bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitalization in Sweden of children born to immigrants
Authors: Danielsson N , Ericsson A , Eriksson M , Källén B , Zetterström R 
Published: August 2010

Aim: To study whether excess hospitalization occurs among certain groups of children born in Sweden to immigrant parents. Methods: The study was based on linkage of the Swedish Medical Birth Register 1987–1997 and the Swedish Hospital Discharge Register 1987–1998. Results: Among children whose parents were of Swedish nationality excess hospitalization was found for children of young mothers, parity 3 or more, and if the mother smoked in early pregnancy. These factors were controlled for in the further analysis. Ten years after birth, a large percentage of children born to parents with foreign nationality could not be followed owing to death or emigration (19.9% vs 1.77% of children with Swedish parents). An excess hospitalization of immigrant children up to the age of about 5 y was seen but after that, if anything, these children were hospitalized less. For the whole group of children born to parents of non‐Swedish nationality there was no difference in hospitalization rate after stratification for risk factors and age. When analysis was performed for specific nationalities significantly reduced rates were found for several western European countries while significantly increased rates were seen for the Middle East, north Africa and especially sub‐Saharan Africa (odds ratio 1.57, 95% confidence interval 1.49–1.64). Conclusion: A moderately increased rate of child hospitalization was only observed for some selected immigrant groups.
Management of vertically HIV‐infected children in Europe
Authors:   European Collaborative Study
Published: August 2010

Aim: To describe policies for the therapeutic management of vertically HIV‐infected children, and to compare these with practice, using children enrolled in a cohort study in the same setting. Methods: A postal questionnaire survey of clinicians in the paediatric centres of the European Collaborative Study (ECS) was used. Prospective data collected within the ECS on the treatment and clinical status of infected children seen in these centres in 1999–2001 were analysed and compared with the year 2000 policies reported. Results: In 3 of the 10 centres, the policy was routinely to administer antiretroviral therapy (ART) to infants upon confirmation of infection, and in 7 centres initiation of therapy was delayed until specific clinical, virological and immunological criteria were reached. Evidence of disease progression was a reason for treatment modification in all centres; other considerations included adherence problems and side effects. However, practice did not always match policy. For the 84 children with at least 5 y of follow‐up (73 treated and 11 untreated), overall, 69% of the 420 person‐years lived were spent without treatment, and 72% without any HIV‐related symptoms. Untreated children were without symptoms for 94% of these 5 y, whereas treated children spent nearly a third of their time with mild or moderately severe symptoms. Conclusions: Therapeutic management of paediatric HIV disease requires a balance between preventing disease progression and minimizing adherence problems and side effects. This is important, as most infected children are without symptoms most of the time. Recent European consensus guidelines for the treatment of infected children will facilitate management.
Plasma lactate and plasma volume recovery in adults and children following high‐intensity exercises
Authors: Berthoin S , Allender H , Baquet G , Dupont G , Matran R , Pelayo P , Robin H 
Published: August 2010

Aim: To compare plasma lactate concentration recovery kinetics when measured and corrected for variations in plasma volume between children and adults. Methods: Nine boys (11.3 ± 1.1 y) and 8 men (21.9 ± 1.9 y) performed a maximal and a supramaximal exercise until exhaustion. Plasma lactate concentrations, haemoglobin and haematocrit were measured at rest, immediately on completion of exercise and after the 2nd, 5th, 12th and 30th minute of recovery. The plasma lactate concentrations and the rate of recovery were corrected for variations in plasma volume. Results: The maximal decreases in plasma volume were significantly higher in adults than in children for maximal exercise (–18.7 ± 2.6% vs – 14.5 ± 3.2%; p < 0.05), but similar for the supramaximal exercise (–16.9 ± 3.4% vs –15.2 ± 3.4%). During recovery, measured and corrected plasma lactate concentrations were significantly higher in adults. The rate of plasma lactate recovery was higher in adults for maximal exercise only. The same results were obtained when the rates of plasma lactate decrease were calculated from corrected plasma lactate concentrations. Conclusion: The correction of the plasma lactate concentrations for variations in plasma volume did not influence the comparison of the concentrations obtained in adults and children, or their rate of recovery.
Tracking of serum total cholesterol during childhood: an 8‐year follow‐up population‐based family study in eastern Finland
Authors: Fuentes RM , Notkola I‐L , Shemeikka S , Tuomilehto J , Nissinen A 
Published: August 2010

Aim: To investigate the tracking of serum total cholesterol (TC) during childhood. Methods: All children born during 1981–1982 in a rural community of eastern Finland were followed at 6 mo, 7 y and 15 y of age. The full follow‐up period was completed by 138 out of 205 children, of whom 82 (33 girls) had TC measured at 7 y and 15 y of age (–7 y, –15 y). The main outcome measurement was TC (mmol/L). Results: TC‐7 y was significantly associated with TC‐15 y (r= 0.655; p‐value <0.001). This correlation did not change significantly after accounting for confounders. Children in the highest tertile of TC‐7y had a significantly higher risk of being in the highest tertile of TC‐15y compared with children in other tertiles of TC‐7 y (relative risk = 6.4 (2.9–13.9)). TC‐15 y was predicted positively by TC‐7 y (linear regression beta = 0.63; p‐value <0.001) and parental high TC (TC ≥5.0 mmol/L in at least one parent) (beta = 0.58; p‐ value = 0.030). Birthweight had no significant association with TC during childhood. Conclusion: The study confirmed the tracking of TC during childhood. The identification of children at risk of developing high TC during adolescence should take into consideration the child's previous TC values during childhood and parental TC status.
The importance of follow‐up of children with vesicoureteral reflux grade 1
Authors: Grmek M , Fettich J 
Published: August 2010

Aim: The objectives of this study were, first, to determine the probability of detecting vesicoureteral reflux (VUR) into the renal collecting system (VUR grade 2 or higher) by follow‐up cyclic radionuclide cystography (CRC) in children with VUR 1 on initial examination, and in children without VUR and with the same clinical history; and secondly, to find out whether dividing VUR 1 into three subclasses, including possible reflux into the ureter, reflux into the lower ureter, and reflux into the whole length of the ureter, enhances detection of higher grade reflux in these children. Methods: 275 children with VUR 1 found on initial CRC, and 31 children without reflux and with the same clinical history were studied. In total, 414 renal units with VUR 1 of different subclasses and 198 renal units without reflux were evaluated. Results: Follow‐up CRC disclosed reflux into the renal collecting system in 20% of children with VUR 1 on initial investigation, and in 23% of children with no reflux at the time of initial investigation. The probability that follow‐up examination would disclose VUR 2 in 3 in renal units with different subclasses of grade 1 reflux was 8–16%, and did not differ significantly from the probability for detecting reflux in kidneys with no reflux on initial examination. Conclusion: In the absence of recurrent urinary tract infection, the management of children with VUR 1 identified by CRC can be the same as in children without reflux. Yet, in children with no reflux or with VUR 1 detected after urinary tract infection, the probability that reflux reaching the pylon was missed should not be underestimated. Dividing VUR 1 into subclasses does not seem to be of diagnostic value.
Impact of inhaled corticosteroids on the risk of earlyPseudomonas aeruginosaacquisition in cystic fibrosis
Authors: Minicucci L , Severi G , Cresta L , Giannattasio A , Lorini R , Haupt R 
Published: August 2010

Aim: To investigate the role of inhaled corticosteroids (IC) on the risk ofPseudomonas aeruginosaacquisition before the age of 10 y in cystic fibrosis (CF) patients.Methods: For each subject the cumulative dose kg‐1of IC received for each year of age was calculated until the end of follow‐up. The age at CF diagnosis, the nutritional status (NS) and the number of respiratory exacerbations (RE) were used as surrogate measures for the severity of CF.Results: A total of 83 patients (40 M, 43 F) entered the study. Their median length of follow‐up was 4.4 y, for a total of 386 person‐years at risk. Twenty‐three patients acquiredP. aeruginosaat a median age of 4.6 y (range 0.4‐9.9 y). The estimated survival withoutP. aeruginosaacquisition was 65% at 10 y of age. The effect of different risk factors (IC, NS, RE and age at CF diagnosis) on the probability ofP. aeruginosaacquisition was evaluated: none of them was significantly associated with the risk ofP. aeruginosaacquisition. In particular, patients receiving very high cumulative doses of IC (4th quartile) had a non‐significantly increased risk ofP. aeruginosaacquisition compared with those receiving low doses of IC (1st quartile) (hazard ratio = 1.73, 95% confidence limits 0.40‐7.38).Conclusion: This retrospective study was not able to demonstrate any role of IC in increasing the risk ofP. aeruginosaacquisition. This complication seems to occur at a constant pace that is independent of CF severity and age. Prospective multi‐institutional randomized studies are needed to investigate the effects of high‐dose IC in CF patients.
Natural course of preclinical type 1 diabetes in siblings of affected children
Authors: Mrena S , Savola K , Kulmala P , Åkerblom HK , Knip M ,   the Childhood Diabetes in Finland Study Group
Published: August 2010

Aim: To define the dynamics of preclinical type 1 diabetes in siblings of affected children and to characterize the siblings experiencing a progressive process. Methods: From 801 families taking part in the “Childhood Diabetes in Finland” (DiMe) Study, 715 initially unaffected siblings were graded into four stages of preclinical type 1 diabetes based on the initial number of disease‐associated autoantibodies detectable close to the time of diagnosis of the index case, while another classification system covering 641 of the siblings was based on a combination of the initial number of antibodies and the first‐phase insulin response (FPIR) to intravenous glucose. Results: Based on the first classification, there was a total of 95 siblings with initial signs of prediabetes, out of whom 34 (36%) progressed, 26 (27%) remained stable and 35 (37%) regressed during prospective observation for a median of 3.6 y (range 0.01–9.8 y). The siblings who progressed were younger, had a higher initial number of detectable autoantibodies, higher initial levels of various antibodies, with the exception of insulin autoantibodies, lower FPIR and a retarded glucose elimination rate in the first intravenous glucose tolerance test as compared with those that regressed. According to the second classification there were 41 siblings with initial signs of prediabetes, among whom 23 (56%) progressed, 14 (34%) remained stable and 4 (10%) regressed during the observation period. Conclusion: These data show that almost half of the siblings with signs of prediabetes at the time of diagnosis of the index case progressed further in their preclinical disease process during prospective observation. Young age, a strong humoral immune response to β‐cell antigens and reduced insulin secretory capacity appeared to be characteristic of those with a progressive process. Advanced and late prediabetes seem to represent a point of no return, as regression from these stages to no prediabetes was extremely rare.
Measuring self‐reported, health‐related, quality of life in adolescents with type 1 diabetes using both generic and disease‐specific instruments
Authors: Graue M , Wentzel‐Larsen T , Hanestad BR , Båtsvik B , Søvik O 
Published: August 2010

Aims: To describe perceived functional health and well‐being and diabetes‐related impact, worry and satisfaction with life in relation to demographic and clinical variables in a population of adolescents with type 1 diabetes. To compare perceived functional health and well‐being between adolescents with diabetes and a group of healthy controls and to analyse the relationship between generic functional health and well‐being and diabetes‐related impact, worry and satisfaction with life. Methods: A total of 130 adolescents were invited to complete the Child Health Questionnaire (CHQ‐CF87) and the Diabetes Quality of Life (DQOL) questionnaire modified for youths. A total of 115 (88.5%) subjects participated in the study; mean age 14.5 y (SD 1.86), mean duration of diabetes 6.99 y (SD 3.77, range 1–16 y), mean HbA1c 9.3% (SD 1.62, range 6.2–14.0%). Forty‐eight percent of the subjects were girls. Results: When compared with healthy adolescents, subjects with diabetes reported a significantly lower degree of general health. The CHQ‐CF87 scales showed that higher age in adolescents with diabetes was associated with lower scores for mental health (p < 0.001), self‐esteem (p < 0.001), behaviour (p= 0.004) and general health (p < 0.001). Findings from the DQOL questionnaire showed that older adolescents were more worried (p < 0.001), perceived a greater impact of diabetes on daily life (p= 0.008) and lower diabetes‐related life satisfaction (p < 0.001). The scores for girls were lower than those for boys in assessment of mental health (p < 0.001), self‐esteem (p= 0.004) and family cohesion (p= 0.002). Girls also reported a greater impact of diabetes (p= 0.028), more worries (p= 0.001) and less satisfaction with life (p= 0.006) than boys. Neither HbA1c nor other clinical variables could sufficiently explain the variations in DQOL or CHQ‐CF87. Conclusions: Health‐related quality of life varied significantly by age and gender, but less so by HbA1c and other clinical variables. Adolescents with diabetes reported a significantly lower degree of general health than that reported by healthy controls. The CHQ‐CF87 is a valuable supplement to DQOL, allowing for comparisons with the general population.
The size of the thymus: an important immunological diagnostic tool?
Authors: Jeppesen DL 
Published: August 2010

The report on the influence of seasonal factors on thymic size in early life describes a pattern of ultrasonographically measured thymic growth in Gambian infants including the finding of a smaller thymus in the hungry season. These factors raise a number of important questions: Is the size of the thymus relevant to its function and could measurement of the thymus be a useful immunological diagnostic tool in the investigation of thymic function in humans with a depressed immune system?Conclusion: Studies using the size of the thymus as an immunological diagnostic tool should be encouraged.
Management of children with dilating vesico‐ureteric reflux in Sweden
Authors: Esbjörner E , Hansson S , Jakobsson B ,   on behalf of the Swedish Paediatric Nephrology Association
Published: August 2010

Aim: To evaluate the management and outcome of children with dilating vesico‐ureteric reflux diagnosed before 2 y of age. Methods: This retrospective, multicentre study was part of a programme for quality assurance in Sweden. A total of 2309 unselected children, aged 0–2 y, were investigated after the first urinary tract infection. Voiding cystourethrography was performed in a total of 1953 children, of whom 584 had reflux. Of these children, 303 (119 boys and 184 girls) had reflux with dilatation (grade 3–5). Results: Follow‐up after 4–6 y was reported in 272 of the 303 children. Spontaneous regression of dilating reflux occurred in more than half of the patients and was significantly more frequent in boys than in girls (p= 0.047). In children with grade 3 reflux and grade 4–5 reflux, there were pyelonephritic recurrences in 18% and 45% of the boys and 28% and 70% of the girls, respectively (p < 0.001). One hundred and eighty‐one children (65%) were managed conservatively, 58 (21%) were treated with subureteric injection and 33 (12%) with ureteric reimplantation. There were considerable differences in treatment strategies between centres. Conclusion: This study of an unselected cohort of children with urinary tract infection and dilating reflux showed spontaneous resolution of dilating reflux in more than half of the subjects and more often in boys than in girls. Pyelonephritic recurrences were more common in girls than in boys, and more frequent in grade 4–5 reflux than in grade 3. The results indicate important differences between the sexes and that boys and girls should be assessed separately when treatment strategies are studied.
Procalcitonin serum levels in perinatal bacterial and fungal infection of preterm infants
Authors: Distefano G , Curreri R , Betta P , Romeo MG , Amato M 
Published: August 2010

Aim: To determine reference values for procalcitonin (PCT) and C‐reactive protein (CRP) for gestational age and to use these parameters as diagnostic markers of perinatal bacterial and fungal infection. Methods: PCT and CRP serum levels were measured in a case‐control study in a group of 35 low birthweight infants (>34wk of gestation). 27 babies (77%) had clinical signs of infection confirmed by positive blood cultures and were compared to 8 (23%) uninfected matched patients. Seventeen (63%) of them had bacterial infection and 10 (37%) had fungal infection (Candida). Serum PCT (Brahms Diagnostika) and CRP (Immunoassay Vitros 950) were measured serially at 3, 7 and 10 d of life. Results: At any time, PCT and CRP levels were significantly higher in neonates with perinatal infection (p < 0.05) (>0.7 ng ml−1 and >1 mg dl−1, respectively). PCT showed a more rapid response to infection (9.3 ± 1.5 ng ml−1), especially to bacterial infection (10.8 ± 1.4 ng ml−1), than CRP (1.5 ± 0.5 mg dl−1) (sensitivity 99% vs 88%). Lower sensitivity was noted for both parameters, PCT and CRP, to follow babies with fungal infection (6.7 ± 0.8 ng ml−1 and 0.9 ± 0.7 mg dl−1, respectively) (sensitivity 77% vs 58%). Conclusion: This study gives PCT reference values in preterm babies with perinatal infection. In these babies, PCT seems to be more sensitive than CRP as a diagnostic marker of infection. Both parameters can be used alone or in combination for a better identification and follow‐up of bacterial and fungal infection during the perinatal period.
Bradycardia and hypoxaemia due to position‐dependent hypoperfusion of the brain stem in a preterm infant
Authors: Vogelberg C , Taut‐Sack H , Friebel D , Maier U , Rupprecht E 
Published: August 2010

The case is reported of a male baby with a decreased time average velocity of the basilar artery to 32%, measured by Doppler sonography in dextro‐rotated head position. The decrease was due to a hypoplastic right vertebral artery with compression of the contralateral vertebral artery at the craniocervical junction during dextro‐rotation of the head. This finding was more prominent in prone than in supine position. A decrease in oxygen saturation and heart rate to >70% and 60bpm, respectively, was monitored during dextro‐rotation. The polysomnography also revealed postural‐dependent bradycardia, decrease of the oxygen saturation, and rising carbon dioxide partial tension in prone position with dextro‐rotation of the head. Conclusion: Hypoperfusion of the brain stem caused by postural changes leads to further clinically relevant changes. Therefore an association with an acute life‐threatening event and sudden infant death syndrome is speculated.
Vitamin A for acute respiratory infection in developing countries: a meta‐analysis
Authors: Brown N , Roberts C 
Published: August 2010

Aim: To determine the efficacy of intervention with high‐dose vitamin A as an adjunct to standard treatment on outcome in acute lower respiratory tract infection in children in developing countries. Methods: A systematic review of double‐blinded, randomized, controlled intervention studies of high‐dose vitamin A or placebo in children aged between 1 mo and 6 y presenting with acute non‐measles lower respiratory tract infection. Results: Five studies fulfilling the criteria were identified and included a total of 2177 children (1067 intervention, 1110 control). The main outcome measures were time to normalization of fever, respiratory rate and oxygen dependence, time to discharge, and mortality. On meta‐analysis, there were no significant differences in any of the recovery measures or mortality between the intervention and control groups. Pooled results for recovery times are given showing difference in days to recovery days and 95% confidence intervals. Positive summary measures indicate faster recovery in the vitamin A group and negative in the placebo: fever: 0.03 (—0.10 to 0.17); oxygen requirement: —0.08 (—0.31 to 0.16); raised respiratory rate: —0.09 (—0.38 to 0.19); hospital stay: —0.06 (—0.52 to 0.40). Mortality was below 2% in both groups, with a non‐significantly higher risk in the intervention group (odds ratio 1.16, 95% CI: 0.61—2.21). Conclusion: There is no evidence from this meta‐analysis that intervention with high‐dose vitamin A improves recovery from pneumonia in children in developing countries aged from 1 mo to 6 y.
Gastrointestinal complaints and diagnosis in children: a population‐based study
Authors: Kokkonen J , Haapalahti M , Tikkanen S , Karttunen R , Savilahti E 
Published: August 2010

Aim: To find out the extent to which children at 10–11 y of age suffer from various gastrointestinal complaints and how often a food‐induced or other diagnostic disorder might be assessed behind them, we carried out a population‐based survey of 404 children in a rural Finnish town. Methods: A questionnaire filled in retrospectively by their parents was used to describe the frequency of various abdominal symptoms during the previous 2 y and to select the symptomatic subjects for closer clinical examination. In the clinical investigation of the children, an elimination challenge with milk protein and lactose intolerance tests, as well as endoscopic examinations in selected cases and blood tests, were performed. Results: In all, 110 (27%) subjects reported some gastrointestinal (GI) complaints during the last 2 y; 64 (16%) meeting the Apley criteria for recurrent abdominal pain. A specific organic or functional disorder was found in 26 subjects (6%), two having no GI symptoms. Milk protein intolerance was the most common specific disorder diagnosed in nine subjects (2.2%), followed by lactose intolerance in eight (2%), coeliac disease in five (1.2%) and Helicobacter pylori infection in three (0.7%). An endoscopic examination performed on 17 subjects (4.2%) and a colonoscopy on three revealed significant findings in 11; lymphonodular changes being most common, occurring in five subjects. Subjects with milk protein‐induced disorders showed significantly lower IgA‐class antibodies to milk and its fractions than the non‐symptomatic controls. Chronic diseases, short breastfeeding, GI problems and food intolerance during the first year of life were observed as significant risk factors in determining whether a subject belonged to the group experiencing any GI complaints. Conclusion: We conclude that in one in five of those with any, even mild, GI complaints we were able to assess a specific organic disease; milk‐induced disorders being most common. A milk protein and/or lactose load test, completed in some cases with an endoscopic examination, would help in assessing a proper individual diagnosis.