bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial
Authors: Nout Remi A. , van de Poll-Franse Lonneke V. , Lybeert Marnix L.M. , Wárlám-Rodenhuis Carla C. , Jobsen Jan J. , Mens Jan Willem M. , Lutgens Ludy C.H.W. , Pras Betty , van Putten Wim L.J. , Creutzberg Carien L. 
Published: March 2011

Purpose To determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial. Patients and Methods Between 1990 and 1997, 714 patients with stage IC grade 1 to 2 or IB grade 2 to 3 EC were randomly allocated to pelvic external-beam radiotherapy (EBRT) or no additional treatment (NAT). HRQL was evaluated with the Short Form 36-Item (SF-36) questionnaire; subscales from the European Organisation for Research and Treatment of Cancer (EORTC) PR25 module for bowel and bladder symptoms and the OV28 and CX24 modules for sexual symptoms; and demographic questions. Analysis was by intention-to-treat. Results Median follow-up was 13.3 years. The 15-year actuarial locoregional recurrence rates were 5.8% for EBRT versus 15.5% for NAT (P < .001), and 15-year overall survival was 52% versus 60% (P = .14). Of the 351 patients confirmed to be alive with correct address, 246 (70%) returned the questionnaire. Patients treated with EBRT reported significant (P < .01) and clinically relevant higher rates of urinary incontinence, diarrhea, and fecal leakage leading to more limitations in daily activities. Increased symptoms were reflected by the frequent use of incontinence materials after EBRT (day and night use, 42.9% v 15.2% for NAT; P < .001). Patients treated with EBRT reported lower scores on the SF-36 scales “physical functioning” (P = .004) and “role-physical” (P = .003). Conclusion EBRT for endometrial cancer is associated with long-term urinary and bowel symptoms and lower physical and role-physical functioning, even 15 years after treatment. Despite its efficacy in reducing locoregional recurrence, EBRT should be avoided in patients with low- and intermediate-risk EC.
Prevalence of Chronic Health Conditions in Children With Intellectual Disability: A Systematic Literature Review
Authors: Oeseburg Barth , Dijkstra Geke J , Groothoff Johan W , Reijneveld Sijmen A , Jansen Daniëlle E. M. C 
Published: March 2011

AbstractA systematic review of the prevalence rates of chronic health conditions in populations of children with intellectual disability was provided. We identified 2,994 relevant studies by searching Medline, Cinahl, and PsycINFO databases from 1996 to 2008. We included the 31 studies that had sufficient methodological quality. The 6 most prevalent chronic health conditions in children with intellectual disability were epilepsy (22.0/100), cerebral palsy (19.8/100), any anxiety disorder (17.1/100), oppositional defiant disorder (12.4/100), Down syndrome (11.0/100), and autistic disorder (10.1/100). The reported prevalence rates of chronic health conditions in this population was much higher than in the general population. However, both the number of studies that were included and the number of chronic health conditions they reported about were limited. There is an urgent need for better evidence on the prevalence of chronic health conditions among children with intellectual disability.
Hier, da und dort– regionale Variation und standardsprachlicher Gebrauch bei den primären Lokaldeiktika im Deutschen
Authors: Möller Robert 
Published: March 2011

Abstract
There is much disagreement with respect to the adequate description of the primary local demonstratives in German. This is partly due to the fact that functions of da have been considered which are not properly locative deictic. However, the problem appears to derive first and foremost from regional differences on the one hand and the influence of written language on the other. In day-to-day language there is considerable variation in the use of local demonstratives. Two-level systems predominate: the most widespread is hier – da, but regionally hier – dort or da – dort are also usual, although a complete parallelism between these oppositions is not always present. For the (intended) standard language use, this is the point of departure (real deixis is normally connected to the proximity situation); but through the orientation of spoken language towards written language, in which the local demonstrative dort is preferred to da for reasons of clarity, dort generally comes into play additionally as a variant which is given a higher value.
Androgen receptor CAG repeat length polymorphism modifies the impact of testosterone on insulin sensitivity in men
Authors: Möhlig Matthias , Arafat Ayman M , Osterhoff Martin A , Isken Frank , Weickert Martin O , Spranger Joachim , Pfeiffer Andreas F H , Schöfl Christof 
Published: March 2011

ObjectiveLow circulating testosterone concentrations have been associated with insulin resistance (IR). Androgen action is mediated by the androgen receptor (AR) whose activity is modulated by a polymorphic CAG repeat sequence within exon 1. An interaction between testosterone and CAG repeat length (CAG length) with respect to IR has been described in women.ObjectiveWe investigated such a putative interaction between testosterone and the CAG length with respect to IR in men with normal glucose tolerance.DesignCross-sectional study.MethodsIn 113 non-diabetic men calculated free testosterone, the CAG length, and a multiplicative interaction term were investigated by multiple linear regression analysis for an association with IR, as indicated by homeostasis model assessment (HOMA %S).ResultsIn a multivariate regression analysis adjusted for age and body mass index, free testosterone, CAG length, and a multiplicative interaction term were significantly associated with IR (P=0.001, P=0.001, P=0.01 respectively). The model explained 36.6% of the variation of IR and predicted that in carriers with a CAG length of 23, changes in testosterone would only minimally affect IR. For CAG lengths longer than 23, however, an increase in testosterone would improve IR, namely the longer the CAG length, the greater the effect. In contrast, in the case of CAG lengths shorter than 23, the effect of increasing testosterone would be the opposite.ConclusionsIn men, testosterone and the AR CAG repeat length polymorphism interacted with respect to IR. The interpretation of the association between testosterone and IR seems to require consideration of the AR CAG repeat polymorphism.
The Influence of Family Characteristics on Perinatal Decision Making
Authors: Marcello Kirstie R. , Stefano John L. , Lampron Kim , Barrington Keith J. , Mackley Amy B. , Janvier Annie 
Published: March 2011

OBJECTIVE:
To determine whether parental characteristics affect estimates of best interests and intervention decisions for preterm infants.

DESIGN AND METHODS:
The study consisted of an anonymous questionnaire given to nurses, physicians, and students. The study included scenarios of 3 sets of parents, including a 16-year-old teenager, a couple who were lawyers, and a couple with a history of in vitro fertilization, about to deliver at 2257 weeks, 24 weeks, or 2757 weeks. Respondents were asked whether active intervention is in the infant's best interests and whether they would comply with family decisions.

RESULTS:
A total of 1105 questionnaires were sent out, with 829 respondents in Canada and the United States. At 2257 weeks' gestation, 21% of the respondents thought that resuscitation was in the infant's best interest; among respondents who did not agree, 59% would intervene if the parents wished. At 2757 weeks' gestation, 95% of respondents thought that resuscitation was in the infant's best interest, yet 34% would accept comfort care. Estimates of best interest, and willingness to comply, varied significantly by parental characteristics. At 2257 weeks' gestation, 17% of respondents believed that resuscitation was in the best interest of the teenaged mother's infant compared with 26% of respondents who believed that resuscitation was in the best interest for the infants of the others; this difference persisted at 24 weeks. At 2257 and at 24 weeks' gestation, compliance with active care despite believing that it not in the infant's best interest was significantly more frequent for the in vitro fertilization couple and the lawyers than for the teenaged mother. At 27 weeks' gestation, more than 93% of respondents complied for all parents.

CONCLUSIONS:
Caregivers frequently are ready to intervene actively, or not, despite believing that it is against the infant's best interest. Willingness to do so varies according to parental characteristics.
Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits
Authors: Sleath Betsy , Ayala Guadalupe X. , Gillette Chris , Williams Dennis , Davis Stephanie , Tudor Gail , Yeatts Karin , Washington Deidre 
Published: March 2011

OBJECTIVE:
The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits.

PATIENTS AND METHODS:
Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants.

RESULTS:
Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.

CONCLUSIONS:
There is a need for providers to demonstrate proper asthma medication and monitoring device techniques to children and to have children demonstrate to proficiency. The 2007 National Heart, Lung, and Blood Institute expert panel report on the diagnosis and management of asthma encourages providers to educate children on these techniques.
Parent Diet Modification, Child Activity, or Both in Obese Children: An RCT
Authors: Collins Clare E. , Okely Anthony D. , Morgan Philip J. , Jones Rachel A. , Burrows Tracy L. , Cliff Dylan P. , Colyvas Kim , Warren Janet M. , Steele Julie R. , Baur Louise A. 
Published: March 2011

OBJECTIVES:
Outcomes of childhood obesity interventions are rarely reported beyond 1 year. We hypothesized that the impact on the BMI z score from a child-centered physical-activity program in combination with a parent-centered dietary-modification program would be greater than either program conducted alone at 24 months' after baseline.

PARTICIPANTS AND METHODS:
A total of 165 overweight prepubertal children (68 boys, aged 5.5–9.9 years, mean BMI z score: 2.8) were randomly assigned to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both conducted together in an assessor-blinded 6-month intervention.

RESULTS:
Using linear mixed models, all groups reduced their mean (95% confidence interval) BMI z score at 24 months from baseline (P &lt; .001) (the activity and diet group: −0.24 [−0.35 to −0.13]; the diet-only group: −0.35 [−0.48 to −0.22]; activity-only group −0.19 [−0.30 to −0.07]). There was a significant group-by-time interaction (P = .04) with the activity + diet and the diet-only groups showing a greater reduction than the activity-only group. For waist z score and waist-to-height ratio, there was a significant time effect (P &lt; .0001) at 24 months but no between-group differences (P &gt; .05). Some metabolic outcomes improved at 24 months, although there were no between-group differences (P &gt; .05).

CONCLUSIONS:
A reduction in BMI z score was sustained at 24 months by treatment with either program combination. The greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment and the possibility of targeting them exclusively in treating obese prepubertal children.
The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals
Authors: Dubowitz Howard , Lane Wendy G. , Semiatin Joshua N. , Magder Laurence S. , Venepally Mamata , Jans Merel 
Published: March 2011

OBJECTIVE:
To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM).

METHODS:
In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression). The SEEK model included the parent screening questionnaire and the participation of a social worker. SEEK's impact was evaluated in 3 ways: (1) the health professional questionnaire (HPQ), which assessed HPs' attitudes and practice regarding the targeted problems; (2) observations of HPs conducting checkups; and (3) review of children's medical records.

RESULTS:
The 102 HPs averaged 45 years of age; 68% were female, and 74% were in suburban practices. Comparing baseline scores with 6-, 18-, and 36-month follow-up data, the HPQ revealed significant (P &lt; .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort level and perceived competence (both at 6, 18, and 36 months). SEEK HPs screened for targeted problems more often than did controls based on observations 24 months after the initial training and the medical records (P &lt; .001).

CONCLUSIONS:
The SEEK model led to significant and sustained improvement in several areas. This is a crucial first step in helping HPs address major psychosocial problems that confront many families. SEEK offers a modest yet promising enhancement of primary care.
Nutritional Supplements and Other Complementary Medicines for Infantile Colic: A Systematic Review
Authors: Perry Rachel , Hunt Katherine , Ernst Edzard 
Published: March 2011

BACKGROUND:Complementary and alternative medicines often are advocated for infantile colic, yet there has been no synthesis of the evidence to inform current practice about their use.OBJECTIVE:To critically evaluate all randomized clinical trials of nutritional supplements and other complementary and alternative medicines as a treatment for infantile colic.METHODS:Five electronic databases were searched from their inception to February 2010 to identify all relevant randomized clinical trials of complementary and alternative medicines and supplements for infantile colic. Reference lists of retrieved articles were hand searched. Data were extracted by two independent reviewers, and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias.RESULTS:Fifteen randomized clinical trials met the inclusion criteria and were included. Thirteen studies were placebo controlled. Eight were of good methodological quality. Eleven trials indicated a significant result in favor of complementary and alternative medicines. However, none of these randomized clinical trials were without flaws. Independent replications were missing for most modalities.CONCLUSIONS:Some encouraging results exist for fennel extract, mixed herbal tea, and sugar solutions, although it has to be stressed that all trials have major limitations. Thus, the notion that any form of complementary and alternative medicine is effective for infantile colic currently is not supported from the evidence from the included randomized clinical trials. Additional replications are needed before firm conclusions can be drawn.
Sudden Deaths and Severe Apparent Life-Threatening Events in Term Infants Within 24 Hours of Birth
Authors: Poets Anette , Steinfeldt Renate , Poets Christian F. 
Published: March 2011

OBJECTIVE AND DESIGN:
To determine the incidence of and possible risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth. This was a monthly epidemiologic survey.

PATIENTS AND METHODS:
Throughout 2009, every pediatric department in Germany was asked to report such cases of unexplained SID or S-ALTE in term infants after a good postnatal adaptation (10-minute Apgar score ≥ 8) to the Surveillance Unit for Rare Pediatric Conditions in Germany. The latter has a capture rate of &gt; 95%. S-ALTE was defined as acute cyanosis/pallor and unconsciousness, requiring bagging, intubation and/or cardiac compressions. Hospitals that reported a case were asked to return an anonymized questionnaire and discharge letter as well as the autopsy protocol in SID cases.

RESULTS:
Of 43 cases reported, 17 fulfilled entry criteria, yielding an incidence of 2.6 in 100 000 live births. There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother's chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake.

CONCLUSIONS:
SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant's condition correctly. Closer observation during these earliest hours seems warranted.
Evidence Suggests There Was Not a “Resurgence” of Kernicterus in the 1990s
Authors: Brooks Jordan C. , Fisher-Owens Susan A. , Wu Yvonne W. , Strauss David J. , Newman Thomas B. 
Published: March 2011

BACKGROUND:Although some have suggested that kernicterus disappeared in the United States in the 1970s to 1980s and dramatically reappeared in the 1990s, population-based data to support such a resurgence are lacking.METHODS:We used diagnosis codes on data collection forms from the California Department of Developmental Services (DDS) to identify kernicterus cases among children born from 1988 to 1997. We examined kernicterus mortality trends in the United States from 1979 to 2006 using death certificate data from the National Center for Health Statistics.RESULTS:We identified 25 cases of physician-diagnosed kernicterus. This figure was augmented to reflect estimates of cases lost to infant mortality, yielding incidence estimates of 1 in 200 000 California live births, 1 in 2500 among children who received services from DDS, and 1 in 400 children with cerebral palsy. There was no significant trend in kernicterus incidence from 1988 to 1997 (P = .77). Incidence before and after the 1994 publication of the AAP practice parameter for hyperbilirubinemia in healthy term infants was not significantly different (P = .92). Nationally, there were 3 reported infant deaths from kernicterus in 1994 and 2 or fewer in the other 28 years from 1979 to 2006 (0.28 deaths per million live births): there was no significant increase in kernicterus mortality over this period.CONCLUSION:Data from California do not support a resurgence of kernicterus in the 1990s. Deaths from kernicterus in the United States have remained rare, with no apparent increase during the last 25 years.
Needle-Entry Angle for Lumbar Puncture in Children as Determined by Using Ultrasonography
Authors: Bruccoleri Rebecca Elaine , Chen Lei 
Published: March 2011

OBJECTIVE:
The purpose of this study was to evaluate the angle for performing lumbar punctures in children aged 0 to 12 years. We hypothesized that the angle changes for different stages of development.

METHODS:
Children aged 0 to 12 years who presented to the Yale–New Haven Children's Hospital at a low-acuity triage level, in need of a lumbar puncture, their accompanying siblings and authors' children were eligible for the study. Subjects in 3 age groups were recruited and grouped as follows: group 1, 0 to 12 months; group 2, 12 to 36 months; and group 3, 3 to 12 years. Ultrasound images of the L3-L4 and L4-L5 lumbar space were taken with subjects in the lateral recumbent and sitting positions. The angle from the interspinous space to the skin was measured.

RESULTS:
Thirty-six subjects were included. The mean angles in the lateral recumbent and sitting positions were group 1, 47.8° (SD: 8.2) and 51.1° (SD: 8.5), respectively; group 2, 58.8° (SD: 6.8) and 59.6° (SD: 5.5); and group 3, 60.5° (SD: 6.6) and 61.9° (SD: 4.0). The results of group 1 were significantly different from those of groups 2 or 3 in both positions (lateral recumbent P = .00526 and 0.00160; sitting P = .0499 and .00282).

CONCLUSIONS:
The angle for lumbar puncture was more acute for infants than for older children in this study. Future studies should assess the difference in success rates of lumbar punctures when clinicians have knowledge of these angles.
Impact of Cannabis Sativa (Marijuana) Smoke on Alveolar Bone Loss: A Histometric Study in Rats
Authors: Nogueira‐Filho Getulio R. , Todescan Sylvia , Shah Adnan , Rosa Bruno T. , Tunes Urbino da R. , Cesar Neto Joao B. 
Published: March 2011

Background: Cannabis sativa (marijuana) can interfere with bone physiopathology because of its effect on osteoblast and osteoclast activity. However, its impact on periodontal tissues is still controversial. The present study evaluates whether marijuana smoke affects bone loss (BL) on ligature‐induced periodontitis in rats.Methods: Thirty male Wistar rats were used in the study. A ligature was placed around one of the mandible first molars (ligated teeth) of each animal, and they were then randomly assigned to one of two groups: control (n = 15) or marijuana smoke inhalation ([MSI] for 8 minutes per day; n = 15). Urine samples were obtained to detect the presence of tetrahydrocannabinol. After 30 days, the animals were sacrificed and decalcified sections of the furcation area were obtained and evaluated according to the following histometric parameters: bone area (BA), bone density (BD), and BL.Results: Tetrahydrocannabinol was positive in urine samples only for the rats of the MSI group. Non‐significant differences were observed for unligated teeth from both groups regarding BL, BA, and BD (P >0.05). However, intragroup analysis showed that all ligated teeth presented BL and a lower BA and BD compared to unligated teeth (P <0.05). The intergroup evaluation of the ligated teeth showed that the MSI group presented higher BL and lower BD (P <0.05) compared to ligated teeth from the control group.Conclusion: Considering the limitations of this animal study, cannabis smoke may impact alveolar bone by increasing BL resulting from ligature‐induced periodontitis.