bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Combined Pneumococcal Conjugate and Polysaccharide Vaccination on Recurrent Otitis Media With Effusion
Authors: van Heerbeek Niels , Straetemans Masja , Wiertsema Selma P. , Ingels Koen J.A.O. , Rijkers Ger T. , Schilder Anne G.M. , Sanders Elisabeth A.M. , Zielhuis Gerhard A. 
Published: March 2006

BACKGROUND. Otitis media with effusion (OME) is very common during childhood. Because Streptococcus pneumoniae is one of the most common bacterial pathogens involved in OME, pneumococcal vaccines may have a role in the prevention of recurrent OME.
OBJECTIVE. We sought to assess the effect of combined pneumococcal conjugate and polysaccharide vaccinations on the recurrence of OME.
METHODS. A randomized, controlled trial was performed with 161 children, 2 to 8 years of age, with documented persistent bilateral OME. All subjects were treated with tympanostomy tubes (TTs). One half of the subjects were assigned randomly to additional vaccination with a 7-valent pneumococcal conjugate vaccine 3 to 4 weeks before and a 23-valent pneumococcal polysaccharide vaccine 3 months after tube insertion. Blood samples were drawn at the first vaccination, at the time of TT placement, and 1 and 3 months after the second vaccination. Levels of IgA and IgG serum antibody against the 7-valent pneumococcal conjugate vaccine serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F were measured with enzyme-linked immunosorbent assays. All children were monitored for recurrence of OME for 6 months after spontaneous extrusion of the TTs.
RESULTS. The overall recurrence rate of bilateral OME was 50%. Pneumococcal vaccinations induced significant 4.6- to 24.4-fold increases in the geometric means of all conjugate vaccine serotype antibody titers but did not affect recurrence of OME.
CONCLUSIONS. Combined pneumococcal conjugate and polysaccharide vaccination does not prevent recurrence of OME among children 2 to 8 years of age previously known to have persistent OME. Therefore, pneumococcal vaccines are not indicated for the treatment of children suffering from recurrent OME.
Does Clinical Presentation Explain Practice Variability in the Treatment of Febrile Infants?
Authors: Bergman David A. , Mayer Michelle L. , Pantell Robert H. , Finch Stacia A. , Wasserman Richard C. 
Published: March 2006

BACKGROUND. Previous studies documented considerable variability in the treatment of febrile infants, despite the existence of practice guidelines for this condition. None of those studies documented the extent to which this variability is accounted for by differences in clinical severity.OBJECTIVE. To quantify the individual effects of the patient's clinical presentation, demographic, provider, and practice characteristics, and regional variables on practice variability in the evaluation and treatment of febrile infants.METHODS. With data collected through the Pediatric Research in Office Settings network, we analyzed data on the treatment of 2712 febrile infants examined by 484 pediatricians located in 194 practices. We analyzed hospitalization, lumbar puncture, urinalysis and/or urine culture, blood work, and initial antibiotic administration. We obtained a summary score for evaluation and treatment intensity (ranging from no tests or treatments to comprehensive testing, hospitalization, and antibiotic therapy) by performing principal-components analysis with these 5 variables. This summary score was regressed with respect to patients' clinical presentation, demographic and practice/practitioner features, and geographic region. Provider fixed effects were also included in the model.RESULTS. Although the overall model explained 46.5% of the variance, the clinical characteristics of the patient alone explained 29.7% of the overall variance. Practice site fixed effects explained nearly 15% of the overall variance. Provider and practitioner characteristics and geographic region had minimal explanatory power.CONCLUSIONS. Our results show that measures of the patient's clinical presentation account for nearly one third of the variability that our model explains. This suggests that differences in clinical presentation and severity of illness underlie much of the observed practice variability among pediatricians evaluating and treating febrile infants. These findings demonstrate that the management of this common and potentially serious condition depends more on the clinical presentation of the patient than on the characteristics of the provider/practice and the residential region.
Benefits and Costs ofChannel Onein a Middle School Setting and the Role of Media-Literacy Training
Authors: Austin Erica Weintraub , Chen Yi-Chun “Yvonnes” , Pinkleton Bruce E. , Johnson Jessie Quintero 
Published: March 2006

OBJECTIVES. Channel One is a public-affairs program that includes 10 minutes of news and 2 minutes of paid product advertising or public service announcements. Advocates assert that it increases public-affairs knowledge, but critics charge that it garners a captive audience for teen-targeted advertising. This experiment analyzed the differential effects of Channel One depending on whether early-adolescent viewers received a media-literacy lesson in conjunction with viewing the program. Outcomes included perceptions of Channel One news programming, recall of program content and advertising, materialism, and political efficacy.METHODS. Researchers used a posttest-only field experiment (N = 240) of seventh- and eighth-grade students using random assignment to conditions. Conditions included a control group, a group that received a fact-based lesson, and a group that received the same lesson content using a more emotive teaching style. It was expected that the emotion-added lesson condition would be more effective than the logic-only lesson condition because of its motivational component.RESULTS. On average, students remembered more ads from Channel One than news stories. Participants in the control group remembered fewer news stories than did the groups that received the lessons. Students reported having purchased during the preceding 3 months an average of 2.5 items advertised on the program. Both fact-based and affect-added training increased student skepticism toward advertisers. As expected, student liking of the program enhanced their learning from it and was associated with higher levels of political efficacy. Students held misconceptions about the role of their school in the production of Channel One.CONCLUSIONS. The use of Channel One by schools can have benefits, but these come with risk that some may consider unacceptable. On the positive side, student liking of the program was associated with their political efficacy. Although those who responded positively to program content and presentation style learned more from it, they also tended to want things that they saw in the advertisements. The data therefore show that the program can provide some benefits to young adolescents, but the results also provide justification for concerns about the commercialization of the classroom.
West Nile Virus Infection Among Pregnant Women in a Northern Colorado Community, 2003 to 2004
Authors: Paisley Jan E. , Hinckley Alison F. , O'Leary Daniel R. , Kramer William C. , Lanciotti Robert S. , Campbell Grant L. , Hayes Edward B. 
Published: March 2006

OBJECTIVE. Since West Nile virus (WNV) was first detected in New York in 1999, it has spread across North America and become a major public health concern. In 2002, the first documented case of intrauterine WNV infection was reported, involving an infant with severe brain abnormalities. To determine the frequencies of WNV infections during pregnancy and of intrauterine WNV infections, we measured WNV-specific antibodies in cord blood from infant deliveries after a community-wide epidemic of WNV disease.
METHODS. Five hundred sixty-six pregnant women who presented to Poudre Valley Hospital (Fort Collins, CO) for delivery between September 2003 and May 2004 provided demographic and health history data through self-administered questionnaires and hospital admission records. Umbilical cord blood was collected from 549 infants and screened for WNV-specific IgM and IgG antibodies with enzyme-linked immunosorbent assays, with confirmation by plaque-reduction neutralization tests. Newborn growth parameters, Apgar scores, and hearing test results were recorded.
RESULTS. Four percent (95% confidence interval: 2.4–5.7%) of cord blood samples tested positive for WNV-specific IgG antibodies. No cord blood samples were positive for WNV-specific IgM antibodies. There were no significant differences between infants of seropositive and seronegative mothers with respect to any of the growth parameters or outcomes measured.
CONCLUSIONS. Intrauterine WNV infections seemed to be infrequent. In our study, WNV infection during pregnancy did not seem to affect adversely infant health at birth. Larger prospective studies are necessary to measure more completely the effects of maternal WNV infection on pregnancy and infant health outcomes.
Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program
Authors: McCormick Marie C. , Brooks-Gunn Jeanne , Buka Stephen L. , Goldman Julie , Yu Jennifer , Salganik Mikhail , Scott David T. , Bennett Forrest C. , Kay Libby L. , Bernbaum Judy C. , Bauer Charles R. , Martin Camilia , Woods Elizabeth R. , Martin Anne , Casey Patrick H. 
Published: March 2006

OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age.METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001–2499 g) and lighter low birth weight (LLBW; ≤2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status.RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (−0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2).CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention.
A Randomized Trial of Home Oxygen Therapy From the Emergency Department for Acute Bronchiolitis
Authors: Bajaj Lalit , Turner Carol G. , Bothner Joan 
Published: March 2006

OBJECTIVE. Hypoxia is a common reason for hospital admission in infants and children with acute bronchiolitis. No study has evaluated discharge from the emergency department (ED) on home oxygen. This study evaluated the feasibility and safety of ED discharge on home oxygen in the treatment of acute bronchiolitis.
METHODS. This was a prospective, randomized trial of infants and children with acute bronchiolitis and hypoxia (room-air saturations of ≤87%) aged 2 to 24 months presenting to an urban, academic, tertiary care children's hospital ED from December 1998 to April 2001. Subjects received inpatient admission or home oxygen after an 8-hour observation period in the ED. We measured the failure to meet discharge criteria during the observation period, return for hospital admission, and incidence of serious complications.
RESULTS. Ninety-two patients were enrolled. Fifty three (58%) were randomly assigned to home and 39 (42%) to inpatient admission. There were no differences between the groups in age, initial room-air saturation, and respiratory distress severity score. Of 53 patients, 37 (70%) randomly assigned to home oxygen completed the observation period and were discharged from the hospital. The remaining 16 patients were excluded from the study (6), resolved their oxygen requirement (5), or failed to meet the discharge criteria and were admitted (5). One discharged patient (2.7%) returned to the hospital and was admitted for a cyanotic spell at home after the 24-hour follow-up appointment. The patient had an uncomplicated hospital course with a length of stay of 45 hours. The remaining 36 patients (97%) were treated successfully as outpatients with home oxygen. Satisfaction with home oxygen was high from the caregiver and the primary care provider.
CONCLUSIONS. Discharge from the ED on home oxygen after a period of observation is an option for patients with acute bronchiolitis. Secondary to the low incidence of complications, the safety of this practice will require a larger study.
A Tuberculosis Outbreak in a Private-Home Family Child Care Center in San Francisco, 2002 to 2004
Authors: Dewan Puneet K. , Banouvong Houmpheng , Abernethy Neil , Hoynes Thomas , Diaz Liliana , Woldemariam Melaku , Ampie Theresa , Grinsdale Jennifer , Kawamura L. Masae 
Published: March 2006

BACKGROUND. Child care facilities are well known as sites of infectious disease transmission, and California child care facility licensure requirements include annual tuberculosis (TB) screening for on-site adults. In April 2004, we detected an adult with TB living in a private-home family child care center (child care center A).
METHODS. We reviewed patient medical records and conducted a contact investigation. The investigation included all persons at the child care center, the workplace and leisure contacts of the adult patient with TB, and the household contacts of secondary case patients. Contact names were obtained through patient interviews. A positive tuberculin skin test result was defined as induration of ≥5 mm. DNA fingerprints of Mycobacterium tuberculosis isolates were analyzed. Outbreak cases were those that had matching DNA fingerprint patterns or were linked epidemiologically, if DNA fingerprint results were not available.
RESULTS. Between August 2002 and July 2004, we detected 11 outbreak cases, including 9 (82%) among children (&lt;18 years of age). All 11 outbreak patients lived or were cared for at child care center A. The 9 pediatric TB patients were young (&lt;7 years of age), United States-born children of foreign-born parents, and 4 (44%) had positive cultures for M tuberculosis. Including isolates recovered from the 2 adult patients, all 6 M tuberculosis isolates shared identical, 7-band, DNA fingerprint patterns. The contact investigation identified 3 (33%) of the 9 pediatric cases; 2 (22%) presented with illness and 4 (44%) were detected by primary care providers during routine TB screening. Excluding case subjects, 36 (54%) of 67 named contacts had latent TB infection.
CONCLUSIONS. Provider adherence to locally adapted pediatric TB screening recommendations proved critical to outbreak control. TB screening compliance by the child care center and more aggressive source-case investigation by the TB program might have prevented or abated this large pediatric TB outbreak.
Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day
Authors: Kent Jacqueline C. , Mitoulas Leon R. , Cregan Mark D. , Ramsay Donna T. , Doherty Dorota A. , Hartmann Peter E. 
Published: March 2006

OBJECTIVE. We aimed to provide information that can be used as a guide to clinicians when advising breastfeeding mothers on normal lactation with regard to the frequency and volume of breastfeedings and the fat content of breast milk.METHODS. Mothers (71) of infants who were 1 to 6 months of age and exclusively breastfeeding on demand test-weighed their infants before and after every breastfeeding from each breast for 24 to 26 hours and collected small milk samples from each breast each time the infant was weighed.RESULTS. Infants breastfed 11 ± 3 times in 24 hours (range: 6–18), and a breastfeeding was 76.0 ± 12.6 g (range: 0–240 g), which was 67.3 ± 7.8% (range: 0–100%) of the volume of milk that was available in the breast at the beginning of the breastfeeding. Left and right breasts rarely produced the same volume of milk. The volume of milk consumed by the infant at each breastfeeding depended on whether the breast that was being suckled was the more or less productive breast, whether the breastfeeding was unpaired, or whether it was the first or second breast of paired breastfeedings; the time of day; and whether the infant breastfed during the night or not. Night breastfeedings were common and made an important contribution to the total milk intake. The fat content of the milk was 41.1 ± 7.8 g/L (range: 22.3–61.6 g/L) and was independent of breastfeeding frequency. There was no relationship between the number of breastfeedings per day and the 24-hour milk production of the mothers.CONCLUSIONS. Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother-infant dyad.
Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality
Authors: Edmond Karen M. , Zandoh Charles , Quigley Maria A. , Amenga-Etego Seeba , Owusu-Agyei Seth , Kirkwood Betty R. 
Published: March 2006

BACKGROUND. Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality.
OBJECTIVES. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact.
METHODS. This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period.
RESULTS. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2–7) were excluded.
CONCLUSIONS. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.
Adherence to and Effectiveness of Positive Airway Pressure Therapy in Children With Obstructive Sleep Apnea
Authors: Marcus Carole L. , Rosen Gerald , Ward Sally L. Davidson , Halbower Ann C. , Sterni Laura , Lutz Janita , Stading Pamela J. , Bolduc Daisy , Gordon Nancy 
Published: March 2006

OBJECTIVES. Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea.METHODS. A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography.RESULTS. Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 ± 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 ± 32 to 3 ± 5/hour, and an improvement in arterial oxygen saturation nadir from 77 ± 17% to 89 ± 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness.CONCLUSIONS. Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children.