bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Early Hospital Readmission for Asthma Among Inner-City Children
Authors: Macy Michelle , Leo Harvey L. 
Published: November 2007

Reznik M, Hailpern SM, Ozuah PO. J Asthma. 2006;43:37–40
PURPOSE OF THE STUDY. To identify modifiable predictors of early readmission in inner-city children with asthma.
STUDY POPULATION. All pediatric patients aged 0 to 21 years who were discharged with a primary diagnosis of asthma during the study period were identified from a single hospital. Case patients were those who were readmitted with asthma within 30 days of discharge, and controls were those who were not readmitted. A total of 152 case patients and 293 controls who met the inclusion criteria were used in this study.
METHODS. Medical chart reviews were performed on the selected patients. Information was collected on demographics, variables related to past asthma history, variables related to the index admission, and variables related to discharge from the index admission. The data were evaluated by using conditional logistic regression analyses.
RESULTS. Case patients were more likely to have been hospitalized for asthma in the past 12 months (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.40–3.50), to have visited the emergency department for asthma in the past 12 months (OR: 3.28; 95% CI: 1.55–6.94), to have a history of an ICU admission for asthma (OR: 1.87; 95% CI: 1.26–3.78), to have received a pulmonary consultation during the index admission (OR: 1.87; 95% CI: 1.12–3.10), and to have been prescribed inhaled corticosteroids before the index admission (OR: 1.61; 95% CI: 1.02–2.52). Multivariate analysis revealed that a history of asthma hospitalization within the past 12 months was an independent predictor of early readmission (OR: 1.89; P = .021).
CONCLUSIONS. A history of asthma hospitalization within the past 12 months was associated with early readmission. Modifiable factors such as medical treatment and management during and at discharge from the index admission did not predict early asthma readmission.
REVIEWER COMMENTS. In this largely minority population, with &gt;50% covered by Medicaid, early readmission was increased in those with markers of more severe and persistent asthma. History of an asthma-related emergency department visit in the last year, ICU admission for asthma, or pulmonary consultation was associated with readmission. Children with a prescription for inhaled corticosteroid (ICS) before hospitalization were more likely to require readmission, yet no protective effect was identified for ICS prescription at the time of discharge. On multivariate analysis, early readmission was associated with hospitalization for asthma in the preceding 12 months. Although limited by its retrospective nature, this study indicates that children who frequently use tertiary care for asthma are at increased risk for early readmission and identifies at-risk asthmatic children who may benefit from targeted interventions at hospital discharge.
Aerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children: To Do or Not to Do?
Authors: Kewalramani Anupama , Bollinger Mary E. 
Published: November 2007

Esposito-Festen J, Ijsselstijn H, Hop W, van Vliet F, de Jongste J, Tiddens H. Chest. 2006;130:487–492
PURPOSE OF THE STUDY. To determine the feasibility of aerosol administration with a metered-dose inhaler (MDI) spacer in sleeping young children.
STUDY POPULATION. Thirty children (18 boys) from the Netherlands between 6 and 23 months of age were treated with inhalation therapy twice per day for recurrent wheezing in the previous month.
METHODS. Parents were trained to use a metal chamber (NebuChamber) with a face mask to administer 200 μg of budesonide aerosol. A filter was placed between the spacer and face mask to trap and then measure the aerosol inhaled from the spacer. The study included 1 run-in week and 2 test weeks. The families were visited at home 4 times in the 3 weeks. At the 1-week run-in, the parents practiced the procedure with a placebo MDI while the child was awake. In weeks 2 and 3, they administered 1 puff while the child was awake (awake administration), 1 puff before bedtime, and 1 puff while the child was asleep (sleep administration). Parents then were asked to score the child's asthma symptoms and degree of cooperation and the feasibility of administration. Filters were washed, and budesonide amounts were measured by high-performance liquid chromatography and spectrophotometry.
RESULTS. Twenty-one children fully completed the study, and a total of 350 awake-administration filters and 331 sleep-administration filters were collected. The mean filter dose was significantly higher for awake administration (47% ± 26%) than that for sleep administration (16% ± 13%). The median variability dose for awake administration was 50%, whereas it was 110% for sleep administration. Poor cooperation was noted for 29% of the awake administrations. In 69% of the sleep administrations, the child woke up, and in 75% of these cases, the child was distressed. Twenty-two percent of parents reported mask-positioning problems while the child was sleeping. Mean symptoms scores were 1.4 ± 2.2 (0 = no symptoms, 4 = severe symptoms; maximum score = 12 for sum of cough, wheeze, and shortness of breath).
CONCLUSIONS. Administering aerosol therapy during sleep has been suggested as a way to overcome cooperation problems in young children, but this study suggests that this is not the answer.
REVIEWER COMMENTS. The study included 30 children, and only 21 completed the study; a larger study would need to be performed with design modifications. One significant concern about the study design is that the children did not receive active drug during the study because the design required capturing the drug in a filter to determine drug delivery (which may explain the high drop-out rate). Furthermore, the design of the study did not allow for a means to determine clinical efficacy or lung deposition of the drug. In the interim, pediatricians may want to reconsider recommending dosing of aerosolized medications during sleep.
Allergic Rhinitis and Its Consequences on Quality of Sleep: An Unexplored Area
Authors: Adinoff Allen 
Published: November 2007

Leger D, Annesi-Maesano I, Carat F, et al. Arch Intern Med. 2006;166:1744–1748
PURPOSE OF THE STUDY. Allergic rhinitis (AR) is common and has been shown to impair social life and sleep. Patients with severe symptoms may have more sleep disturbances than those with a mild form of the disease, but this has never been assessed with a validated tool. The objective of this study was to assess, in patients with AR, whether duration and severity of AR are associated with sleep impairment.
METHODS. A nationwide controlled, cross-sectional epidemiologic study was conducted. A representative sample of 260 French ear, nose, and throat and allergy specialists enrolled 591 patients aged 18 to 50 years with AR of at least 1 year's duration. Sleep disorders, sleep quality, and AR were assessed by using validated tools (Sleep Disorders Questionnaire, Epworth sleepiness scale, and score for allergic rhinitis). The severity of AR was assessed by using the allergic rhinitis and its impact on asthma classification.
RESULTS. All dimensions of sleep were impaired by AR, particularly by the severe type. Sleep was significantly more impaired in patients with severe AR than in those with the mild type. The duration of AR (intermittent or persistent) had no effect on sleep.
CONCLUSIONS. These data underline the close relationship between AR and sleep and highlight the need for clinicians, particularly general practitioners, to be attentive in this respect.
REVIEWER COMMENTS. This was the DREAMS study (Etude Descriptive des Rhinites Allergiques et des Modifications du Sommeneil), and although that is really cute, I am not sure it is truly fair to use the authors’ native French to make an English acronym. Anyway, the main weakness here is that they did not perform sleep studies on the patients. Nonetheless, they used validated instruments (questionnaires) to establish the severity of the AR and its impact on sleep quality. There is no reason to think that similar effects would not also occur in children with AR. The study also points out the importance of understanding the effects of AR on many quality-of-life indicators.
Long-term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma
Authors: Chipps Bradley E. 
Published: November 2007

Guilbert TW, Morgan WJ, Zeiger RS, et al. N Engl J Med. 2006;354:1985–1997
PURPOSE OF THE STUDY. To determine the role of inhaled corticosteroid (ICS) in preventing the development of asthma in a group of high-risk children before the development of symptomatic disease or abnormal lung function.
STUDY POPULATION. Subjects were 285 children aged 2 to 3 years at high risk for developing asthma.
METHODS. Subjects were assigned to fluticasone propionate (FP) 88 μg twice per day with a pressurized metered-dose inhaler with spacer or placebo for a 2-year treatment period. The patients were observed without treatment for 1 year.
RESULTS. During the 2-year treatment period, there was significant improvement in symptom-free days for those in the FP group (86.8%–85.9%). Children in the FP group had more episode-free days, decreased exacerbations, and decreased need for extra controller medication. Those in the ICS group had a 1.1-cm decrement in growth after the first 2 years of the study, but this difference decreased to 0.7 cm after the 1-year observation period.
CONCLUSIONS. Although ICS had a significant effect on the burden of asthma during the treatment period, there was no evidence that a long-term effect was carried over to the 1-year observation period.
REVIEWER COMMENTS. The burden of childhood asthma is benefited with administration of ICS, but there is no evidence that long-term disease modification occurs.
Patterns of Global Tobacco Use in Young People and Implications for Future Chronic Disease Burden in Adults
Authors: Simons Elinor 
Published: November 2007

Warren CW, Jones NR, Eriksen MP, Asma S; Global Tobacco Surveillance System (GTSS) Collaborative Group. Lancet. 2006;367:749–753
PURPOSE OF THE STUDY. The Global Youth Tobacco Survey assessed current tobacco use and exposure among young teenagers and evaluated susceptibility to starting smoking among nonsmokers.
STUDY POPULATION. Students aged 13 to 15 years (N = 747 603) at 395 sites in 131 countries and the Gaza Strip and West Bank.
METHODS. Students completed questionnaires to assess current tobacco use, cigarette smoking, susceptibility to smoking among nonsmokers, and exposure to secondhand smoke in homes and public places. Susceptibility to smoking was defined as an answer other than “definitely not” when asked if they would smoke a cigarette offered by a best friend or if they thought they would smoke at any time in the next 12 months.
RESULTS. Among all students, 17.3% currently used tobacco products and 8.9% currently smoked cigarettes. Current tobacco-product use was highest in the region of the Americas (22.2%), and current cigarette smoking was highest in the European region (17.9%) and region of the Americas (17.5%). Among students who had never smoked cigarettes, 18.3% reported susceptibility to smoking during the coming year. Susceptibility was highest in the European region (30.5%) and the region of the Americas (24.8%). Measures of use, susceptibility, and exposure were similar for boys and girls. Worldwide, never-smokers were less likely than current smokers to report exposure to secondhand smoke at home (prevalence: 39.1% [95% confidence interval (CI): 36.6–41.6] vs 72.8% [95% CI: 64.0–81.6]) and in public places (prevalence: 49.5% [95% CI: 46.7–52.3] vs 81.2% [95% CI: 74.2–88.2]).
CONCLUSIONS. Although tobacco exposure and susceptibility remain high among young teenagers, this study demonstrated a significant association between lower secondhand cigarette-smoke exposure and never smoking.
REVIEWER COMMENTS. Cigarette smoke is a common respiratory irritant that contributes to exacerbations of childhood asthma and rhinitis. This study provided evidence supporting the association between lower secondhand cigarette-smoke exposure and never smoking among young teenagers, which suggests an additional reason to counsel patients and their families regarding the immediate and long-term risks of exposure to secondhand cigarette smoke and cigarette smoking.
Montelukast Improves Regional Air-Trapping Due to Small Airways Obstruction in Asthma
Authors: Rangsithienchai Pitud A. , Phipatanakul Wanda 
Published: November 2007

Zeidler MR, Kleerup EC, Goldin JG, et al. Eur Respir J. 2006;27:307–315
PURPOSE OF THE STUDY. To assess the effects of montelukast on regional air-trapping, airway hyperresponsiveness, and small-airway physiology using quantitative image analysis with high-resolution computed tomography (HRCT).
STUDY POPULATION. Sixteen patients (7 women, 9 men) aged 18 to 65 with no use of inhaled corticosteroids for the past 2 months, a forced expiratory volume in 1 second (FEV1) of &gt;60% predicted, a provocation dose that causes a 20% decrease in FEV1, and a clinical diagnosis of asthma.
METHODS. The study was designed as a randomized, double-blind, placebo-controlled crossover trial. Subjects received either montelukast 10 mg or a placebo given once daily in the evening for 4 weeks. The subjects then crossed over to the alternate treatment for 4 more weeks. Regional air-trapping was assessed by HRCT at residual volume before and after methacholine challenge and was performed at baseline and after each of the drug phases was complete. Other indices of hyperresponsiveness and physiology were measured as well.
RESULTS. Significantly less regional air-trapping was seen on the premethacholine images of patients treated with montelukast. However, no effect on increases in regional air-trapping was seen on the postmethacholine images in these same patients. There were no differences seen in global indices of small-airways physiology between montelukast and placebo. Montelukast resulted in improved quality-of-life scores.
CONCLUSIONS. Montelukast improved small-airways disease in asthmatic subjects, but this improvement can only be detected by HRCT, not by physiologic studies.
REVIEWER COMMENTS. Although montelukast improved distal airway function, it is noted that at baseline, the patients in the montelukast group showed a greater degree of air-trapping, and this difference cannot be excluded as having an effect on the findings. One question that this study raised is why montelukast's beneficial effects are only measurable with HRCT and not by physiologic means. The authors alluded to the poor sensitivity of physiologic indices and their large degree of intrasubject test variability. They also refer to the inhomogeneous pattern of small-airway involvement and the greater reliability of computer-derived quantitative image analysis versus qualitative radiographic techniques. Sample size was also limited in this study, which involved only mildly asthmatic subjects, indicating that further and expanded studies need to be performed. Montelukast's inability to reduce hyperresponsiveness to methacholine should also be investigated further.
Suppression of IFN-Gamma Production in Atopic Group at the Acute Phase of RSV Infection
Authors: Wang Julie 
Published: November 2007

Kaneko H, Matsui E, Asano T, et al. Pediatr Allergy Immunol. 2006;17:370–375
PURPOSE OF THE STUDY. Several studies have suggested that respiratory syncytial virus (RSV) bronchiolitis induces a change in the cytokine-production profile in childhood. The authors of this study sought to determine if the RSV-induced cytokine production was affected by the patient's atopic background.
STUDY POPULATION. Fourteen children between 1 month and 14 years of age who were admitted to the hospital with RSV infection and divided into 2 groups: those who were nonatopic and those who were atopic.
METHODS. Interferon-γ (IFN-γ) and interleukin 4 (IL-4) in the supernatant of peripheral blood mononuclear cells was measured after culture for 24 hours in the presence of phytohemagglutinin, IL-12, or IL-18.
RESULTS. In RSV-infected infants with atopic diseases, IFN-γ production from IL-12–or especially IL-18–stimulated peripheral blood mononuclear cells was subtotally suppressed in the acute phase, whereas in RSV-infected infants without atopic diseases, IFN-γ production was not suppressed in the acute phase.
CONCLUSIONS. The IFN-γ suppression observed in the atopic group was not caused by the immaturity of the infants’ immune system, because reduced IFN-γ production to RSV was not observed in the infants in the nonatopic group. IFN-γ suppression in regard to RSV infection might be caused by some genetic factor involved in the development of atopic disease, such as IL-18 signal cascade.
REVIEWER COMMENTS. Several studies have suggested a link between RSV infection and the development of persistent wheezing later in childhood. However, a causal role for RSV infection in early life in the development of asthma is not clear. The results of this study indicate that there may be a genetic predisposition to T-helper 2–type immune responses to RSV in atopic children, which may play a role in the development of recurrent wheezing in this subset of children.
Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome
Authors: Wang Julie 
Published: November 2007

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Pediatr Allergy Immunol. 2006;17:351–355
PURPOSE OF THE STUDY. This prospective study was undertaken to determine if the atopy patch test (APT) is able to predict the results of the oral food challenge (OFC) for food protein–induced enterocolitis syndrome (FPIES). The APT involves placement of food in a Finn chamber (metal cap) left on the skin for 48 hours and evaluated for rash in the subsequent days after removal.
STUDY POPULATION. Nineteen patients aged 5 to 30 months who had suspected FPIES on the basis of clinical history.
METHODS. The infants underwent APT to the suspected foods. After APT was performed, the subjects underwent OFC to determine if FPIES was present. The results of APT and OFC were compared and used to calculate sensitivity and specificity of the APT.
RESULTS. APT predicted the results of OFCs in 28 of 33 instances. There were 16 cases of FPIES confirmed by OFCs. In all 16 cases of FPIES, the APT result was positive to the suspected food. However, the APT was positive in 5 instances in which the OFC result was negative. All 12 patients with a negative APT result had a negative OFC result to the suspected food.
CONCLUSIONS. APT seems to be a promising diagnostic tool for the diagnosis of FPIES.
REVIEWER COMMENTS. FPIES is a non–immunoglobulin E (IgE)-mediated food allergy in which affected infants develop gastrointestinal symptoms hours after ingestion of the offending food. Current allergy skin and serum tests are not useful for diagnosing this disorder, because they test for food-specific IgE levels that are often negative in FPIES. A diagnostic OFC is the gold standard. The role for APT in diagnosing other non–IgE-mediated food hypersensitivities has been investigated. The results of this study suggest that APT may have some utility in guiding the diagnosis and management of FPIES.
Are We Overprescribing Antireflux Medications for Infants With Regurgitation?
Authors: Khoshoo Vikram , Edell Dean , Thompson Aaron , Rubin Mitchell 
Published: November 2007

OBJECTIVE. Our goal was to evaluate the diagnosis and treatment of infants with persistent regurgitation who were referred to a pediatric gastroenterology service.
METHODS. The records of 64 infants with persistent regurgitation and without any neurodevelopmental abnormalities, underlying illness, or cigarette smoke exposure were evaluated for diagnostic workup and treatment. Forty-four infants underwent extended esophageal pH monitoring.
RESULTS. Only 8 of 44 pH studies showed abnormal acid reflux. Forty-two of these 44 infants were already on antireflux medications. Other etiologies included hypertrophic pyloric stenosis (4) and renal tubular acidosis (1). Discontinuation of medication did not result in worsening of symptoms in most infants with normal pH studies.
CONCLUSIONS. The majority of infants who were prescribed antireflux drugs did not meet diagnostic criteria for gastroesophageal reflux disease.
Movement and Habitat Use of Stocked Juvenile Paddlefish in the Ohio River System, Pennsylvania
Authors: Barry Patrick M. , Carline Robert F. , Argent David G. , Kimmel William G. 
Published: November 2007

Abstract
In 2002 and 2003 we released a total of 66 hatchery-reared, juvenile paddlefish Polyodon spathula (249–318 mm eye-to-fork length) in Pennsylvania's upper Ohio River system and tracked them with radiotelemetry in two different pools of the Ohio and Allegheny rivers to determine (1) poststocking survival, (2) whether release site influences survival, (3) dispersal distance and direction of movement, and (4) habitat selection. Survival was fair (mean = 78% in 2002 and 67% in 2003) for 0.23–0.43-kg paddlefish after 9 weeks. In 2003, fish stocked in the upstream half of the pool had a greater survival (100%) after 63 d than those stocked in the downstream half (44%). Within 4 d of stocking, 77% of juvenile paddlefish were located in tailwaters, and fish found these habitats regardless of stocking location. Habitat measurements at all postdispersal locations had median depths of 5.2 and 6.1 m in 2002 and 2003, respectively, and median near-surface velocities of 0.17 and 0.12 m/s. Fish selected tailwater habitats and avoided habitats with disturbance from commercial barge traffic in both years.
Stress Response and Avoidance Behavior of Fishes as Influenced by High-Frequency Strobe Lights
Authors: Richards Nathan S. , Chipps Steven R. , Brown Michael L. 
Published: November 2007

Abstract
We examined the effects of strobe lights on plasma cortisol concentrations and avoidance behavior across a broad range of fish taxa. Representative fish taxa from five families were evaluated and included: Centrarchidae (largemouth bass Micropterus salmoides), Cyprinidae (fathead minnow Pimephales promelas), Ictaluridae (channel catfish Ictalurus punctatus), Percidae (yellow perch Perca flavescens), and Salmonidae (Chinook salmon Oncorhynchus tshawytscha). Mean (±SE) plasma cortisol concentrations for channel catfish (89 ± 22 ng/mL), yellow perch (81 ± 39 ng/mL), and Chinook salmon (173 ± 27 ng/mL) increased significantly compared with those in control groups (50 ± 11, 3.0 ± 1.9, and 102 ± 35 ng/mL, respectively) after 1 h of exposure to strobe lights. After 7 h of exposure, plasma cortisol levels were similar to those in control groups for all fish taxa. Fathead minnow showed no detectable response to strobe lights at either 1 or 7 h of exposure. Behavior experiments showed that the mean distance moved from the strobe light varied significantly between test and control fish and was highest for largemouth bass (mean distance after 1 h = 8.3 m), followed by Chinook salmon (7.3), yellow perch (7.3), and channel catfish (5.1). In contrast, avoidance behavior by fathead minnow exposed to strobe lights did not differ from that of controls. Although a significant increase in plasma cortisol level was useful for predicting an avoidance response, relative change in cortisol concentration was a poor indicator of sensitivity of individual fish taxa to strobe lights. Direct observations of avoidance behavior revealed that largemouth bass, Chinook salmon, and yellow perch were more sensitive to strobe lights than channel catfish and fathead minnow. Lack of both a cortisol response and avoidance behavior by fathead minnow indicates low sensitivity of this species to strobe lights and warrants further investigation into the effectiveness of strobe lights on cyprinids.