bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of Rhinovirus, Respiratory Syncytial Virus, and Coronavirus Infections in Acute Otitis Media by Reverse Transcriptase Polymerase Chain Reaction
Authors: Pitkäranta Anne , Virolainen Anni , Jero Jussi , Arruda Eurico , Hayden Frederick G. 
Published: August 2004

Objective. To determine the frequencies of human rhinovirus (HRV), respiratory syncytial virus (RSV), and coronavirus (HCV) infection in children with acute otitis media (AOM).Methods. Middle ear fluids (MEF) collected by tympanocentesis and nasopharyngeal aspirates (NPA) at the time of the AOM diagnosis were examined by reverse transcriptase polymerase chain reaction for HRV, RSV, and HCV RNA.Patients. Ninety-two children aged 3 months to 7 years during a 1-year period.Results. Virus RNA was detected in a total of 69 children (75%) and in 44 MEF samples (48%) and 57 NPA samples (62%) at the time of AOM diagnosis. HRV RNA was detected in both MEF and NPA in 18 (20%), in MEF alone in 4 (4%), and in NPA alone in 10 (11%). RSV was detected in both MEF and NPA in 12 (13%), in MEF alone in 5 (5%), and in NPA alone in 9 (10%). HCV RNA was detected in both MEF and NPA in 5 (5%), in MEF alone in 2 (2%), and in NPA alone in 9 (10%). Dual viral infections were detected in 5% of children. HRV and RSV were detected simultaneously in 2 MEF samples and in 2 NPA samples; RSV and HCV were detected in 1 NPA sample. Bacterial pathogens were detected in 56 (62%) MEF from 91 children. Viral RNA was detected in 20 (57%) MEF of 35 bacteria-negative and in 25 (45%) of 56 bacteria-positive MEF samples. No important differences in the risk of treatment failure, relapse, or occurrence of late secretory otitis media were noted between children with virus-positive and virus-negative MEF aspirates.Conclusion. These findings highlight the importance of common respiratory viruses, particularly HRV and RSV, in predisposing to and causing AOM in young children.
Serum Interleukin-6 in Bacterial and Nonbacterial Acute Otitis Media
Authors: Heikkinen Terho , Ghaffar Faryal , Okorodudu Anthony O. , Chonmaitree Tasnee 
Published: August 2004

Background. Increasing prevalence of antibiotic-resistant bacteria is a serious clinical problem that calls for reduction of unnecessary use of antibiotics. Acute otitis media (AOM) is the most common reason for antibiotic therapy in the United States. Approximately 30% of AOM cases do not have a bacterial etiology. Rapid identification of these cases could help withhold unnecessary antibiotic treatment.Objective. To determine the usefulness of serum levels of interleukin-6 (IL-6), an acute phase cytokine shown to be a reliable marker of neonatal bacterial infection, in differentiation between bacterial and nonbacterial AOM in children.Study Design. IL-6 was measured in stored serum samples from 184 children (mean age, 22 months) with AOM who were enrolled in antibiotic efficacy trials at our department. The samples were obtained at enrollment and at 9 to 12 days after initiation of antibiotic therapy. Sera from 21 uninfected children (mean age, 23 months) were used as controls. The etiology of AOM was determined by bacterial and viral cultures as well as respiratory syncytial virus antigen detection in the middle ear fluids obtained by tympanocentesis.Results. Bacterial etiology of AOM was confirmed in 125 children (68%), whereas in 59 children (32%) no bacterial pathogen could be detected in the middle ear fluid. Children with bacterial AOM had significantly higher IL-6 levels than those with nonbacterial AOM (median, 11.5 vs 3.7 pg/mL). However, this difference was almost entirely attributable to pneumococcal AOM specifically. IL-6 levels in children with AOM caused by Streptococcus pneumoniae were significantly higher (median, 40.1 pg/mL) than in AOM caused byHaemophilus influenzae (7.3 pg/mL) or Moraxella catarrhalis (6.8 pg/mL). At the cutoff value of 30 pg/mL, the specificity of IL-6 for detection of pneumococcal AOM was 91% with a sensitivity of 61%, but its sensitivity for detection of bacterial AOM in general was only 27%.Conclusions. Low levels of IL-6 do not rule out bacterial etiology of AOM in general; therefore, IL-6 is not sensitive enough as a marker of bacterial AOM. Surprisingly, serum IL-6 levels in pneumococcal AOM were significantly higher than the levels associated with other bacterial AOM, and serum IL-6 levels of &gt;30 pg/mL were highly specific for pneumococcal AOM. These findings suggest a distinctive role for S pneumoniae in the pathogenesis of AOM.
Perinatal Correlates of Cerebral Palsy and Other Neurologic Impairment Among Very Low Birth Weight Children
Authors: Wilson-Costello Deanne , Borawski Elaine , Friedman Harriet , Redline Raymond , Fanaroff Avroy A. , Hack Maureen 
Published: August 2004

Background and Objective. The etiology of neurologic impairments among very low birth weight (VLBW, &lt;1.5 kg) children is poorly understood. We sought to investigate the perinatal predictors of major neurologic impairment, including cerebral palsy, among VLBW children.Methods. Antenatal, intrapartum, and neonatal events and therapies were compared between 72 singleton inborn VLBW children born between 1983 to 1991 who had neurologic impairment at 20 months corrected age (including 50 with cerebral palsy and 22 with other neurologic impairments) and 72 neurologically normal VLBW children matched by birth weight, gestational age, race, and sex via a retrospective case-control method. Multiple logistic regression was conducted, entering only those variables found to be significant at the bivariate level.Results. There were no significant differences in the rates of pregnancy-induced hypertension, maternal tocolytic use including magnesium, or antenatal steroid therapy. Higher rates of clinical chorioamnionitis were found among the mothers of the neurologically impaired children as compared with controls (31% vs 11%), but not among the subgroup of mothers of children with cerebral palsy (22% vs 12%). Significant differences in neonatal factors among the total neurologically-impaired group (n = 72) versus controls included oxygen dependence at 36 weeks (31% vs 15%), septicemia (53% vs 31%), severe cranial ultrasound abnormality (50% vs 17%), and hypothyroxinemia (43% vs 25%). In the subgroup with cerebral palsy (n = 50), significant differences included days on the ventilator (23 vs 14 days), septicemia (54% vs 33%), and severe cranial ultrasound abnormality (52% vs 12%). Multivariate analysis controlling for birth weight, gestational age, race, sex, and the birth period (before 1990 versus 1990 and after) revealed direct and independent effects of clinical chorioamnionitis [odds ratio (OR), 3.79; confidence interval (CI), 1.34–10.78], severe cranial ultrasound abnormality (OR, 9.97; CI, 3.84–25.87), and septicemia (OR, 2.46; CI, 1.10–5.52) on total neurologic impairment. Consideration of the 50 cases with cerebral palsy revealed direct and independent effects of severe cranial ultrasound abnormality only (OR, 15.01; CI, 4.34–51.93).Conclusions. Both antenatal and neonatal risk factors contribute to the development of severe neurologic impairment, including cerebral palsy among VLBW children. Because prevention of chorioamnionitis may not be feasible in the near future, attempts to decrease neonatal risk factors such as severe cranial ultrasound abnormalities and sepsis may be most feasible at this time.
Family Member Knowledge of Children's Medical Problems: The Need for Universal Application of an Emergency Data Set
Authors: Carraccio Carol L. , Dettmer Karen S. , duPont M. Lynne , Sacchetti Alfred D. 
Published: August 2004

Objective. Advances in medical care have led to a growing population of special needs children who are at risk for suboptimal care when they present to a physician with no previous knowledge of their medical history. This risk may be amplified in the emergency department setting when time-sensitive interventions must be initiated without immediate access to consultants or past records. Our purpose in this study was to evaluate caretakers' knowledge of their children's chronic medical problems and their ability to relate this knowledge to unfamiliar health care providers.
Methods. Caretaker/child pairs presenting for specialty visits were surveyed. Questions focused on knowledge of the child's illness, medicine regime, and how to contact the specialist. Chart review confirmed responses of caretakers and provided sociodemographic information. Descriptive statistics and χ2 were used in data analysis.
Results. Of the 49 caretakers interviewed, 85% were parents, 53% were African-American, and 43% were Caucasian. One-half of the group received medical assistance. The mean age of the children was 55 months. Responses showed that 53% of caretakers were unable to provide their children's specific diagnoses. Of these, one half could provide a lay diagnosis whereas the remaining one half could only identify the organ system involved or that there was a problem. For children on medications, 29% of caretakers could not provide an accurate list. Name of the subspecialist and phone number of the subspecialty clinic was unknown by 25% of caretakers. No child wore medical identification jewelry.
Conclusions. Caretakers are not always able to accurately relay vital information on their child's essential medical needs, a problem that may be compounded in emergency situations. The use of some form of independent identification and information set is needed to assure proper treatment of children with special health care needs encountering an unfamiliar health care provider.
Auditory Integration Training and Facilitated Communication for Autism
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired July 2017.
This statement reviews the basis for two new therapies for autism—auditory integration training and facilitative communication. Both therapies seek to improve communication skills. Currently available information does not support the claims of proponents that these treatments are efficacious. Their use does not appear warranted at this time, except within research protocols.
Should Pediatric Echocardiography Be Performed in Adult Laboratories?
Authors: Hurwitz Roger A. , Caldwell Randall L. 
Published: August 2004

Objectives. Current health care management has resulted in a change in referral patterns. The present study was undertaken to define the efficacy and value of pediatric echocardiography performed and interpreted in adult laboratories.Methods. We reviewed the findings in 100 consecutive pediatric patients 1 month to 18 years of age referred for possible heart disease and evaluated previously by echocardiography performed in an adult laboratory. Technical adequacy and interpretation of the echocardiogram at the outside facility was correlated with our final diagnosis.Results. Of the studies, 32 (32%) were performed in hospital laboratories, and 68 (68%) in physician offices. A total of 52 (52%) of the 100 patients arrived with an outside diagnosis in agreement with our final diagnosis. Technical difficulties were reported in 14 (14%) studies by the original laboratory; we felt that 32 (32%) studies were inadequate. Interpretation or communication between the outside echocardiography laboratory, primary care physicians, and patients' family was erroneous in 32 (32%) cases. Repeat echocardiography was necessary in 38 (38%) patients (6 because of planned surgery). If initial referral had been to our own institution, 25 to 30 patients would not have undergone echocardiography.Conclusions. Slightly more than half of echocardiography studies performed in pediatric patients in adult laboratories were technically adequate and interpreted correctly with proper physician–family communication. Many patients require repeat studies on further referral. A significant number would be spared echocardiography if they were sent to a pediatric cardiology center initially.
Decline in Sepsis-associated Neonatal and Infant Deaths in the United States, 1979 Through 1994
Authors: Stoll Barbara J. , Holman Robert C. , Schuchat Anne 
Published: August 2004

Background. Infant mortality in the United States has continued to decline in recent years, but changes in sepsis-associated deaths among infants have not been evaluated previously.
Methods. Data from US death records were analyzed for the period 1979 through 1994 to assess trends in sepsis-associated deaths among newborns and older infants.
Results. Annual neonatal mortality associated with sepsis declined by 25% from 50.5 deaths per 100 000 live births in 1979 through 1981 to 38.0 deaths per 100 000 live births in 1992 through 1994. Although infant mortality associated with sepsis declined from 71.7 to 56.4 per 100 000 live births over the same period, this decline was attributable to lower sepsis-related mortality among newborns. The rates of sepsis-associated deaths declined for both preterm and term deliveries. Approximately 2260 infants (1521 of whom were newborns) died of sepsis per year in 1992 through 1994. Sepsis-associated death was more likely to occur among infants who were male, black, preterm, or born in the South. Among black infants, the racial gap in sepsis-associated mortality was greater for term than for preterm infants.
Conclusions. Despite declines in the overall sepsis-related mortality among newborns, racial and regional gaps in mortality persisted over the 16-year study period. Almost half of the sepsis-related deaths occurred among infants who were born prematurely. Disproportionate rates of prematurity among blacks and infants born in the South may have contributed to persistently high sepsis-related mortality in these groups. Future efforts to reduce the incidence of sepsis-associated deaths will depend on targeting higher risk populations and reducing prematurity.
Estimation of Outcome and Restriction of Interventions in Neonates
Authors: Haywood James L. , Morse Steven B. , Goldenberg Robert L. , Bronstein Janet , Nelson Kathleen G. , Carlo Waldemar A. 
Published: August 2004

Objective. To learn whether pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitude influence their choice of interventions that may enhance survival of extremely preterm infants.Methods. Pediatricians practicing in Alabama were surveyed using a pretested questionnaire designed to identify pediatricians' knowledge regarding survival and handicap-free rates of infants born at gestational ages between 21 and 36 weeks. For infants born at each week of gestation, they were asked if they would provide specific therapeutic interventions. Survival and handicap-free rates were compared with published national rates. Pediatricians were divided into an optimist group and a pessimist group based on how their estimates of survival compared with national published data. The rates at which each group used therapeutic interventions were compared.Results. The 159 (57%) responding pediatricians underestimated survival rates from 23 through 34 weeks' gestation and freedom from serious handicap from 23 through 36 weeks. Responses of the optimists approximated actual data whereas the pessimists underestimated neonatal outcome. Those pediatricians who underestimated neonatal outcome would intervene less often with invasive therapies, including mechanical ventilation, cardiopulmonary resuscitation, inotropes, and intravenous fluids, compared with those who accurately predicted outcome from 23 through 27 weeks' gestation.Conclusion. Pediatricians often underestimate neonatal outcome of preterm infants. Appropriate neonatal practice may be affected by this underestimation of the survival potential of preterm infants.
Gambling and Other Risk Behaviors Among 8th- to 12th-Grade Students
Authors: Proimos Jenny , DuRant Robert H. , Pierce Judith Dwyer , Goodman Elizabeth 
Published: August 2004

Objective. To examine the associations between a self-reported history of gambling or problems related to gambling and health risk behaviors in adolescence.
Design. An anonymous risk behavior survey was administered to 21 297 8th- through 12th-grade students in 79 public and private schools in Vermont. Gambling or problems related to gambling were the outcome variables of interest. Demographic variables and 13 target risk behaviors related to substance use, sexual activity, and violence were tested for association with gambling and problems related to gambling.
Results. Of the students, 53% reported gambling in the past 12 months, and 7% reported problems attributable to gambling. Male gender, any use of alcohol, infrequent use of cigarette smoking, any marijuana use, any inhalant use, infrequent steroid use, frequent illegal drug use, seatbelt nonuse, driving after drinking alcohol, being threatened, carrying a weapon, being involved in a fight, and years of sexual activity were all significantly associated with reported gambling in the past 12 months. Among the students who gambled, younger age, male gender, daily marijuana use, frequent use of cocaine, frequent use of inhalants, any steroid use, never wearing seatbelts, carrying a weapon for up to 3 days a month, fighting, and years of sexual activity were all significantly associated with reported problems with family and friends as a consequence of gambling. There was an increase in the absolute number of risk behaviors reported between those who had not gambled, those who had gambled, and those for whom gambling had created problems.
Conclusions. Risk behaviors are associated with gambling in adolescence. The typology of risk behaviors was different for adolescents who reported gambling compared with those for whom gambling had created problems. Both gambling and problems related to gambling were significantly associated with the absolute number of risk behaviors reported by adolescents in a graded manner. Involvement in gambling should be assessed as part of the health encounter. Assessment may provide a nonthreatening entry into the evaluation of other risk behaviors. Furthermore, it may identify youth who are at risk of developing additional risk behaviors or pathological gambling. Interventions then could be targeted toward prevention of these undesirable outcomes.
Parental Literacy Level and Understanding of Medical Information
Authors: Moon Rachel Y. , Cheng Tina L. , Patel Kantilal M. , Baumhaft Kalanit , Scheidt Peter C. 
Published: August 2004

Objective. To ascertain the impact of literacy level on parents' understanding of medical information and ability to follow therapy prescribed for their children.Design/Methods. A prospective cohort of parents accompanying their children for acute care. Parents were interviewed about demographic status, their child's health, and use of pediatric preventive services. The Rapid Estimate of Adult Literacy in Medicine (REALM) test was used to assess parental literacy. The same parent was interviewed 48 to 96 hours later and asked to recall the child's diagnosis, any medication prescribed, and instructions.Results. A total of 633 patients were enrolled. Follow-up was obtained in 543 patients (85.8%). Mean parental age was 32.43 years (SD = 9.07). Mean REALM score was 57.6 (SD = 10.9), corresponding to a 7th- to 8th-grade reading level, with a mean parental educational level of 13.43 years (SD = 2.09). Low REALM score was significantly correlated with young parental age and parental education. African-American race was associated with lower REALM scores. After controlling for these variables, REALM score significantly correlated with parental perception of how sick the child was, but not with use of preventive services, comprehension of diagnosis, medication name and instructions, or ability to obtain and administer prescribed medications.Conclusions. Parental literacy level did not correlate with use of preventive services or parental understanding of or ability to follow medical instructions for their children.
Comparative Efficacy of the Lederle/Takeda Acellular Pertussis Component DTP (DTaP) Vaccine and Lederle Whole-Cell Component DTP Vaccine in German Children After Household Exposure
Authors: Heininger Ulrich , Cherry James D. , Stehr Klemens , Schmitt-Grohé Sabina , Überall Michael , Laussucq Suzanne , Eckhardt Thomas , Meyer Martin , Gornbein Jeffrey ,   the Pertussis Vaccine Study Group
Published: August 2004

Background.
A household contact substudy was performed as part of a prospective, cohort pertussis vaccine efficacy trial in Germany.

Design.
Infants received four doses of either the Lederle/Takeda acellular pertussis component diphtheria-tetanus toxoids (DTP) vaccine (DTaP) or Lederle whole-cell component DTP vaccine at 3, 4.5, 6, and 15 to 18 months of age (Wyeth-Lederle Vaccines and Pediatrics, Pearl River, NY). An open control group received three doses of diphtheria and tetanus toxoids vaccine (DT) at 3, 4.5, and 15 to 18 months of age. Vaccine efficacy rates were calculated using a number of principal and ancillary case definitions for primary, secondary, and noncases by analyzing secondary attack rates in study infants after exposure to pertussis in the household using 7- to 28- and 7- to 42-day postexposure observation periods and the inclusion and the exclusion of noncases who received macrolide antibiotics or trimethoprim-sulfamethoxazole during the exposure period.

Results.
During a 3.5-year study period, 10 271 infants (DTP or DTaP, n = 8532; DT, n = 1739) were enrolled and actively followed along with all household members for cough illnesses. Depending on the case definition, 160 to 519 household exposures to pertussis were identified. In general, secondary attack rates in DT recipients were low and this was primarily because of the frequent use of antimicrobial prophylaxis. Using the principal case definitions and the exclusion of noncases who received macrolide antibiotics or trimethoprim-sulfamethoxazole during the exposure period and the 7- to 42-day observation period, the efficacy of DTP against cough illness of ≥7 days duration caused by Bordetella pertussis was 84% (95% confidence interval [CI] = 65–93) and that of DTaP was 58% (95% CI = 30–75). Using similar criteria, the efficacy against typical pertussis (≥21 days of cough with either paroxysms, whoop, or posttussive vomiting) was 94% (95% CI = 77–99) and 86% (95% CI = 62–95) for DTP and DTaP, respectively. The efficacy against any cough illness (with or without) laboratory confirmation was 54% (95% CI = 32–69) and 38% (95% CI = 13–56) for DTP and DTaP, respectively.

Conclusion.
This household contact substudy within our cohort study, with active investigator-generated surveillance, was a severe test of vaccine efficacy. Both vaccines (DTP and DTaP) are better at preventing typical pertussis than mild illness. When case definitions similar to those in other recent trials are used, the Lederle/Takeda vaccine has an efficacy similar to other multicomponent DTaP vaccines.