bluuebunny/crossref_metadata_2025_split huggingface dataset:
Too Many Pediatric Trampoline Injuries
Authors: Furnival Ronald A. , Street Kellee A. , Schunk Jeff E. 
Published: August 2004

Background.Recent reports note a dramatic increase in the number of pediatric trampoline injuries (PTI) during the past several years. In 1996, the US Consumer Product Safety Commission estimates that 83 000 patients received treatment for trampoline injuries in US hospital emergency departments (EDs), and that ∼75% of these patients were &lt;15 years of age. We sought to review our experience with PTI since our previous report (Pediatrics 1992;89:849), and to determine if the American Academy of Pediatrics' current (Pediatrics1981;67:438) safety recommendations are adequate.Methods.Retrospective medical record review of all PTI patients presenting to the pediatric ED from November 1990 through November 1997.Results.A total of 727 PTI patients were included; medical records were unavailable for 3 patients. The annual number of PTI nearly tripled during the study period, from 51 in 1991 to a peak of 148 in 1996. PTI patients were 53% female, with a median age of 7 years; 37% were &lt;6 years of age. Privately owned trampolines accounted for 99% of PTI. Most injuries (66%) occurred on the trampoline, 28% resulted from falls off, and 4% from imaginative mechanisms. One hundred eleven patients (15%) suffered severe injury (1990 Abbreviated Injury Scale value ≥3), usually of an extremity (89 out of 111). Fractures occurred in 324 patients (45%). Spinal injuries were common (12%), including 7 patients with cervical or thoracic fractures, and 1 with C7 paraplegia. Fractures were more frequently associated with falls off the trampoline, whereas spinal injuries more frequently occurred on the trampoline. Eighty patients (11%) required prehospital medical transport to our ED, 584 (80%) had ED radiographs, and 382 (53%) required pediatric surgical subspecialty involvement. Seventeen percent of PTI patients (125 out of 727) were admitted to the hospital, including 9 to the pediatric intensive care unit; 99 (14%) required one or more operations. Mean hospital stay was 2 days (range, 1–63 days); 24 stays (19%) were for ≥3 days. We estimate that the hospital charges for the acute medical care of PTI study patients at our institution totaled ∼$700 000.Conclusions.PTI are dramatically increasing in number, and result in considerable childhood morbidity. Most PTI occur on privately owned trampolines. Few, if any, safety recommendations for the trampoline are followed. We support recommendations for a ban on the recreational, school, and competitive pediatric use of trampolines.
Monkeybar Injuries: Complications of Play
Authors: Waltzman Mark L. , Shannon Michael , Bowen Anne P. , Bailey Mary Christine 
Published: August 2004

Background.
Playground equipment resulted in &gt;200 000 injuries from 1990 to 1994, according to the Consumer Product Safety Commission; 88% were attributable to climbers (monkeybars/jungle gyms [MB/JGs]), swings, and slides. Equipment-specific injury requiring emergency department (ED) evaluation has not been reported previously.

Objective.
To describe the spectrum of significant MB/JG-related injuries.

Methods.
A 2-year retrospective chart review was performed using the computerized charting system at a large urban Children's Hospital/Regional Pediatric Trauma Center with 50 000 ED visits per year. A telephone survey also was conducted after the chart review to obtain additional information concerning the injury location, the surface type below the equipment, and the presence of adult supervision.

Results.
A total of 204 patients were identified. Mean age was 6.2 years (range, 20 months to 12 years); 114 (56%) were male. A seasonal variation was noted with June to August accounting for 43% of visits. Injuries included fractures in 124 (61%), contusions in 20 (10%), neck and back strains in 17 (8%), lacerations in 16 (8%), closed head injuries in 10 (5%), abdominal trauma in 5 (3%), genitourinary injuries in 5 (3%), and miscellaneous injuries in the remainder. Among fractures, 90% were fractures of the upper extremity; 48 (40%) were supracondylar fractures. One child sustained a C7 compression fracture. Abdominal injuries included 1 child who sustained a splenic laceration. All genitourinary injuries (2 vaginal hematomas, 1 vaginal contusion, 1 penile laceration, and 1 urethral injury) were from straddle-type injuries. Fifty-one (25%) patients were admitted to the hospital. Of these, 47 (92%) required an operative procedure (orthopedic reduction or vaginal examination under anesthesia).
Analysis of the telephone data revealed that the surface did not influence the injury type. Of the 79 fractures, 30 occurred on “soft surfaces.” Injury type was associated significantly with chronologic age. Younger children (1 to 4 years of age) sustained more long-bone fractures than did older children. The presence of adult (at least 18 years of age) supervision, did not influence the occurrence of fractures.

Conclusions.
These data suggest that 1) a significant proportion (25%) of MB/JG-related injuries that are evaluated in the ED require hospitalization; 2) most of the injuries resulting in admission will require operative intervention (92%); 3) the surface below the equipment has no influence on the type or severity of the injury; 4) younger children are more likely to sustain long-bone fractures than are older children; and 5) adult supervision does not influence the injury pattern. These data identify the need for additional investigation of means of making MB/JGs safer for child use.
Safety and Immunogenicity of an Acellular Pertussis Vaccine in Premature Infants
Authors: Schloesser Rolf L. , Fischer Doris , Otto Walter , Rettwitz-Volk Werner , Herden Peter , Zielen Stefan 
Published: August 2004

Objectives.To evaluate the safety and immunogenicity of a two-component acellular pertussis vaccine in preterm infants.Study Design.Fifty preterm infants (25–35 weeks of gestation; mean, 30.8 weeks) and 50 term infants as a control group received a two-component acellular pertussis vaccine irrespective of their biological age and actual weight. Adverse reactions were registered by parents on a diary card and reviewed on each visit. Antibodies against pertussis toxoid (PT) and filamentous hemagglutinin (FHA) were determined with an enzyme-linked immunosorbent assay before the first and after the third vaccination.Results.The infants of both groups showed an increase in geometric mean titers (GMT) against PT and FHA after vaccination (3 doses). There was a significant difference of antibody concentration between the preterm and the control group. The GMT for PT antibody of the preterm infants was 64.16 U/L, and for the term infants it was 98.96 U/L. The GMT for FHA was 50.92 U/L in preterm versus 86.02 U/L in the control group. Efficacy of the immunization (more than a fourfold increase of antibody concentration in each infant) was 93.5% in the preterm group with respect to PT and 82.6% with respect to FHA. The incidence of adverse reactions was low and comparable in both study groups.Conclusion.Immunization with an acellular pertussis vaccine is safe for preterm infants. The immune response is significantly lower compared with a control group of term infants, but efficacy is high.
Combination Therapy With Stavudine (d4T) Plus Didanosine (ddI) in Children With Human Immunodeficiency Virus Infection
Authors: Kline Mark W. , Van Dyke Russell B. , Lindsey Jane C. , Gwynne Margaret , Culnane Mary , Diaz Clemente , Yogev Ram , McKinney Ross E. , Abrams Elaine J. , Mofenson Lynne M. ,   the Pediatric AIDS Clinical Trials Group 327 Team
Published: August 2004

Objectives.To evaluate the safety, tolerance, and antiviral activity of combination therapy with stavudine (d4T) plus didanosine (ddI) in symptomatic human immunodeficiency virus (HIV)-infected children.Methods.The study enrolled HIV-infected children who successfully completed Pediatric AIDS Clinical Trials Group (PACTG) protocol 240 (d4T versus zidovudine [ZDV] monotherapy) without disease progression or who had received ZDV monotherapy by prescription for at least the preceding 6 months. Children who had received d4T monotherapy in PACTG 240 were assigned to treatment with d4T plus ddI (arm 1). Children who had received ZDV monotherapy in PACTG 240 or by prescription were randomized in a double-blind manner to treatment with either d4T alone (arm 2) or d4T plus ddI (arm 3). Patients were followed for 48 weeks each.Results.A total of 108 children were enrolled. The mean age was 5.0 years (range, 1.6 to 11.5 years), with mean baseline plasma HIV RNA concentration and CD4+ lymphocyte count of 4.6 log10 copies/mL (range, 2.6 to 5.9 log10copies/mL) and 819 cells/μL (range, 8 to 3431 cells/μL), respectively. Both d4T monotherapy and d4T plus ddI combination therapy were well-tolerated, with 96 (89%) patients completing 48 weeks of study treatment. Plasma HIV RNA concentrations showed larger average declines in arm 3 compared with arm 2 at study week 12 (0.49 vs 0.18 log10 copies/mL, respectively); these average declines were maintained through week 48 (0.51 vs 0.17 log10 copies/mL, respectively). Fewer than 8% of the patients in any of the treatment arms had plasma HIV RNA concentrations below the limit of quantification (200 copies/mL) at any time point.Conclusions.Combination therapy with d4T plus ddI is safe and well-tolerated in HIV-infected children, producing durable, but incomplete, suppression of virus replication. This combination of nucleoside antiretroviral agents may provide a valuable backbone to protease inhibitor-containing treatment regimens for HIV-infected children.
Age-Within-School-Class and Adolescent Gun-carrying
Authors: Hayes D. Neil , Hemenway David 
Published: August 2004

Background.Intentional injuries (suicide and homicide) are a leading causes of morbidity and mortality in the United States. Firearms cause ∼70% of these fatal intentional injuries. Risk factors associated with gun-carrying in adolescent populations include male gender, smoking, alcohol use, drug use, and number of sexual partners. Current knowledge of these and other risk factors has provided limited benefit because many are no more obvious to the clinician a priori than is the tendency to carry guns. Increasing relative age of a student within school class is an easily measured parameter that has been associated with behavioral problems, absenteeism, negative self-image, and high dropout rates.Objective.To characterize the association between relative student age-within-class and tendency to carry firearms.Design.The Massachusetts Youth Risk Behavior Survey, which collects data on demographic characteristics, risk behaviors, and health outcomes.Participants.A randomly selected group of 3153 Massachusetts students in grades 9 through 11.Primary Outcome Measure.The odds of firearms-carrying comparing older to average-age and younger students.Results.Using multivariate logistic regression, seven risk factors predicted gun-carrying with statistically significant results: older age-within-class (OR: 2.12; 95% CI: 1.09–4.12), male gender (OR: 4.95; 95% CI: 3.01–8.15), black race (OR: 2.49; 95% CI: 1.20–5.14), gang membership (OR: 7.22; 95% CI: 4.51–11.56), missing school out of concern for safety (OR: 2.50; 95% CI: 1.30–4.80), seeking medical treatment after a fight (OR: 4.47; 95% CI: 2.56–7.78), and fighting without seeking medical treatment (OR: 5.73; 95% CI: 3.09–10.60).Conclusion.Older 9th-, 10th-, and 11th-grade students are more likely than their classmates to carry firearms. This information may prove helpful in identifying high-risk students and targeting prevention strategies.
Plasma Insulin-like Growth Factor-1, Type 1 Procollagen, and Serum Tumor Necrosis Factor α in Children Recovering FromTrichuris Dysentery Syndrome
Authors: Duff E. Marilyn Watson , BScN Nutr), MSc (Nutr), , Anderson Norma McFarlane , Cooper Edward S. 
Published: August 2004

Objectives.
To explore: 1) the relationship between plasma insulin-like growth factor-1 (IGF-1) and other markers of growth; and 2) the effect of serum concentrations of tumor necrosis factor α (TNF) on growth variables in children (2–10 years) stunted by Trichuris dysentery syndrome (TDS), recovering cases, and their matched controls.

Method.
Fourteen patients with TDS were admitted to the Tropical Metabolism Research Unit, treated with albendazole and iron, and then followed with matched controls (n = 28) for 1 year. Anthropometric and biochemical measurements were done on admission and then every 3 months for the year. Plasma IGF-1, the carboxyterminal propeptide of type 1 procollagen, serum TNF, total serum protein, serum albumin, and complete blood count were determined.

Results.
Low admission plasma levels of IGF-1 in TDS cases were accompanied by high serum levels of TNF, and total serum protein, normal serum albumin, low hemoglobin, reduced collagen synthesis (low plasma carboxyterminal propeptide of type 1 procollagen), and growth failure. These variables improved significantly after treatment. Plasma levels of IGF-1 were significantly related to theZ-scores for height-for-age (r = 0.60, 0.73, 0.68) and weight-for-age (r = 0.69, 0.80, 0.69) of cases and controls, height-for-age (r = 0.51, 0.52, 0.54) and weight-for-age (r = 0.51, 0.52, 0.54) at each measurement throughout the year. Serum levels of TNF were not related to any of the growth variables.

Conclusion.
These findings may contribute to the understanding of growth failure in children affected by other forms of chronic inflammatory bowel disease.
Breastfeeding Effects on Intelligence Quotient in 4- and 11-Year-Old Children
Authors: Jacobson Sandra W. , Chiodo Lisa M. , Jacobson Joseph L. 
Published: August 2004

ObjectiveA study of preterm children found an IQ advantage among those who were breastfed as infants after controlling for maternal social class and educational status. However, this advantage needs to be examined in light of other maternal characteristics, such as maternal IQ and parenting skills, which were not measured in that study and which have been found to be related to breastfeeding.Methodology.IQ was assessed in 323 children at 4 years of age on the McCarthy Scales of Children's Abilities and the Peabody Picture Vocabulary Test-Revised and in 280 children on the Wechsler Intelligence Test for Children-Revised at 11 years of age.Results.Children who were breastfed in infancy had significantly higher scores on IQ tests at both ages, even after adjusting for social class and education, confirming the earlier findings and extending them to a predominantly full-term sample. However, the effect of breastfeeding was no longer significant after adjusting for maternal IQ assessed on the Peabody Picture Vocabulary Test-Revised and for parenting skills assessed on the Home Observation for Measurement of the Environment. Significant relations between breastfeeding and Woodcock Reading Achievement scores at 11 years were also reduced to nonsignificant levels after the inclusion of maternal IQ and the Home Observation for Measurement of the Environment.Conclusions.These findings suggest that the observed advantage of breastfeeding on IQ is related to genetic and socioenvironmental factors rather than to the nutritional benefits of breastfeeding on neurodevelopment. They should not be interpreted as detracting from the medical benefits associated with breastfeeding.
Antiangiogenic Therapy of a Recurrent Giant Cell Tumor of the Mandible With Interferon Alfa-2a
Authors: Kaban Leonard B. , Mulliken John B. , Ezekowitz R. Alan , Phil D , Ebb David , Smith Peter S. , Folkman Judah 
Published: August 2004

We report a 5-year-old girl with a large rapidly growing giant cell tumor of the mandible that recurred 2 months after the first surgical excision and 3 months after a second resection. An angiogenic protein, (bFGF), was abnormally elevated in her urine. The patient was treated with interferon alfa-2a for 1 year because this agent inhibits angiogenesis by suppressing bFGF overexpression in infantile hemangiomas and in other human tumors. During this time the bone tumor regressed and disappeared, the urinary bFGF fell to normal levels, and the mandible regenerated. She has remained tumor-free and has been off therapy for 3 years at this writing.
This first successful use of interferon alfa-2a to treat a mandibular tumor in a child demonstrates: 1) low grade tumors that overexpress bFGF may respond to interferon alfa-2a, in a manner similar to life-threatening infantile hemangiomas; 2) antiangiogenic therapy, given without interruption for 1 year, was safe and effective in this patient; and 3) treatment may be continued for 1 year without the development of drug resistance.
Epidemiology of Otitis Media Onset by Six Months of Age
Authors: Daly Kathleen A. , Brown Judith E. , Lindgren Bruce R. , Meland Mary H. , Le Chap T. , Giebink G. Scott 
Published: August 2004

Objective.Although early otitis media (OM) onset predicts later recurrent and chronic OM, little research has been directed at illuminating the role of prenatal exposures in early OM. This prospective study examined prenatal, innate, and early environmental exposures associated with acute otitis media (AOM) onset and recurrent OM (ROM) by age 6 months.Design and Methods.Prospective study of 596 infants from a health maintenance organization followed from birth to 6 months. Mothers completed monthly forms on prenatal exposures (diet, medications, and illnesses) and infant risk factors (eg, smoke exposure and child care) during pregnancy and until infants were 6 months old. Urine samples were collected when infants were 2 months of age and analyzed for cotinine and creatinine. Physicians and nurse practitioners examined infants at each clinic visit and completed standard ear examination forms.Results.Thirty-nine percent had an episode of AOM and 20% had ROM by age 6 months. Using Cox's regression models to control for confounding, respiratory tract infection (relative risk [RR] 7.5), day care (RR 1.7), &gt;1 sibling (RR 1.4), maternal, paternal, and sibling OM history (RR 1.6, 1.5, and 1.7, respectively) were significantly related to early OM onset. ROM was related to respiratory tract infection (RR 9.5), day care (RR 1.9), conjunctivitis (RR 2.0), maternal OM history (RR 1.9), and birth in the fall (RR 2.6). Among prenatal exposures, only high prenatal dietary vitamin C intake was significantly inversely related to early AOM with univariate but not multivariate analysis.Conclusion.Prenatal factors were not linked to early AOM onset with multivariate analysis, but environmental and innate factors play an important role in early AOM onset. Strategies to reduce exposure to environmental variables could reduce rates of early AOM, which could potentially result in declining rates of ROM and chronic OME.
Access for Low-income Children: Is Health Insurance Enough?
Authors: Rosenbach Margo L. , Irvin Carol , Coulam Robert F. 
Published: August 2004

Objective.
The Balanced Budget Act of 1997 authorizes $20 billion for states to expand health insurance coverage among uninsured low-income children. This study identifies lessons learned from the Medicaid Extension Demonstration, which was authorized by Congress to experiment with innovative approaches to providing health care coverage for low-income children. The three programs compare and contrast a variety of features that may enhance or detract from access, including a traditional Medicaid expansion, a private indemnity model, and a comprehensive managed care delivery system.

Methodology.
Two waves of telephone surveys were conducted with a sample of parents of children participating in the Medicaid Extension Demonstration, and a comparison group of parents of children who were eligible but not participating. Descriptive and multivariate analyses were conducted to determine the impact of the demonstration on access to care.

Results.
Compared with those who were uninsured, children in the managed care program were more likely to have a medical home and a physician visit and were less likely to have an emergency room visit, and had lower levels of unmet need. Outcomes across the other two demonstration programs were less favorable.

Conclusions.
This study suggests that simply providing a Medicaid card or private indemnity insurance card is not enough to ensure access to care. Future initiatives also need to consider the structure of the delivery system, especially the availability of a medical home (with adequate after-hours care), as well as the impact of discontinuous insurance coverage on access to and continuity of care.
Impact of Simple Screening Criteria on Utilization of Low-yield Bacterial Stool Cultures in a Children's Hospital
Authors: Zaidi Anita K. M. , Macone Ann , Goldmann ASCP); and Donald 
Published: August 2004

Objective.
To determine diagnostic yield of stool cultures for Salmonella,Shigella, Campylobacter jejuni,Yersinia enterocolitica, and Escherichia coli O157:H7 (SSCYE) among hospitalized children and to develop guidelines for appropriate use of these tests.

Setting.
Tertiary care pediatric hospital.

Design.
Computerized records from the Microbiology Laboratory from January 1992 to December 1996 were reviewed retrospectively to collect data on the number of stool cultures performed in inpatients and outpatients, the length of hospital stay at the time cultures were sent, and diagnostic yield of cultures in hospitalized patients. A detailed review of medical records of all patients with a stool pathogen isolated after 3 days of hospitalization was also undertaken.
The results from this retrospective analysis were used to develop guidelines to reduce unwarranted stool cultures and to educate medical care providers in the appropriate use of these tests. The impact of these guidelines on reduction in the volume of stool cultures performed on hospitalized patients was measured prospectively from January 1998 to June 1998.

Results.
A total of 27 110 stool cultures for SSCYE were performed in the 5-year study period. Of the 14 125 cultures from inpatients, 174 (1.2%) were positive. Among the cultures from inpatients, 9378 (66%) were from patients hospitalized for &gt;3 days. Only 13 (.14%) were positive. Of these 13 cultures, 4 represented nosocomial infections, whereas the remaining 9 cultures either were sent to document clearance from a patient known previously to be infected with an enteric pathogen (7), or were attributed to delayed testing in individuals admitted with a diarrheal illness (2).
Introduction of guidelines to reject all SSCYE cultures from patients hospitalized for &gt;3 days who did not meet specified criteria was associated with an overall reduction of 689 (43%) in the volume of tests performed in the 6-month period evaluated. This included 497 fewer cultures ordered and 192 cultures that were ordered but rejected because screening criteria were not met. Only 11 (5.4%) of 203 cultures sent &gt;3 days after admission were processed because they met clinical criteria for testing. None were positive. Estimated cost savings were $50 163/year.

Conclusions.
Stool cultures for SSCYE among hospitalized patients have very low diagnostic yield and are extremely overutilized. Simple guidelines, such as rejecting (with few exceptions) cultures from patients hospitalized for &gt;3 days, can reduce substantially such unnecessary testing.