bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Birth Weight: Race and Maternal Nativity— Impact of Community Income
Authors: Fang Jing , Madhavan Shantha , Alderman Michael H. 
Published: August 2004

Background. The purpose of this article is to determine the effect of community income as a co-factor in the association of low birth weight, race, and maternal nativity in New York City.Methods. New York City birth records, 1988 through 1994, provided data on maternal and infant characteristics. There were 274 121 white and 279 826 black mothers included in this study. Black mothers were classified as US-born (South and Northeast) and foreign-born (the Caribbean, South America, and Africa). Based on the 1990 US census income data, census tracts of the city were aggregated by tertile of per capita income as low-, middle-, and high-income communities. Incidence of low birth weight was estimated by race, maternal nativity in the city as a whole, and each income community.Results. Overall, black women had a substantially higher risk of low birth weight infants (&lt;2500 g) than did whites (13.1% vs 4.8%). Foreign-born black mothers had a birth weight advantage over US-born black mothers (10.0% vs 16.7%). After controlling for socioeconomic and medical characteristics, the risks of low birth weight for blacks compared with whites were 0.95 (95% confidence interval: 0.87–1.03) and 0.86 (0.69–1.02) for Caribbean- and African-born black mothers, respectively. Moreover, in low-income communities, compared with white mothers, the risks for Caribbean- and African-born black mothers were 0.88 (0.79–0.97) and 0.77 (0.61–0.96), respectively. By contrast, US and South American-born black mothers had a consistently higher risk of low birth weight infants, regardless of community income level.Conclusion. Low birth weight was significantly less frequent among whites than among blacks. However, this overall finding masked substantial variation among blacks, determined by maternal nativity and the income level of the community in which they lived. In fact, Caribbean- and African-born black mothers had birth outcomes generally similar to and, in poor communities, even more favorable than those for whites.
Parents, Physicians, and Antibiotic Use
Authors: Bauchner Howard , Pelton Stephen I. , Klein Jerome O. 
Published: August 2004

Background.Emergence of resistant bacterial pathogens has increased concerns about antibiotic prescribing patterns. Parent expectations and pressure may influence these patterns.Objective.To understand how parents influence the prescribing patterns of physicians and what strategies physicians believe are important if we are going to reduce inappropriate use of oral antimicrobial agents.Designs and Methods.One thousand pediatricians who are members of the American Academy of Pediatrics were asked to complete a semi-structured questionnaire. The physicians were chosen randomly by the American Academy of Pediatrics.Results.Nine hundred fifteen pediatricians were eligible and 610 surveys were analyzable, for a response rate of 67%. The majority of respondents were male (56%), worked in a group practice (51%), saw an average of 114 patients per week and were in practice for 14 years. Forty percent of the pediatricians indicated that 10 or more times in the past month a parent had requested an antibiotic when the physician did not feel it was indicated. Forty-eight percent reported that parents always, most of the time, or often pressure them to prescribe antibiotics when their children are ill but antibiotics are not indicated. In follow-up questions, approximately one-third of physicians reported they occasionally or more frequently comply with these requests. Seventy-eight percent felt that educating parents would be the single most important program for reducing inappropriate oral antibiotic use and 54% indicated that parental pressure, in contrast to concerns about legal liability (12%) or need to be efficient in practice (19%), contributed most to inappropriate use of oral antibiotics.Conclusions.Pediatricians acknowledge prescribing antimicrobial agents when they are not indicated. Pediatricians believe educating parents is necessary to promote the judicious use of antimicrobial agents.
Risk Factors and Course of Illness Among Children With Invasive Penicillin-resistant Streptococcus pneumoniae
Authors: Deeks Shelley L. , Palacio Rosario , Ruvinsky Raúl , Kertesz Daniel A. , Hortal Maria , Rossi Alicia , Spika John S. , Di Fabio José Luis ,   The Streptococcus pneumoniae Working Group
Published: August 2004

Objectives.
To assess differences in risk factors, clinical presentation, and course of illness between children infected with penicillin-sensitive and drug-resistantStreptococcus pneumoniae (DRSP).

Design.
A retrospective cohort study conducted in Uruguay and Argentina using information from a hospital-based surveillance system. Hospitalized children 5 years of age and younger who hadS pneumoniae isolated from a normally sterile site between June 1993 and October 1996 were eligible. Hospital records were linked with surveillance data. Both stratified univariate analysis and logistic regression was completed.

Results.
Of the 380 children eligible for the study, 274 records (72%) were available for review. Ninety-nine children (36%) had DRSP; 46 showed intermediate susceptibility (minimum inhibitory concentration, 0.12–1.0 μg/mL) and 53 showed high-level resistance (minimum inhibitory concentration ≥2.0 μg/mL). Children with meningitis were less likely to have DRSP than those with other forms of invasive disease (relative risk = 0.5; 95% confidence interval [CI], 0.2–0.9). Risk factors associated with DRSP were use of penicillin or ampicillin in the 3 months before illness (odds ratio = 2.9; 95% CI, 1.5–5.7) and possession of private medical coverage (odds ratio = 2.4; 95% CI, 1.2–5.0). Response to therapy, including response to penicillin or ampicillin among children with nonmeningeal invasive disease, course of illness, and clinical outcome did not differ significantly between children infected with penicillin-susceptible or penicillin-resistant isolates.

Conclusion.
In this study, previous use of penicillin or ampicillin and private medical coverage were associated with having DRSP. Children with nonmeningeal invasive disease responded equally well to penicillin regardless of the penicillin susceptibility of their pneumococcal isolate.
A Multiple-dosing, Placebo-controlled Study of Budesonide Inhalation Suspension Given Once or Twice Daily for Treatment of Persistent Asthma in Young Children and Infants
Authors: Baker James W. , Mellon Michael , Wald Jeffrey , Welch Michael , Cruz-Rivera Mario , Walton-Bowen Karen 
Published: August 2004

Rationale.
Topical antiinflammatory medications such as inhaled corticosteroids are recommended for therapy of asthma, but no formulation suitable for administration to infants and young children is available in the United States.

Methods.
This was a 12-week, multicenter, double-blind, randomized, parallel-group study comparing the efficacy and safety of four dosing regimens of bude-sonide inhalation suspension (BIS) or placebo in 480 asthmatic infants and children (64% boys), ages 6 months to 8 years, with moderate persistent asthma. Approximately 30% of children were previously on inhaled corticosteroids that were discontinued before the study. Active treatments were comprised of BIS 0.25 mg once daily (QD), 0.25 mg twice a day (BID), 0.5 mg BID, or 1.0 mg QD. Efficacy was assessed by twice daily recording at home of asthma symptom scores and use of rescue medication, and discontinuation from the study because of worsening asthma and/or a requirement for systemic steroids. Peak flow measurements were recorded twice daily on diary and spirometry was recorded at clinic visits for those children able to perform these tests. Safety was assessed by reported adverse events and by cortisol testing (adrenocorticotropic hormone stimulation) in a subset of patients.

Results.
Patients enrolled had an average duration of asthma of 34 months; the mean asthma symptom score was ∼1.3 (scale of 0–3). All dosing regimens with BIS produced statistically significant improvement in various clinical efficacy measures for asthma control compared with placebo. The lowest dose used, 0.25 mg QD, was efficacious but with fewer efficacy parameters than seen with the other doses administered. Separation between active treatment and placebo in daytime and nighttime symptom scores were observed by week 2 of treatment for all BIS treatment regimens. A significant increase in peak flow measurement was observed in most active treatment groups compared with placebo in the subset of children able to do pulmonary function testing. All treatment groups showed numerical improvement in forced expiratory volume in 1 second but only the 0.5-mg BID dose was significantly different from placebo. Adverse events for the entire group and response to adrenocorticotropic hormone in a subgroup of children who underwent cortisol testing before and at the end of the treatment period were no different in budesonide-treated patients in comparison to placebo.

Conclusion.
Results of this study demonstrate that BIS is effective and safe for infants and young children with moderate persistent asthma in a multiple dose range, and that QD dosing is an important option to be considered by the prescribing physician.
Hair and Skin Disorders as Signs of Mitochondrial Disease
Authors: Bodemer Christine , Rötig Agnès , Rustin Pierre , Cormier Valerie , Niaudet Patrick , Saudubray Jean-Marie , Rabier Denis , Munnich Arnold , de Prost Yves 
Published: August 2004

Objective.
To compare and explore the skin manifestations of mitochondrial disorders in 14 children with puzzling and unexpected cutaneous presentations.

Study Design.
One hundred forty children with mitochondrial disorders who had been under observation in our hospital for the last 10 years, were carefully examined by the same physicians. Skin and hair characteristics were investigated by the same dermatologist. All the children developed an early unexplained association of symptoms. Metabolic screening for abnormal oxidative-reduction in plasma and mitochondrial enzyme investigations confirmed the diagnosis of oxidative phosphorylation disorders.

Results.
Fourteen children with mitochondrial disorders (10% of the original cohort) developed specific hair and skin abnormalities. Their cutaneous manifestations were similar, and could be classified into four categories: hair abnormalities, rashes and pigmentation disorders, hypertrichosis, and acrocyanosis. In 3 cases, skin disorders constituted the puzzling and unexpected manifestations of mitochondrial disease. Respiratory chain deficiencies in the cultured skin fibroblasts of 3 patients and heteroplasmic mitochondrial DNA rearrangement in the skin fibroblasts of 1 patient indicated that mitochondrial disorders may be expressed in the skin.

Conclusion.
Hair abnormalities and pigmented skin eruptions might belong to the broad spectrum of presenting symptoms of mitochondrial disease. The association of these dermatologic lesions with unrelated disorders should lead physicians to consider a diagnosis of mitochondriopathy as early as possible.
Regulation of Arginine Vasopressin in Enuretic Children Under Fluid Restriction
Authors: Eggert Paul , Müller-Schlüter Karen , Müller Dominik 
Published: August 2004

Background.Treatment of primary nocturnal enuresis using 1-deamino-8-d-arginine-vasopressin is based on the hypothesis that antidiuretic hormone (arginine vasopressin [AVP]) secretion is insufficient during the night. Persisting doubts about the theoretical background of this treatment and first results pointing to a different AVP regulation in children with nocturnal enuresis were the motives for the present study.Objective.To determine if children with primary nocturnal enuresis have different AVP levels during fluid restriction when compared with normal controls.Methods.Twenty-three children with nocturnal enuresis (median age, 11 years) were compared with a corresponding control group of 18 healthy children. Plasma osmolality, urine osmolality, and plasma AVP concentrations were determined before and after a defined fluid restriction.Results.Regarding plasma and urine osmolality, no differences were found between the two groups. AVP levels after fluid restriction, however, showed significant differences. To maintain osmolality, the plasma AVP concentrations of the controls rose to a median value of 5.7 pg/mL (range: 0.9–29.0 pg/mL) in comparison to a median of 14.0 pg/mL (range: 3.5–64.0 pg/mL, P = .015) for the enuretic children.Conclusion.The results are consistent with the established fact that AVP secretion is a function of plasma osmolality. They contradict the hypothesis that enuretic children have a AVP deficiency that has to be supplemented. Rather, the results point to a defect at the AVP receptor level or of the signal transduction pathway.
Mitochondrial Dysfunction in Skeletal Muscle of Children With Cardiomyopathy
Authors: Marin-Garcia Jose , Ananthakrishnan Radha , Goldenthal Michael J. , Filiano James J. , Perez-Atayde Antonio 
Published: August 2004

Objectives.
This study sought to examine skeletal muscle of children with cardiomyopathy (CM) for changes in mitochondrial enzyme activities and in mitochondrial DNA (mtDNA).

Background.
Heart mitochondrial enzymatic activity defects have been often found in dilated and hypertrophic CM. The defects primarily involve the activities of the electron transport system and oxidative phosphorylation pathway including respiratory complexes I, III, IV, and V.

Methods.
Skeletal muscle biopsies of 8 children with CM were examined for specific mitochondrial enzyme activities, mtDNA copy number and the presence of pathogenic mutations and deletions in mtDNA.

Results.
A marked deficiency in specific mitochondrial enzyme activities was found in 6 of 8 patients in skeletal muscle as well as in 2 of 3 hearts of those in whom cardiac tissue was available. Specific activity defects were found in complex I (2 cases), complex III (5 cases), complex IV (3 cases), and complex V (4 cases). Complex II and citrate synthase activities were unaffected. None of the previously reported pathogenic mutations associated with CM were detected, nor was there any evidence of mtDNA depletion. The incidence of defective respiratory complex activities in skeletal muscle was similar to the incidence of defective complex activities previously reported in cardiac tissue.

Conclusions.
Mitochondrial analysis of skeletal muscle is warranted in the overall clinical evaluation of children with CM, and particularly before consideration for cardiac transplantation.
How Pediatricians Can Respond to the Psychosocial Implications of Disasters
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: August 2004

This Policy Statement was retired October 2005.
Natural and human-caused disasters, violence with weapons, and terrorist acts have touched directly the lives of thousands of families with children in the United States.1 Media coverage of disasters has brought images of floods, hurricanes, and airplane crashes into the living rooms of most American families, with limited censorship for vulnerable young children. Therefore, children may be exposed to disastrous events in ways that previous generations never or rarely experienced. Pediatricians should serve as important resources to the community in preparing for disasters, as well as acting in its behalf during and after such events.
Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease
Authors: Kuppermann Nathan , Malley Richard , Inkelis Stanley H. , Fleisher Gary R. 
Published: August 2004

Objective. To determine the frequency of unsuspected meningococcal disease (UMD) in young febrile children with meningococcal infections and evaluate whether clinical and laboratory parameters commonly used in the evaluation of fever can help identify children with UMD.Methods. We reviewed the records of children with meningococcal disease from 1985 to 1996 at four referral centers. Children who were evaluated as outpatients and then discharged to home, from whom Neisseria meningitidis was isolated from blood or cerebrospinal fluid cultures obtained during these outpatient visits, were considered to have UMD. We compared clinical and laboratory parameters between these children and 6414 febrile outpatients 3 to 36 months old with negative blood cultures enrolled in a separate study of occult bacteremia.Results. We identified 381 children with meningococcal disease, of whom 45 (12%) had UMD. Of the 45 with UMD, 37 (82%) were 3 to 36 months old. Compared with the 6414 culture-negative patients, these 37 patients with UMD were significantly younger (8.9 ± 5.4 vs 14.2 ± 8.1 months) and had significantly higher band counts (14.3 ± 11.1 vs 7.3 ± 7.5%). There were no significant differences, however, in temperature, white blood cell counts, and absolute neutrophil counts. Multivariate analysis identified young age and the band count as independent predictors of UMD.Conclusions. Children ultimately diagnosed with meningococcal disease have commonly been evaluated as outpatients and discharged to home before diagnosis. Of the hematologic parameters frequently used in the evaluation of fever, only the band count differs significantly between young febrile children with UMD and those with negative cultures. Because UMD is uncommon in young febrile pediatric outpatients, however, the predictive value of the band count is low. Thus, the complete blood count is not routinely helpful for the diagnosis of UMD.
A Study of 10 296 Pediatric and Adolescent Papanicolaou Smear Diagnoses in Northern New England
Authors: Mount Sharon L. , Papillo Jacalyn L. 
Published: August 2004

Objective.
This study analyzes pediatric and adolescent Papanicolaou (Pap) smear diagnoses to determine the prevalence rates of squamous intraepithelial lesion (SIL) as well as infectious and reactive processes in this age group.

Design.
A total of 10 296 Pap smear diagnoses from patients 10 to 19 years of age collected over a 1-year period and classified according to the Bethesda system were reviewed. This population was almost exclusively white, the majority residing in rural or suburban areas of Maine, New Hampshire, and Vermont. The percentage of abnormal smear results was then compared with data generated for older age subsets.

Results.
The following diagnoses were made on 10 296 Pap smears from patients 10 to 19 years of age: 7208 (70.01%) normal; 1689 (16.4%) benign cellular change; 1004 (9.75%) atypical squamous cells of undetermined significance; 388 (3.77%) squamous intraepithelial lesion (SIL); and 7 (0.06%) atypical glandular cells of undetermined significance. A total of 1503 (14.6%) of smears showed infectious processes. Compared with the results of adult Pap smears collected over the same time period, the age 20 to 29 subset with 27 067 Pap smears and the age 30+ subset with 42 617 Pap smears showed 11.79% and 8.43% infectious processes and 3.49% and 1.27% SIL, respectively. Therefore, the highest rate of infectious processes and SIL was found in the subset of patients age 10 to 19 years.

Conclusions.
Because the development of SIL and hence cervical cancer is causally related to sexually transmitted human papilloma virus (HPV) infection, this high rate of abnormal Pap smear results of both an infectious and precancerous nature in this population may reflect a high level of sexual activity among adolescent girls. These data reinforce the importance of implementing early cervical Pap smear screening in the sexually active pediatric and adolescent population.
Clinical Studies of Families With Hearing Loss Attributable to Mutations in the Connexin 26 Gene (GJB2/DFNB1)
Authors: Cohn Edward S. , Kelley Philip M. , Fowler Thomas W. , Gorga Michael P. , Lefkowitz David M. , Kuehn Harold J. , Schaefer G. Bradley , Gobar Lisa S. , Hahn Francis J. , Harris Djuana J. , Kimberling William J. 
Published: August 2004

Objective.
This retrospective study describes the phenotype associated with the single most common cause of genetic hearing loss. The frequency of childhood deafness is estimated at 1/500. Half of this hearing loss is genetic and ∼80% of genetic hearing loss is nonsyndromic and inherited in an autosomal recessive manner. Approximately 50% of childhood nonsyndromic recessive hearing loss is caused by mutations in the connexin 26 (Cx26) gene (GJB2/DFNB1), making it the most common form of autosomal recessive nonsyndromic hearing loss with a carrier rate estimated to be as high as 2.8%. One mutation, 35delG, accounts for ∼75% to 80% of mutations at this gene.

Methods.
Hearing loss was examined in 46 individuals from 24 families who were either homozygous or compound heterozygous for Cx26 mutations. A subset of these individuals were examined for vestibular function, otoacoustic emissions, auditory brainstem response, temporal bone computed tomography, electrocardiography, urinalyses, dysmorphology, and thyroid function.

Results.
Although all persons had hearing impairment, no consistent audiologic phenotype was observed. Hearing loss varied from mild-moderate to profound, even within the group of families homozygous for the common mutation 35delG, suggesting that other factors modify the phenotypic effects of mutations in Cx26. Furthermore, the hearing loss was observed to be progressive in a number of cases. No associations with inner ear abnormality, thyroid dysfunction, heart conduction defect, urinalyses, dysmorphic features, or retinal abnormality were noted.

Conclusion.
Newborns with confirmed hearing loss should have Cx26 testing. Cx26 testing will help define a group in which ∼60% will have profound or severe-profound hearing loss and require aggressive language intervention (many of these patients will be candidates for cochlear implants).
Parental Knowledge and Attitudes of Minnesota Laws Concerning Adolescent Medical Care
Authors: Cutler Ellen M. , Bateman Michael D. , Wollan Peter C. , Simmons Patricia S. 
Published: August 2004

Objective.
To determine parents' knowledge and attitudes of medicolegal issues affecting adolescent medical care.

Design.
An anonymous, mailed survey with 16 questions concerning Minnesota consent and confidentiality laws that affect adolescents' medical care.

Setting.
A community of &gt;70 000 in rural, southeastern Minnesota.

Participants.
Parents of 600 randomly selected 7th- through 12th-grade public school students.

Results.
Two hundred eighty-eight (48%) parents returned the surveys. Parents achieved a median score of 18.8% (range, 0%–93.8%) correct on a test of knowledge. Opinion was a median of +0.3 on a scale where −1 signified “a bad law,” 0 signified “neither a good nor bad law,” and +1 signified “a good law.” Four questions, however, generated a more intense response. Seventy-seven percent of parents reported that, as a whole, the laws in the survey had no effect on them and/or their children.

Conclusions.
These results suggest that parents are not knowledgeable of Minnesota laws that affect adolescent medical care. Overall opinion of these laws was mildly positive, with notable exceptions. Parents also lack a sense of impact of laws affecting adolescent medical care. Lack of knowledge and the presence of certain attitudes allow for identification of issues that clinicians should address by incorporating medicolegal education into the care of adolescents and their families. These results are especially timely in light of the Parental Rights and Responsibilities Act under consideration in Congress, which would provide parents greater authority over their children's medical care.