bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Tagum Study I: Analysis and Clinical Correlates of Mercury in Maternal and Cord Blood, Breast Milk, Meconium, and Infants' Hair
Authors: Ramirez Gloria B. , Cruz Ma. Cristina Vince , Pagulayan Olive , Ostrea Enrique , Dalisay Crispin 
Published: August 2004

Objectives.To compare the indicators and levels of mercury (Hg) exposure in the mother with those in the fetal compartments, and determine its effects on the newborn.Methods.Hg levels using atomic absorption spectrophotometry were determined in maternal blood, breast milk, cord blood, infants' hair, and meconium of 78 consecutive mother-infant pairs in a community with high Hg pollution. The prevalence and levels of Hg both in meconium and in cord blood were correlated with maternal and infant risk factors.Results.The prevalence of Hg in the fetal compartments was higher than in the maternal fluid compartments. Hg was present in 6.4% of maternal blood and 6.4% of breast milk, as compared with 16.7% of cord blood, 31.6% of infants' hair, and 46.1% of meconium. Forty-six percent of infants with Hg in cord blood had none in meconium, whereas 80.6% with Hg in meconium had none in cord blood. Hg was not present in the maternal blood of all infants (n = 36) with Hg in their meconium. Among those with detectable Hg, the mean levels were: mothers' blood 24 parts per billion ± 5.47, cord blood 53.3 parts per billion ± 37.49, and meconium 48.6 ± 43.48. Quantitative measurement in hair was not done because of insufficient sample. Paired comparisons were all significant between Hg levels in the mothers' blood and meconium, mothers' blood and cord blood, and cord blood and meconium. Regression analysis showed Hg levels in meconium to be correlated with prevalence of Hg in infants' hair, length of stay in Tagum, and meconium-stained amniotic fluid. Fisher's Exact probability test showed that the prevalence of Hg in meconium was significantly related to the prevalence of Hg in the mothers' blood and length of stay in Tagum.The prevalence of Hg in cord blood was significantly related to the prevalence in the mothers' blood. Regression analysis of levels of Hg in cord blood showed a significant relation to levels in mothers' blood (.0001), prevalence in infants' hair (.0126), gestational age (GA) (.0091), and head circumference (HC) (.0469). By quadrant analysis of weight against HC in 66 full-term infants all of 4 infants weighing an average of &gt;3000 g at birth and with HCs lower than the fifth percentile had Hg in meconium.Conclusion.The higher prevalence and levels of Hg in the fetal compartments reflect the ease of placental transfer with fetal trapping. Hg determinations in the mothers' blood underestimate the degree and extent of fetal exposure. There is a significant difference in each compartment's ability to reflect Hg exposure of the fetus. A small HC may be associated with the presence of Hg in meconium. Hg in meconium should be measured in addition to cord blood to determine the load of fetal Hg.
Patterns of Alcohol and Drug Use in Adolescents Can Be Predicted by Parental Substance Use Disorders
Authors: Biederman Joseph , Faraone Stephen V. , Monuteaux Michael C. , Feighner Jennifer A. 
Published: August 2004

Objective.
To examine the specificity of risk for alcohol or drug abuse or dependence (substance use disorders [SUDs]) in offspring exposed to particular subtypes of parental SUDs.

Methods.
The original sample was derived from 2 groups of index children: 140 attention-deficit/hyperactivity disorder (ADHD) probands and 120 non-ADHD comparison probands. These groups had 174 and 129 biological siblings and 279 and 240 parents, respectively.

Results.
Independent of familial risk, exposure to parental SUDs predicted SUDs in the offspring. Controlling for duration of exposure, we found that adolescence was a critical developmental period for exposure to parental SUDs. Because all our analyses controlled for social class, ADHD status, and parental lifetime history of SUDs, these results show that exposure to parental SUDs predicts offspring SUDs independently of these risk factors.

Conclusions.
These results support the critical importance of familial environmental risk factors for the development of SUDs in youth in general and particularly in those at high risk for these disorders. These results highlight adolescence as a critical period for the deleterious effects of exposure to parental SUDs, supporting the need to develop preventive and early intervention strategies targeted at adolescents at high risk for SUDs.
Role of Naloxone in Newborn Resuscitation
Authors: Herschel Marguerite , Khoshnood Babak , Lass Nancy A. 
Published: August 2004

Objective.
Because of questions about the basis for the use of naloxone in resuscitation of the newborn, we wished to evaluate the use of naloxone at our institution and an affiliated hospital.

Methodology.
Evaluation of the actual use of naloxone at a university hospital and a community hospital: we document naloxone use by daily survey for a month in one; in the other, we perform a retrospective record review of 1 year's use.

Results.
The university hospital had 240 births during February, 1998. Naloxone was given twice: once, 7 minutes before delivery to a woman at term who had received opiates about 2 hours previously; and once, intramuscularly, to a premature infant for apnea, before being intubated. The community hospital had 2044 births during fiscal 1998. Twenty-six neonates were identified as having received naloxone. Of the 26, 13 received naloxone without needing ventilatory support; all 13 with respiratory depression had a predisposing perinatal complication.

Conclusion.
The use of naloxone in practice may not conform to the American Academy of Pediatrics' guidelines for use in resuscitation of the newborn. The use of naloxone in resuscitation of the newborn should be reevaluated.
The Role of the Pediatrician in Transitioning Children and Adolescents With Developmental Disabilities and Chronic Illnesses From School to Work or College
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired May 2011.
The role of the pediatrician in transitioning children with disabilities and chronic illnesses from school to work or college is to provide anticipatory guidance and to promote self-advocacy and self-determination. Knowledge of the provisions of the key federal laws affecting vocational education is essential for the pediatrician's successful advocacy for patients.
Primary Care Treatment of Pediatric Psychosocial Problems: A Study From Pediatric Research in Office Settings and Ambulatory Sentinel Practice Network
Authors: Gardner William , Kelleher Kelly J. , Wasserman Richard , Childs George , Nutting Paul , Lillienfeld Harris , Pajer Kathleen 
Published: August 2004

Objective.Psychosocial problems cause much of the morbidity among children, and their frequency of presentation in primary care is growing. How is primary care treatment of children's psychosocial problems affected by child symptoms, physician training, practice structure, insurance, physician/patient relationship, and family demographics?Design.Questionnaire study of treatment of psychosocial problems during office visits by children.Settings.At total of 401 primary care offices from 44 US states, Puerto Rico, and Canada.Patients.From 21 150 children seen in office visits, we selected children with an identified psychosocial problem but who were not already receiving specialty mental health services (n = 2618 children).Outcome Measures.Clinicians' decisions to counsel families, to refer children to mental health specialists, or to prescribe medication.Results.The treatment choices of primary care clinicians (PCCs) were generally independent of patients' demographics or insurance status. Clinicians' training, beliefs about mental health, and practice structure had no effect on treatment choices. However, clinicians seeing their own patients were more likely to prescribe medications for attention problems. The clinician's perception about whether the parent agreed with the treatment choice was important for every treatment modality. Counseling and referral were more common and medication was less common when a problem was newly recognized at the visit.Conclusions.Structural factors such as practice type, insurance coverage, and physician training were less important for treatment than were process factors, such as whether the visit was a psychosocial problem visit, whether the problem was newly or previously recognized, and whether the family and clinician were familiar with each other and in accord about treatment.
Time for a New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment
Authors: Halamek Louis P. , Kaegi David M. , Gaba David M. , Sowb Yasser A. , Smith Bradford C. , Smith Brian E. , Howard Steven K. 
Published: August 2004

Objectives.
Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the real delivery room. We developed a simulation-based training program in neonatal resuscitation (NeoSim) to bridge the gap between textbook and real life and to assess trainee satisfaction with the elements of this program.

Methods.
Thirty-eight subjects (physicians and nurses) participated in 1 of 9 full-day NeoSim programs combining didactic instruction with active, hands-on participation in intensive scenarios involving life-like neonatal and maternal manikins and real medical equipment. Subjects were asked to complete an extensive evaluation of all elements of the program on its conclusion.

Results.
The subjects expressed high levels of satisfaction with nearly all aspects of this novel program. Responses to open-ended questions were especially enthusiastic in describing the realistic nature of simulation-based training. The major limitation of the program was the lack of fidelity of the neonatal manikin to a human neonate.

Conclusion.
Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.
Television Commercial Violence During Nonviolent Programming: The 1998 Major League Baseball Playoffs
Authors: Anderson Charles R. 
Published: August 2004

Objectives.
To identify the frequency of violent commercials during the major league baseball playoffs in 1998 and to compare it with the 1996 playoffs.

Design and Setting.
All 4 World Series games televised on the Fox Television Network (Fox), all 6 National League Championship Series (NLCS) televised by Fox, and 5 of 6 American League Championship Series (ALCS) playoff games televised by the National Broadcasting Company (NBC) were videotaped in October 1998. The results were compared with a similar study that analyzed the 1996 playoffs.

Results.
Forty-four commercials (11.0 per game) that included violent interactions were noted during the World Series, 53 violent commercials (8.8 per game) during the NLCS, and 40 (8.0 per game) during the ALCS for a total of 137. Of these 137 violent commercials, 78 contained at least 1 violent act, 126 contained at least 1 violent threat, and 12 contained evidence of at least 1 violent consequence. One hundred five of the 137 violent commercials (76.6%) were television promotions and 23 (16.8%) were for big-screen movie promotions. Twenty-three of 35 big-screen movie promotions (65.7%) were violent. Ten of the 137 violent commercials (7.3%) contained obvious blood, of which 9 were televised by NBC. There were, however, an additional 20 commercials televised by Fox that contained visible blood if the videotape was slowed or paused. Sixty-three of the 137 violent commercials (46.0%) used fire and explosions, of which 53 were televised by Fox and 10 by NBC. Guns were involved in 86 of 137 violent commercials (62.8%), with Fox accounting for 64 (6.4 per game) and NBC accounting for 22 (4.4 per game). Knives were used in 1 violent commercial on both Fox and NBC. Comparisons that can be made to 1996 include the following: 1) violent commercials during the World Series (both televised by Fox) increased from 10.1 to 11.0 per game; and 2) violent commercials during the ALCS (both televised by NBC) increased from 6.0 to 8.0 per game.

Conclusion.
Commercials during the 1998 major league playoffs were similar in violent content, compared with 1996. The violent commercials continue to consist primarily of promotions for television programs and big-screen movies. It continues to be counterintuitive to find such commercials in family-oriented programming and makes it difficult for parents to avoid exposing their children to this form of violence.
Long-Term Effect of Dust Control on Blood Lead Concentrations
Authors: Lanphear Bruce P. , Eberly Shirley , Howard Cynthia R. 
Published: August 2004

Background.Dust control is recommended to prevent children's exposure to residential lead hazards, but the long-term effect of dust control on children's exposure to environmental lead is unknown.Objective.To determine the effect of dust control on children's exposure to lead, as measured by blood lead concentration at 48 months of age.Design.A randomized, controlled trial.Setting.Rochester, New York.Participants.A total of 275 urban children were randomized at 6 months of age; 189 (69%) were available for the 48-month follow-up blood test.Intervention.Children and their families were randomly assigned to an intervention group that received cleaning equipment and up to 8 visits by a trained lead hazard control advisor or to a control group. The intervention was terminated when the children were 24 months of age.Outcome Measures.Geometric mean blood lead concentration and prevalence of elevated blood lead concentration (ie, ≥10 μg/dL, ≥15 μg/dL, and ≥20 μg/dL), by group assignment.Results.For children with 48-month blood tests, baseline geometric mean blood lead concentrations were 2.8 μg/dL (95% confidence interval [CI]: 2.6,3.0); there were no significant differences in baseline characteristics or lead exposure by group assignment. At 48 months of age, the geometric mean blood lead was 5.9 μg/dL (95% CI: 5.3,6.7) for the intervention group and 6.1 μg/dL (95% CI: 5.5,6.9) for the control group. The percentage of children with a 48-month blood lead ≥10 μg/dL, ≥15 μg/dL, and ≥20 μg/dL was 19% versus 19%, 2% versus 9%, and 1% versus 2% in the intervention and control groups, respectively.Conclusions.We conclude that dust control, as performed by families and in the absence of lead hazard controls to reduce ongoing contamination from lead-based paint, was not effective in preventing children's exposure to residential lead hazards.
Interferon-α and Ribavirin in Treating Children and Young Adults With Chronic Hepatitis C After Malignancy
Authors: Lackner Herwig , Moser Andrea , Deutsch Johann , Kessler Harald H. , Benesch Martin , Kerbl Reinhold , Schwinger Wolfgang , Dornbusch Hans-Jürgen , Preisegger Karl-Heinz , Urban Christian 
Published: August 2004

Objective.
Chronic hepatitis C is a major long-term problem for children who survive cancer. Interferon (IFN)-α has been shown to be effective in treating patients with chronic hepatitis C; however, the rate of sustained response is low. Combining IFN-α and ribavirin (RBV) has been shown to significantly improve the response in adult patients with chronic hepatitis C. The aim of this pilot study was to evaluate the efficacy and safety of a combined virostatic treatment with IFN-α and RBV in a small cohort of children and adolescents with chronic hepatitis C and previous malignancy.

Methods.
Twelve patients with a history of a hematooncologic disease (median follow-up: 13.5 years; range: 7–14.7 years) and chronic hepatitis C were treated with recombinant IFN-α-2a (6 megaunits/m2 body surface area, 3 times a week, subcutaneously) combined with RBV (15 mg/kg body weight/day, orally) for 12 months. They were tested monthly for blood counts and liver function, and for serum virus concentrations (hepatitis C virus RNA by polymerase chain reaction) every 3 months.

Results.
At the end of the treatment, hepatitis C virus RNA could not be detected in the serum of 8 of the 12 patients; 2 of these patients relapsed soon after therapy withdrawal, whereas 6 patients maintained in sustained virologic and biochemical remission (follow-up: 12 months). Treatment-induced toxicity was moderate and reversible with influenza-like symptoms and a decrease in blood counts in all 12 patients, alopecia in 5 of the 12, hemolysis in 4 of the 12, and weight loss of &gt;10% in 2 of the 12.

Conclusions.
As demonstrated in adults with chronic hepatitis C, treatment with IFN-α and RBV also seems to be an effective and safe therapeutic option for children and adolescents with chronic hepatitis C after malignancy.
Effectiveness of a Clinical Pathway for Inpatient Asthma Management
Authors: Johnson Kevin B. , Blaisdell Carol J. , Walker Allen , Eggleston Peyton 
Published: August 2004

Background.Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines, but their effect on patient outcomes has not been documented.Objectives.To determine the effect of an asthma clinical pathway on patients' length of stay, use of nebulized β-agonist therapy while hospitalized, and use of acute care clinics for 2 weeks after discharge.Design/Methods.The study was a randomized, controlled trial. Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study. Patients were randomized either to a conventional ward (control group) or to a ward using the clinical pathway (intervention group). For 2 weeks after discharge, we collected data to determine whether patients visited a health care provider for worsening asthma.Results.One hundred ten patients (26%) were enrolled. Control and intervention groups had similar demographic and asthma severity profiles. The intervention group had an average length of stay 13 hours shorter than did the control group. In addition, at every dosing interval, the intervention group received less nebulized β-agonist therapy. There were no deaths in either group.Conclusion.A clinical pathway for inpatient asthma decreased the length of stay and β-agonist medication use with no adverse outcomes or increased acute-care encounters through 2 weeks after discharge.
Respiratory Symptoms in Mothers of Young Children
Authors: d'Arcy Hannah , Gillespie Brenda , Foxman Betsy 
Published: August 2004

Objectives.Children receiving child care outside the home are at greater risk of upper respiratory infection, but whether parents of those children are also at increased risk is undocumented. We describe the incidence of 2 or more respiratory symptoms in the previous 2 weeks among 185 mothers of children 3 years of age or younger by child care use.Methods.Mothers in Michigan and Nebraska were interviewed by phone regarding respiratory symptoms, use of outside child care (for an index child), sleeping habits, and demographic information.Results.Nearly one half (46.5%) reported 2 or more symptoms during the past 2 weeks; 15.1% had contacted a health care provider and 13.0% spent 1 or more days in bed because of their symptoms, which lasted an average of 5.5 days. Prevalence of symptoms was invariant to sociodemographic characteristics. Mothers using outside child care (74.6%) were twice as likely as those without outside care to have been ill in the past 2 weeks (odds ratio: 2.26; 95% confidence interval [CI]: 1.12,4.54). Most mothers (69.2%) reported having their sleep interrupted by their children at least once in the last 2 weeks or sharing a bed with a child part or all of the night (61.1%); 25.4% slept 6 hours or less nightly. Women reporting that they rarely or never felt rested (26.5%) were 2.65 times more likely to be ill (95% CI: 1.26,5.55), compared with those reporting that they frequently or always felt rested (46.5%), after adjusting for any outside child care.Conclusions.Future studies should focus on risk factors that can be modified to reduce illness among both children and their parents.
Care to Underserved Children: Residents' Attitudes and Experiences
Authors: Weitzman Carol Cohen , Freudigman Kimberly , Schonfeld David J. , Leventhal John M. 
Published: August 2004

Objectives.
To examine: 1) the relationship between residents' responses toward caring for underserved children and families during residency and their perceptions of their continuity clinic experience; and 2) which characteristics are related to continuing to care for the underserved after completion of training.

Design.
Cross-sectional descriptive study.

Methods.
A 49-item questionnaire was mailed to 210 third-year pediatric residents at 12 urban training programs in the Northeast in May 1995. Information was collected about residents' emotional responses toward caring for underserved families, their assessments of clinic operations, their sense of effectiveness in caring for underserved patients in continuity clinic, preresidency experiences with the underserved, and their intent to care for the underserved after training.

Results.
Of 210 surveys mailed, 71% were returned. Thirty-six percent of residents planned to pursue a career in primary care, 53% did not, and 11% did not answer or were planning a year as chief resident. Fifty-seven percent of all residents planned to devote a portion of their practice toward caring for the underserved after training.
Residents whose emotional responses toward caring for the underserved included: 1) not worrying that they had become numb to children's psychosocial difficulties, 2) not feeling angry with how families cared for their children, and 3) feeling more empathy with the underserved had significantly higher mean scores on both their assessment of clinic operations and their sense of effectiveness. The only demographic characteristic associated with a greater sense of effectiveness was being black.
To better characterize which residents planned to care for the underserved after training, we examined a subsample of 46 residents who recalled an interest in caring for the underserved during residency training and who were pursuing a career in primary care. Residents that did not recall an interest in caring for the underserved at the onset of residency training were unlikely to have plans to care for the underserved after the completion of training. Within this group residents who planned to care for the underserved after training differed significantly from residents who did not plan to continue this work by feeling a greater sense of effectiveness in clinic, feeling less worried about becoming numb, and having greater empathy for underserved families.

Conclusions.
There are a number of identifiable emotional responses residents develop toward caring for the underserved that relate to their perceptions of continuity clinic and whether a resident chooses to continue to care for the underserved after training.