bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Race, Ethnicity, and Socioeconomic Status in Schoolchildren Dispensed Injectable Epinephrine in 3 Massachusetts School Districts
Authors: Goldsobel Alan B. 
Published: September 2006

Purpose of the Study.
To analyze the demographic characteristics of schoolchildren dispensed injectable epinephrine in 3 school districts with widely diverse socioeconomic, racial, and ethnic populations.

Study Population.
Students (prekindergarten to grade 12) from 3 school districts in Massachusetts (n = 21 875) were evaluated. Two of the school districts were affluent, suburban towns outside of Boston (5855 students). The third district (16 020 students) was also a Boston suburb but with a very low per-capita income, with 23% of the school-age population living below the poverty line. The 2 suburban districts were 92% and 95% white, respectively, and the third district was 60% nonwhite.

Methods.
All school districts in Massachusetts are required to report the number of students using daily or as-needed prescription medications to the Department of Public Health. Data were taken from reports filed by school nurses monthly for all students from the 2003–2004 school year for these 3 school districts.

Results.
A total of 181 schoolchildren (0.83%) in the 3 districts were dispensed injectable epinephrine during the school year studied. Diagnoses listed for the prescription of epinephrine included peanut ree nut allergy (65%), stinging-insect allergy (19%), seafood allergy (6%), and egg or dairy allergy (3%). A miscellaneous group (7%) included diagnoses for latex, chocolate, pollen, fruit, cold air, and ibuprofen allergy. Males were more likely to be dispensed epinephrine than females (odds ratio [OR]: 1.44; P &lt; .02). White students were nearly 5 times more likely to have been dispensed epinephrine for peanut and tree nut allergy (OR: 4.5; P &lt; .001) and almost 9 times more likely for stinging-insect allergy (OR: 8.7; P &lt; .001). Seventy-five percent of students dispensed epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5.

Conclusions.
Significant racial and socioeconomic differences for prescribing self-injectable epinephrine was seen in 3 school districts in Massachusetts.

Reviewer Comments.
This study describes the racial and socioeconomic demographics of children prescribed injectable epinephrine but does not address the reasons for the disparity between affluent and nonaffluent or white and nonwhite populations. This study suggests that minority, socioeconomically disadvantaged students are being either underdiagnosed or undertreated for potential anaphylactic reactions that require epinephrine. Other studies have not shown racial differences in the incidence of food allergies, suggesting that other factors are involved in the lower rate of epinephrine dispensed to disadvantaged minority students.
Exercise-Induced Dyspnea in Children and Adolescents: If Not Asthma Then What?
Authors: Skolnick Helen 
Published: September 2006

Purpose of the Study.
Exercise-induced asthma (EIA) is the most commonly recognized cause of exercise-induced dyspnea (EID) in children and adolescents. However, EID in otherwise healthy children and adolescents may have other causes besides asthma. The purpose of this study is to report the outcome of evaluations for EID when other signs and symptoms of asthma were absent or there was no response to previous use of an inhaled β2 agonist.

Study Population.
One hundred forty-two patients, 6 to 21 years old (mean: 14 years), with EID were studied.

Methods.
In this retrospective study, investigators reviewed the results of all exercise tests performed in otherwise healthy patients with EID between 1996 and 2003. Physiologic measures assessed included preexercise and postexercise spirometry with the addition of oxygen uptake, carbon dioxide production, continuous oximetry, and electrocardiogram monitoring during most tests. EIA was diagnosed if treadmill exercise resulted in reproduction of symptoms in association with a decrease in forced expiratory volume in 1 second of at least 15%. Endoscopy was performed if stridor and/or decreased maximal inspiratory flow were present. Criteria were established for restrictive abnormalities, physical conditioning, exercise-induced hyperventilation, and normal physiologic limitation.

Results.
EID was present in the subjects for an average of 30.2 months (range: &lt;1 to 192 months) before evaluation, and in 98 patients the symptoms were attributed to asthma. Symptoms of EID were reproduced during exercise testing in 117 patients. EIA was identified as the cause of EID in only 11 of the 117. Seventy-four demonstrated only normal physiologic exercise limitation; 48 of the 74 had normal-to-high cardiovascular conditioning, and 26 had poor conditioning. Other diagnoses for reproducible EID included restrictive abnormalities in 15, vocal cord dysfunction in 13, laryngomalacia in 2, primary hyperventilation in 1, and supraventricular tachycardia in 1.

Conclusions.
The diagnoses of EIA should be questioned as the etiology of EID in children and adolescents who do not have other symptoms of asthma and who do not respond to pretreatment with a β2 agonist.

Reviewer Comments.
Although asthma is the most common cause of EID, this article demonstrates the important point that not all EID is caused by asthma. Patients who experience EID but not other signs or symptoms of asthma or who do not benefit from pretreatment with an inhaled β2 agonist clearly can benefit from a treadmill test with cardiac and respiratory physiologic monitoring. A large portion of these patients demonstrated normal physiologic limitation associated with reproduction of symptoms. Routine treatment of EID as asthma can lead to both unnecessary medication and frustration on the part of the patients and their families.
Paradoxical CD4+ T-Cell Decline in HIV-Infected Patients With Complete Virus Suppression Taking Tenofovir and Didanosine
Authors: Church Joseph A. 
Published: September 2006

Purpose of the Study.
Tenofovir and didanosine are adenosine analogs commonly used in highly active antiretroviral therapy combinations. Although virologically effective, this combination is theoretically associated with pharmacokinetic interactions and increased risks of pancreatitis and hyperglycemia. The study examined the CD4+ T-cell effects of the use of these 2 drugs as part of a highly active antiretroviral therapy regimen.

Methods.
Data from 570 individuals were analyzed retrospectively according to the nucleoside analog “backbone” of protease inhibitor–containing regimens: tenofovir + didanosine in 298 subjects, didanosine in 88, tenofovir in 44, and neither didanosine nor tenofovir in 140.

Results.
Significant CD4+ T-cell declines were noted in patients taking the combination of tenofovir + didanosine relative to all other nucleoside analog combinations including didanosine or tenofovir only. Patients exposed to higher didanosine doses showed a more pronounced CD4+ T-cell decline, and plasma levels of didanosine correlated with the extent of T-cell loss.

Conclusions.
Although patients receiving tenofovir + didanosine–based combinations generally achieved excellent viral suppression, their CD4+ T cells often paradoxically declined. This effect generally progressed over time. It is hypothesized that the use of these 2 agents together results in a condition that metabolically resembles purine nucleoside phosphorylase deficiency, a rare but well-described primary immunodeficiency syndrome.

Reviewer Comments.
Tenofovir and didanosine frequently are the only nucleoside analog agents available to patients with drug-resistant virus. This combination with either a nonnucleoside reverse transcriptase inhibitor or a protease inhibitor is often effective in suppressing virus in patients with limited options. However, the paradoxical decline in T-cell numbers is of great concern. Patients on this regimen must be monitored carefully for this potential complication.
Risk Factors for Atopic Dermatitis in New Zealand Children at 3.5 Years of Age
Authors: Spergel Jonathan M. 
Published: September 2006

Purpose of the Study.
To examine factors associated with a diagnosis of atopic dermatitis (AD) at 3.5 years of age, especially factors implicated by the hygiene hypothesis.

Study Population.
There were 871 children enrolled at birth for the Auckland Birthweight Collaborative study, 744 (85.4%) participated at 1 year, and 550 (63.2%) at 3.5 years. AD was diagnosed in 87 (15.8%) children at 3.5 years.

Methods.
The Auckland Birthweight Collaborative study is a case-control study of risk factors for small-for-gestational-age infants. Case subjects were born at term with birth weight at ≤10th percentile; controls were appropriate for gestational age, with birth weight &gt;10th percentile. AD was defined as the presence of an itchy rash in the past 12 months with ≥3 of the following by history: flexural involvement, generally dry skin, atopic disease in parents or siblings, or visible flexural dermatitis by photographic protocol.

Results.
The prevalence of AD did not differ by birth weight. AD at 3.5 years was associated with raised serum immunoglobulin E, wheezing, asthma, rash, or eczema at 1 year. In multivariate analysis adjusting for parental atopy and breastfeeding, AD at 3.5 years was associated with atopic disease in the parents (maternal atopy only [adjusted odds ratio (aOR): 3.83; 95% confidence interval (CI): 1.2–12.2]; paternal atopy only [aOR: 3.6; 95% CI: 1.09–11.75]; both parents atopic [aOR: 6.12; 95% CI: 2.0–18.5]). There was a higher risk of AD with longer duration of breastfeeding (&lt;6 months [aOR: 6.13; 95% CI: 1.5–25.9]; &gt;6 months [aOR: 9.70; 95% CI: 2.5–38.2]) compared with never breastfeeding. AD at 3.5 years had a negative association with cat ownership (aOR: 0.5; 95% CI: 0.2–0.97) but was not associated with owning a dog at 3.5 years, having pets at 1 year, or with older siblings. AD at 3.5 years was not associated with gender, socioeconomic status, maternal smoking, parity, mold exposure, immunizations, BMI, or antibiotic use in the first year of life.

Conclusions.
A personal and a parental history of atopic disease are risk factors for AD at 3.5 years. Duration of breastfeeding was associated with an increased risk of AD. No association was found with factors implicated by the hygiene hypothesis.

Reviewer Comments.
This is one of many studies to look at various risk factors for atopy, here focusing on AD. Similar to other studies, the authors show that family history of atopy is a risk factor for AD. However, compared with other studies, the authors did not find any association with gender, socioeconomic status, environmental risks, or BMI. This discrepancy is probably attributable to differences in populations and different environmental factors. The data on atopy prevention by breastfeeding remain unclear and may be affected by reverse causation (breastfeeding longer in response to observing AD); although this is one of several negative studies, meta-analyses of multiple studies typically show a prevention effect.
Predictors of Primary Care Follow-up After a Pediatric Emergency Visit for Asthma
Authors: Leo Harvey L. 
Published: September 2006

Purpose of the Study.
To identify predictors associated with primary care pediatrician (PCP) follow-up in children evaluated for acute asthma in a pediatric emergency department (ED).

Study Population.
Parents of children aged 2 to 18 years being discharged after asthma treatment in a pediatric ED.

Methods.
Parents were surveyed by coordinators and described their child’s asthma history and perceived benefits and barriers to making a PCP follow-up visit. Bivariate tests and multivariable logistic regression were used to determine association with completion of a follow-up visit within 4 weeks of the ED visit.

Results.
A total of 278 subjects (n = 278) were enrolled; 55% saw their PCP within 4 weeks of the ED visit. Baseline factors that were associated with an increased likelihood of follow-up included a recent hospitalization, &gt;1 ED visit for asthma in the past year, the parent’s assessment that the child had “very severe” asthma, and current daily use of a controller medication. Parental beliefs that taking daily asthma medications and finding out about the causes of asthma attacks were also associated with increased PCP follow-up rate. Parents were less likely to follow-up if they reported a lack of convenient appointments or prolonged waits in the PCP office. A multivariable model including clinical factors, parental beliefs, and the study intervention predicted the likelihood of follow-up.

Conclusions.
Parental beliefs about asthma severity, the benefits of controlling asthma, and organizational barriers to seeing a PCP were associated with follow-up after a pediatric ED visit for asthma.

Reviewer Comments.
Many children receive their first and subsequent follow-up visits for acute asthma attacks in the ED. Unfortunately, this is an inefficient and cost-prohibitive method of managing asthma. This study attempted to identify parental perceptions of their child’s disease and the barriers to proper follow-up. These issues are paramount for the pediatrician caring for these children. Addressing parental concerns and removing barriers to follow-up can improve asthma control and allow for more cost-effective management and proper utilization of health care resources. Both the acute treating physician and practicing pediatrician can influence the possibility of appropriate follow-up and care.
Massive Infection and Loss of Memory CD4+ T Cells in Multiple Tissues During Acute SIV Infection
Authors: Church Joseph A. 
Published: September 2006

Purpose of the Study.
It was recently established that both acute HIV and its simian counterpart, simian immunodeficiency virus (SIV), are accompanied by dramatic and selective loss of memory CD4+ T cells. This loss has been shown to primarily occur in mucosal tissues. The extent and mechanisms underlying this depletion have not been defined. The purpose of this study was to investigate these questions in a simian model.

Methods.
Eight rhesus macaque monkeys were infected with a pathogenic strain of SIV. Plasma and tissue samples were collected at various time points by biopsy and necropsy. Lymphocyte subsets were analyzed with standard flow cytometry, and T-cell–associated viral DNA was measured by a highly sensitive quantitative polymerase chain reaction assay.

Results.
This study demonstrated that in this monkey model, memory CD4+ T cells are depleted in multiple tissues during acute SIV infection. In addition, the loss of these cells is explained by a massive infection of these cells by the virus. Specifically, ∼50% of these cells throughout the body are infected by SIV at the peak of infection, and most of the infected cells disappear within several days. Alternative mechanisms are not required. This depletion occurs to a similar extent in all tissues.

Conclusions.
Acute immunodeficiency virus infection results in the loss of ∼50% of all memory T cells within days of infection. This and other studies strongly suggest that this loss, at least in adult animals and humans, is irreversible.

Reviewer Comments.
This study confirms and extends previous findings demonstrating massive memory T-cell loss during acute HIV or SIV infection. The extent to which this loss is recoverable is likely to be very limited. Most interesting is that these authors also noted that naive T cells are highly resistant to SIV infection. These observations are particularly important for infants infected with HIV. Young infants have fewer memory CD4+ T cells, and, therefore, their loss may not be as critical in newborns. In addition, the thymus in young children may be more capable of reconstituting memory T-cell functions if HIV is completely suppressed early. Similar studies should be performed on infant laboratory animals to determine the extent to which recovery is likely in infected children.
BCG Immunization at Birth and Atopic Diseases in a Homogeneous Population of Spanish Schoolchildren
Authors: Maloney Jennifer M. , Sicherer Scott H. 
Published: September 2006

Purpose of the Study.
To investigate the effect of vaccination with BCG on the development of atopic diseases in a homogeneous population of Spanish schoolchildren.

Study Population.
Children aged 6 to 7 years who were living in 3 cities (Bilbao, San Sebastian, and La Coruna) and 1 province (Asturias) of the North Atlantic coast of Spain.

Methods.
The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in 4 different centers of the Spanish North Atlantic coast. Bilbao, San Sebastian, and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruna discontinued this practice in 1989. Except for this center, immunization coverage was &gt;90%. Parents of children aged 6 and 7 years were surveyed from a random sample of schools of Asturias or all schools in the city district among the remainder of the centers.

Results.
The participation rate was &gt;70%. After excluding those children born outside Spain, there were 6762 immunized and 2828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, presence of older and younger siblings, and ownership of a cat or a dog during the first year of the child’s life, the adjusted odds ratios of the BCG-immunized children according to disease outcome were 0.87 for asthma (95% confidence interval [CI]: 0.76–1.00), 0.87 for hay fever (95% CI: 0.75–1.01), and 0.89 for atopic dermatitis (95% CI: 0.76–1.05).

Conclusions.
BCG immunization offers weak protection against atopic diseases in Spanish schoolchildren.

Reviewer Comments.
BCG vaccination has received attention because of its ability to provoke a T-helper (Th)1 response. Many investigators have hypothesized that vaccination with BCG may offer protection from Th2-skewed diseases such as asthma, allergic rhinitis, and atopic dermatitis. Although this study reveals that immunization with BCG offers weak protection against asthma and allergic rhinitis in a homogeneous population, it is important to remember that these diseases are multifactorial, with genetic and environmental influences also impacting pathogenesis.
Hypersensitivity Reactions to Paracetamol in Children: A Study of 25 Cases
Authors: Davis Karla L. , Mikita Cecilia P. 
Published: September 2006

Purpose of the Study.
Reports of paracetamol (acetaminophen) allergic and nonallergic hypersensitivity reactions are rare. However, urticaria, angioedema, dyspnea, and allergic and nonallergic anaphylactic reactions have been reported in both children and adults in association with paracetamol administration. Most reactions to paracetamol occur in patients with a nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs (NSAIDs). Alternatively, reactions may result from an allergic hypersensitivity to paracetamol, with tolerance of NSAIDs. This study reports an investigation of 25 children with suspected paracetamol hypersensitivity.

Study Population.
Twenty-five children, aged 8 months to 15 years, with a history of adverse reactions associated with paracetamol administration. In 12 of the 25 children studied, paracetamol adverse reactions were associated with concurrent administration of other medications or biological agents.

Methods.
Diagnosis of paracetamol hypersensitivity was based on either clinical history or the results of an oral challenge test. Reported reactions included urticaria, angioedema, conjunctivitis, dyspnea, and a maculopapular rash. Oral challenge tests with paracetamol were performed in the hospital setting. Paracetamol dosing was initiated at 1 mg and gradually increased until the appropriate cumulative dose for age and weight was achieved. An oral challenge with acetylsalicylic acid was performed in 1 child with a history highly suggestive of paracetamol hypersensitivity.

Results.
Paracetamol hypersensitivity was diagnosed in 1 patient (4%) on the basis of clinical history. The child reported accelerated reactions on 2 occasions, including facial angioedema, conjunctivitis, and dyspnea with wheezing, after isolated intake of paracetamol. Oral challenge to acetylsalicylic acid in this patient induced urticaria and angioedema. Oral challenges to paracetamol in the 24 other children studied were tolerated.

Conclusions.
Results of this study of 25 children with suspected paracetamol hypersensitivity concur with those of previous reports: paracetamol hypersensitivity is rare and is associated with hypersensitivity reactions to antiinflammatory medications.

Reviewer Comments.
Adverse reactions temporally associated with paracetamol may result from reactions to other medications or the underlying conditions for which these medications have been prescribed. Diagnostic evaluation of suspected paracetamol hypersensitivity is complicated further by the lack of validated, available skin or in vitro testing. Adverse reactions to paracetamol can be both allergic and nonallergic in nature. The results of this study underscore the need for careful evaluation for both paracetamol and NSAID hypersensitivity in children with a history suggestive of adverse reactions to paracetamol.
Hospitalization for RSV Bronchiolitis Before 12 Months of Age and Subsequent Asthma, Atopy and Wheeze: A Longitudinal Birth Cohort Study
Authors: Wang Julie 
Published: September 2006

Purpose of the Study.
To compare asthma and atopy outcomes of children according to whether they had been admitted to a hospital in the first 12 months with respiratory syncytial virus (RSV)–proven bronchiolitis.

Study Population.
Data from a large, population-based, birth cohort (Avon Longitudinal Study of Parents and Children) were used.

Methods.
Outcomes considered were 12-month prevalence of wheeze at 2 ages (between 30–42 and 69–81 months), cumulative prevalence of doctor-diagnosed asthma at 91 months, and skin-prick test–defined atopy at 7 years. Multivariable logistic-regression models were used to calculate odds ratios for outcomes adjusted for potential confounders.

Results.
A total of 150 infants (1.1% of the cohort) were admitted to a hospital within 12 months of birth with RSV bronchiolitis. The prevalence of wheezing was 28.1% in the RSV group and 13.1% in controls at 30 to 42 months and 22.6% vs 9.6% at 69 to 81 months. The cumulative prevalence of asthma was 38.4% in the RSV group and 20.1% in the controls at 91 months. Atopy was found in 14.6% of those in the RSV group and in 20.7% of the controls at 7 years. RSV bronchiolitis was associated with subsequent wheezing between 30 to 42 months (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3–3.9) and 69 to 81 months (OR: 3.5; 95% CI: 1.8–6.6) and with the cumulative prevalence of asthma at 91 months (OR: 2.5; 95% CI: 1.4–4.3) but not with atopy (OR: 0.7; 95% CI: 0.2–1.7).

Conclusions.
In a population-based birth cohort, RSV bronchiolitis was associated with subsequent wheezing and asthma but not with the development of atopy by 7 years of age.

Reviewer Comments.
Because infants who have severe RSV infection have recurrent wheezing later in life, RSV has been suggested to be a risk factor for asthma. Some also postulate that early RSV infection may predispose children to atopy; however, this has been controversial. Henderson et al show in their large prospective cohort that severe RSV infection requiring hospitalization is associated with wheezing but not atopy. These results indicate that RSV infection may be a risk factor for nonallergic asthma.