bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial and Socioeconomic Disparity in Perforated Appendicitis Among Children: Where Is the Problem?
Authors: Nwomeh Benedict C. , Chisolm Deena J. , Caniano Donna A. , Kelleher Kelly J. 
Published: March 2006

OBJECTIVE. Significant racial, ethnic, and socioeconomic disparities have been observed in the rates of perforated appendicitis among children, by using large administrative databases. This study evaluated whether these factors had an impact on the care of patients with appendicitis at a major children's hospital with a well-established, comprehensive, primary referral system.METHODS. A retrospective analysis was performed for all children between the ages of 2 and 20 years who were treated for appendicitis between January 1, 2001, and December 31, 2003. Demographic variables included patient age, gender, race, insurance status, parental educational status, and income level. Coding data were used to identify patients with perforated appendicitis. The use of radiologic imaging was also analyzed.RESULTS. During the 3-year period, 788 patients were treated for appendicitis. The racial distribution (white: 81%; black: 12%; other: 7%) was consistent with the demographic composition of the local population. The overall perforation rate was 25%, and the rate was significantly greater in the age group of &lt;6 years, compared with older children. However, there were no significant differences in the perforation rate with respect to race, insurance status, educational level, or income status. Rates of radiologic imaging use were similar among all racial and socioeconomic groups.CONCLUSIONS. Although racial and socioeconomic disparities in the rates of perforated appendicitis among children have been reported, we found no significant evidence for such inequality at our institution. This may reflect improved access, early diagnosis, and referral by primary care physicians in the community. Pooled national and multiple-state administrative databases have been used to highlight persistent disparities in health care. This study illustrates how single-institution data sources can be used to test a local hypothesis generated by national data, with surprisingly different results.
Prophylaxis With Acetaminophen or Ibuprofen for Prevention of Local Reactions to the Fifth Diphtheria-Tetanus Toxoids-Acellular Pertussis Vaccination: A Randomized, Controlled Trial
Authors: Jackson Lisa A. , Dunstan Maya , Starkovich Patty , Dunn John , Yu Onchee , Nelson Jennifer C. , Rees Thom , Zavitkovsky Ann 
Published: March 2006

BACKGROUND. The frequency of local vaccination reactions increases with successive doses of diphtheria-tetanus toxoids-acellular pertussis (DTaP) vaccine, and local reactions occur for the majority of children receiving the fifth DTaP vaccination. It is not known whether these reactions can be prevented with prophylactic use of acetaminophen or ibuprofen.
METHODS. In this 3-group, randomized, blinded, controlled trial, 372 children were assigned randomly, in a 2:2:1 ratio, to receive 3 doses of acetaminophen, ibuprofen, or placebo. The first dose of study medication was administered within 2 hours before the fifth DTaP vaccination, and the remaining 2 doses were given at 6-hour intervals. The primary outcome measures included a local reaction with an area of redness or discoloration ≥5 cm in diameter on the evening of or during the 2 days after vaccination, an increase in mid-limb circumference of ≥2 cm on the evening of or during the 2 days after vaccination, and a persistent local reaction, defined as an area of redness or discoloration present on the third day after vaccination.
RESULTS. Local reactions with a ≥5-cm area of redness or discoloration were reported for 35% of children in the placebo group, compared with 33% of children in the acetaminophen group and 37% of children in the ibuprofen group. There was also no significant difference between the placebo and treatment groups in the proportions of children with a ≥2-cm increase in mid-limb circumference or with a persistent local reaction.
CONCLUSIONS. We did not find evidence that prophylaxis with acetaminophen or ibuprofen offers a clinically significant benefit in prevention of local reactions to the fifth DTaP vaccination.
Clinical Characteristics and Natural History of Freeman-Sheldon Syndrome
Authors: Stevenson David A. , Carey John C. , Palumbos Janice , Rutherford Ann , Dolcourt Joyce , Bamshad Michael J. 
Published: March 2006

OBJECTIVE. Freeman-Sheldon syndrome (FSS) is a rare, multiple congenital contracture syndrome that is nonetheless relatively well-known, because affected children have a striking appearance: it was historically called “whistling-face syndrome” because of involvement of the facial muscles. FSS is often confused with other congenital contracture syndromes and, as a result, the clinical characteristics and natural history are poorly understood. The objective of this study was to analyze the presentation, natural history, and outcome of a cohort of individuals ascertained using strict diagnostic criteria for FSS.METHODS. Data from questionnaires, medical charts, examination, and photographs were analyzed to describe the physical features, therapeutic interventions, and functional outcomes in 73 individuals referred with the diagnosis of FSS.RESULTS. Only 32 referred cases (∼40%) met diagnostic criteria for FSS. In addition to contractures, common features in these cases included severe scoliosis (85%), strabismus (42%), and hearing loss (30%). Most infants required supplementary feedings via a nasogastric (45%) or gastrostomy tube (17%). Children walked by an average age of 19 months, but ∼80% required ambulation-assist devices. An average of ∼10 surgeries was performed on each child, and anesthetic and/or surgical complications were reported in 50% of individuals. All individuals were cognitively normal.CONCLUSIONS. The clinical characteristics and natural history of FSS distinguish it from other forms of arthrogryposis, yet FSS is frequently misdiagnosed. Children with FSS require considerable nutritional, surgical, and rehabilitative intervention. Such intensive therapeutic demands differ substantially from most other congenital contracture syndromes. These findings underscore the necessity of making an accurate diagnosis.
Survival of Infants With Neural Tube Defects in the Presence of Folic Acid Fortification
Authors: Bol Kirk A. , Collins Julianne S. , Kirby Russell S. ,   for the National Birth Defects Prevention Network
Published: March 2006

OBJECTIVE. Neural tube defects (NTDs) are preventable through preconceptional and periconceptional folic acid intake. Although decreases in the prevalence of NTDs have been reported since folic acid fortification of United States grain products began, it is not known whether folic acid plays a role in reducing the severity of occurring NTDs. Our aim was to determine whether survival among infants born with spina bifida and encephalocele has improved since folic acid fortification and to measure the effects of selected maternal, pregnancy, and birth characteristics on first-year (infant) survival rates.
METHODS. A retrospective cohort study was conducted and included 2841 infants with spina bifida and 638 infants with encephalocele who were born between 1995 and 2001 and were registered in any of 16 participating birth defects monitoring programs in the United States. First-year survival rates for both spina bifida and encephalocele cohorts were measured with Kaplan-Meier estimation; factors associated with improved chances of first-year survival, including birth before or during folic acid fortification, were measured with Cox proportional-hazards regression analysis.
RESULTS. Infants with spina bifida experienced a significantly improved first-year survival rate of 92.1% (adjusted hazard ratio: 0.68; 95% confidence interval: 0.50–0.91) during the period of mandatory folic acid fortification, compared with a 90.3% survival rate for those born before fortification. Infants with encephalocele had a statistically nonsignificant increase in survival rates, ie, 79.1% (adjusted hazard ratio: 0.76; 95% confidence interval: 0.51–1.13) with folic acid fortification, compared with 75.7% for earlier births.
CONCLUSIONS. Folic acid may play a role in reducing the severity of NTDs in addition to preventing the occurrence of NTDs. This phenomenon contributes to our understanding of the efficacy of folic acid. Additionally, as survival of NTD-affected infants improves, health care, education, and family support must expand to meet their needs.
Successful Implementation of a Radiology Sedation Service Staffed Exclusively by Pediatric Emergency Physicians
Authors: Pershad Jay , Gilmore Barry 
Published: March 2006

OBJECTIVE. As the number of diagnostic imaging studies performed has increased, the demand for sedation in support of these radiologic tests has also increased. Our objectives were to (1) assess the safety and efficacy of a radiology sedation service that is staffed exclusively by pediatric emergency medicine (PEM) physicians, (2) determine the frequency and the type of commonly performed pediatric imaging studies that require procedural sedation, and (3) assess the average duration of procedural sedation for commonly performed radiologic studies.
METHODS. We conducted a retrospective observational study of patient encounters in 2004 involving procedural sedation to facilitate diagnostic imaging. We are a university-affiliated group of PEM physicians that provide a radiology sedation service during weekdays at a freestanding urban children's hospital.
RESULTS. The sedation service participated in 1285 patient encounters during the study period. Deep sedation was provided to 1027 patients. Moderate sedation was administered to 258 patients. Procedural sedation times for the most frequently performed imaging studies ranged from 5 to 183 minutes. Agents that were used to provide deep sedation were pentobarbital (with midazolam, fentanyl, or both) in 65% of cases, propofol in 31%, and ketamine (with or without midazolam) in 4%. Moderate sedation was achieved with chloral hydrate in 86% and oral diazepam in 14% of the cases. A total of 99.1% of the imaging studies were completed successfully. Six imaging studies were aborted because of failed sedation or occurrence of adverse event. Five patients who were deemed high risk on their presedation evaluation were referred electively for general anesthesia.
CONCLUSIONS. Our data suggest that a dedicated sedation team in support of diagnostic imaging services, staffed exclusively by PEM physicians, can be a successful clinical enterprise. The service consumes significant resources and physician time.
Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force
Authors: Shipman Scott A. , Helfand Mark , Moyer Virginia A. , Yawn Barbara P. 
Published: March 2006

BACKGROUND. Developmental dysplasia of the hip (DDH) represents a spectrum of anatomic abnormalities that can result in permanent disability.
OBJECTIVE. We sought to gather and synthesize the published evidence regarding screening for DDH by primary care providers.
METHODS. We performed a systematic review of the literature by using a best-evidence approach as used by the US Preventive Services Task Force. The review focused on screening relevant to primary care in infants from birth to 6 months of age and on interventions used in infants before 1 year of age.
RESULTS. The literature on screening and interventions for DDH suffers from significant methodologic shortcomings. No published trials directly link screening to improved functional outcomes. Clinical examination and ultrasound identify somewhat different groups of newborns who are at risk for DDH. A significant proportion of hip abnormalities identified through clinical examination or ultrasound in the newborn period will spontaneously resolve. Very few studies examine the functional outcomes of patients who have undergone therapy for DDH. Because of the high rate and unpredictable nature of spontaneous resolution of DDH and the absence of rigorous comparative studies, the effectiveness of interventions is not known. All surgical and nonsurgical interventions have been associated with avascular necrosis of the femoral head, the most common and most severe harm associated with all treatments of DDH.
CONCLUSIONS. Screening with clinical examination or ultrasound can identify newborns at increased risk for DDH, but because of the high rate of spontaneous resolution of neonatal hip instability and dysplasia and the lack of evidence of the effectiveness of intervention on functional outcomes, the net benefits of screening are not clear.
Formation of Pancreatic Duct Epithelium from Bone Marrow During Neonatal Development
Authors: Wang Xiuli , Ge Shundi , Gonzalez Ignacio , McNamara George , Rountree C. Barth , Xi Kenny Kezhe , Huang Grace , Bhushan Anil , Crooks Gay M. 
Published: March 2006

Abstract
Recent reports suggest that bone marrow–derived cells engraft and differentiate into pancreatic tissue at very low frequency after pancreatic injury. All such studies have used adult recipients. The aim of our studies was to investigate the potential of bone marrow to contribute to the exocrine and endocrine components of the pancreas during the normal rapid growth of the organ that occurs during the neonatal period. Five to ten million bone marrow cells from adult, male, transgenic, green fluorescent protein (GFP) mice were injected into neonatal nonobese diabetic/severely compromised immunodeficient/β2microglobulin-null mice 24 hours after birth. Two months after bone marrow transplantation, pancreas tissue was analyzed with fluorescence immunohistochemistry and fluorescence in situ hybridization (FISH). Co-staining of GFP, with anticytokeratin antibody, and with FISH for the presence of donor Y chromosome indicated that up to 40% of ducts (median 4.6%) contained epithelial cells derived from donor bone marrow. In some of these donor-derived ducts, there were clusters of large and small ducts, all comprised of GFP+ epithelium, suggesting that whole branching structures were derived from donor bone marrow. In addition, rare cells that coexpressed GFP and insulin were found within islets. Unlike pancreatic damage models, no bone marrow–derived vascular endothelial cells were found. In contrast to the neonatal recipients, bone marrow transplanted into adult mice rarely generated ductal epithelium or islet cells (p &lt; .05 difference between adult and neonate transplants). These findings demonstrate the existence in bone marrow of pluripotent stem cells or epithelial precursors that can migrate to the pancreas and differentiate into complex organ-specific structures during the neonatal period.
The Association Between Length of Stay in Canada and Intimate Partner Violence Among Immigrant Women
Authors: Hyman Ilene , Forte Tonia , Mont Janice Du , Romans Sarah , Cohen Marsha M. 
Published: March 2006

Objective. We examined the prevalence of intimate partner violence (IPV) among recent (0–9 years) and nonrecent (≥ 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. Methods. We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. Results. The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. Conclusions. Our findings have important implications for both prevention and detection of IPV among immigrant women.
Understanding Health Disparities: The Role of Race and Socioeconomic Status in Children’s Health
Authors: Chen Edith , Martin Andrew D. , Matthews Karen A. 
Published: March 2006

Objectives. We sought to determine whether childhood health disparities are best understood as effects of race, socioeconomic status (SES), or synergistic effects of the two. Methods. Data from the National Health Interview Survey 1994 of US children aged 0 to 18 years (n=33911) were used. SES was measured as parental education. Child health measures included overall health, limitations, and chronic and acute childhood conditions. Results. For overall health, activity and school limitations, and chronic circulatory conditions, the likelihood of poor outcomes increased as parental education decreased. These relationships were stronger among White and Black children, and weaker or nonexistent among Hispanic and Asian children. However, Hispanic and Asian children exhibited an opposite relationship for acute respiratory illness, whereby children with more educated parents had higher rates of illness. Conclusions. The traditional finding of fewer years of parent education being associated with poorer health in offspring is most prominent among White and Black children and least evident among Hispanic and Asian children. These findings suggest that lifestyle characteristics (e.g., cultural norms for health behaviors) of low-SES Hispanic and Asian children may buffer them from health problems. Future interventions that seek to bolster these characteristics among other low-SES children may be important for reducing childhood health disparities.
Exploring Lack of Trust in Care Providers and the Government as a Barrier to Health Service Use
Authors: Whetten Kathryn , Leserman Jane , Whetten Rachel , Ostermann Jan , Thielman Nathan , Swartz Marvin , Stangl Dalene 
Published: March 2006

Objectives. We examined associations between trust of health care providers and the government and health service use and outcomes. Methods. Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers. Results. Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible. Conclusions. Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.
Effects of Mood State and Psychosocial Functioning on Plasma Interleukin-6 in Adult Patients before Cardiac Surgery
Authors: Ai Amy L. , Kronfol Ziad , Seymour Elisabeth , Bolling Steve F. 
Published: March 2006

Objective: The purpose of this study was to examine the potential effect of mood states and psychosocial functioning during the waiting weeks prior to major cardiac surgery on the plasma Interleukin-6 (IL-6) levels in 236 patients immediately before their operation. Method: The sample was recruited from patients at the cardiac clinic of the University of Michigan Medical Center (Ann Arbor). Two weeks before cardiac surgery, trained research assistants conducted a face-to-face interview with these middle-aged and older patients on their preoperative physical examination date at the clinic. Standardized instruments were used to assess mood states and psychosocial functioning. The blood samples of 236 patients, obtained on the morning of the operation, were analyzed for plasma IL-6. Results: In bivariate analysis, poor psychological functioning and anxiety, as well as bodily pain and body mass index (BMI), were correlated with plasma IL-6 ( p < .05), but sociodemographics, chronic illness and use of psychotropic medications were not. When the effect of bodily pain and BMI were taken into account, partial correlation analysis showed that psychological functioning continued to be associated with plasma IL-6 ( p < .05); the association of IL-6 with depression now became significant ( p < .05), whereas that with anxiety became even more significant ( p < .001). Conclusions: Preoperative psychological disturbances during the waiting weeks before cardiac surgery may influence the plasma levels of IL-6 immediately prior to the procedure. The clinical implications of these findings remain to be determined.
Aripiprazole in the Treatment of Delirium
Authors: Alao Adekola O. , Soderberg Maureen , Pohl Elyssa L. , Koss Marvin 
Published: March 2006

Objective: Delirium is a common condition frequently seen in consultation-liaison psychiatry. It is especially common among medically compromised patients, and is an indicator of the severity of the medical illness. In addition, it is associated with a higher morbidity, mortality, and longer hospitalization. Traditionally, haloperidol has been used to treat agitation as it may occur in delirium. However, atypical antipsychotics are being increasingly used to treat delirium. Method: In this article, we will describe two cases of delirium successfully treated with aripiprazole. Results: Both patients had significant improvement in their delirium as measured by the delirium rating scale. Conclusion: Aripiprazole appears to be effective in reducing the symptoms of delirium.
Coprophagia in an Elderly Man: A Case Report and Review of the Literature
Authors: Beck David A. , Frohberg Nora R. 
Published: March 2006

Objective: Coprophagia or the ingestion of feces has long been associated with psychiatric illness. It is considered to be a variant of pica. This behavior requires an extensive medical and psychiatric differential diagnosis. Medical disorders associated with coprophagia include seizure disorders, cerebral atrophy, and tumors. Psychiatric disorders associated with coprophagia include mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium, and dementia. In animals, coprophagia is associated with boredom, thiamine deficiency, and lesions of the amygdala. Methods: A case of coprophagia in an elderly man is reported here. A 77-year-old man with mild mental retardation was referred for urgent psychiatric evaluation due to coprophagia. The case is discussed and the literature reviewed. Results: Psychiatric evaluation revealed cognitive dysfunction and depression. Physical examination and laboratory evaluation were noncontributory. He was started on sertraline 25 mg daily with resolution of his coprophagia. Coprophagia has been treated using behavioral interventions, supportive psychotherapy, elemental diets, tricyclic antidepressants, carbamazepine, haloperidol, and electroconvulsive therapy. Conclusions: Use of Selective Serotonin Reuptake Inhibitors (SSRIs) may also be an effective treatment for coprophagia, particularly in the setting of depression or anxiety.