bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): A Tool to Screen Adolescents for Below-Grade Reading in Health Care Settings
Authors: Davis Terry C. , Wolf Michael S. , Arnold Connie L. , Byrd Robert S. , Long Sandra W. , Springer Thomas , Kennen Estela , Bocchini Joseph A. 
Published: December 2006

OBJECTIVE. The magnitude and consequences of low literacy in adolescent health and health care are unknown. The purpose of this study was to validate the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen), a word-recognition test in English that can be used as a brief literacy-screening tool in health care settings.
PATIENTS AND METHODS. A total of 1533 adolescents aged 10 to 19 years attending 1 of 5 middle schools, 3 high schools, 1 pediatric clinic, or 2 summer programs in Louisiana and North Carolina participated in face-to-face interviews. Demographic information was solicited, and participants were administered a battery of reading tests, including the REALM-Teen, Wide Range Achievement Test–Revised (WRAT-3), and Slosson Oral Reading Test–Revised (SORT-R). Internal consistency for the REALM-Teen was determined using Cronbach’s α, and criterion validity was established through correlations with both the WRAT-R and SORT-R. Using reading below grade level (according to SORT-R scores) as an outcome, instrument accuracy and corresponding cutoff scores were calculated by plotting receiver operating characteristic curves and stratum-specific likelihood ratios.
RESULTS. Participants were 50% black and 53% female; 34% were enrolled in middle school and 66% in high school. The average time required to administer the REALM-Teen was 3 minutes. Internal consistency was excellent, as was test-retest reliability. The REALM-Teen is strongly correlated with both the WRAT-R and SORT-R. Five reading level categories were identified: 3rd grade and below, 4th to 5th grade, 6th to 7th grade, 8th to 9th grade, and 10th grade and above. Forty-six percent of participants were reading below grade level according to the SORT-R and 28% had repeated at least 1 grade.
CONCLUSION. The REALM-Teen is a brief, reliable instrument for assessing adolescent literacy skills and reading below grade level.
A Case-Control Study of the Epidemiology of SporadicSalmonellaInfection in Infants
Authors: Jones Timothy F. , Ingram L. Amanda , Fullerton Kathleen E. , Marcus Ruthanne , Anderson Bridget J. , McCarthy Patrick V. , Vugia Duc , Shiferaw Beletshachew , Haubert Nicole , Wedel Stephanie , Angulo Frederick J. 
Published: December 2006

OBJECTIVE. Rates of Salmonella infection are highest in infants, but little is known about potential sources of infection in this high-risk population. We performed a case-control study to identify dietary and environmental risk factors for sporadic salmonellosis among infants.PATIENTS AND METHODS. In 2002–2004, the Foodborne Diseases Active Surveillance Network conducted a population-based, case-control study of sporadic salmonellosis among infants &lt;1 year of age in 8 states. Cases were identified via active laboratory-based surveillance. Healthy controls were frequency matched by age and identified through birth registries or published birth announcements. We assessed diet and environmental exposures in the 5 days before illness onset or interview. Data were analyzed by using logistic regression adjusting for age.RESULTS. The study enrolled 442 subjects and 928 controls. Compared with healthy controls, infants with Salmonella infection were less likely to have been breastfed and more likely to have had exposure to reptiles, to have ridden in a shopping cart next to meat or poultry, or to have consumed concentrated liquid infant formula during the 5-day exposure period. Travel outside the United States was associated with illness in infants 3 to 6 and &gt;6 months of age. Attending day care with a child with diarrhea was associated with salmonellosis in infants &gt;6 months of age.CONCLUSIONS. We identified a number of modifiable protective and risk factors for salmonellosis in infants. Attention should be directed at developing effective preventive measures for this high-risk population.
Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization
Authors: Manzoni Paolo , Farina Daniele , Leonessa MariaLisa , d'Oulx Elisa Antonielli , Galletto Paolo , Mostert Michael , Miniero Roberto , Gomirato Giovanna 
Published: December 2006

OBJECTIVE. Colonization by Candida spp is a major risk factor for development of fungal sepsis, but little is known about the variables associated with progression to invasive disease in already colonized neonates. We investigated such variables in a large number of colonized preterm neonates in an NICU.SETTING. This study was conducted in the Department of Neonatology and the NICU at Sant'Anna Hospital in Torino, Italy.DESIGN AND PATIENTS A database search of clinical charts and weekly surveillance cultures was used to identify all neonates with birth weights &lt;1500 g (very low birth weight) who were admitted to our NICU during 1998–2005 and were colonized (≥1 site) by Candida spp during their stay, as well as infants with invasive fungal infection. The association between a number of factors with progression to invasive fungal infection was evaluated. Those shown to be significantly associated by univariate analysis were cross-checked by logistic regression.RESULTS. Colonization occurred in 201 infants (32.1% of very low birth weight admitted neonates), and invasive fungal infection occurred in 51 (8.1%) of them, with an overall progression rate of 0.25. At univariate analysis, 10 factors (namely low birth weight, low gestational age, use of third-generation cephalosporins, endotracheal intubation, duration of stay in the NICU, bacterial sepsis, colonization of central venous catheter, of endotracheal tube, of gastric aspirate, or in ≥3 [multiple] sites) were associated with an increased risk of progression, whereas prophylaxis with fluconazole was associated to a decreased risk. After logistic regression, only colonization of central venous catheter and colonization in multiple sites remained significantly associated with invasive fungal infection. Fluconazole prophylaxis remained an independent protective factor.CONCLUSIONS. Central venous catheter colonization and multiple-site colonization are independent risk factors and predictors of progression to fungal sepsis in preterm very low birth weight neonates colonized by Candida spp during their stay in the NICU. Fluconazole prophylaxis is an independent protective factor. These findings can be used to improve the surveillance, prophylaxis, or preemptive measures in neonates at high risk.
Survival Rates and Mode of Delivery for Vertex Preterm Neonates According to Small- or Appropriate-for-Gestational-Age Status
Authors: Lee Henry Chong , Gould Jeffrey B. 
Published: December 2006

OBJECTIVE. The goal was to characterize the relationship between cesarean section delivery and death for preterm vertex neonates according to intrauterine growth.
METHODS. Maternal and infant data from the National Center for Health Statistics for 1999 and 2000 were analyzed. Neonates with gestational ages of 26 to 36 weeks were characterized as small for gestational age (&lt;10th percentile) or appropriate for gestational age (10th to 90th percentile). Mortality rates at 28 days and relative risks were calculated for each gestational age group according to mode of delivery.
RESULTS. Cesarean section rates were higher for small-for-gestational-age neonates compared with appropriate-for-gestational-age neonates, most prominently from 26 weeks to 32 weeks of gestation, at which small-for-gestational-age neonates had cesarean section rates of 50% to 67%, whereas appropriate-for-gestational-age neonates had rates of 22% to 38%. Small-for-gestational-age neonates at gestational ages of &lt;31 weeks had increased survival rates associated with cesarean section, whereas small-for-gestational-age neonates at &gt;33 weeks and appropriate-for-gestational-age neonates overall had decreased survival rates associated with cesarean section. After adjustment for sociodemographic and medical factors, the survival advantage for small-for-gestational-age neonates at gestational ages of 26 to 30 weeks persisted.
CONCLUSIONS. Cesarean section delivery was associated with survival for preterm small-for-gestational-age neonates but not preterm appropriate-for-gestational-age neonates. We speculate that vaginal delivery may be particularly stressful for small-for-gestational-age neonates. We found no evidence that prematurity alone is a valid indication for cesarean section for preterm appropriate-for-gestational-age neonates.
Clinical Deterioration Among Patients With Fever and Erythroderma
Authors: Byer Robyn L. , Bachur Richard G. 
Published: December 2006

BACKGROUND. Some children who present with fever and erythroderma have rapid clinical deterioration or progress to toxic shock syndrome. Our primary objective was to determine whether specific clinical features of those who present with fever and erythroderma can predict who will develop hypotension or progress to toxic shock syndrome. Our secondary objective was to describe the clinical presentation, course, and outcome of children with fever and erythroderma.METHODS. We conducted a medical chart review of children ≤19 years of age with fever and erythroderma who presented to an urban pediatric emergency department over 60 months. Historical, clinical, and laboratory data were abstracted from the medical chart.RESULTS. Fifty-six patients with fever and erythroderma were studied. Eighteen percent of patients presented with hypotension. Thirty-three percent of the remaining patients who were normotensive on arrival developed shock. Fifty-two percent of patients with hypotension required vasopressor support. The most important predictors of developing hypotension after presentation were: age ≥3 years, ill appearance, vomiting, glucose ≥110 mg/dL, calcium ≤8.6 mg/dL, platelets ≤300000/μL, elevated creatinine, polymorphonuclear leukocytes ≥80%, and presence of a focal infection. Among all patients studied, 4 variables were determined to be the most important predictors of developing toxic shock syndrome: age ≥3 years, ill appearance, elevated creatinine, and hypotension on arrival.CONCLUSIONS. Overall, 45% of patients with fever and erythroderma developed shock, including 33% of those who were normotensive on presentation. Older age, presence of vomiting, identification of a focal bacterial source, as well as specific laboratory parameters can be used to help predict which patients are likely to have hemodynamic deterioration. Given the high rate of clinical decompensation, all of the patients with fever and erythroderma should be hospitalized, closely monitored, and managed aggressively.
Risk Profiles for Metabolic Syndrome in a Nonclinical Sample of Adolescent Girls
Authors: Ventura Alison K. , Loken Eric , Birch Leann L. 
Published: December 2006

OBJECTIVES. The purpose of this work was to describe risk profiles for metabolic syndrome during adolescence and identify the childhood antecedents for these profiles among a nonclinical sample of non-Hispanic, white girls.
METHODS. Participants were part of a longitudinal study (n = 154) and were assessed at 5, 7, 9, 11, and 13 years of age. At 13 years, girls were grouped based on values for the 6 metabolic syndrome factors (blood pressure, high-density lipoprotein, triglycerides, waist circumference, and blood glucose) using a mixture model approach. Fat mass was measured by dual-energy radiograph absorptiometry. Dietary intake was assessed by a 24-hour recall. Mothers reported family demographics and disease history. Girls' physical activity, sedentary behaviors, and fitness levels were also assessed.
RESULTS. Statistical support was strongest for a 4-group solution: (1) lower metabolic syndrome risk (n = 62), (2) lower dyslipidemia risk (n = 36), (3) lower hypertension risk (n = 33), and (4) higher metabolic syndrome risk (n = 21). At 13 years, the hypertension and higher metabolic syndrome risk groups had significantly higher weight status and percentage of body fat compared with the lower metabolic syndrome and dyslipidemia risk groups. In addition, the higher metabolic syndrome and hypertension risk groups had greater increases in both BMI and fat mass across childhood. The hypertension and higher metabolic syndrome risk groups had significantly more family history of type 2 diabetes and obesity. The higher metabolic syndrome risk group consumed significantly more servings of sweetened beverages during childhood. The dyslipidemia risk group had the lowest physical activity participation during childhood, and the lower metabolic syndrome risk group had the highest fitness levels at age 13 years.
CONCLUSIONS.A risk typology consisting of 4 groups was identified based on the components of metabolic syndrome. Findings on the antecedents of this risk typology suggest ways to identify those at higher risk for chronic disease and point to potential opportunities for intervention during childhood to prevent the development of metabolic syndrome.
Are We There Yet? Distance to Care and Relative Supply Among Pediatric Medical Subspecialties
Authors: Mayer Michelle L. 
Published: December 2006

OBJECTIVE. The objective of this study was to describe geographic proximity, quantify variation in supply, and estimate pediatric population increments that are needed to support providers across pediatric subspecialties.
METHODS. Data from the American Board of Pediatrics and the Claritas Pop-Facts Database were used to calculate subspecialty-specific straight-line distances between each zip code and the nearest board-certified subspecialist. These data sources also were used to estimate the percentage of hospital referral regions with providers and calculate physician-to-population ratios for each of 16 pediatric medical subspecialties. Coefficients of variation for the ratios were used to assess intraspecialty variation in supply across markets. Estimates of the pediatric population that is needed to support an initial or additional physician in a market were generated using subspecialty-specific ordered logit analyses.
RESULTS. The population-weighted average distance to a subspecialist ranged from 15 miles for neonatology to 78 miles for pediatric sports medicine. For most pediatric subspecialties, more than two thirds of children live within 40 miles of a certified physician. For 7 of 16 of pediatric subspecialties, fewer than one half of hospital referral regions have a provider. Coefficients of variation vary across subspecialties and are lowest for neonatology at 76% and greatest for pediatric sports medicine at 287%. Pediatric population thresholds likewise vary with a tendency toward lower thresholds for procedural specialties, such as cardiology and critical care medicine.
CONCLUSIONS. The practice locations of pediatric subspecialists parallel the geographic distribution of children in the United States, yet many hospital referral regions lack pediatric subspecialists and coefficients of variation vary widely across subspecialties. These findings suggest that either the supply of pediatric subspecialists is inadequate, pediatric subspecialists are distributed inequitably, or the market for pediatric subspecialists is larger than the hospital referral regions. Furthermore, population thresholds for many cognitive pediatric subspecialties are high; the extent to which high thresholds reflect low disease prevalence versus other factors, such as inadequate reimbursement, is not established.
Patterns of Inhaled Antiinflammatory Medication Use in Young Underserved Children With Asthma
Authors: Butz Arlene M. , Tsoukleris Mona , Donithan Michele , Hsu Van Doren , Mudd Kim , Zuckerman Ilene H. , Bollinger Mary E. 
Published: December 2006

BACKGROUND. Asthma guidelines advocate inhaled corticosteroids as the cornerstone treatment of persistent asthma, yet several studies report underuse of inhaled corticosteroids in children with persistent asthma. Moreover, few studies use objective pharmacy data as a measure of drug availability of asthma medications. We examined factors associated with the use of inhaled corticosteroids in young underserved children with persistent asthma using pharmacy records as their source of asthma medications.
METHODS. This was a cross-sectional analysis of questionnaire and pharmacy record data over a 12-month period from participants enrolled in a randomized clinical trial of a nebulizer educational intervention.
RESULTS. Although exposure to ≥1 inhaled corticosteroids refill was high at 72%, 1 of 5 children with persistent asthma had either no medication or only short-acting β agonist fills for 12 months. Only 20% of children obtained ≥6 inhaled corticosteroids fills over 12 months. Obtaining ≥3 inhaled corticosteroids fills over 12 months was significantly associated with an increase in short-acting β agonist fills and receiving specialty care in the regression models while controlling for child age, asthma severity, number of emergency department visits, having an asthma action plan, and seeking preventive care for the child's asthma.
CONCLUSIONS. Overreliance on short-acting β agonist and underuse of inhaled corticosteroid medications was common in this group of young children with persistent asthma. Only one fifth of children obtained sufficient controller medication fills.
Higher Survival Rates Among Younger Patients After Pediatric Intensive Care Unit Cardiac Arrests
Authors: Meaney Peter A. , Nadkarni Vinay M. , Cook E. Francis , Testa Marcia , Helfaer Mark , Kaye William , Larkin G. Luke , Berg Robert A. ,   for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators
Published: December 2006

BACKGROUND. Age is an important determinant of outcome from adult cardiac arrests but has not been identified previously as an important factor in pediatric cardiac arrests except among premature infants. Chest compressions can result in more effective blood flow during cardiac arrest in an infant than an older child or adult because of increased chest wall compliance. We, therefore, hypothesized that survival from cardiac arrest would be better among infants than older children.
METHODS. We evaluated 464 pediatric ICU arrests from the National Registry of Cardiopulmonary Resuscitation from 2000 to 2002. NICU cardiac arrests were excluded. Data from each arrest include &gt;200 variables describing facility, patient, prearrest, arrest intervention, outcome, and quality improvement data. Age was categorized as newborn (&lt;1 month; N = 62), infant (1 month to &lt;1 year; N = 105), younger child (1 year to &lt;8 years; N = 90), and older child (8 years to &lt;21 years; N = 207). Multivariable logistic regression was performed to examine the association between age and survival.
RESULTS. Overall survival was 22%, with 27% of newborns, 36% of infants, 19% of younger children and 16% of older children surviving to hospital discharge. Newborns and infants demonstrated double and triple the odds of surviving to hospital discharge from a cardiac arrest in an intensive care setting when compared with older children. When potential confounders were controlled, newborns increased their advantage to almost fivefold, while infants maintained their survival advantage to older children.
CONCLUSIONS. Survival from pediatric ICU cardiac arrest is age dependent. Newborns and infants have better survival rates even after adjusting for potential confounding variables.
To What Extent Is the Protective Effect of Breastfeeding on Future Overweight Explained by Decreased Maternal Feeding Restriction?
Authors: Taveras Elsie M. , Rifas-Shiman Sheryl L. , Scanlon Kelley S. , Grummer-Strawn Laurence M. , Sherry Bettylou , Gillman Matthew W. 
Published: December 2006

OBJECTIVE. Previous studies have found that breastfeeding may protect infants against future overweight. One proposed mechanism is that breastfeeding, as opposed to bottle feeding, promotes maternal feeding styles that are less controlling and more responsive to infant cues of hunger and satiety, thereby allowing infants greater self-regulation of energy intake. The objective of this study was to determine the extent to which the protective effect of breastfeeding on future overweight is explained by decreased maternal feeding restriction.PATIENTS AND METHODS. We studied 1012 mother-infant pairs in Project Viva, an ongoing prospective cohort study of pregnant mothers and their children. The main exposure was breastfeeding duration, assessed at 1 year postpartum. At 3 years of age, the main outcomes were age- and gender-specific BMI z score and the sum of subscapular and triceps skinfold thicknesses, with overweight defined as a BMI ≥95th percentile. We defined maternal restriction of infant’s access to food as strongly agreeing or agreeing, with the following question from the Child Feeding Questionnaire: “I have to be careful not to feed my child too much.” To examine the association between breastfeeding duration and our outcomes, we used multivariate linear and logistic models, adjusting for several potential confounders. In subsequent models, we also adjusted for maternal restriction of infant’s access to food.RESULTS. The mean duration of breastfeeding was 6.5 months, and 12% of women strongly agreed or agreed with the restriction question. At age 3, mean for BMI z score was 0.47. Each 3-month increment in breastfeeding duration was associated with a reduction of 0.045 BMI z score. After adjusting for maternal restriction, the estimate was −0.039, a 13% attenuation.CONCLUSION. The protective effect of breastfeeding on future overweight seems to be explained only partially by decreased maternal feeding restriction.
A Fast Procedure for the Detection of Defects in Toll-like Receptor Signaling
Authors: von Bernuth Horst , Ku Cheng-Lung , Rodriguez-Gallego Carlos , Zhang Shenying , Garty Ben-Zion , Maródi László , Chapel Helen , Chrabieh Maya , Miller Richard L. , Picard Capucine , Puel Anne , Casanova Jean-Laurent 
Published: December 2006

OBJECTIVES. Inborn defects in Toll-like receptor signaling are recently described primary immunodeficiencies that predispose affected children to life-threatening infections. Patients with interleukin-1 receptor-associated kinase-4 deficiency are prone to invasive pneumococcal disease, and patients with UNC-93B deficiency are prone to herpes simplex virus encephalitis. These genetic disorders are underdiagnosed, partly because diagnosis currently requires expensive and time-consuming techniques available at only a few specialized centers worldwide. We, therefore, aimed to develop a cheap and fast test for the detection of defects in Toll-like receptor signaling.PATIENTS AND METHODS. We used flow cytometry to evaluate the cleavage of membrane-bound L-selectin on granulocytes in 38 healthy controls and in 7 patients with genetically defined Toll-like receptor signaling defects (5 patients with interleukin-1 receptor-associated kinase-4 deficiency and 2 patients with UNC-93B deficiency), on activation with various Toll-like receptor agonists.RESULTS. Impaired L-selectin shedding was observed with granulocytes from all of the interleukin-1 receptor-associated kinase-4-deficient patients on activation with agonists of Toll-like receptors 1/2, 2/6, 4, 7, and 8 and with granulocytes from all of the UNC-93B-deficient patients on activation with agonists of Toll-like receptors 7 and 8. All of the healthy controls responded to these stimuli.CONCLUSIONS. The assessment of membrane-bound L-selectin cleavage on granulocytes by flow cytometry may prove useful for the detection of primary immunodeficiencies in the Toll-like receptor pathway, such as interleukin-1 receptor-associated kinase-4 deficiency and UNC-93B deficiency. This procedure is cheap and rapid. It may, therefore, be suitable for routine testing worldwide in children with invasive pneumococcal disease and in patients with herpes simplex encephalitis.