bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Symptoms and Stooling Patterns Do Not Drive Diagnostic Costs for Children With Functional Abdominal Pain and Irritable Bowel Syndrome in Primary or Tertiary Care
Authors: Lane Mariella M. , Weidler Erica M. , Czyzewski Danita I. , Shulman Robert J. 
Published: March 2009

OBJECTIVE. The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation.METHODS. Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay.RESULTS. Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group.CONCLUSIONS. Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in seeking tertiary care.
Evaluation of Vaccine Coverage for Low Birth Weight Infants During the First Year of Life in a Large Managed Care Population
Authors: Batra Jagmohan S. , Eriksen Eileen M. , Zangwill Kenneth M. , Lee Martin , Marcy S. Michael , Ward Joel I. ,   for the Vaccine Safety Datalink
Published: March 2009

OBJECTIVE. There are few recent population-based assessments of vaccine coverage in premature infants available. This study assesses and compares age- and dose-specific immunization coverage in children of different birth weight categories during the first year of life.METHODS. We performed a retrospective cohort analysis of computerized vaccination data from a large managed care organization in southern California. The participants were children born between January 1, 1997, and December 31, 2002, and continuously enrolled from birth to at least 12 months of age in the Southern California Kaiser Permanente health plan. We measured age-specific up-to-date and age-appropriate immunization rates according to birth weight (extremely low birth weight: &lt;1000 g; very low birth weight: 1000–1499 g; low birth weight: 1500–2499 g; normal birth weight: ≥2500 g) for 4 vaccines (hepatitis B, diphtheria and tetanus toxoids with pertussis, Haemophilus influenzae type b, and poliovirus) through the first year of life.RESULTS. We identified 127 833 infants born during the study period and continuously enrolled through the first year of life; 120 048 were normal birth weight infants; 6491 were low birth weight infants; 788 were very low birth weight infants; and 506 were extremely low birth weight infants. Vaccine-specific age-appropriate immunization rates were 3% to 15% lower for low birth weight infants and 17% to 33% lower for extremely low birth weight infants compared with the rates for normal birth weight infants in the first 6 months of life. Extremely low birth weight infants had the lowest age-specific up-to-date immunization levels (5%–31% lower) compared with normal birth weight infants at each age assessed. By 12 months, extremely low birth weight infants still had significantly lower up-to-date levels (87%) compared with very low birth weight, low birth weight, and normal birth weight infants (91%–92%).CONCLUSIONS. Despite recommendations that lower birth weight infants be vaccinated as the same chronological age as normal birth weight infants, extremely low birth weight and very low birth weight infants are immunized at significantly lower rates relative to low birth weight and normal birth weight infants at 2, 4, and 6 months of age. However, by 12 months of age this finding persists only in extremely low birth weight infants.
Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage
Authors: Tuzcu Volkan , Nas Selman , Ulusar Umit , Ugur Ahmet , Kaiser Jeffrey R. 
Published: March 2009

OBJECTIVE. Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system's control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.METHODS. This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis.RESULTS. Twenty-four infants (mean ± SD, birth weight: 845 ± 213g: gestational age: 26.1 ± 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 ± 0.1 vs 0.45 ± 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage.CONCLUSIONS. Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage.
Private Cord Blood Banking: Experiences and Views of Pediatric Hematopoietic Cell Transplantation Physicians
Authors: Thornley Ian , Eapen Mary , Sung Lillian , Lee Stephanie J. , Davies Stella M. , Joffe Steven 
Published: March 2009

OBJECTIVE. Private cord blood banks are for-profit companies that facilitate storage of umbilical cord blood for personal or family use. Pediatric hematopoietic cell transplantation physicians are currently best situated to use cord blood therapeutically. We sought to describe the experiences and views of these physicians regarding private cord blood banking.PARTICIPANTS AND METHODS. We e-mailed a cross-sectional survey to pediatric hematopoietic cell transplantation physicians in the United States and Canada; 93 of 152 potentially eligible physicians (93 of 130 confirmed survey recipients) from 57 centers responded. Questions addressed the number of transplants performed by using privately banked cord blood, willingness to use banked autologous cord blood in specific clinical settings, and recommendations to parents regarding private cord blood banking.RESULTS. Respondents reported having performed 9 autologous and 41 allogeneic transplants using privately banked cord blood. In 36 of 40 allogeneic cases for which data were available, the cord blood had been collected because of a known indication in the recipient. Few respondents would choose autologous cord blood over alternative stem cell sources for treatment of acute lymphoblastic leukemia in second remission. In contrast, 55% would choose autologous cord blood to treat high-risk neuroblastoma, or to treat severe aplastic anemia in the absence of an available sibling donor. No respondent would recommend private cord blood banking for a newborn with 1 healthy sibling when both parents were of northern European descent; 11% would recommend banking when parents were of different minority ethnicities.CONCLUSIONS. Few transplants have been performed by using cord blood stored in the absence of a known indication in the recipient. Willingness to use banked autologous cord blood varies depending on disease and availability of alternative stem cell sources. Few pediatric hematopoietic cell transplantation physicians endorse private cord blood banking in the absence of an identified recipient, even for mixed-ethnicity children for whom finding a suitably matched unrelated donor may be difficult.
Socioeconomic, Family, and Pediatric Practice Factors That Affect Level of Asthma Control
Authors: Bloomberg Gordon R. , Banister Christina , Sterkel Randall , Epstein Jay , Bruns Julie , Swerczek Lisa , Wells Suzanne , Yan Yan , Garbutt Jane M. 
Published: March 2009

BACKGROUND. Multiple issues play a role in the effective control of childhood asthma.OBJECTIVE. To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians.PATIENTS AND METHODS. Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications.RESULTS. Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control.CONCLUSIONS. Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.
Outcomes of Meningococcal Disease in Adolescence: Prospective, Matched-Cohort Study
Authors: Borg Jennie , Christie Deborah , Coen Pietro G. , Booy Robert , Viner Russell M. 
Published: March 2009

OBJECTIVE. We examined the physical, cognitive, educational, social, and psychological outcomes of invasive meningococcal disease in adolescence, as well as demographic and disease factors associated with outcomes.METHODS. A population-based, matched-cohort study was performed. A total of 101 gender- and age-matched case-control pairs (15–19 years of age at the time of disease; 46% male) from 6 regions of England underwent follow-up evaluations 18 to 36 months after invasive meningococcal disease. Educational, social, and vocational function, mental health, social support, self-efficacy, and quality-of-life data were collected by using standardized questionnaires and neuropsychological tests.RESULTS. Fifty-seven percent of case subjects (n = 58) had major physical sequelae. Survivors had greater depressive symptoms, greater fatigue, less social support, greater reduction in quality of life, and lower educational attainment compared with control subjects. Survivors with serogroup C disease had greater physical sequelae than did those with serogroup B disease. Greater cognitive deficits were associated with younger age at diagnosis. Only 53 of 101 case subjects reported any medical follow-up care after invasive meningococcal disease.CONCLUSIONS. Survivors of invasive meningococcal disease in adolescence have a disturbing series of deficits, including poorer physical and mental health, quality of life, and educational achievement. Serogroup C is associated with poorer outcomes. Invasive meningococcal disease attributable to serogroup B disease remains a major cause of morbidity and death among adolescents. Medical care is poor after discharge from the hospital. Routine follow-up care of adolescent survivors may prevent or ameliorate physical and psychosocial morbidity after invasive meningococcal disease.
Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Topiramate for Migraine Prevention in Pediatric Subjects 12 to 17 Years of Age
Authors: Lewis Donald , Winner Paul , Saper Joel , Ness Seth , Polverejan Elena , Wang Steven , Kurland Caryn L. , Nye Jeff , Yuen Eric , Eerdekens Marielle , Ford Lisa 
Published: March 2009

OBJECTIVE. Currently, no drugs are Food and Drug Administration-approved for migraine prophylaxis in pediatric patients. The objective of this study was to evaluate the efficacy and safety of topiramate for migraine prevention in adolescents.
METHODS. Adolescents (12–17 years of age) with a ≥6-month history of migraine were assigned randomly to receive 16 weeks of daily treatment with topiramate (50 or 100 mg/day) or placebo. The primary efficacy measure was the percent reduction in monthly migraine attacks, with the use of the 48-hour rule, from the prospective baseline period to the last 12 weeks of the double-blind phase. The 48-hour rule defined a single migraine episode as all recurrences of migraine symptoms within 48 hours after onset. Several secondary efficacy measures were evaluated, including the reduction from baseline in the monthly migraine day rate and the 50% responder rate. Safety and tolerability were also assessed.
RESULTS. A total of 29 (83%) of 35 subjects treated with topiramate at 50 mg/day, 30 (86%) of 35 subjects treated with topiramate at 100 mg/day, and 26 (79.0%) of 33 placebo-treated subjects completed double-blind treatment. Topiramate at 100 mg/day, but not 50 mg/day, resulted in a statistically significant reduction in the monthly migraine attack rate from baseline versus placebo (median: 72.2% vs 44.4%) during the last 12 weeks of double-blind treatment. Topiramate at 100 mg/day, but not 50 mg/day, also resulted in a statistically significant reduction in the monthly migraine day rate from baseline versus placebo. The responder rate favored topiramate at 100 mg/day (83% vs 45% for placebo). Upper respiratory tract infection, paresthesia, and dizziness occurred more commonly in the topiramate groups than in the placebo group.
CONCLUSIONS. The 100 mg/day topiramate group demonstrated efficacy in the prevention of migraine in pediatric subjects. Overall, topiramate treatment was safe and well tolerated.
Distinct Genetic Risk Based on Association of MET in Families With Co-occurring Autism and Gastrointestinal Conditions
Authors: Campbell Daniel B. , Buie Timothy M. , Winter Harland , Bauman Margaret , Sutcliffe James S. , Perrin James M. , Levitt Pat 
Published: March 2009

OBJECTIVE. In addition to the core behavioral symptoms of autism spectrum disorder, many patients present with complex medical conditions including gastrointestinal dysfunction. A functional variant in the promoter of the gene encoding the MET receptor tyrosine kinase is associated with autism spectrum disorder, and MET protein expression is decreased in the temporal cortex of subjects with autism spectrum disorder. MET is a pleiotropic receptor that functions in both brain development and gastrointestinal repair. On the basis of these functions, we hypothesized that association of the autism spectrum disorder–associated MET promoter variant may be enriched in a subset of individuals with co-occurring autism spectrum disorder and gastrointestinal conditions.
PATIENTS AND METHODS. Subjects were 918 individuals from 214 Autism Genetics Resource Exchange families with a complete medical history including gastrointestinal condition report. Genotypes at the autism spectrum disorder–associated MET promoter variant rs1858830 were determined. Family-based association test and χ2 analyses were used to determine the association of MET rs1858830 alleles with autism spectrum disorder and the presence of gastrointestinal conditions.
RESULTS. In the entire 214-family sample, the MET rs1858830 C allele was associated with both autism spectrum disorder and gastrointestinal conditions. Stratification by the presence of gastrointestinal conditions revealed that the MET C allele was associated with both autism spectrum disorder and gastrointestinal conditions in 118 families containing at least 1 child with co-occurring autism spectrum disorder and gastrointestinal conditions. In contrast, there was no association of the MET polymorphism with autism spectrum disorder in the 96 families lacking a child with co-occurring autism spectrum disorder and gastrointestinal conditions. χ2 analyses of MET rs1858830 genotypes indicated over-representation of the C allele in individuals with co-occurring autism spectrum disorder and gastrointestinal conditions compared with non-autism spectrum disorder siblings, parents, and unrelated controls.
CONCLUSION. These results suggest that disrupted MET signaling may contribute to increased risk for autism spectrum disorder that includes familial gastrointestinal dysfunction.
Readmission and Late Mortality After Pediatric Severe Sepsis
Authors: Czaja Angela S. , Zimmerman Jerry J. , Nathens Avery B. 
Published: March 2009

OBJECTIVE. Pediatric severe sepsis remains a significant health problem with hospital mortality up to 10%. However, there is little information about later health outcomes or needs of survivors. Therefore, our goal was to evaluate the rates of and risk factors for rehospitalization and late mortality among survivors of pediatric severe sepsis.PATIENTS AND METHODS. This was a population-based retrospective cohort study of survivors of pediatric severe sepsis (age 1 month to 18 years) in Washington State over the years 1990–2004. The sentinel admission was linked to subsequent death or episodes of hospitalization. The main outcome measures were readmission and/or late death after surviving an initial hospitalization with severe sepsis. Risk factors for readmission or death were identified by using a multivariate extended Cox model.RESULTS. Overall, 7183 children were admitted with severe sepsis, 6.8% of whom died during the sentinel admission or within 28 days of discharge, whereas an additional 6.5% died subsequently. Almost half (47%) of the survivors were readmitted at least once (median: 3) after a median of 3 months, and the majority of these readmissions were emergent. Sentinel admission factors independently associated with both adverse outcomes were neurologic or hematologic organ dysfunction, government-based insurance, as well as several coexisting health conditions. In addition, age less than 1 year at the time of sepsis and bloodstream and cardiovascular infections were highly associated with subsequent readmission.CONCLUSIONS. Late death occurred with similar frequency as early death associated with hospitalization with severe sepsis. Almost half of the pediatric patients suffering from an episode of severe sepsis had at least 1 subsequent hospitalization, two thirds of which were emergent or urgent. These data suggest that late outcomes after an episode of severe sepsis are poor and call for the evaluation of interventions designed to reduce later morbidity and mortality.
Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children
Authors: Renzetti Gabriele , Silvestre Gaetano , D'Amario Claudio , Bottini Egidio , Gloria-Bottini Fulvia , Bottini Nunzio , Auais Alexander , Perez Miriam K. , Piedimonte Giovanni 
Published: March 2009

OBJECTIVE. Air pollution can promote airway inflammation, posing significant health risks for children with chronic respiratory problems. However, it is unknown whether this process is reversible, so that limiting pollution will benefit these children. We measured the short-term response of allergic asthmatic children exposed to a real-life reduction in outdoor air pollution by using noninvasive biomarkers of airway inflammation and function.PATIENTS AND METHODS. Thirty-seven untreated allergic children with mild persistent asthma were recruited from a highly polluted urban environment and relocated to a less polluted rural environment. Air pollution, pollen counts, and meteorological conditions were carefully monitored at both sites. Nasal eosinophils, fractional exhaled nitric oxide, peak expiratory flow, and urinary leukotriene E4 were measured first in the urban environment and then again 7 days after relocation to the rural environment.RESULTS. One week after relocation to the rural environment, we measured, on average, a fourfold decrease in nasal eosinophils and significant decrease in fractional exhaled nitric oxide. We also noted an improvement in lower airway function, reflected by highly significant increase in peak expiratory flow. In contrast, mean urinary leukotriene E4 concentration remained unchanged after 1 week of exposure to the rural environment.CONCLUSIONS. Better air quality is associated with a rapid reduction of airway inflammation in allergic asthmatic children. Nasal eosinophils and fractional exhaled nitric oxide are sensitive indicators of this effect, and their rapid decline is paralleled by improved airway function measured by peak expiratory flow. Leukotriene synthesis has a more variable response to environmental modifications.