bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection: A Randomized, Controlled Trial
Authors: Adinoff Allen 
Published: September 2006

Purpose of the Study.
Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. This study evaluated the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection.

Study Population.
A randomized, controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting to a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics).

Methods.
Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of the patients in each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics).

Results.
A total of 562 patients (70%) returned complete diaries, and 78 (10%) provided information about both symptom duration and severity. Cough rated at least “a slight problem” lasted a mean of 11.7 days (25% of the patients had a cough lasting ≥17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed prescription, 0.75 days; 95% confidence interval: −0.37–1.88; immediate prescription, 0.11 days; 95% confidence interval: −1.01–1.24) or other primary outcomes. Compared with those in the immediate-antibiotic group, slightly fewer patients in the delayed-prescription and control groups used antibiotics (96%, 20%, and 16%, respectively; P &lt; .001), fewer patients were “very satisfied” (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P &lt; .001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics: 0.19; delayed prescription: 0.12; immediate prescription: 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet: 0.11; mean attendances for leaflet: 0.17; P = .02).

Conclusions.
No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics.

Reviewer Comments.
This is good that we do not need yet another patient-information leaflet. I have always liked the “delayed-offer” approach, because it is a compromise to the patient, and most of the time they get better and never need the drug.
Racial and Ethnic Differences in Asthma Diagnosis Among Children Who Wheeze
Authors: Randolph Christopher 
Published: September 2006

Purpose of the Study.
To determine if racial and ethnic differences in documented pediatric asthma prevalence relate to true prevalence differences or a different probability of receiving the diagnosis.

Study Population.
The study population was 3- to 17-year-old children of non-Hispanic white, non-Hispanic black, Puerto Rican, and Mexican ethnicity taken from a continuous survey administered by the National Center for Health Statistics.

Methods.
The results for children aged 3 to 17 years in the 1999 National Health Interview Survey were analyzed for those with reported wheezing. Asthma diagnosis was evaluated for racial and ethnic differences while controlling for age, gender, parental education, single-parent household, residence, insurance, health care, and parent-reported severity of symptoms.

Results.
Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04–1.63) for Puerto Rican, 1.22 (95% CI: 1.03–1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94–1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children.

Conclusions.
These findings do not support the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.

Reviewer Comments.
This study suggests that minority children with wheezing severity measured by National Health Interview Survey guidelines are not underdiagnosed. These results suggest that public health endeavors should be directed toward better management and control.
Screening for Children’s Exposure to Environmental Tobacco Smoke in a Pediatric Primary Care Setting
Authors: Smart Brian A. 
Published: September 2006

Purpose of the Study.
To develop a brief screening tool to accurately predict environmental tobacco smoke (ETS) exposure.

Study Population.
A total of 291 healthy children aged 2 weeks to 3 years. These children were recruited from a primary care center that provides care to a low-income population. Exclusion criteria included history of birth at &lt;36 weeks’ gestation, asthma, other chronic pulmonary disease, or cardiac disease.

Methods.
The primary caregivers of the children in the study filled out a questionnaire that included items on demographics, smoking status of individuals living in the children’s homes, number of cigarettes smoked per day, and the locations in which individuals smoked. Primary caregivers also gave samples of their own and their children’s hair for measurement of levels of cotinine.

Results.
A total of 7 subjects (2%) had hair cotinine levels of &lt;0.01 ng/mg, 99 subjects (34%) had levels of &lt;0.3 mg/ng, 68 (23%) had midrange levels of 0.3–0.7 ng/mg, and 124 (43%) had levels of &gt;0.7 mg/ng. Factors associated with higher cotinine levels included maternal smoking, the presence of other smokers in the home, and where persons other than the mothers smoke (ie, in the home or outside the home). Interestingly, the reported location of mothers’ smoking (indoors versus outdoors) was not associated with cotinine levels in the hair. The investigators used this information to create a model questionnaire to predict ETS exposure. Three questions were selected: does the mother smoke, do others in the home smoke, do others who smoke remain inside the home or go outside. Using this model, children of mothers who smoke and are also exposed to others who smoke inside the home have an 81% chance of having high exposure to ETS. In contrast, children of mothers who do not smoke and are not exposed to others who smoke have a 64% chance of low exposure to ETS.

Conclusions.
It was possible to derive a simple and valid screening tool to identify children at risk for ETS exposure, but this tool still needs to be tested prospectively.

Reviewer Comments.
We all struggle with our patients’ exposure to ETS in the home. Part of the struggle has to do with obtaining accurate information about exposures. The screening tool described in this study needs to be tested prospectively, but it may prove to be highly useful. Of interest is the finding that it did not matter, in terms of levels of cotinine in children’s hair, whether their mothers smoked indoors or reported that they limited themselves to outdoor smoking. We may speculate that this finding has to do with inaccurate reporting (shame about smoking indoors) or to the large amount of particulate residue that remains on smokers after they smoke.
Daily Versus As-Needed Corticosteroids for Mild Persistent Asthma
Authors: Chipps Bradley E. 
Published: September 2006

Purpose of the Study.
To determine the effectiveness of as-needed versus regular controller therapy in adults with mild persistent asthma.

Study Population.
A total of 225 adults with symptom criteria for mild persistent asthma and forced expiratory volume in 1 second (FEV1) &gt;70% predicted with &gt;12% reversibility or PC20 (provocative concentration causing a 20% decrease in FEV1) methacholine at ≤16 mg/mL.

Methods.
Patients were assigned to 1 of 3 treatment groups: budesonide DPI 200 μg twice daily (BUD), oral zafirlukast 20 mg twice daily (ZAF), or placebo. The study was double-blind, double-dummy. At the beginning and the end of the study, all patients were treated with 0.5 mg/kg per day of prednisone, 800 μg twice a day of budesonide, and 20 mg twice a day of zafirlukast plus as-needed albuterol. Evaluation was accomplished by assessing asthma symptoms followed by pulmonary-function testing and gathering information on, albuterol use and exacerbations over the 1-year study.

Results.
For both of the primary efficacy outcomes, morning peak expiratory flow rate and exacerbations, there were no differences between the groups. Several outcomes were superior for the BUD group, including prebronchodilator FEV1, bronchial reactivity, symptom scores, exhaled nitric oxide, asthma control score, and symptom-free days (26 more). Postbronchodilator FEV1 and quality of life were not different between the groups. The as-needed group took budesonide, on average, for only one-half week during the study.

Conclusions.
Adults with mild persistent asthma can be managed with high-dose budesonide on an intermittent basis. However, greater improvement in markers of airway inflammation and more symptom-free days (26 per year) occurred with regular use of low-dose budesonide.

Reviewer Comments.
This is an adult study that focused on short-term outcomes, which may not translate to children. It is not known if similar results would be seen with a longer-term study.
Long-term Safety of Once-Daily Budesonide in Patients With Early-Onset Mild Persistent Asthma: Results of the Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) Study
Authors: Skolnick Helen 
Published: September 2006

Purpose of the Study.
Inhaled corticosteroids are the recommended treatment for all patients with persistent asthma. The aim of this study was to evaluate the safety and tolerability of long-term treatment of patients with mild persistent asthma with once-daily budesonide.

Study Population.
Seven thousand two hundred twenty-two patients (aged 5–66 years) with mild persistent asthma diagnosed within 2 years of study entry, with wheeze, cough, dyspnea, or chest tightness weekly and demonstration of reversible airway obstruction, were enrolled into the study.

Methods.
This was a prospective, double-blind, placebo-controlled study. Patients were divided into 2 groups according to age. Those patients younger than 11 years received 200 μg of budesonide via a dry-powder inhaler or placebo, and patients 11 years and older received 400 μg of budesonide via dry-powder inhaler or placebo. All treatments were administered for 3 years and in addition to the patients’ usual asthma therapy.

Results.
Overall, 21 520 adverse events were reported (10 850 in the budesonide group and 10 670 in the placebo group). The most commonly reported events were respiratory infections such as rhinitis, pharyngitis, bronchitis, viral infections, and sinusitis. Oral candidiasis was more common in the budesonide group (1.2%) than in the placebo group (0.5%); the frequencies of other adverse effects previously reported to be associated with inhaled corticosteroids (skin disorders, psychiatric disorders, and allergic reactions) were similar between the 2 groups. The number of deaths and serious adverse events were similar for children and adults in both treatment groups.

Conclusions.
Three-year treatment with budesonide (200 or 400 μg) is safe and well tolerated in both children and adults who have recent onset of mild persistent asthma.

Reviewer Comments.
This study shows not only that budesonide dramatically reduces the overall risk of experiencing a severe asthma-related event but also that budesonide has very little risk of causing any significant adverse events. One of the most difficult, yet very important tasks as a physician is to educate the patient that inhaled corticosteroids are not the enemy, but rather that the patient’s health is at greater risk from asthma itself. Clearly, early intervention is safe and effective. This study provides valuable information and should help patients and their families to feel comfortable with long-term inhaled corticosteroids use in asthma.
The Natural History of Tree Nut Allergy
Authors: Nowak-Wegrzyn Anna 
Published: September 2006

Purpose of the Study.
To estimate the proportion of children who outgrow tree nut (TN) allergy and examine predictors of outgrowing it.

Study Population.
All children with TN allergy followed at the authors’ pediatric allergy clinic.

Methods.
Patients with TN allergy, defined as a history of reaction on ingestion and evidence of TN-specific immunoglobulin E (TN-IgE) or positive TN-specific IgE level but no history of ingestion, were evaluated. If all current TN-IgE levels were &lt;10 kU of antibody (kUA)/L, double-blind, placebo-controlled food challenges were offered. Patients who had undergone open oral TN challenges as part of routine clinical care were also included.

Results.
Two hundred seventy-eight patients with TN allergy were identified. One hundred one (36%) had a history of acute reactions, 12 (12%) of whom had reactions to multiple TNs and 73 (63%) of whom had a history of moderate-to-severe reactions. Nine of 20 patients who had previously reacted to a TN passed challenges, so that 9 (8.9%; 95% confidence interval: 4%–16%) of 101 patients with a history of previous TN reactions outgrew TN allergy. Of 19 patients who had never ingested TNs but had detectable TN-specific IgE levels, 14 passed challenges. One hundred sixty-one did not meet the challenge criteria, and 78 met the criteria but declined challenges. Looking at specific TN-IgE values, 58% with TN-IgE levels of ≤5 kUA/L and 63% with TN-IgE levels of ≤2 kUA/L passed challenges.

Conclusions.
Approximately 9% of patients outgrow TN allergy, including some who had previous severe reactions. Although ideal cutoffs for challenge cannot be firmly recommended on the basis of these data, patients aged 4 years or older with all TN-IgE levels of ≤5 kUA/L should be considered for physician-supervised oral food challenges.

Reviewer Comments.
This is the first study to comprehensively address the natural history of TN allergy. Although the 9% chance of outgrowing TN allergy may seem low, it may be an underestimate of the actual resolution rate, because a large number of eligible patients declined diagnostic food challenges. The results of this study should encourage regular follow-up of children with TN allergy and consideration, when clinically indicated, for physician-supervised oral food challenges to determine the possibility of resolution. Because these oral food challenges can trigger anaphylaxis, they are generally undertaken under the supervision of an allergist and with immediate access to medications and equipment to treat a significant allergic reaction.
A Meta-analysis on Intravenous Magnesium Sulphate for Treating Acute Asthma
Authors: Kelso John M. 
Published: September 2006

Purpose of the Study.
To evaluate the effectiveness of intravenous magnesium sulfate in the treatment of acute asthmatic attacks in children.

Study Population.
Pediatric patients (n = 182) with moderate-to-severe asthmatic attacks in the emergency department in 5 randomized, placebo-controlled trials comparing intravenous magnesium sulfate to placebo, with co-therapies of inhaled β2 agonists and systemic steroids.

Methods.
Meta-analysis that evaluated outcomes of hospitalization, short-term pulmonary-function tests, and symptom scores.

Results.
Magnesium sulfate was effective in preventing hospitalization (odds ratio: 0.29; 95% confidence interval: 0.143–0.589). The number needed to treat was 4 (95% confidence interval: 3–8). Secondary outcomes of short-term pulmonary-function tests and clinical symptom scores also showed significant improvement. The therapy was well tolerated with only minor adverse effects reported.

Conclusion.
Intravenous magnesium sulfate probably provides additional benefit in moderate-to-severe acute asthma in children treated with bronchodilators and steroids.

Reviewer Comments.
Meta-analyses are useful when multiple previous studies have shown inconsistent results. They may not, however, be the final answer, because subsequent large trials can alter the conclusion of a meta-analysis. Nonetheless, the data to date considered in this meta-analysis seem quite convincing. Also, the treatment is inexpensive and well tolerated, and the number needed to treat is small (you would need to give this therapy to only 4 children to keep 1 out of the hospital).
Presenting Phenotype in 100 Children With the 22q11 Deletion Syndrome
Authors: Bonilla Francisco A. 
Published: September 2006

Purpose of the Study.
To describe the clinical presentations of individuals having deletion of the 22q11 region.

Study Population.
The first 100 individuals &lt;20 years old presenting to the Queen Sylvia Children’s Hospital (Göteborg, Sweden) and found to have 22q11 deletion (from 1993–2002).

Methods.
All diagnoses were confirmed by fluorescence in situ hybridization. Clinical data collected at diagnosis included age and clinical findings in 8 categories (1, cardiac defects; 2, thymus size, infection history, autoimmune disease; 3, hypocalcemia; 4, feeding difficulties; 5, cleft lip/palate, speech/language impairment; 6, developmental delay, learning difficulties, behavioral abnormalities; 7, other malformations/deformities; 8, dysmorphic features). Those features that led (in particular) to the consideration of the diagnosis were distinguished.

Results.
The largest number was diagnosed by cardiologists (39) at a median age of 0.5 years old, with cleft palate or speech pathology specialists second (22) at a median age of 8 years, and neurologists or psychiatrists third (19) at a median age of 11.2. Note that 68 of the 74 children diagnosed after age 2 were born before the fluorescence in situ hybridization test was routinely available. The main findings are summarized in Table 1.

Conclusions.
The authors offer diagnostic guidelines for testing for 22q11 deletion (for infants: any typical cardiac defect or 2 of the features in categories 2 through 5, 7, or 8; for preschool-aged children and adolescents: any 2 of the 8 categories either present currently or in the past medical history).

Reviewer Comments.
22q11 deletion leads to a spectrum of phenotypes most commonly called velocardiofacial syndrome and/or DiGeorge syndrome. Occurring in ∼1 in 3000 to 4000 live births, it is among the most common syndromes associated with primary immunodeficiency. Serious infection occurs but is relatively rare. Early diagnosis is most desirable to prevent or mitigate morbidity arising from developmental and psychiatric complications in childhood and adolescence. Of the major clinical manifestations, the symptoms arising from velopharyngeal insufficiency (poor suck, nasal reflux) and various associated malformations seem to be significantly overlooked. The fact that all patients had subtle characteristic dysmorphisms that did not contribute very much to diagnosis shows how much our vision improves with the aid of molecular genetic glasses.
Public participation in water management in northern Thai highlands
Authors: Heyd Helene , Neef Andreas 
Published: September 2006

In the early 1990s, Thailand launched an ambitious program of decentralized governance, conferring greater responsibilities upon sub-district administrations and providing fiscal opportunities for local development planning. This process was reinforced by Thailand's new Constitution of 1997, which explicitly assures individuals, communities and local authorities the right to participate in the management of natural resources.
Drawing on a study of water management in the Mae Sa watershed, northern Thailand, this article analyzes to what extent the constitutional right of participation has been put into practice. To this end, a stakeholder analysis was conducted in the watershed, with a focus on local people's interests and strategies in water management and the transformation of participatory policies through government agencies at the local level. While government officers stressed the importance of stakeholder inclusion and cooperation with the local people, there is a sharp contrast between the official rhetoric and the reality on the ground. The analysis reveals that government officers, particularly in the conservation-oriented agencies, are not disposed to devolve power to lower levels and that participation of local people in water management seems currently to be passive or, at best, consultative in nature.
In order to deal with the increasingly severe water problems in northern Thailand, decision makers have to recognize the value of participation and promote a profound change in government officers' attitudes towards local people through training programs and incentives.
Hydro-hegemony – a framework for analysis of trans-boundary water conflicts
Authors: Zeitoun Mark , Warner Jeroen 
Published: September 2006

The increasing structural and physical scarcity of water across the globe calls for a deeper understanding of trans-boundary water conflicts. Conventional analysis tends to downplay the role that power asymmetry plays in creating and maintaining situations of water conflict that fall short of the violent form of war and to treat as unproblematic situations of cooperation occurring in an asymmetrical context. The conceptual Framework of Hydro-Hegemony presented herein attempts to give these two features – power and varying intensities of conflict – their respective place in the perennial and deeply political question: who gets how much water, how and why?
Hydro-hegemony is hegemony at the river basin level, achieved through water resource control strategies such as resource capture, integration and containment. The strategies are executed through an array of tactics (e.g. coercion-pressure, treaties, knowledge construction, etc.) that are enabled by the exploitation of existing power asymmetries within a weak international institutional context. Political processes outside the water sector configure basin-wide hydro-political relations in a form ranging from the benefits derived from cooperation under hegemonic leadership to the inequitable aspects of domination. The outcome of the competition in terms of control over the resource is determined through the form of hydro-hegemony established, typically in favour of the most powerful actor.
The Framework of Hydro-hegemony is applied to the Nile, Jordan and Tigris and Euphrates river basins, where it is found that current hydro-hegemonic configurations tend towards the dominative form.. There is evidence in each case of power asymmetries influencing an inequitable outcome – at the expense of lingering, low-intensity conflicts. It is proposed that the framework provides an analytical paradigm useful for examining the options of such powerful or hegemonized riparians and how they might move away from domination towards cooperation.