidence for a protective effect of a delayed introduction of solids on AD and atopic sensitization in children of atopic parents. There was clear evidence for reverse causality between early skin or allergic symptoms and the introduction of solids.

CONCLUSIONS. This study does not find evidence supporting a delayed introduction of solids beyond the sixth month of life for the prevention of AD and atopic sensitization. We cannot rule out that delaying the introduction of solids for the first 4 months of life might offer some protection. Measures to avoid reverse causality have to be considered in the conduction, analysis, and interpretation of cohort studies on the topic.
Epidemiology of DSM-IV Insomnia in Adolescence: Lifetime Prevalence, Chronicity, and an Emergent Gender Difference
Authors: Johnson Eric O. , Roth Thomas , Schultz Lonni , Breslau Naomi
Published: February 2006

OBJECTIVE. The confluence of sleep/wake cycle and circadian rhythm changes that accompany pubertal development and the social and emotional developmental tasks of adolescence may create a period of substantial risk for development of insomnia. Although poor sleep affects cognitive performance and is associated with poor emotional and physical health, epidemiologic studies among adolescents have been limited. In this first epidemiologic study of insomnia defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a US sample of adolescents, we estimated lifetime prevalence of insomnia, examined chronicity and onset, and explored the role of pubertal development.

METHODS. Data come from a random sample of 1014 adolescents who were 13 to 16 years of age, selected from households in a 400000-member health maintenance organization encompassing metropolitan Detroit. Response rate was 71.2%. The main outcome measured was DSM-IV–defined insomnia.

RESULTS. Lifetime prevalence of insomnia was 10.7%. A total of 88% of adolescents with a history of insomnia reported current insomnia. The median age of onset of insomnia was 11. Of those with insomnia, 52.8% had a comorbid psychiatric disorder. In exploratory analyses of insomnia and pubertal development, onset of menses was associated with a 2.75-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but a difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys.

CONCLUSIONS. Insomnia seems to be common and chronic among adolescents. The often found gender difference in risk for insomnia seems to emerge in association with onset of menses.
Neck/Shoulder, Low Back, and Arm Pain in Relation to Computer Use, Physical Activity, Stress, and Depression Among Dutch Adolescents
Authors: Diepenmaat A.C.M. , van der Wal M.F. , de Vet H.C.W. , Hirasing R.A.
Published: February 2006

OBJECTIVE. To examine among adolescents (1) the prevalence of neck/shoulder, low back, and arm pain within different sociodemographic groups and (2) the association of neck/shoulder, low back, and arm pain with computer use, physical activity, depression, and stress.

METHODS. A school-based questionnaire survey in 2002 and 2003 of neck/shoulder, low back, and arm pain, computer use, physical activity, depression, and stress. The survey was given to 3485 adolescents aged 12 to 16 years who attended secondary schools in Amsterdam, Netherlands.

RESULTS. The overall prevalence of neck/shoulder, low back, and arm pain was 11.5%, 7.5%, and 3.9%, respectively. The prevalence of neck/shoulder pain was higher among girls and adolescents not living with both parents. The prevalence of low back pain also was higher among girls. Depressive symptoms were associated with neck/shoulder pain, low back pain, and arm pain. The stress experienced was associated with neck/shoulder pain and with low back pain.

CONCLUSIONS. This study strengthens the findings that musculoskeletal pain is common among adolescents and is associated with depression and stress but not with computer use and physical activity.
Effect of Altitude on Hospitalizations for Respiratory Syncytial Virus Infection
Authors: Choudhuri Julie A. , Ogden Lorraine G. , Ruttenber A. James , Thomas Deborah S.K. , Todd James K. , Simoes Eric A.F.
Published: February 2006

OBJECTIVE. Respiratory syncytial virus (RSV) infection is the foremost cause of serious lower respiratory tract infection in young children and infants. Because higher rates of hospitalization for bronchiolitis and pneumonia have been noted in high-altitude regions, we hypothesized that physiologic responses to altitude would predispose children to more severe illness from RSV infection. This study examined the effect of residential altitude on hospitalizations for RSV infection in Colorado from 1998 through 2002.

METHODS. A geographic information system was used to assemble data for altitude and demographic variables by zip code–tabulation areas. Data then were linked with hospital discharge data for RSV infections. Poisson regression models were developed to explore correlations between hospitalization rates and residential altitude, after adjustment for socioeconomic differences in the underlying population.

RESULTS. RSV-associated hospitalizations averaged 15.9 per 1000 infants who were younger than 1 year and 1.8 per 1000 children who were 1 to 4 years of age per season. A multivariate analysis suggested that the rate of hospitalization for RSV-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes increased 25% among infants who were younger than 1 year and 53% among children who were 1 to 4 years of age for every 1000-m increase in altitude. The risk for RSV-associated hospitalization was highest at elevations above 2500 m.

CONCLUSIONS. High altitude above 2500 m is a modest predictor for RSV-associated hospitalization. Practitioners in these regions should consider additional efforts to educate parents about RSV infection and its prevention and the importance of early treatment.
Project Universal Preschool Vision Screening: A Demonstration Project
Authors: Hartmann E. Eugenie , Bradford Geoffrey E. , Nottingham Chaplin P. Kay , Johnson Tammy , Kemper Alex R. , Kim Sunnah , Marsh-Tootle Wendy ,   Writing Committee, Submitted on behalf of PUPVS Panel for the American Academy of Pediatrics
Published: February 2006

OBJECTIVES. Visual disorders among preschool-aged children are common, yet screening is infrequent. The purpose of this project was to implement the vision screening recommendations proposed by the Maternal and Child Health Bureau and National Eye Institute Vision Screening in the Preschool Child Task Force: monocular visual acuity and stereopsis testing.

METHODS. Four sites fully participated in the implementation of the task force recommendations with 3- and 4-year-old children. Two of the sites worked with primary care practices (testing performed by staff); 2 worked with community-based programs (testing performed by lay volunteers). Each site tracked number of children screened by age, as well as proportion testable, referred, and with documented follow-up evaluation.

RESULTS. Variations in implementation of the recommendations were observed. Successful screening among 3-year-olds ranged from 70% to 93%; referral rates were 1% to 41%, and follow-up rates were 29% to 100%. Successful screening among 4-year-olds ranged from 88% to 98%; referral rates were 2% to 40%, and follow-up rates were 41% to 100%. The proportion of 3-year-olds who were treated was significantly different between the community-based sites (n = 20) and the primary care sites (n = 2). Similarly, the proportion of 4-year-olds who were treated was significantly different between the community-based sites (n = 36) and the primary care sites (n = 11).

CONCLUSIONS. The variability across pilot sites in numbers successfully screened and numbers referred suggests that all aspects of preschool vision screening need thorough review before the goal of universal preschool vision screening can be realized.
Temporal Associations Among Energy Intake, Plasma Linoleic Acid, and Growth Improvement in Response to Treatment Initiation After Diagnosis of Cystic Fibrosis
Authors: Shoff Suzanne M. , Ahn Hong-Yup , Davis Lisa , Lai HuiChuan ,   the Wisconsin CF Neonatal Screening Group
Published: February 2006

OBJECTIVE. It is unclear why some patients with cystic fibrosis (CF) succeed (“responders”) in recovering from malnutrition and growth faltering after treatment initiation whereas others fail to do so (“nonresponders”). We conducted a study to test the hypothesis that sustained high energy intake (↑EN) and normal plasma essential fatty acid status are critical determinants of treatment responsiveness within 2 years after diagnosis of CF.

METHODS. A total of 71 CF children who had pancreatic insufficiency but not meconium ileus and were enrolled in the Wisconsin CF Neonatal Screening Project were studied. Responders were defined by having achieved adequate weight gain, as indicated by a recovery of weight z score (Wtz) comparable to Wtz at birth (WtzBR) within 2 years of diagnosis. ↑EN and sustained normal plasma linoleic acid level (↑pLA) were defined by achieving energy intake ≥120% of estimated requirement for ≥75% of the time and maintaining plasma LA ≥26% of total fatty acids for ≥75% of the time, respectively.

RESULTS. Thirty-two (68%) screened patients and 13 (54%) patients whose CF was diagnosed conventionally recovered WtzBR within 2 years of diagnosis. Screened patients responded at significantly younger ages (mean/median: 6.3/4.3 months) than patients whose CF was diagnosed conventionally (mean/median: 15.8/11.8 months). Proportionately fewer screened patients (33%) achieved ↑EN compared with patients whose CF was diagnosed conventionally (73%). However, more screened patients responded to ↑EN and recovered WtzBR (91%) than patients whose CF was diagnosed conventionally (56%), although this difference was of borderline significance. Compared with having neither ↑EN nor ↑pLA, the likelihood of being a responder was greatest with combined ↑EN and ↑pLA, followed by ↑EN only. The positive associations between ↑EN and ↑pLA to treatment responsiveness remained significant after adjustment for neonatal screening status, baseline height and weight status, and indices of pulmonary disease severity.

CONCLUSION. ↑EN and ↑pLA are critical in promoting adequate weight gain in children with newly diagnosed CF.
Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity
Authors: Gordon-Larsen Penny , Nelson Melissa C. , Page Phil , Popkin Barry M.
Published: February 2006

CONTEXT. Environmental factors are suggested to play a major role in physical activity (PA) and other obesity-related behaviors, yet there is no national research on the relationship between disparity in access to recreational facilities and additional impact on PA and overweight patterns in US adolescents.

OBJECTIVE. In a nationally representative cohort, we sought to assess the geographic and social distribution of PA facilities and how disparity in access might underlie population-level PA and overweight patterns.

DESIGN, SETTING, AND PARTICIPANTS. Residential locations of US adolescents in wave I (1994–1995) of the National Longitudinal Study of Adolescent Health (N = 20745) were geocoded, and a 8.05-km buffer around each residence was drawn (N = 42857 census-block groups [19% of US block groups]). PA facilities, measured by national databases and satellite data, were linked with Geographic Information Systems technology to each respondent. Logistic-regression analyses tested the relationship of PA-related facilities with block-group socioeconomic status (SES) (at the community level) and the subsequent association of facilities with overweight and PA (at the individual level), controlling for population density.

MAIN OUTCOME MEASURES. Outcome measures were overweight (BMI ≥ 95th percentile of the Centers for Disease Control and Prevention/National Center for Health Statistics growth curves) and achievement of ≥5 bouts per week of moderate-vigorous PA.

RESULTS. Higher-SES block groups had a significantly greater relative odds of having 1 or more facilities. Low-SES and high-minority block groups were less likely to have facilities. Relative to zero facilities per block group, an increasing number of facilities was associated with decreased overweight and increased relative odds of achieving ≥5 bouts per week of moderate-vigorous PA.

CONCLUSIONS. Lower-SES and high-minority block groups had reduced access to facilities, which in turn was associated with decreased PA and increased overweight. Inequality in availability of PA facilities may contribute to ethnic and SES disparities in PA and overweight patterns.
A Combination Measles, Mumps, Rubella, and Varicella Vaccine (ProQuad) Given to 4- to 6-Year-Old Healthy Children Vaccinated Previously With M-M-RII and Varivax
Authors: Reisinger Keith S. , Hoffman Brown Michelle L. , Xu Jin , Sullivan Bradley J. , Marshall Gary S. , Nauert Beth , Matson David O. , Silas Peter E. ,   Protocol 014 Study Group for ProQuad, Schödel Florian , Gress Jacqueline O. , Kuter Barbara J.
Published: February 2006

BACKGROUND. In the United States, children receive primary doses of M-M-RII (Merck & Co, Inc, West Point, PA) and Varivax (Merck & Co, Inc) beginning at 12 months, often at the same health care visit. Currently a second dose of M-M-RII is given to 4- to 6-year-old children, to increase vaccination rates and to reduce the number of individuals without detectable antibodies. A second dose of a varicella-containing vaccine may result in similar benefits.

OBJECTIVES. To demonstrate that ProQuad (measles, mumps, rubella, and varicella virus vaccine live; Merck & Co, Inc) may be given in place of a second dose of M-M-RII or second doses of M-M-RII and Varivax for 4- to 6-year-old children.

METHODS. Four- to 6-year-old children who had been immunized previously with M-M-RII and Varivax were assigned randomly to receive either ProQuad and placebo (N = 399), M-M-RII and placebo (N = 195), or M-M-RII and Varivax (N = 205) and were then monitored for safety and immunogenicity.

RESULTS. ProQuad was generally well tolerated. Similarity (noninferiority) was demonstrated in postvaccination antibody responses to measles, mumps, and rubella between recipients of ProQuad and all recipients of M-M-RII and in responses to varicella between recipients of ProQuad and recipients of Varivax. Postvaccination seropositivity rates for antibodies against all 4 viruses were nearly 100% in all 3 groups. Small fold increases were observed for measles, mumps, and rubella antibody titers. In contrast, substantial boosts in varicella antibody titers were observed among recipients of a second dose of varicella vaccine, administered as ProQuad or Varivax.

CONCLUSIONS. ProQuad may be used in place of a second dose of M-M-RII or second doses of M-M-RII and Varivax for 4- to 6-year-old children.
Onset of Mechanical Ventilation Is Associated With Rapid Activation of Circulating Phagocytes in Preterm Infants
Authors: Turunen Riikka , Nupponen Irmeli , Siitonen Sanna , Repo Heikki , Andersson Sture
Published: February 2006

OBJECTIVE. In preterm infants with respiratory distress syndrome (RDS), circulating neutrophils are activated. Kinetics and effects of surfactant therapy on this activation are unknown. Therefore, we studied activation of circulating neutrophils and monocytes in newborn preterm infants with and without RDS.

PATIENTS AND METHODS. Preterm infants with RDS who were mechanically ventilated and received surfactant (“ventilated infants”: n = 38; mean gestational age ± SD: 28.3 ± 2.2 weeks; mean birth weight ± SD: 1086 ± 353 g) and preterm infants who received nasal continuous positive airway pressure (n = 8) or no ventilatory support (n = 17) (“control infants”: mean gestational age ± SD: 32.1 ± 1.2 weeks; mean birth weight ± SD: 1787 ± 457 g) were recruited. Blood samples were taken from ventilated infants at birth, before surfactant treatment, at 1 and 2 hours after surfactant, and at 12 to 24 hours of age. Blood samples were taken from control infants at birth, at 2 to 6 hours, and at 12 to 24 hours of age. Phagocyte CD11b expression was analyzed by flow cytometry.

RESULTS. In ventilated infants, phagocyte CD11b expression increased from birth to the first postnatal samples. It increased further by 12 to 24 hours of age. Control infants with or without nasal continuous positive airway pressure showed no significant increase after birth. At 12 to 24 hours of age, phagocyte CD11b expression was higher in ventilated infants than in control infants. In ventilated infants, neutrophil CD11b expression at 1 and 2 hours after surfactant correlated positively with gestational age.

CONCLUSIONS. In preterm infants with RDS, significant activation of circulating phagocytes occurs within 1 to 3 hours of the onset of mechanical ventilation, independent of surfactant administration, which indicates that mechanical ventilation may be the inducer of this systemic inflammatory response.
Factors Associated With Neurodevelopmental Outcome at 2 Years After Very Preterm Birth: The Population-Based Nord-Pas-de-Calais EPIPAGE Cohort
Authors: Fily Antoine , Pierrat Véronique , Delporte Valérie , Breart Gérard , Truffert Patrick ,   on behalf of the EPIPAGE Nord-Pas-de-Calais Study Group
Published: February 2006

OBJECTIVE. We sought to (1) evaluate at 2 years the postsurfactant era developmental outcome of children who were born before 33 weeks of gestational age (GA) in the Nord-Pas-de-Calais area in France in 1997 and (2) identify risk factors of poor developmental quotient (DQ). Children were part of the EPIPAGE study, which included all of these births in 9 French regions.

METHODS. A prospective observational study was conducted of all births before 33 weeks in 1997. Risk factors of poor DQ were obtained from a multiple linear regression, and results were expressed as DQ differences with 95% confidence intervals.

RESULTS. A total of 546 births were included in the study. A total of 461 (84.4%) had a clinical evaluation at 2 years of age, and 380 (69.6%) had an assessment with the use of the Brunet-Lezine scale of infant development. Their mean GA was 29.9 weeks (29.7–30.1 weeks), and mean birth weight was 1378 g (1338–1418 g). A total of 9% had a recognizable pattern of cerebral palsy, 0.2% were blind, and 0.8% required hearing aids. The mean DQ was 94 ± 11 and decreased from 97 at 32 weeks to 86 at 24 to 25 weeks. After multivariate analysis, children who were born at 24 to 25 weeks had a mean DQ reduction of 11 points (−20 to −1) compared with those who were born at 32 weeks, but minor differences were found from 26 to 32 weeks. Boys had a DQ 4 points lower than girls (−7 to −1).

CONCLUSIONS. In this study, the outcome of extremely preterm infants was poor. After 25 weeks, outcome was related mainly to the sociocultural level of the family and to the presence of severe cerebral ultrasound abnormalities. Consequently, in the postsurfactant era, we have to propose follow-up programs to children who are born extremely preterm and to concentrate our efforts on children with less-than-optimal social and family setting.
Quality of Life for Children and Adolescents: Impact of HIV Infection and Antiretroviral Treatment
Authors: Lee Grace M. , Gortmaker Steven L. , McIntosh Kenneth , Hughes Michael D. , Oleske James M. ,   Pediatric AIDS Clinical Trials Group Protocol 219C Team
Published: February 2006

BACKGROUND. HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance.

OBJECTIVES. To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children.

METHODS. Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated.

RESULTS. HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5–11 years of age) and adolescents (12–21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found.

CONCLUSIONS. Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.
Persistent Bacteremia and Severe Thrombocytopenia Caused by Coagulase-NegativeStaphylococcusin a Neonatal Intensive Care Unit
Authors: Khashu Minesh , Osiovich Horacio , Henry Deborah , Khotani Aziz Al , Solimano Alfonso , Speert David P.
Published: February 2006

OBJECTIVE. Coagulase-negative Staphylococcus (CoNS) is the most frequent cause of late-onset sepsis in NICUs, but mortality is rare and morbidity is unusual. We report a new syndrome of CoNS sepsis characterized by significant morbidity and persistent bacteremia despite aggressive antibiotic therapy and no identified focus of infection.

METHODS. We conducted a retrospective review of infants in the NICU with CoNS bacteremia between 2000 and 2002. Statistical analysis included an initial exploratory analysis followed by logistic regression. Microbiological identification of all isolates and molecular typing were performed.

RESULTS. Thirty-one neonates with persistent CoNS bacteremia were compared with 60 randomly selected neonates from a group of 140 with nonpersistent CoNS bacteremia. The clinical manifestations at presentation, gestational ages, and birth weights were similar in the 2 groups. Thrombocytopenia was present in 26 (84%) neonates with persistent CoNS bacteremia but only in 8 (13%) neonates in the nonpersistent group. Central venous catheterization increased the risk for persistent CoNS bacteremia, but 42% of the persistent group was never catheterized. Staphylococcus epidermidis was the most common isolate in both groups. Molecular typing failed to identify a predominant clone.

CONCLUSIONS. The syndrome of persistent CoNS septicemia is remarkable for thrombocytopenia and persistence in the absence of central venous catheterization. Clinical manifestations at presentation and demographic characteristics did not discriminate between the persistent and nonpersistent groups. We did not identify the emergence of a particularly virulent clone, but it is possible that some strains of CoNS have acquired the capacity to persist under different conditions.
Improved Asthma Care After Enrollment in the State Children's Health Insurance Program in New York
Authors: Szilagyi Peter G. , Dick Andrew W. , Klein Jonathan D. , Shone Laura P. , Zwanziger Jack , Bajorska Alina , Yoos H. Lorrie
Published: February 2006

BACKGROUND. Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care.

OBJECTIVES. We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma.

DESIGN. Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends.

MAIN OUTCOME MEASURES. Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP).

RESULTS. Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were “better or much better” than at baseline, generally because of insurance coverage or lower costs of medications and medical care.

CONCLUSIONS. Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.
Anticipatory Guidance and Violence Prevention: Results From Family and Pediatrician Focus Groups
Authors: Sege Robert D. , Hatmaker-Flanigan Elizabeth , De Vos Edward , Levin-Goodman Rebecca , Spivak Howard
Published: February 2006

OBJECTIVES. Anticipatory guidance is a cornerstone of modern pediatric practice. Recent American Academy of Pediatrics policies related to violence prevention, notably those that advocate firearms safety and the use of alternatives to corporal punishment, seem to be discrepant with common parenting practices. To develop more effective anticipatory guidance, we sought the opinions of parents and pediatricians on how best to communicate these messages.

DESIGN. Focus groups were conducted to elicit parent and provider opinions.

SUBJECTS. Forty-nine parents participated in a total of 9 90-minute focus groups that were held in 3 cities. Twenty-six pediatricians participated in 3 focus groups that were held at a single national meeting.

PROCEDURES. Participants were read summaries of current American Academy of Pediatrics policies and led through a systematic discussion of how these policies might best be communicated. The group discussions were audiotaped, transcribed, and analyzed. Common themes heard in multiple groups are reported.

RESULTS. Parents provided specific feedback about corporal punishment and firearms and also raised a number of general issues. Pediatricians reported that anticipatory guidance was important to them but cited cultural and reimbursement issues as barriers to practice. They also reported the need for additional training and support to make anticipatory guidance more effective.

DISCUSSION. Focus groups provide insight into doctor-patient communications and can inform efforts to improve primary prevention in the clinical setting. Anticipatory guidance that consists of authoritative useful information, offered in a supportive manner that communicates respect for parental decision-making, may be effective in improving parenting practices.