bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risks of Invasive Pneumococcal Disease in Children With Underlying Chronic Diseases
Authors: Hjuler Thomas , Wohlfahrt Jan , Staum Kaltoft Margit , Koch Anders , Biggar Robert John , Melbye Mads 
Published: July 2008

OBJECTIVE. The risk of invasive pneumococcal disease is increased among children with some chronic diseases. The objective of this study was to quantify the risk of invasive pneumococcal disease in a wide range of chronic diseases.
PATIENTS AND METHODS. Cases of invasive pneumococcal disease among children (aged 0–17 years) were identified from 1977 through 2005 by using a national surveillance program in Denmark. Rate ratios were assessed in a case-control study by using 10 age- and gender-matched controls per case. Chronic diseases were defined a priori.
RESULTS. Among 1655 children with invasive pneumococcal disease, 19% had a history of chronic disease, according to our definition, versus 5% of controls. An increased risk of invasive pneumococcal disease was observed for children followed &gt;30 days after initial hospital contact for a chronic disease, but it was also increased in children with ≥5 hospital contacts for any other reason. Children with a history of cancer, chronic renal disease, splenectomy, and transplantation were particularly susceptible to invasive pneumococcal disease. Adjusted for number of hospital contacts, the risk for children with other types of chronic disease was 1.4-fold more than for those with hospital contacts for any reason.
CONCLUSIONS. Cancer, chronic renal diseases, splenectomy, and transplantation were strongly associated with an increased risk of invasive pneumococcal disease in children. For children with other chronic diseases, their excess risk seemed to be attributable mostly to frail children having repeated hospital contact rather than their underlying condition.
Epidemiology of Pediatric Burns Requiring Hospitalization in China: A Literature Review of Retrospective Studies
Authors: Kai-Yang Lv , Zhao-Fan Xia , Luo-Man Zhang , Yi-Tao Jia , Tao Tan , Wei Wei , Bing Ma , Jie Xiong , Yu Wang , Yu Sun 
Published: July 2008

OBJECTIVE. This review was an effort to systematically examine the nationwide data available on pediatric burns requiring hospitalization to reveal burn epidemiology and guide future education and prevention.
METHODS. The China Biomedical Disk Database, Chongqing VIP Database, and China Journal Full-Text Database were searched for articles reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of pediatric burns requiring hospitalization in China. Twenty-eight articles met the inclusion criteria, all of which were retrospective analyses. For each study included, 2 investigators independently abstracted the data related to the population description by using a standard form and included the percentage of patients with burn injury who were &lt;15 years old; gender and distribution of age; type of residential area; place of injury; distribution of months and time; reasons for burn; anatomical sites of burn; severity of burn; and mortality and cause of death. These data were extracted, and a retrospective statistical description was performed with SPSS11.0 (SPSS Inc, Chicago, IL).
RESULTS. Of the pediatric patients studied, the proportion of children with burn injury ranged from 22.50% to 54.66%, and the male/female ratio ranged from 1.25:1 to 4.42:1. The ratio of children aged ≤3 years to those &gt;3 years was 0.19:1 to 4.18:1. The rural/urban ratio was 1.60:1 to 12.94:1. The ratio of those who were burned indoors versus outdoors was 1.62 to 17.00, and there were no effective hints on the distribution of seasons and anatomical sites of burn that could be found. The peak hours of pediatric burn were between 17:00 and 20:00. Most articles reported the sequence of reasons as hot liquid &gt; flame &gt; electricity &gt; chemical, and scalding was, by far, the most predominant reason for burn. The majority of the studies reported the highest proportion involved in moderate burn, and the lowest proportion was for critical burn. The mortality rate ranged from 0.49% to 9.08%, and infection, shock, and multiple organ dysfunction syndrome were the most common causes of death.
CONCLUSIONS. Considering the national proportion of children, a high proportion of hospitalized patients with burn injury were children; those who were male, aged ≤3 years, and lived most of the time indoors were especially susceptible. Great attention should be paid when hot water is used or during suppertime. This compilation and analysis of hospitalization-based information has proved useful in establishing the rational priorities for prevention; a family-school-factory-government mode of preventive strategy has come into being and was performed effectively.
Age at First Introduction of Cow Milk Products and Other Food Products in Relation to Infant Atopic Manifestations in the First 2 Years of Life: The KOALA Birth Cohort Study
Authors: Snijders Bianca E.P. , Thijs Carel , van Ree Ronald , van den Brandt Piet A. 
Published: July 2008

OBJECTIVES. Scientific evidence is scarce about timing of solid-food introduction and its association with the development of atopy. We aimed to evaluate any associations between the introduction of cow milk products/other solid food products and infant atopic manifestations in the second year of life, taking into account reverse causation.
METHODS. Data from 2558 infants in an ongoing prospective birth cohort study in the Netherlands were analyzed. Data on the main determinants (introduction of cow milk products and other food products), outcomes (eczema; atopic dermatitis [United Kingdom Working Party criteria]; recurrent wheeze; any sensitization; sensitization against cow milk, hen egg, peanut, and at least 1 inhalant allergen), and confounders were collected by repeated questionnaires at 34 weeks of gestation and 3, 7, 12, and 24 months postpartum. Information on sensitization was gathered by venous blood collections performed during home visits at age 2. Analyses were performed by multiple logistic regression analyses.
RESULTS. More delay in introduction of cow milk products was associated with a higher risk for eczema. In addition, a delayed introduction of other food products was associated with an increased risk for atopy development at the age of 2 years. Exclusion of infants with early symptoms of eczema and recurrent wheeze (to avoid reverse causation) did not essentially change our results.
DISCUSSION. Delaying the introduction of cow milk or other food products may not be favorable in preventing the development of atopy.
Global Occurrence of Infant Botulism, 1976–2006
Authors: Koepke Ruth , Sobel Jeremy , Arnon Stephen S. 
Published: July 2008

OBJECTIVE. To summarize the worldwide occurrence of reported infant (intestinal toxemia) botulism cases since first recognition of the disease in 1976.PATIENTS AND METHODS. We collected information on infant botulism cases by active and passive surveillance, by provision of therapeutic Human Botulism Immune Globulin to suspected cases, and by searching the medical literature. We defined a case as laboratory-confirmed botulism that occurred in an infant ≤12 months of age that was not caused by the ingestion of botulinum toxin in food.RESULTS. Twenty-six countries representing 5 continents reported the occurrence of at least 1 case of infant botulism among their residents. The United States, Argentina, Australia, Canada, Italy, and Japan, in this order, reported the largest number of cases. A history of honey exposure was significantly more common among case subjects hospitalized outside of the United States than among those who were recently hospitalized in California.CONCLUSIONS. Most countries have not yet reported cases of infant botulism. This limited reporting of the disease to date contrasts with the known global occurrence of Clostridium botulinum spores in soils and dust and suggests that infant botulism may be underrecognized, underreported, or both. When bulbar palsies, hypotonia, and weakness are present, physicians should consider the possibility of infant botulism even if the patient has not been fed honey. Publication of additional case reports and surveillance summaries will enhance understanding of the occurrence and extent of this underrecognized disease.
Increasing Burden and Risk Factors for Bronchiolitis-Related Medical Visits in Infants Enrolled in a State Health Care Insurance Plan
Authors: Carroll Kecia N. , Gebretsadik Tebeb , Griffin Marie R. , Wu Pingsheng , Dupont William D. , Mitchel Edward F. , Enriquez Rachel , Hartert Tina V. 
Published: July 2008

OBJECTIVES. The goals were to estimate the year-round burden of health care visits attributable to bronchiolitis and to identify risk factors for bronchiolitis in term healthy infants.
METHODS. We conducted a population-based, retrospective cohort study of 103 670 term, non–low birth weight infants enrolled in Tennessee Medicaid in 1995–2003. We monitored infants through the first year of life. Risk factors for bronchiolitis during infancy and rates of inpatient, emergency department, and outpatient visits during the study period were calculated by using claims data.
RESULTS. Over the 9 study years, rates of bronchiolitis visits were 238 outpatient visits per 1000 infant-years, 77 emergency department visits per 1000 infant-years, and 71 hospitalizations per 1000 infant-years. Average annual rates of bronchiolitis visits increased 41%, from 188 visits per 1000 infant-years to 265 visits per 1000 infant-years, from 1996–1997 to 2002–2003. Analysis of the linear trend in 500-g increments demonstrated a negative association between increasing birth weight and bronchiolitis diagnosis. There was a significant negative trend between maternal age and infant bronchiolitis diagnosis. Compared with infants of mothers 20 to 29 years of age, infants of mothers 15 to 19 years of age had a small increase in risk of having a bronchiolitis visit, whereas infants of older mothers (30–39 or 40–44 years of age) were less likely to have a visit.
CONCLUSIONS. The disease burden of bronchiolitis is substantial, with increasing rates of all types of visits among term, otherwise-healthy infants enrolled in Tennessee Medicaid between 1995 and 2003. Protective factors in this cohort of term infants included higher birth weight and older maternal age.
Global Health Training in Pediatric Residency Programs
Authors: Nelson Brett D. , Lee Anne CC , Newby P. K. , Chamberlin M. Robert , Huang Chi-Cheng 
Published: July 2008

OBJECTIVE. Our goal was to describe current resident interest, participation, curricula, resources, and obstacles related to global health training within pediatric residency programs.
METHODS. We conducted a cross-sectional survey of the 201 accredited pediatric residency programs in the United States, Puerto Rico, and the Caribbean from October 2006 to January 2007. Survey topics included resident interest and participation in electives, training opportunities, program support, and educational curricular content related to global health.
RESULTS. Of the 201 surveyed pediatric residency programs, 106 (53%) responded. Fifteen percent of responding programs reported that a majority of their residents were interested in global health. Fifty-two percent offered a global health elective within the previous year, and 47% had formally incorporated global health into their training curricula. Six percent of the programs reported a formalized track or certificate in global health. The median number of residents per program participating in global health electives within the previous year was 0 during postgraduate year 1, 1 during postgraduate year 2, and 2 during postgraduate year 3. The median number of all residents per program participating in a global health elective in the previous year was 3 (7.4% of program size). Among programs that offered a global health elective, support to participating residents included prerequisite clinical training (36%), cultural orientation (36%), language training (15%), faculty mentorship (82%), and postelective debriefing (77%). Fourteen percent of the programs provided full funding for resident electives. Characteristics of pediatric residency programs that were significantly associated with higher resident participation in a global health elective were larger program size, university affiliation, greater reported resident interest, and faculty involvement in global health.
CONCLUSIONS. More than half of the pediatric residency programs surveyed offered a global health elective in the previous year. An American Academy of Pediatrics survey 10 years earlier had shown 1 of 4 programs with global health electives. Observance of American Academy of Pediatrics consensus guidelines for global health electives varied widely among programs, and additional efforts should focus on resident preparation, mentorship, and funding.
Effects of Higher Versus Lower Dexamethasone Doses on Pulmonary and Neurodevelopmental Sequelae in Preterm Infants at Risk for Chronic Lung Disease: A Meta-analysis
Authors: Onland Wes , De Jaegere Anne P. , Offringa Martin , van Kaam Anton H. 
Published: July 2008

OBJECTIVES. Systemic postnatal dexamethasone treatment reduces the risk of chronic lung disease in preterm infants but also may be associated with increased risk of neurodevelopmental impairment. Because it is not known whether these effects are modulated by the cumulative dexamethasone dose, we systematically reviewed the available randomized evidence on the effects of lower versus higher cumulative dexamethasone doses, in terms of death, pulmonary morbidity, and neurodevelopmental outcomes, in preterm infants.METHODS. Randomized, controlled trials comparing higher- versus lower-dosage dexamethasone regimens in ventilated preterm infants were identified by searching the main electronic databases, references from relevant studies, and abstracts from the Societies for Pediatric Research (from 1990 onward). Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted.RESULTS. Six studies that enrolled a total of 209 participants were included; 2 studies contrasted cumulative dexamethasone doses in the higher ranges (&gt;2.7 mg/kg in the higher-dosage regimen) and 4 in the lower ranges (≤2.7 mg/kg in the higher-dosage regimen). Meta-analysis revealed no effect of dexamethasone dose on rates of death and neurodevelopmental sequelae in these 2 subgroups. Subgroup analysis of the studies contrasting dexamethasone doses in the higher ranges showed that the higher dose of dexamethasone was more effective in reducing the occurrence of chronic lung disease than was the lower dose. Interpretation of these data was hampered by the small samples of randomly assigned children, heterogeneity of study populations and designs, use of late rescue glucocorticoids, and lack of long-term neurodevelopmental data in some studies.CONCLUSIONS. Recommendations for optimal dexamethasone doses for preterm infants at risk for chronic lung disease cannot be based on current evidence. A well-designed, large, randomized, controlled trial is urgently needed to establish the optimal dexamethasone dosage regimen.
Impact of the HIV/AIDS Epidemic on the Neurodevelopment of Preschool-Aged Children in Kinshasa, Democratic Republic of the Congo
Authors: Van Rie Annelies , Mupuala Aimee , Dow Anna 
Published: July 2008

OBJECTIVES. Pediatric HIV infection is a growing problem in most regions of the world. Data on the effects of HIV on the neurodevelopment of children in resource-poor settings are scarce but necessary to guide interventions. The purpose of this study was to compare the neurodevelopment of preschool-aged HIV-infected, HIV-affected (HIV-uninfected AIDS orphans and HIV-uninfected children whose mother had symptomatic AIDS), and healthy control children in Kinshasa, Democratic Republic of Congo.METHODS. Thirty-five HIV-infected, 35 HIV-affected, and 90 control children aged 18 to 72 months were assessed by using the Bayley Scales of Infant Development II, Peabody Developmental Motor Scales, Snijders-Oomen Nonverbal Intelligence Test, and Rossetti Infant-Toddler Language Scale, as appropriate for age.RESULTS. Overall, 60% of HIV-infected children had severe delay in cognitive function, 29% had severe delay in motor skills, 85% had delays in language expression, and 77% had delays in language comprehension, all significantly higher rates as compared with control children. Young HIV-infected children (aged 18–29 months) performed worse, with 91% and 82% demonstrating severe mental and motor delay, respectively, compared with 46% and 4% in older HIV-infected children (aged 30–72 months). HIV-affected children had significantly more motor and language expression delay than control children.CONCLUSIONS. The impact of the HIV pandemic on children's neurodevelopment extends beyond the direct effect of the HIV virus on the central nervous system. AIDS orphans and HIV-negative children whose mothers had AIDS demonstrated significant delays in their neurodevelopment, although to a lesser degree and in fewer developmental domains than HIV-infected children. Young HIV-infected children were the most severely afflicted group, indicating the need for early interventions. Older children performed better as a result of a “survival effect,” with only those children with less aggressive disease surviving.
The Bright Futures Training Intervention Project: Implementing Systems to Support Preventive and Developmental Services in Practice
Authors: Lannon Carole M. , Flower Kori , Duncan Paula , Moore Karen Strazza , Stuart Jayne , Bassewitz Jane 
Published: July 2008

OBJECTIVES. The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.
METHODS. Fifteen pediatric primary care practices from 9 states participated in a 9-month learning collaborative. Support to practices included a toolkit, 2 workshops, training in quality-improvement methods, monthly conference calls and data feedback, and a listserv moderated by faculty. Aggregated medical chart reviews and practice self-assessments on 6 key office system components were compared before and after the intervention.
RESULTS. Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.
CONCLUSIONS. This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.
Pneumococcal Mastoiditis in Children and the Emergence of Multidrug-Resistant Serotype 19A Isolates
Authors: Ongkasuwan Julina , Valdez Tulio A. , Hulten Kristina G. , Mason Edward O. , Kaplan Sheldon L. 
Published: July 2008

OBJECTIVE. We review the impact of pneumococcal conjugate vaccine on pneumococcal mastoiditis in children at Texas Children's Hospital.
METHODS. The medical charts (including the number of pneumococcal conjugate vaccine doses) for children with pneumococcal mastoiditis treated at Texas Children's Hospital between January 1995 and June 2007 were reviewed retrospectively. Isolates were serotyped with the capsular swelling method. Pulsed-field gel electrophoresis was performed on the 19A isolates and multilocus sequence typing on selected 19A clones.
RESULTS. Forty-one pneumococcal mastoiditis cases were identified, and 19A (n = 19) was the most common serotype. Before the introduction of pneumococcal conjugate vaccine (from 1995 to December 1999), 0 of 12 cases were 19A. Between April 2000 and October 2006, 15 cases of pneumococcal mastoiditis occurred, and 5 were 19A. Fourteen cases of pneumococcal mastoiditis occurred between November 2006 and June 2007, all of which were 19A. Mastoiditis caused by 19A isolates was more likely to present with subperiosteal abscess and was more likely to need intraoperative mastoidectomy than was mastoiditis caused by non-19A isolates. Multidrug resistance was also common among the 19A isolates; 13 (68%) of the 19A isolates were resistant to all antibiotics tested routinely. Pulsed-field gel electrophoresis analysis placed 14 (74%) of the 19 serotype 19A isolates into a highly related group; 12 isolates were classified as closely related, and 2 were possibly related. Multilocus sequence typing analysis placed the pulsed-field gel electrophoresis cluster isolates into clonal complex 271 (sequence types 320 and 1451).
CONCLUSIONS. At Texas Children's Hospital, 19A has become the predominant serotype causing pneumococcal mastoiditis, partly related to the emergence of multidrug-resistant clonal complex 271 strains. Subperiosteal abscesses and the need for mastoidectomy were more common in children with mastoiditis caused by serotype 19A isolates, compared with isolates of other serotypes.