bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fears About HIV Transmission in Families With an HIV-Infected Parent: A Qualitative Analysis
Authors: Cowgill Burton O. , Bogart Laura M. , Corona Rosalie , Ryan Gery , Schuster Mark A. 
Published: October 2008

OBJECTIVE. Children of HIV-infected parents may be affected by their parents' disease even if not infected themselves. Because of advances in HIV treatment that have reduced the risk for vertical HIV transmission from mother to child, more HIV-infected adults are having children. Few studies have examined whether families with an HIV-infected parent experience fears about transmission to children and how they address such fears. In this article, we describe transmission-related fears in families with an HIV-infected parent.
METHODS. We used semistructured qualitative interviews, conducted in person from March 2004 to March 2005, with 33 HIV-infected parents, 27 minor children who were 9 to 17 years of age, 19 adult children, and 15 caregivers (adult family members or friends who helped care for the children and/or parents) to investigate their fears about HIV transmission. The parents are a subset from the HIV Cost and Services Utilization Study, a study of people in care for HIV throughout the United States. We analyzed the interview transcripts for themes related to transmission fears.
RESULTS. In many of the families, participants identified ≥1 HIV transmission–related fear. Themes included specific fears related to blood contact, bathroom items, kissing/hugging, and food. Families addressed their fears by educating children about modes of HIV transmission and establishing rules or taking precautions to reduce the risk for HIV transmission in the household. HIV-infected parents were also concerned about catching opportunistic infections from a sick child.
CONCLUSIONS. Many of the fears experienced by HIV-infected parents and their children were based on misconceptions about modes of HIV transmission. Pediatricians and others who treat these children may be able to offer counseling to allay fears that family members have about household transmission of HIV.
Parental Alcohol Screening in Pediatric Practices
Authors: Wilson Celeste R. , Harris Sion Kim , Sherritt Lon , Lawrence Nohelani , Glotzer Deborah , Shaw Judith S. , Knight John R. 
Published: October 2008

OBJECTIVES. Pediatricians are in an ideal position to screen parents of their patients for alcohol use. The objective of this study was to assess parents’ preferences regarding screening and intervention for parental alcohol use during pediatric office visits for their children.
METHODS. A descriptive multicenter study that used 3 pediatric primary care clinic sites (rural, urban, suburban) was conducted between June 2004 and December 2006. Participants were a convenience sample of consecutively recruited parents who brought children for medical care. Parents completed an anonymous questionnaire that contained demographics; 2 alcohol-screening tests (TWEAK and Alcohol Use Disorders Identification Test); and items that assessed preferences for who should perform alcohol-screening, acceptance of screening, and preferred interventions if the screening result was positive.
RESULTS. A total of 929 of 1028 eligible parents agreed to participate, and 879 of 929 completed surveys that yielded sufficient data for analysis. Most participants were mothers. A total of 101 of 879 parents screened positive on either the TWEAK or the Alcohol Use Disorders Identification Test. Parents with a negative alcohol screen (alcohol-negative) were more likely than parents with a positive alcohol screen (alcohol-positive) to report that they would agree to being asked about their alcohol use. There were no significant differences in preferences within alcohol-positive and alcohol-negative groups for screening by the pediatrician or computer-based questionnaire. Most preferred interventions for the alcohol-positive group were for the pediatrician to initiate additional discussion about drinking and its effect on their child, give educational materials about alcoholism, and refer for evaluation and treatment. Alcohol-positive men were more accepting than alcohol-positive women of having no intervention.
CONCLUSIONS. A majority of parents would agree to being screened for alcohol problems in the pediatric office. Regardless of their alcohol screen status, parents are accepting of being screened by the pediatrician, a computer-based questionnaire, or a paper-and-pencil survey. Parents who screen positive prefer that the pediatrician discuss the problem further with them and present options for referral.
Hemodynamic Changes During Weaning From Nasal Continuous Positive Airway Pressure
Authors: Abdel-Hady Hesham , Matter Mohamed , Hammad Ayman , El-Refaay Ahmed , Aly Hany 
Published: October 2008

BACKGROUND. Nasal continuous positive airway pressure is frequently used to support preterm infants with respiratory distress syndrome. Little is known about the hemodynamic changes that occur, particularly during the weaning phase when lung compliance has improved and most of the airway pressure can be transmitted to the heart and major blood vessels.
METHODS. We conducted a prospective study on preterm infants (gestational age ≤32 weeks) with resolving respiratory distress syndrome, who were receiving nasal continuous positive airway pressure of 5 cm H2O and 21% oxygen. While cycling nasal continuous positive airway pressure, we performed 2-dimensional M-mode and pulsed Doppler echocardiography on all infants during nasal continuous positive airway pressure and 1 hour after being off nasal continuous positive airway pressure.
RESULTS. A total of 25 preterm infant were studied. The use of nasal continuous positive airway pressure significantly decreased right ventricular output (320 ± 22.7 vs 410.5 ± 44.1 mL/kg per min); right ventricular end diastolic diameter (6 ± 0.7 vs 6.4 ± 0.4 mm), left ventricular end diastolic diameter (11.6 ± 0.9 vs 13.6 ± 0.7 mm), left ventricular end systolic diameter (7.1 ± 0.6 vs 8.3 ± 0.4 mm), left atrial diameter (6.3 ± 0.5 vs 8 ± 0.5 mm), aortic root diameter (6.4 ± 0.3 vs 6.6 ± 0.4 mm), superior vena cava flow (70.2 ± 8.5 vs 91.1 ± 4 mL/kg per minute), and pulmonary maximum velocity (0.6 ± 0.1 vs 0.7 ± 0.1 m/seconds). It significantly increased mean inferior vena cava diameter (4.3 ± 0.5 vs 3.5 ± 0.6 mm), whereas nasal continuous positive airway pressure did not influence left ventricular output, aortic maximum velocity, fractional shortening, heart rate, or mean arterial blood pressure. Changes associated with nasal continuous positive airway pressure were similar in infants with (n = 8) and without (n = 17) patent ductus arteriosus.
CONCLUSIONS. In infants with resolving respiratory distress syndrome, nasal continuous positive airway pressure can impede systemic and pulmonary venous return, but it does not compromise systemic arterial pressure or heart rate. It is not clear whether the degree of these hemodynamic changes can affect the success of weaning off nasal continuous positive airway pressure.
Survey of Pediatricians' Opinions on Donation After Cardiac Death: Are the Donors Dead?
Authors: Joffe Ari R. , Anton Natalie R. , deCaen Allan R. 
Published: October 2008

OBJECTIVE. There has been debate in the ethics literature as to whether the donation-after-cardiac-death donor is dead after 5 minutes of absent circulation. We set out to determine whether pediatricians consider the donation-after-cardiac-death donor as dead.METHODS. A survey was mailed to all 147 pediatricians who are affiliated with the university teaching children's hospital. The survey had 4 pediatric patient scenarios in which a decision was made to donate organs after 5 minutes of absent circulation. Background information described the organ shortage, and the debate about the term “irreversibility” applied to death in donation after cardiac death. Descriptive statistics were used, with responses between groups compared by using the χ2 statistic.RESULTS. The response rate was 54% (80 of 147). In each scenario, when given a patient described as dead with absent circulation for 5 minutes, ≤60% of respondents strongly agreed/agreed that the patient is definitely dead, ≤50% responded that the patient is in the state called “dead,” and ≤56% strongly agreed/agreed that the physicians are being truthful when calling the patient dead. On at least 1 of the scenarios, 38 (48%) of 147 responded uncertain, disagree, or strongly disagree that the patient is definitely dead. Although the patients in the 4 scenarios were in the identical physiologic state, with absent circulation for 5 minutes, 12 (15%) of 80 respondents did not consistently consider the patients in the state called “dead” between scenarios. Fewer than 5% of respondents answered strongly agree/agree to allow donation after cardiac death while also answering disagree/strongly disagree that the patient is definitely dead, suggesting little support to abandon the dead-donor rule.CONCLUSIONS. Most pediatrician respondents were not confident that a donation-after-cardiac-death donor was dead. This suggests that additional debate about the concept of irreversibility applied to donation after cardiac death is needed.
Unlicensed Teenaged Drivers: Who Are They, and How Do They Behave When They Are Behind the Wheel?
Authors: Elliott Michael R. , Ginsburg Kenneth R. , Winston Flaura K. 
Published: October 2008

OBJECTIVE. The objective of this study was to determine the prevalence and associated risk factors for unlicensed driving among 9th- through 11th-graders.
METHODS. A nationally representative school-based survey of 5665 9th-, 10th-, and 11th-graders ascertained whether students engaged in unlicensed driving and determined associated driving behaviors, risk behaviors, and demographic factors. Unlicensed driving, defined as not having any type of license and “driving on [one's] own” as opposed to learning to drive, or not driving yet was ascertained.
RESULTS. One (4.2%) in 25 US 9th- through 11th-graders reported that they drove at least 1 hour/week without a license. Unlicensed drivers were more likely to identify as being black or Hispanic, to live in rural or central city districts, and to report lower grades in school. No relationship was found between license status and reported crashes; however, unlicensed teenaged drivers were less likely to report seat belt use, more likely to report driving while under the influence of alcohol or drugs, and more likely to report more trips without a purpose. One fourth (28%) of them had taken a driver's education class, and one half (50%) reported parents as most helpful in learning to drive. Two thirds (66%) of the unlicensed drivers reported most often using a vehicle that others usually drive.
CONCLUSIONS. Considering the high burden of teen crashes, it is important to reach and deliver effective anticipatory guidance to unlicensed teenaged drivers who are at high risk for unsafe driving practices. Parents and driver's education instructors have contact with many of these unlicensed drivers. Clinicians, particularly those in rural and central city districts, should discuss unlicensed driving starting before the legal age of driving while screening for other health risk behaviors. Additional research is needed for better understanding of barriers to licensing among the teen population of licensing age.
Communication About Child Development During Well-Child Visits: Impact of Parents’ Evaluation of Developmental Status Screener With or Without an Informational Video
Authors: Sices Laura , Drotar Dennis , Keilman Ashley , Kirchner H. Lester , Roberts David , Stancin Terry 
Published: October 2008

BACKGROUND. The American Academy of Pediatrics recommends periodic administration of standardized developmental screening instruments during well-child visits to facilitate timely identification of developmental delay. However, little is known about how parents and physicians communicate about child development or how screening impacts communication.OBJECTIVE. Our goal was to examine whether parent-physician communication about child development is affected by (1) administration of a developmental screen or (2) video presentation on child development before well-child visits.METHODS. Six primary care pediatricians in a practice serving predominantly Medicaid-insured children participated. Fifteen parents of children 9 to 31 months of age per pediatrician were assigned to 1 of 3 previsit conditions (n = 89): (1) usual care; (2) parent completed the Parents’ Evaluation of Developmental Status screen; or (3) parent viewed 5-minute “activation” video before completing the Parents’ Evaluation of Developmental Status. Visits were audiorecorded and coded by blinded raters using a classification system that assesses communication content. Outcomes included visit length, physicians’ questions, information giving, reassurance or counseling about development, and parents’ concerns and requests for developmentally related services.RESULTS. Mean visit duration was similar for the 3 groups (22.5 minutes). Physicians made more information-giving and counseling statements about development and raised more developmental concerns in group 3 (video plus the Parents’ Evaluation of Developmental Status) than in group 1 (usual care) visits. A trend toward increased use of such communication was also seen in group 2 (Parents’ Evaluation of Developmental Status only). Parents were more likely to raise a developmental concern in group 3 than in group 1. No parent requested early intervention, therapy, or other related services.CONCLUSIONS. Use of a validated screening test did not increase average visit duration, an important consideration in primary care. Although use of the Parents’ Evaluation of Developmental Status alone led to some increase in parent-physician communication about development and developmental concerns, additional increase in communication was seen with the addition of a brief parent activation video shown before the Parents’ Evaluation of Developmental Status was completed.
Sensitization to Human Milk
Authors: Huang Faith , Nowak-Wegrzyn Anna 
Published: October 2008

Schulmeister U, Swoboda I, Quirce S, et al. Clin Exp Allergy. 2008;38(1):60–68
PURPOSE OF THE STUDY. To analyze the specificity and possible biological relevance of immunoglobulin E (IgE) reactivity to human milk antigens in milk-allergic patients.
STUDY POPULATION. Milk-allergic children and adults from different European countries with a positive case history, positive skin-prick reactions, and specific IgE to cow's milk extract were selected.
METHODS. The specificity of IgE reactivity to cow's milk and human milk antigens was analyzed with sera from milk-allergic children and adults by immunoblotting. IgE cross-reactivity between milk antigens was studied by immunoblot inhibition experiments. To demonstrate that IgE reactivity to human milk antigens is not caused by alloreactivity or transmission of foreign antigens, genetically unrelated mothers’ milk samples were analyzed before and after intake of dietary milk products. Skin-prick tests were performed with cow's, sheep's, mare's, and human milk samples.
RESULTS. IgE antibodies to human milk were found in &gt;80% of the tested milk-allergic patients (n = 17). Cross-reactive IgE-reactive human antigens such as α-lactalbumin and non–cross-reactive human milk antigens were identified. Immunoblots showed IgE reactivity to antigens of the same molecular weights in each of the 4 milk samples from unrelated mothers. An immediate-type skin reaction could be elicited with human milk samples in 2 tested patients with IgE reactivity to human milk.
CONCLUSIONS. IgE reactivity to human milk in milk-allergic patients may be caused by cross-sensitization and genuine sensitization, causing allergic symptoms. Sensitization to human milk is common in milk-allergic patients and may require diagnostic testing and clinical monitoring.
REVIEWER COMMENTS. This is one of the first studies to have addressed the nature and biological relevance of IgE reactivity to human milk. The study demonstrated that sensitization to human milk is common in milk-allergic patients, but additional research is necessary, because it is unclear if patients with positive skin reactions suffered from clinically significant reactions to human milk. One may consider searching for the presence of IgE antibodies to human milk in children who have signs of allergy after breastfeeding. However, the benefits of breastfeeding, including its protective effect against early atopic diseases, must also be considered before advising dietary changes.
The Presence of Rhinovirus in Lower Airways of Patients With Bronchial Asthma
Authors: Williams Larry W. 
Published: October 2008

Wos M, Sanak M, Soja J, Olechnowicz H, Busse WW, Szczeklik A. Am J Respir Crit Care Med. 2008;177(10):1082–1089
PURPOSE OF THE STUDY. To determine if there was identifiable rhinovirus in the bronchi of stable asthmatic subjects and whether there is a difference in the prevalence of bronchial rhinovirus in asthmatic subjects versus nonasthmatic controls.
STUDY POPULATION. Adult asthmatic subjects having bronchoscopy for clinical indications were enrolled if they had a forced expiratory volume in 1 second of &lt;80% of predicted and had &gt;12% improvement with bronchodilator or airway hyperreactivity to methacholine. Subjects must have had stable symptoms for at least 2 weeks and no upper airway infection in the previous 3 weeks. Control subjects were nonasthmatic patients who were undergoing diagnostic bronchoscopy for symptoms such as dyspnea, hemoptysis, or tumor or having lobectomy or pulmonectomy for tumor. Controls must not have had upper airway infection within 3 weeks.
METHODS. Mucosal biopsies and lung tissue samples were analyzed by immunohistochemical staining using monoclonal antibody to rhinovirus and by in situ reverse-transcription polymerase chain reaction to identify rhinoviral RNA.
RESULTS. Immunochemical staining showed rhinovirus in 64% (9 of 14) of the bronchial biopsies from asthmatic subjects and in 33% (2 of 6) of the controls. With the polymerase chain reaction method, 73% of biopsies from asthmatic subjects and 22% of the controls had evidence of rhinovirus RNA. Asthmatic subjects who tested positive for rhinovirus had worse pulmonary function and increased serum and tissue eosinophilia and increased tissue leukocytes compared with subjects in the virus-negative group.
CONCLUSIONS. Rhinovirus is more often present in the lower airways of asthmatic patients, and its presence is associated with worse lung function and increased eosinophilic inflammation.
REVIEWER COMMENTS. Traditional teaching has been that rhinovirus does not replicate at 37°C but instead only at the nasal temperature of 35°C. However, our local experience indicates that this may not be an absolute; we have followed an infant with severe combined immunodeficiency with persistent pulmonary infiltrates and respiratory failure who had only rhinovirus grow from bronchoscopy several times and from lung-biopsy tissue. In hosts with supposedly normal immune systems, this study is intriguing and provides a possible therapeutic opening if agents for enterovirus (which includes the rhinovirus group) are eventually available. The studied asthmatic subjects are not a representative population of asthmatic people, because they are a convenience sample with illness for which bronchoscopy was indicated, but the data certainly should stimulate further investigation in better characterized asthmatic people who do not otherwise have an indication for bronchoscopy.
Sensitization Does Not Develop In Utero
Authors: Turbyville Joseph C. , Mikita Cecilia P. 
Published: October 2008

Bønnelykke K, Pipper CB, Bisgaard H. J Allergy Clin Immunol. 2008;121(3):646–651
PURPOSE OF THE STUDY. To investigate the relationship of allergen-specific immunoglobulin E (IgE) in cord blood to sensitization in early infancy and the origin of such IgE.
STUDY POPULATION. There were 243 children followed from birth. The patients were part of the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) and, thus, were considered to be at risk for atopy because of a maternal history of asthma.
METHODS. Cord blood IgE was determined at the time of birth and again at 6 months of age. Total IgE, specific IgE to milk and egg, and a cumulative level of specific IgE to a panel of common aeroallergens were analyzed and compared with maternal IgE. Cord blood IgA was also assessed as a marker of maternal contamination of fetal blood, because IgA is not thought to cross the placental barrier during pregnancy.
RESULTS. Specific IgE against mixed allergens was detected in 34 (14%) of the cord blood samples, and specific IgE against single allergens was detected in 22 samples. IgA was detected in 98% of the samples. None of the specific IgE found in cord blood was detected at 6 months of age. Cord blood IgE was not detected in any infants whose mothers were not sensitized, and the infants who did have cord blood IgE detected displayed a “fingerprint match” to maternal IgE. In every case, the IgE for a specific allergen detected in cord blood was the same as that detected in maternal blood, and it was present in a relatively similar concentration to that found in maternal blood. The cord blood IgA level also showed a linear relationship to the IgE level, suggesting that more maternal contamination resulted in higher IgE levels in cord blood.
CONCLUSIONS. IgE in cord blood does not reflect in utero sensitization but seems to reflect maternofetal transfer of IgE.
REVIEWER COMMENTS. The questions rarely change, but our answers often do. In recent years, the American Academy of Pediatrics recommended that some parents avoid certain foods during pregnancy to reduce the chance of their child developing atopic disease. These recommendations were based on studies that showed that the human fetus is capable of producing IgE as early as the 20th week of gestation and that cord blood IgE seemed to be a predictor of future atopy. Now the evidence seems to suggest that although sensitization could theoretically occur in utero, it simply does not. This study provides convincing evidence that the IgE in cord blood does not come from the infant but, rather, from the mixing of maternofetal blood, probably at the time of delivery. This study, along with other evidence that has come to light recently, raises questions about whether maternal dietary restriction of allergens during pregnancy impacts allergy outcomes to the avoided food/foods.