bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient Treatment of Moderate Croup With Dexamethasone: Intramuscular Versus Oral Dosing
Authors: Rittichier Kristine K. , Ledwith Carol A. 
Published: August 2004

Objective.Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.Methods.Patients between the ages of 3 months and 12 years with moderate croup (history or presence of stridor, cyanosis, or retractions) were eligible for enrollment in this single-blind, prospective study. Patients were randomized to receive a single dose (0.6 mg/kg, maximum 8 mg) of IM or PO dexamethasone. Parents were contacted by phone to assess resolution of symptoms and need for further evaluation.Results.Two hundred seventy-seven patients were enrolled (median age: 2.1 years). One hundred thirty-nine patients received IM dexamethasone, and 138 received PO. At phone follow-up, 141 (51%) had total resolution of symptoms (75 in IM, 66 in PO). Eighty patients (29%) returned for further evaluation (45 in IM, 35 in PO). Twenty-three (8%) received either more steroids, racemic epinephrine, or admission (11 in IM, 12 in PO).Conclusion.No statistically significant difference was found in the need for subsequent interventions after a single dose of either IM or PO dexamethasone. A single PO dose of dexamethasone can be effectively and safely used for the outpatient treatment of moderate croup.
Infantile Colic: Crying Time Reduction With a Whey Hydrolysate: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Lucassen Peter L. B. J. , Assendelft Willem J. J. , Gubbels Jan W. , van Eijk Jacques ThM. , Douwes Adriaan C. 
Published: August 2004

Objective.To determine the effectiveness of whey hydrolysate formula in the treatment of infantile colic in a primary care setting in the Netherlands.Study Design.Randomized, double-blind, parallel trial with a 1-week qualification period and a 1-week intervention period.Participants.Forty-three healthy, thriving, formula-fed infants, &lt;6 months old, crying &gt;3 hours per day on at least 3 days per week. Infants were randomized to whey hydrolysate formula (n = 23) or standard formula (n= 20).Main Outcome Measure.Difference in duration of crying (minutes per day) between qualification week and intervention week.Results.Analysis according to the intention to treat principle showed a difference in the decrease of crying duration of 63 minutes per day [95% confidence interval: 1–127 minutes per day] in favor of the whey hydrolysate formula. Five infants did not complete the trial. The scope of the study was not sufficient to expect significant differences in the subgroup analyses.Conclusions.An extensively hydrolyzed whey formula is effective in reducing the duration of crying in a primary care setting.
Do Pediatricians Recognize Mothers With Depressive Symptoms?
Authors: Heneghan Amy M. , Silver Ellen Johnson , Bauman Laurie J. , Stein Ruth E. K. 
Published: August 2004

Objective.To determine whether pediatric health care providers recognize maternal depressive symptoms and to explore whether maternal, provider, and visit characteristics affect pediatric providers' ability to recognize inner-city mothers with depressive symptoms.Design.A cross-sectional study was conducted at a hospital-based, inner-city, general pediatric clinic. Two groups of participants completed questionnaires, each unaware of the other's responses: 1) mothers who brought their children ages 6 months to 3 years for health care maintenance or a minor acute illness and 2) pediatric health care providers (attending pediatricians, pediatric trainees, and nurse practitioners). The mothers' questionnaire consisted of sociodemographic items and a self-administered assessment of depressive symptoms using the Psychiatric Symptom Index (PSI). Pediatric providers assessed child, maternal, and family functioning and documented maternal depressive symptoms. Criteria for positive identification of a mother by the pediatric health care provider were met if the provider reported one or more maternal symptoms (from a 10-item list of depressive symptoms), a rating of 4 or less on a scale of functioning, a yes response to the question of whether the mother was acting depressed, or a response that the mother was somewhat to very likely to receive a diagnosis of depression.Results.Of 338 mothers who completed the questionnaire, 214 (63%) were assessed by 1 of 60 pediatric providers. Seventy-seven percent of surveys were completed by the child's designated pediatric provider. The mean visit length was 23 minutes. Mothers primarily were single, were black or Hispanic, and had a mean age of 26 years (15–45 years). Almost 25% of mothers were living alone with their children. Eighty-six (40%) mothers scored ≥20 on the PSI, representing high symptom levels. Of these, 25 were identified by pediatric providers (sensitivity = 29%). A total of 104 of 128 mothers with a PSI score &lt;20 were identified as such by providers (specificity = 81%). Pediatric providers were more likely to identify mothers who were &lt;30 years old, living alone, and on public assistance. Also, mothers who were assessed by the child's own primary provider or by an attending pediatrician were more likely to be identified accurately than were mothers whose children were seen by a pediatric trainee or a nurse practitioner.Conclusions.Pediatric health care providers did not recognize most mothers with high levels of self-reported depressive symptoms. Pediatricians may benefit from asking directly about maternal functioning or by using a structured screening tool to identify mothers who are at risk for developing depressive symptoms. In addition, training pediatric providers to identify mothers with depressive symptoms may be beneficial.
Prevention of Sexual Harassment in the Workplace and Educational Settings
Authors:   Committee on Pediatric Workforce, Subcommittee on Women in Pediatrics
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2006-1816.
The American Academy of Pediatrics is committed to all its constituents supporting workplaces and educational settings free of sexual harassment. The purpose of this statement is to heighten awareness and sensitivity to this important issue, recognizing that institutions may have existing policies.
Technical Report: Irradiation of Food
Authors:   Katherine M. Shea, MPH MD, ,   the Committee on Environmental Health
Published: August 2004

This Technical Report was retired October 2004.
Recent well-publicized outbreaks of foodborne illness have heightened general interest in food safety. Food irradiation is a technology that has been approved for use in selected foods in the United States since 1963. Widespread use of irradiation remains controversial, however, because of public concern regarding the safety of the technology and the wholesomeness of irradiated foods. In this report, we describe the technology, review safety and wholesomeness issues, and give a historical perspective of the public controversy regarding food irradiation.
Hepatitis B Immunization Coverage Among Vietnamese-American Children 3 to 18 Years Old
Authors: Jenkins Christopher N. H. , McPhee Stephen J. , Wong Ching , Nguyen Thoa , Euler Gary L. 
Published: August 2004

Objective.Persons with chronic hepatitis B virus (HBV) infection are at increased risk of chronic hepatitis, cirrhosis, and liver cancer. Although HBV infection is relatively uncommon in the United States, the disease is endemic in persons born in Southeast Asia, including Vietnamese-Americans. Current US infant immunization recommendations and state-mandated school-entry programs have left many nontargeted age-cohorts unvaccinated and at risk of infection. To assess the need for catch-up hepatitis B immunizations, this study reports the hepatitis B immunization rates of Vietnamese-American children 3 to 18 years old living in the metropolitan areas of Houston and Dallas, Texas, and the Washington, DC, area.Design.We conducted 1508 telephone interviews with random samples of Vietnamese households in each of the 3 study sites. We asked for hepatitis B immunization dates for a randomly selected child in each household. Attempts were made to verify immunization dates through direct contact with each child's providers. Low and high estimates of coverage were calculated using reports from providers when reached (n = 720) and for the entire sample (n = 1508).Results.Rates of having 3 hepatitis B vaccinations ranged from 13.6% (entire sample) to 24.1% (provider reports, Dallas), 10.3% to 26.4% (Houston), and 18.1% to 37.8% (Washington, DC). Children living in the Texas sites, older children, children whose families had lived in the United States for a longer time, and children whose provider was Vietnamese or who had an institutional provider were less likely to have been immunized. The odds of being immunized were greater, however, for children who had had at least 1 diphtheria, tetanus toxoid, and pertussis shot, and whose parents had heard about HBV infection, and were married.Conclusions.The low rates of hepatitis B vaccine coverage among children and adolescents portend a generation which, too old to benefit from infant programs and school entry laws, will grow into adulthood without the protection of immunization. Increased efforts are needed to design successful catch-up campaigns for this population.
Demographic and Therapeutic Determinants of Pain Reactivity in Very Low Birth Weight Neonates at 32 Weeks' Postconceptional Age
Authors: Grunau Ruth Eckstein , Oberlander Tim F. , Whitfield Michael F. , Fitzgerald Colleen , Lee Shoo K. 
Published: August 2004

Background.
Management of pain in very low birth weight infants is limited by a lack of empiric knowledge about the multiple determinants of biobehavioral reactivity in infants receiving neonatal intensive care.

Objective.
To examine relationship of early neonatal factors and previous medication exposure to subsequent biobehavioral reactivity to acute pain of blood collection.

Design.
Prospective cohort study.

Methods.
One hundred thirty-six very low birth weight (≤1500 g) infants who underwent heel lance for blood collection at 32 weeks' postconceptional age formed the study sample, after excluding those with significant cerebral lesions (periventricular leukomalacia or cerebral parenchymal infarction [grade 4 intraventricular hemorrhage]) on cranial ultrasound. Pain reactions were assessed using the Neonatal Facial Coding System, infant state, and spectral analysis of change in heart rate variability from baseline to reaction to invasive stimulation. Factor analysis was used to provide an empirical basis for deriving summary pain scores, one factor was primarily behavioral and the other primarily autonomic.

Results.
A normal reaction to procedural pain is characterized by facial grimacing and heightened cardiac sympathetic activity. The most significant factors associated with altered behavioral and autonomic pain reactivity at 32 weeks' postconceptional age were a greater number of previous invasive procedures since birth and gestational age (GA) at birth, both of which were related to a dampened response. After controlling for these variables, exogenous steroid exposure made an independent contribution to both the behavioral and autonomic pain scores, also in the direction of dampening the response. Conversely, previous exposure to morphine was associated with “normalized” (ie, increased) rather than diminished responses. In addition, higher mean heart rate at baseline was associated with lower GA at birth and longer time on mechanical ventilation.

Conclusion.
Early pain exposure at very low GA may alter the autonomic substrate, resulting in infants who are in a perpetual state of stress. The results of this study suggest that the judicious use of analgesia may ameliorate these effects on later pain reactivity. However, although early morphine exposure may “normalize” subsequent pain reaction, this study did not examine its effects on neurodevelopment.
Does Fluorescent Urine Indicate Antifreeze Ingestion by Children?
Authors: Casavant Marcel J. , Shah Manish N. , Battels Ralph 
Published: August 2004

Objective.
Fluorescent urine has been reported to indicate antifreeze ingestion. Recently, we evaluated a child who was suspected of ethylene glycol ingestion. Although she had fluorescent urine, subsequent studies showed that she had not ingested antifreeze. We tested whether fluorescent urine indicates antifreeze ingestion by children.

Methods.
A convenience sample of urine specimens from 30 hospitalized children was obtained. All of the patients had been hospitalized for reasons unrelated to poisoning. The specimens were viewed with a Wood's lamp, and the samples were identified as fluorescent or not fluorescent. A second convenience sample of urine specimens from a group of 16 healthy children was obtained, and these specimens were identified as fluorescent or not fluorescent in a similar manner.

Results.
The majority of urine specimens obtained from children are fluorescent. There is variation in the interpretation of urine fluorescence among observers. The type of container used may influence the finding of fluorescence.

Conclusions.
Fluorescent urine is not an indicator of ethylene glycol antifreeze ingestion by children.
Behavior Problems in Children Before First Recognized Seizures
Authors: Austin Joan K. , Harezlak Jaroslaw , Dunn David W. , Huster Gertrude A. , Rose Douglas F. , Ambrosius Walter T. 
Published: August 2004

Objective.It is not known when behavior problems begin in children with epilepsy. The purposes of this study were to: 1) describe the rates of behavior problems in children before their first recognized seizure, 2) determine the differences in behavior problems between children with a first recognized seizure and their healthy siblings, and 3) identify the seizure variables early in the course of the condition that are associated with behavior problems before the first recognized seizure.Methods.The sample was 224 children (4–14 years old) with a first recognized seizure and their 135 healthy siblings. As part of a larger study, computer-assisted structured telephone interviews were conducted with mothers to measure child and sibling behavior problems. Behavior problems were measured using the Child Behavior Checklist. Frequencies, t tests, correlational analysis, and multiple regression were used to analyze data.Results.Higher than expected rates of behavior problems in the 6 months before the first recognized seizure were found in the total seizure sample, with 32.1% being in the clinical or at-risk range. Rates were highest in children who had previous events that were probably seizures, with 39.5% in the clinical or at-risk range. Children with seizures had significantly higher Total, Internalizing, Attention, Thought, and Somatic Complaints problem scores than their nearest-in-age healthy siblings. Within the seizure sample, variables significantly associated with behavior problems after adjusting for research site, child sex, child age, and socioeconomic status (as represented by primary caregiver's education) were interactions of previously unrecognized seizures with gender and epilepsy syndrome/type of seizures.Conclusions.Children with previously unrecognized seizures are already at increased risk for behavior problems at the time of their first recognized seizure. These findings are consistent with the hypothesis that in some children, epilepsy is a pervasive condition that includes both seizures and behavioral problems.
Child Health in the Information Age: Media Education of Pediatricians
Authors: Rich Michael , Bar-on Miriam 
Published: August 2004

Objective.Substantial research has associated exposure to entertainment media with increased levels of interpersonal violence, risky sexual behavior, body image distortion, substance abuse, and obesity. The objective of this study was to determine what pediatric residency programs are teaching trainees about media and the influence of media on the physical and mental health of children and adolescents.Design.Survey of residency curricula, consisting of 17 items about children's exposure to media, including television, movies, popular music, computer/video games and the Internet, the effects of this exposure on specific health risks, and associations between program characteristics and media education in the residency curriculum.Participants.Directors of the 209 accredited pediatric residency programs in the United States.Results.Two hundred four programs (97.6%) responded. Fifty-eight programs (28.4%) offered formal education on 1 or more types of media; 60 programs (29.4%) discussed the influences of media when teaching about specific health conditions. Residents in 96 programs (47.1%) were encouraged to discuss media use with patients and parents; 13 programs (6.4%) taught media literacy as an intervention. Among program characteristics, only media training received by program directors was significantly associated with inclusion of media in residency curricula.Conclusions.Despite increasing awareness of media influence on child health, less than one-third of US pediatric residency programs teach about media exposure. Developing a pediatric media curriculum and training pediatric residency directors or designated faculty may be a resource-effective means of improving health for children growing up in a media-saturated environment.
Peer, Parent, and Media Influences on the Development of Weight Concerns and Frequent Dieting Among Preadolescent and Adolescent Girls and Boys
Authors: Field Alison E. , Camargo Carlos A. , Taylor C. Barr , Berkey Catherine S. , Roberts Susan B. , Colditz Graham A. 
Published: August 2004

Objective.To assess prospectively the influence of peers, parents, and the media on the development of weight concerns and frequent dieting.Design.Prospective cohort study.Setting.Questionnaires mailed annually to participants throughout the United States.Participants.One-year follow-up of 6770 girls and 5287 boys who completed questionnaires in 1996 and 1997 and were between 9 and 14 years of age in 1996.Main Outcome Measure.Onset of high levels of concern with weight and dieting frequently to control weight.Results.During 1 year of follow-up, 6% of girls and 2% of boys became highly concerned with weight and 2% of girls and 1% of boys became constant dieters. Peer influence was negligible. Independent of age and body mass index, both girls (odds ratio [OR]): 1.9; 95% confidence interval [CI]: 1.1–3.1) and boys (OR: 2.7; 95% CI: 1.1–6.4) who were making a lot of effort to look like same-sex figures in the media were more likely than their peers to become very concerned with their weight. Moreover, both girls (OR: 2.3; 95% CI: 1.1–5.0) and boys (OR: 2.6; 95% CI: 1.1–6.0) who reported that their thinness/lack of fat was important to their father were more likely than their peers to become constant dieters.Conclusions.Our results suggest that parents and the media influence the development of weight concerns and weight control practices among preadolescents and adolescents. However, there are gender differences in the relative importance of these influences.
Review of 49 Neonates With Acquired Fungal Sepsis: Further Characterization
Authors: Makhoul Imad R. , Kassis Imad , Smolkin Tatiana , Tamir Ada , Sujov Polo 
Published: August 2004

Background.Neonatal acquired fungal sepsis (AFS) is a risky condition that warrants every effort for early diagnosis and management.Methods.We retrospectively reviewed the medical charts of all 4445 neonatal intensive care unit (NICU) admissions in the past 10 years and detected 49 neonates with AFS. We then compared their data with those of 49 matched control neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacterial therapy; laboratory and imaging investigations; and antifungal therapy and its complications.Results.The incidence of AFS was .4 to 2 cases per 1000 live-births and 3.8% to 12.9% of very low birth weight (VLBW) infants. Compared with 1989 through 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significantly increased (3.8%–5.6% → 9.6%–12.9%), along with a significant increase of NICU admission rate (369–410 → 496–510 admissions/year). Compared with controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previous treatment with broad-spectrum antibacterial agents (amikacin, vancomycin, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hyperthermia and 40.9% had normal white blood cell count. Causative fungi were as follows: Candida albicans—42.8% of cases, Candida parapsilosis—26.5%, and Candida tropicalis—20.4%. Fungal dissemination was rare, complications of antifungal therapy were infrequent, and no deaths occurred.Conclusions.First, non-albicans Candidahave become more frequent in neonatal AFS. Second, mechanical ventilation and antibacterial agents are significant risk factors for AFS. Third, hyperthermia is a frequent presenting sign of AFS. Fourth, a normal white blood cell count does not rule out AFS. Fifth, meningeal involvement in neonatal AFS should be ruled out before initiation of antifungal therapy. Sixth, the policy of empiric antifungal therapy for AFS should be considered on an individual NICU basis. newborn infant, fungal sepsis, clinical signs, risk factors.
The Timing of Neonatal Discharge: An Example of Unwarranted Variation?
Authors: Touch Suzanne M. , Greenspan Jay S. , Kornhauser Michael S. , O'Connor John P. , Nash David B. , Spitzer Alan R. 
Published: August 2004

Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week.
Objective. To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.
Study Design. All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.
Results. The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.
Conclusions. We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost.