bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Pediatric Patients With Mild-to-Moderate Hypertension: Yield of Diagnostic Testing
Authors: Wiesen Jonathan , Adkins Matthew , Fortune Sherwin , Horowitz Judah , Pincus Nava , Frank Rachel , Vento Suzanne , Hoffman Cathy , Goilav Beatrice , Trachtman Howard 
Published: October 2008

OBJECTIVE. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension.
METHODS. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mmHg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring.
RESULTS. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13.3 ± 4.4 years. BMI was 26.1 ± 6.7 kg/m2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of &gt;170 mg/dL, and 26 (19%) had severe hypercholesterolemia (&gt;200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of &gt;95% at least 20% of the time, and 28 (36%) had diastolic readings of &gt;95% at least 20% of the time.
CONCLUSIONS. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.
Coadministration of RIX4414 Oral Human Rotavirus Vaccine Does Not Impact the Immune Response to Antigens Contained in Routine Infant Vaccines in the United States
Authors: Dennehy Penelope H. , Bertrand Helen R. , Silas Peter E. , Damaso Silvia , Friedland Leonard R. , Abu-Elyazeed Remon 
Published: October 2008

OBJECTIVE. This study was conducted to confirm the absence of immune interference of 2 doses of RIX4414 (Rotarix) on routine infant vaccinations in the United States.STUDY DESIGN. A total of 484 healthy infants aged 6 to 12 weeks were randomly assigned to 1 of 2 groups to receive 3 doses of Pediarix (combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliovirus vaccine [DTaP-HBV-IPV]), Prevnar (7-valent pneumococcal conjugate vaccine [PCV7]), and ActHIB (Haemophilus influenzae type b conjugate vaccine [Hib]) at 2, 4, and 6 months of age with RIX4414 either coadministered at 2 and 4 months (Co-ad) or administered separately at 3 and 5 months (Sep-ad). Serum antibodies were measured 1 month after dose 3 of the DTaP-HBV-IPV, PCV7, and Hib vaccines.RESULTS. Antibody responses to all antigens were similar in infants in both the Co-ad and Sep-ad groups. Seroprotective antibody concentrations against diphtheria, tetanus, hepatitis B, and poliovirus types 1, 2, and 3 were achieved by ≥97.9% of the infants in both groups. Antipolyribosyl ribitol phosphate antibody levels of ≥1.0 μg/mL were achieved by 88.3% to 89.4% of infants in both groups. In both groups, ≥97.8% of the infants were seropositive for antipertussis antibodies and the 7 pneumococcal serotypes. Predefined criteria for noninferiority between groups were reached for all antigens.CONCLUSIONS. Two doses of RIX4414 coadministered with routine infant vaccines as recommended in the United States (DTaP-HBV-IPV, PCV7, and Hib) did not impair the immune response to any of the coadministered antigens.
Longitudinal Effects of Violent Video Games on Aggression in Japan and the United States
Authors: Anderson Craig A. , Sakamoto Akira , Gentile Douglas A. , Ihori Nobuko , Shibuya Akiko , Yukawa Shintaro , Naito Mayumi , Kobayashi Kumiko 
Published: October 2008

CONTEXT. Youth worldwide play violent video games many hours per week. Previous research suggests that such exposure can increase physical aggression.
OBJECTIVE. We tested whether high exposure to violent video games increases physical aggression over time in both high- (United States) and low- (Japan) violence cultures. We hypothesized that the amount of exposure to violent video games early in a school year would predict changes in physical aggressiveness assessed later in the school year, even after statistically controlling for gender and previous physical aggressiveness.
DESIGN. In 3 independent samples, participants’ video game habits and physically aggressive behavior tendencies were assessed at 2 points in time, separated by 3 to 6 months.
PARTICIPANTS. One sample consisted of 181 Japanese junior high students ranging in age from 12 to 15 years. A second Japanese sample consisted of 1050 students ranging in age from 13 to 18 years. The third sample consisted of 364 United States 3rd-, 4th-, and 5th-graders ranging in age from 9 to 12 years.
RESULTS. Habitual violent video game play early in the school year predicted later aggression, even after controlling for gender and previous aggressiveness in each sample. Those who played a lot of violent video games became relatively more physically aggressive. Multisample structure equation modeling revealed that this longitudinal effect was of a similar magnitude in the United States and Japan for similar-aged youth and was smaller (but still significant) in the sample that included older youth.
CONCLUSIONS. These longitudinal results confirm earlier experimental and cross-sectional studies that had suggested that playing violent video games is a significant risk factor for later physically aggressive behavior and that this violent video game effect on youth generalizes across very different cultures. As a whole, the research strongly suggests reducing the exposure of youth to this risk factor.
Procalcitonin Levels in Febrile Infants After Recent Immunization
Authors: Dauber Andrew , Weiss Scott , Maniaci Vincenzo , Nylen Eric , Becker Kenneth L. , Bachur Richard 
Published: October 2008

BACKGROUND. Procalcitonin has been identified as a useful blood marker of serious bacterial infection in febrile infants. Many infants present with a febrile reaction after receiving immunizations. The effects of immunization on procalcitonin have not been investigated.
METHODS. We performed a prospective observational cohort study at a large, urban pediatric emergency department. Infants ≤90 days of age with fever of ≥38°C were enrolled. Subjects were divided into 3 groups: infants with serious bacterial infection; subjects without serious bacterial infection who received recent (&lt;48 hours) immunizations; and subjects without serious bacterial infection who did not recently receive immunizations. Procalcitonin was measured by using a quantitative immunometric assay.
RESULTS. Over 13 months, procalcitonin was measured for 271 infants. There were 44 (16%) patients with serious bacterial infection, 35 in the recent-immunization group, and 192 in the no-recent-immunization group. The median procalcitonin level for serious bacterial infection was 0.53 ng/mL, for recent immunization was 0.29 ng/mL, and for no recent immunizations was 0.17 ng/mL. Procalcitonin values were elevated for patients with serious bacterial infection compared with patients both with and without recent immunizations. Compared with patients who had no recent immunizations, procalcitonin levels were elevated in patients with recent immunization. Using a cut point of 0.12 ng/mL, the sensitivity of procalcitonin for serious bacterial infection was 96%, specificity was 23%, and negative predictive value was 96%. Two patients with recent immunization who had serious bacterial infection were identified with this cut point.
CONCLUSIONS. Among febrile infants with recent immunization, procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Despite this increase, procalcitonin can still reliably discriminate infants with serious bacterial infection.
Growth of Infants With IgE-Mediated Cow's Milk Allergy Fed Different Formulas in the Complementary Feeding Period
Authors: Wang Julie 
Published: October 2008

Agostoni C, Fiocchi A, Riva E, et al. Pediatr Allergy Immunol. 2007;18(7):599–606
PURPOSE OF THE STUDY. Observational studies have shown that allergic infants, irrespective of their type of diet, show various degrees of growth depression in the first year of life. The authors investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age [WA], length-for-age [LA], and weight-for-length [WL] z scores) in infants with cow's milk allergy (CMA).
STUDY POPULATION. One hundred sixty infants with immunoglobulin E–mediated CMA entered the study in a 5-year period; 108 were formula fed and 52 were still breastfed at 6 months.
METHODS. Infants were randomly assigned to 3 special formulas: a soy formula (n = 32); a casein hydrolysate (n = 31); or a rice hydrolysate (n = 30). A fourth, nonrandomized group was made up of allergic infants who were still breastfed at up to 12 months (n = 32). Groups were compared for WA, LA, and WL z scores at 6, 9, and 12 months of age.
RESULTS. All groups showed low WA and LA z scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula.
CONCLUSIONS. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA.
REVIEWER COMMENTS. Use of infant formulas for children with CMA, if not exclusively breastfeeding, is necessary to provide adequate nutrition at a critical time for a child's growth. Few studies have compared growth parameters in children with CMA using different formulas. This study demonstrates that different formulas can contribute to different growth rates in allergic children. This area requires additional investigation to optimize nutrition for these infants.
Childhood Asthma After Bacterial Colonization of the Airway in Neonates
Authors: Smart Brian A. 
Published: October 2008

Bisgaard H, Hermansen MN, Buchvald F, et al. N Engl J Med. 2007;357(15):1487–1495
PURPOSE OF THE STUDY. To investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.
STUDY POPULATION. The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood who were born to mothers with asthma. Samples were obtained from 321 subjects at the age of 1 month when the infants were asymptomatic.
METHODS. Aspirates from the hypopharyngeal region were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Peripheral eosinophil count, total immunoglobulin E (IgE) levels, and specific IgE levels were measured at 4 years of age. Lung function was measured and asthma was diagnosed at the age of 5.
RESULTS. Overall, 21% of the infants were colonized with S pneumoniae, M catarrhalis, H influenzae, or a combination of these organisms. Colonization with ≥1 of these organisms, but not S aureus, was significantly associated with persistent wheeze, acute severe exacerbation of wheeze, and hospitalization for wheeze. Eosinophil counts and total IgE levels at age 4 were significantly increased in children colonized at age 1 month with S pneumoniae, M catarrhalis, or H influenzae, but the specific IgE level was not significantly affected. Children who had been colonized neonatally with S pneumoniae, M catarrhalis, or H influenzae also had, at age 5, increased prevalence of asthma, increased risk for hospitalization for wheeze, and increased reversibility of airway resistance after the administration of a bronchodilator.
CONCLUSIONS. Neonates colonized in the hypopharyngeal region with S pneumoniae, M catarrhalis, H influenzae, or a combination of these organisms are at increased risk for recurrent wheeze and asthma early in life.
REVIEWER COMMENTS. This is a fascinating study. Although it must be pointed out that this was a high-risk population (the mothers had asthma) and the “photograph” of these patients at ages 4 and 5 may not represent their final end point, this study gives new insight into the interaction between infectious disease, atopy, and asthma. I hope the investigators will extend this trial to older ages and that other groups will try to replicate these findings in both low- and high-risk populations of children.
Adherence to Follow-up Recommendations in Asthma
Authors: Lasley Mary V. 
Published: October 2008

van Gent R, de Meer G, Rovers MM, Kimpen JL, van der Ent CK, van Essen LE. Arch Dis Child. 2008;93(3):236–238
PURPOSE OF THE STUDY. To assess the willingness of parents of children with possible asthma to visit their general practitioner (GP).
STUDY POPULATION. A cross-sectional group of 130 Dutch children aged 7 to 10 years with possible asthma were studied.
METHODS. Participating parents completed the International Study of Asthma and Allergies in Childhood questionnaire. A child was considered to have “diagnosed asthma” if a doctor had diagnosed him or her with asthma in the preceding 12 months. A child was considered to have “possible asthma” if the child had (1) no physician-diagnosed asthma in the preceding 12 months, (2) asthma symptoms in the preceding 12 months, and (3) either reversible airway obstruction or bronchial hyperreactivity. Parents of children with possible asthma were sent a letter recommending further medical evaluation by their GP. The GP received a letter with the results of the questionnaire and lung-function tests. A research nurse contacted parents to conduct a telephone interview regarding adherence to recommendations.
RESULTS. A total of 2745 children were invited to participate in the study, and 1758 children participated. Eighty-one (5%) children were diagnosed with asthma and 130 (8%) had a possible diagnosis of asthma, which represented the study population. A follow-up interview was completed for 114 children (88%). Sixty-two percent of the children visited a doctor, and 38% of the parents refused to visit the GP. The main reason for parents not visiting a GP was absence or mildness of symptoms. Most of the parents stated that they would visit a GP if symptoms worsened.
CONCLUSIONS. Two thirds of the children with undiagnosed asthma visited their GP. Willingness to follow-up the recommendations was greater for children with more severe airway reversibility and if the mother was less well educated.
REVIEWER COMMENTS. Asthma screening in children relies on parental recognition of asthma symptoms. The authors pointed out that parents often underrecognize symptoms of asthma in their child. However, when confronted with information of a possible asthma diagnosis, the majority of parents sought advice from their GP. Asthma screening programs can be a useful tool for helping children with undiagnosed asthma to seek professional care.
Duration of Humoral Immunity to Common Viral and Vaccine Antigens
Authors: Smart Brian A. 
Published: October 2008

Amanna IJ, Carlson NE, Slifka MK. N Engl J Med. 2007;357(19):1903–1915
PURPOSE OF THE STUDY. To better define the duration of humoral immunity and the role played by memory B cells.
STUDY POPULATION. There were 45 human subjects followed for up to 26 years. These participants were recruited from the Oregon National Primate Research Center. The only inclusion criteria was that subjects had at least 3 serum samples banked for at least 3 years before the study began. The average age at the start and end of the study was 37 and 52 years, respectively.
METHODS. Blood samples were drawn at least annually, and serum was banked. Antibody titers were measured to vaccinia, measles, mumps, rubella, varicella-zoster, Epstein-Barr, tetanus, and diphtheria. Each subject gave an average of 14 serum samples over an average of 15.2 years. Also, the investigators measured antigen-specific memory B cells by means of limiting-dilution analysis and compared memory B-cell frequencies to their corresponding serum antibody levels. The majority of subjects had vaccination to smallpox in childhood and had recovered from the other viral diseases such as measles and rubella.
RESULTS. The antibody responses to viral antigens were very stable, with estimated half-lives ranging from 50 years for varicella-zoster to &gt;200 years for measles and mumps. Against tetanus and diphtheria, the antibody responses waned more rapidly with half-lives of 11 and 19 years, respectively. The investigators also found that B-cell memory was long-lived, but there was no significant correlation between peripheral memory B-cell numbers and antibody levels for 5 of the 8 antigens.
CONCLUSIONS. Serologic memory for multiple antigens is maintained for remarkably sustained periods of time. Also, memory B-cell numbers did not correlate with antibody titers, which suggests that peripheral memory B-cells and antibody-secreting plasma cells may represent independently regulated cell populations and may play different roles in the maintenance of immunity.
REVIEWER COMMENTS. At the end of the study, the average age of the participants was 52 years. Most had received vaccination to smallpox, but most had also contracted natural measles, mumps, or rubella during childhood. This study population, therefore, does not represent our current population of children with complex schedules of vaccinations. Furthermore, we cannot conclude from this study that vaccination-induced immunity is necessarily as long-lived as natural infection-induced immunity. Nonetheless, this report does give fascinating insight into the “adult” side of immunity to many of the childhood diseases against which we vaccinate. This study also sheds light on possible mechanisms for sustained humoral immunity, which it seems may not entirely depend on regulation by memory B cells.
Infections in Child Day Care Centers and Later Development of Asthma, Allergic Rhinitis, and Atopic Dermatitis Infections in Child Day Care Centers: Prospective Follow-up Survey 12 Years After Controlled Randomized Hygiene Intervention
Authors: Kim Jennifer S. 
Published: October 2008

Dunder T, Tapiainen T, Pokka T, Uhari M. Arch Pediatr Adolesc Med. 2007;161(10):972–977
PURPOSE OF THE STUDY. To evaluate the effect of prevention of common infections in child day care centers (CDCCs) on the later development of allergic disease.
STUDY POPULATION. Children &lt;2 years of age were recruited from 20 CDCCs in Finland for a 15-month randomized, controlled hygiene intervention trial conducted in 1991–1992. Among the children in the intervention CDCCs, there were 27% fewer episodes of acute otitis media and 24% fewer days of antimicrobial agents.
METHODS. Questionnaires were sent in 2003 (12 years later) to 1376 participants of the previous intervention trial; 928 participated (response rate: 68%). The main outcome measures were the number of respondents with a physician diagnosis of asthma, allergic rhinitis, and/or atopic dermatitis (AD) and those who reported symptoms of atopic disease.
RESULTS. No differences were found between the intervention and control groups with regard to rates of asthma, allergic rhinitis, or AD or with frequency of atopic symptoms.
CONCLUSIONS. The prevention of common respiratory tract and enteric infections during early childhood does not change later allergic morbidity.
REVIEWER COMMENTS. This particular hygiene intervention, aimed at decreasing the frequency of common childhood upper respiratory and gastrointestinal illnesses, was not successful in decreasing the development of asthma, allergic rhinitis, or AD among this cohort. The authors argued that the magnitude of the reduction in infections and duration of the intervention should have led to an increase in asthma rates as proposed by the hygiene hypothesis. However, the infection history was based on clinical symptoms and use of antibiotics rather than more definitive laboratory diagnostic measures for specific bacteria and/or viruses. In addition, the follow-up data were based solely on questionnaire findings, which have an inherent reporting bias. Regardless, additional studies are necessary to characterize the role of the hygiene hypothesis in the development of atopic disease.
Home Exposures to Environmental Tobacco Smoke and Allergic Symptoms Among Young Children in Singapore
Authors: Maloney Jennifer M. 
Published: October 2008

Zuraimi MS, Tham KW, Chew FT, Ooi PL, David K. Int Arch Allergy Immunol. 2008;146(1):57–65
PURPOSE OF THE STUDY. To investigate the association of environmental tobacco smoke (ETS) exposure among preschool-aged children with allergic symptoms in homes in Singapore.
STUDY POPULATION. The authors studied children between the ages of 1.5 and 6 years who were attending 687 child care centers in Singapore.
METHODS. This study used a cross-sectional design, adopting an expanded and modified International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire for the evaluation of asthma and allergies in 6794 children attending 120 randomly selected child care centers. Specific information on demographics and ETS exposures was obtained. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were determined by using Poisson multivariate regression with a log-link function and robust variance estimates as recommended for cross-sectional studies.
RESULTS. The response rate was 70.0%, and 4759 children from 97 centers participated. After adjusting for covariates, it was found that home ETS exposure was associated with increased risks of current symptoms of rhinitis (PR: 1.23 [95% CI: 1.01–1.50]) and rhinoconjunctivitis (PR: 1.79 [95% CI: 1.26–2.54]). These associations followed dose-response trends with respect to the number of cigarettes smoked or smokers in the home. Home ETS exposures were also associated with higher PRs of wheeze, nocturnal cough, and doctor-diagnosed asthma. Compared with paternal smoking, higher risks of the above-listed outcomes were found for maternal smoking.
CONCLUSIONS. Home ETS exposure is a risk factor associated with rhinitis and asthma among preschool-aged children.
REVIEWER COMMENTS. This article provides additional evidence that exposure to ETS is associated with asthma and rhinitis. These findings support the continued need to discuss the risks of ETS exposure when reviewing anticipatory guidance items with families.