bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lead and Mercury in Breast Milk
Authors: Gundacker Claudia , Pietschnig Beate , Wittmann Karl J. , Lischka Andreas , Salzer Hans , Hohenauer Leonhard , Schuster Ernst 
Published: August 2004

Objective. Heavy metals are potentially toxic substances, especially for the susceptible infant. Exposure to mercury (Hg) and lead (Pb) may result in neurotoxic and nephrotoxic impairment and in anemia. Previous data on breast milk Pb and Hg contents are sparse or missing for the Austrian population. No evaluations of the influence of mothers’ lifestyles on Pb and Hg levels in breast milk are available.Methods. Five- to 10-mL individual samples of breast milk were provided from healthy mothers in Vienna (urban; n = 59), Linz (industrial; n = 47), and Tulln (rural; n = 59). A questionnaire about area of residence, maternal nutrition, smoking habits, and dental fillings was filled out by the lactating mothers. Milk samples and infant formulas were lyophilized, wet-ashed with nitric acid (65%), and analyzed with atomic absorption spectrophotometry. Spiked skim milk powder was used as reference material. Statistical analysis included the Kruskal-Wallis test and multiple robust regression analysis.Results. Breast milk showed low Hg and Pb concentrations (Hg: 1.59 ± 1.21 1g/l, n = 116; Pb: 1.63 ± 1.66 6g/l, n = 138). Eight percent of the breast milk samples marginally exceeded the screening level of 3.5 μg/L for Hg. Austrian Pb values declined strongly during the last 20 years. Bivariate comparison revealed that the factors significantly related to metal levels in breast milk were area of residence (Hg, Pb), prematurity (Hg), consumption of fish (Pb) and cereals (Hg), vitamin supplementation (Hg), and smoking (Pb). The Hg and Pb contents of cow milk and infant formulas were far below respective guideline values.Conclusions. Neither Hg nor Pb concentrations exceeded critical levels. There are no reports on infants harmed by the intake of milk from unexposed mothers. We conclude that even theoretical risks from current Hg or Pb levels for the breastfed infant of a healthy mother can be ruled out.
Cardiorespiratory Stability of Premature and Term Infants Carried in Infant Slings
Authors: Stening Waltraud , Nitsch Patrizia , Wassmer Gernot , Roth Bernhard 
Published: August 2004

Objective. Parents in industrialized societies make increasing use of infant slings to carry their infants. This study was conducted to determine whether infants who are carried in slings are at risk of experiencing clinically relevant changes in cardiorespiratory measurements.Methods. In a 3-period crossover trial, 24 preterm and 12 term newborns were continually monitored while being carried horizontally or vertically in a sling or lying in a pram. Oxygen saturation, heart rate, nasal airflow, abdominal breathing, and movements were recorded.Results. Infants who were carried in slings were not at risk of clinically relevant changes of oxygen saturation or heart rate. The 90% confidence interval of oxygen saturation in both infant sling positions remained within a ±2% interval around the average oxygen saturation in the pram. However, a significant decrease of oxygen saturation was observed while infants were carried in a sling with a mean oxygen saturation of 96.3% (standard deviation [SD]: 1.8) in the vertical and 96.1% (SD: 2.0) in the horizontal sling position compared with the mean oxygen saturation in the pram (97.1%; SD: 1.5). The degree and the incidence of desaturations and bradycardia did not change while the infants were carried. Both types of episodes were seen only in preterm infants.Conclusion. The use of carrying slings is not associated with an increased risk of clinically relevant cardiorespiratory changes in term and preterm infants.
Effect of Supplemental Oxygen on Sleep Architecture and Cardiorespiratory Events in Preterm Infants
Authors: Simakajornboon Narong , Beckerman Robert C. , Mack Cindy , Sharon Denise , Gozal David 
Published: August 2004

Objective. To investigate the effect of low-flow supplemental oxygen (SupOx) on sleep architecture and cardiorespiratory events in asymptomatic preterm infants.Methods. An overnight polysomnographic evaluation was conducted prospectively in 23 premature infants who were born at 30.0 ± 3.2 (standard deviation) weeks’ gestational age and studied at 38.1 ± 4.4 weeks’ postconceptional age. Infants were free of any adverse events, including cardiorespiratory monitor alarms in the nursery for at least 1 week before the study. Infants received room air (RA) or SupOx via nasal cannula at 0.25 L/min.Results. Quiet sleep density was increased during SupOx (33.3 ± 10.8% vs 26.6 ± 10.0% total sleep time [TST] in RA), and a reciprocal decrease in active sleep density was observed (61.5 ± 11.1% vs 68.4 ± 9.9% TST in RA). No differences in sleep efficiency emerged (69.7 ± 10.6% SupOx vs 69.7 ± 8.8% RA). SupOx elicited significant decreases in apnea index (3.8 ± 2.4 events/h vs 11.1 ± 6.4 events/h in RA) and in the percentage of time spent in periodic breathing (1.8 ± 2.9% vs 6.7 ± 8.9% in RA). In addition, SupOx decreased the frequency of bradycardic events (0.3 ± 0.8 events vs 2.5 ± 0.03 events in RA) and improved overall oxygen saturation (98.7 ± 1.1% vs 96.4 ± 2.2%). No changes in alveolar ventilation, as derived from end-tidal CO2 measurements, was detected (38.6 ± 5.8 mm Hg in SupOx vs 38.4 ± 5.4 mm Hg in RA).Conclusions. Asymptomatic preterm infants exhibit frequent and potentially clinically adverse cardiorespiratory events when assessed in the sleep laboratory. Administration of SupOx to these infants is associated with an increase in the overall duration and percentage TST spent in quiet sleep with reciprocal changes in active sleep. In addition, improvement in respiratory stability is observed with the use of low-flow SupOx, as evidenced by a decrease in apnea, periodic breathing, and bradycardia, without adverse effects on alveolar ventilation.
Short-Term Growth Hormone Treatment in Girls With Turner Syndrome Decreases Fat Mass and Insulin Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study
Authors: Gravholt Claus Højbjerg , Naeraa Rune Weis , Brixen Kim , Kastrup Knud William , Mosekilde Leif , Jørgensen Jens Otto Lunde , Christiansen Jens Sandahl 
Published: August 2004

Background. Most girls with Turner syndrome (TS) receive growth hormone (GH) treatment during childhood and adolescence, but controlled data on the effects on body composition and glucose metabolism are lacking.
Objective. To study the effects of GH treatment on insulin sensitivity, glucose metabolism, bone turnover, and body composition.
Methods. A randomized, placebo-controlled, crossover study was conducted with girls with TS. All girls with TS were treated with GH 0.1 IU/kg/d subcutaneously at bedtime or with placebo for 2 months and studied at the end of each period. Control subjects were studied once without treatment. Twelve girls with TS, aged 9.5 to 14.8 years (median: 12.9 years) and 16 age-matched control subjects (10.3–16.0 years; median: 12.1 years) were studied. Twenty-four-hour sampling of blood was performed; GH, insulin-like growth factor I (IGF-I), IGF binding proteins (IGFBPs), insulin, glucose, and lipolytic and gluconeogenic precursors were assayed, followed by an oral glucose tolerance test. Body composition was evaluated by dual-energy x-ray absorptiometry scanning and body mass index (BMI). Fasting bone markers were measured.
Results. Height was reduced in TS as compared with control subjects. In the placebo situation, 24-hour integrated GH as well as IGF-I was significantly reduced in girls with TS compared with control subjects. Controlling for differences in lean body mass (LBM; or fat mass [FM]) and sexual development did not explain the difference in 24-hour integrated GH. Differences in sexual development, BMI, FM, insulin sensitivity, and IGFBP-3 could explain the difference in IGF-I between TS and control subjects. Carbohydrate metabolism in TS was comparable with control subjects. GH treatment induced insulin resistance, with increments in fasting glucose andinsulin, as well as 24-hour insulin. Circulating levels of lipid and gluconeogenic substrates were comparable in TS and control subjects and unchanged in response to treatment. Bone markers increased in response to GH. Total FM was increased in girls with TS, accounted for by an increased FM in the arms and trunk, whereas LBM was decreased. Especially LBM in the legs was decreased. Overall, bone mineral content was diminished. Treatment with GH reduced FM in TS, especially in the arms and legs, and likewise increased total LBM, primarily in the trunk.
Conclusion. This study documented evidence of impaired GH secretion and action, disproportionate body composition, but a normal carbohydrate metabolism in girls with TS. Short-term GH administration was associated with favorable changes in body composition but also with relative impairment of glucose tolerance and insulin sensitivity. We recommend that glucose metabolism be monitored carefully during long-term GH treatment in these patients.
National Estimates of the Timing of Sexual Maturation and Racial Differences Among US Children
Authors: Sun Shumei S. , Schubert Christine M. , Chumlea William Cameron , Roche Alex F. , Kulin Howard E. , Lee Peter A. , Himes John H. , Ryan Alan S. 
Published: August 2004

Objective. To provide clinically meaningful, normative reference data that describe the timing of sexual maturity indicators among a national sample of US children and to determine the degree of racial/ethnic differences in these estimates for each maturity indicator.
Methods. Tanner staging assessment of sexual maturity indicators was recorded from 4263 non-Hispanic white, black, and Mexican American girls and boys aged 8.00 to 19.00 years as part of the Third National Health and Nutrition Examination Survey (NHANES III) conducted between 1988 and 1994. NHANES III followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate the mean age and standard error for each maturity stage and the proportion of entry into a maturity stage and to incorporate the sampling weight and design effects of the NHANES III complex sampling design. Probit analysis and median age at entry into a maturity stage and its fiducial limits were calculated using SAS 8.2.
Results. Reference data for age at entry for maturity stages are presented in tabular and graphical format. Non-Hispanic black girls had an earlier sexual development for pubic hair and breast development either by median age at entry for a stage or for the mean age for a stage than Mexican American or non-Hispanic white girls. There were few to no significant differences between the Mexican American and non-Hispanic white girls. Non-Hispanic black boys also had earlier median and mean ages for sexual maturity stages than the non-Hispanic white and Mexican American boys.
Conclusion. Non-Hispanic black girls and boys mature early, but US children completed their sexual development at approximately the same ages. The present reference data for the timing of sexual maturation are recommended for the interpretation of assessments of sexual maturity in US children.
Discrepancies Between Direct and Indirect Blood Pressure Measurements Using Various Recommendations for Arm Cuff Selection
Authors: Clark Jeff A. , Lieh-Lai Mary W. , Sarnaik Ashok , Mattoo Tej K. 
Published: August 2004

Objective. The current recommendation for choosing an appropriate size cuff for measuring blood pressure (BP) is a bladder width to equal 40% of the upper arm circumference (UAC). However, most physicians use the older two-thirds or three-fourths upper arm length (UAL) recommendations to choose a cuff. The aim of this study was to verify the disparity in cuff size by using two-thirds UAL, three-fourths UAL, and 40% UAC criteria for cuff selection and to compare the indirectly measured BP by these criteria with directly measured radial intra-arterial BP.
Methods. A prospective, cross-sectional, observational study was conducted in 65 hemodynamically stable patients, aged 5 days to 22 years. Direct BP measurements were obtained from a radial intra-arterial catheter. Indirect BP measurements were taken from the same arm as the arterial catheter with a mercury sphygmomanometer and standard-size arm cuffs. UAL and UAC of each patient were measured, and the 3 cuffs closest to two-thirds and three-fourths UAL and 40% UAC were used. For each cuff, 3 direct and 3 indirect BP measurements were taken. Student t test was used to compare mean systolic and diastolic BP for direct and indirect measurements.
Results. A total of 172 observations were recorded, including 56 by two-thirds UAL, 55 by three-fourths UAL, and 61 by 40% UAC criteria. There was no significant difference between the means of the ideal cuff size by 40% UAC criterion and the actual cuffs used from the available standard cuffs. However, because of an unavailability of the larger cuffs for UAL criteria, the actual cuffs used were significantly smaller than ideal. Comparison of direct and indirect BP measurements revealed no significant difference in systolic BP when the latter was obtained by 40% UAC criterion. However, the difference in diastolic BP was significant. With available cuffs, a significant difference in systolic as well as diastolic BP was seen with both UAL criteria.
Conclusions. Practitioners are likely to use significantly larger arm cuffs when following the two-thirds and three-fourths UAL criteria than when following the 40% UAC criterion. Of the 3 criteria for cuff selection, systolic BP by 40% UAC criterion most accurately reflects directly measured radial arterial pressure. However, the 40% UAC cuff significantly overestimates the diastolic pressure. Using available cuffs for indirect measurements by two-thirds and three-quarters UAL criteria significantly underestimates systolic as well as diastolic BP when compared with radial intra-arterial BP.
Time Lag to Diagnosis of Stroke in Children
Authors: Gabis Lidia V. , Yangala Ravi , Lenn Nicholas J. 
Published: August 2004

Objective. Strokes occur rarely in children, and the causes are different from those in adults. Frequently, more than 1 cause is found. The consequences are lifelong significant disability in a majority of cases. Children who are younger than 18 years have not been included in therapeutic trials of thrombolytic or neuroprotective agents. We evaluated whether children who receive a diagnosis of stroke meet a major inclusion criterion for such trials, namely time to diagnosis of &lt;3 to 6 hours.
Methods. Prospective documentation and retrospective chart review was conducted of children who were 0 to 18 years and carried a diagnosis of stroke during the last 2 years in the hospital database, including children who presented with either ischemic or hemorrhagic strokes.
Results. Forty-seven events were encountered in 41 children. Twelve neonates with stroke, diagnosed in the neonatal period, were excluded from the subsequent analysis. In the remaining 29 children, the mean age at presentation was 8.67 years. Accurate time records were available in 24 children. In this group, 28 events were recorded. Time from clinical onset to first medical contact averaged 28.5 hours, and the time to diagnosis of stroke averaged 35.7 hours. We subsequently separated between children with ischemic (21 documented events) and hemorrhagic strokes (7 documented events), because the presentation and the intervention options are different.
Conclusions. Stroke in children is rarely diagnosed in the time frame of 3 to 6 hours. Given the causes and outcome of stroke in children, this age group might benefit from thrombolysis and from neuroprotective therapy, yet the long delay in diagnosis in this age group excludes most cases from being considered for such treatments. This situation should encourage attempts to increase public and professional awareness of stroke in children and of the potential value of early diagnosis and treatment, preferably by broadening current educational efforts to all age groups.
Hepatitis B Vaccination Among Adolescents in 3 Large Health Maintenance Organizations
Authors: González Idalia M. , Averhoff Francisco M. , Massoudi Mehran S. , Yusuf Hussain , DeStefano Frank , Kramarz Piotr , Maher Julie E. , Mullooly John P. , Chun Colleen , Davis Robert L. , Black Steven B. , Shinefield Henry R. ,   the Vaccine Safety Datalink Team
Published: August 2004

Objective. In 1995, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis B (HB) vaccination of all unvaccinated 11- to 12-year-old adolescents. Little is known about the implementation of these recommendations in a managed care setting. The objective of this study was to determine the impact of ACIP recommendations on HB vaccination among adolescents in 3 managed care settings.
Methods. We assessed HB vaccination coverage among adolescents who were enrolled in 3 large health maintenance organizations (HMOs) and who turned 13 years old after the 1995 ACIP recommendations. Children who were 8 to 10 years of age during May 1993 and were continuously enrolled through December 1998 were eligible. We used the HMOs’ computerized immunization tracking system to collect HB vaccination dates. The percentage of adolescents who received 3 doses of HB vaccine was determined.
Results. In HMOs A, B, and C, coverage levels for 3 doses of HB vaccine were 43.4%, 65.5%, and 25.7%, respectively, among 13-year-olds in 1998 compared with 26.1%, 50.4%, and 5.5% among 13-year-olds in 1996. Between the ages of 11 and 13 years, coverage rates among adolescents aged 13 in 1998 rose more than the coverage among adolescents aged 13 in 1996. The proportion of 13-year-olds in 1998 who received the first dose of HB vaccine by December 1998 was much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B, and C, respectively, compared with the proportion who completed the 3-dose series (43.4%, 65.5%, and 25.7%, respectively).
Conclusions. After the 1995 ACIP recommendations, HB vaccination coverage levels among 13-year-olds increased in each of the HMOs, suggesting adherence with national recommendations. Differences among the 3 HMOs may reflect differences in internal policies. More effective strategies may be needed to achieve the Healthy People 2010 goal of 90% vaccination coverage rates among adolescents.
Timeliness of Childhood Immunizations
Authors: Luman Elizabeth T. , McCauley Mary Mason , Stokley Shannon , Chu Susan Y. , Pickering Larry K. 
Published: August 2004

Objective.To examine the timeliness of vaccine administration among infants and young children in the United States.
Methods. We analyzed age at receipt of vaccines among 16 211 children aged 24 to 35 months in the 2000 National Immunization Survey and examined receipt at the recommended time of each dose and selected vaccination series, as well as receipt at 4 additional time frames: acceptably early, late, never by 24 months, and too early to be considered valid. We also examined the relationship between timeliness of vaccinations and characteristics of the child, mother, and immunization provider, using multivariate logistic regression.
Results. Only 9% of children received all recommended vaccines at the recommended ages. The rates varied significantly by antigen, ranging from 24% for all Haemophilus influenzae type b doses to 75% for all hepatitis B doses as recommended. Overall, 55% of children did not receive all recommended doses by 24 months of age, and 8% of children received at least 1 vaccination dose too early to be considered valid. Factors associated with not receiving all vaccines as recommended were having more children in the household, mothers younger than 30 years, use of public providers, and multiple vaccination providers.
Conclusions. By 24 months of age, 9 of 10 children received at least 1 vaccine outside the recommended age ranges. High vaccination status of children at 24 months of age does not reflect the reality that many vaccinations are not given at the appropriate ages. Timeliness of vaccination is critical to prevent disease outbreaks, protect children through their first 2 years of life, and minimize the need to repeat doses.
Effect of Child Health Insurance Plan Enrollment on the Utilization of Health Care Services by Children Using a Public Safety Net System
Authors: Eisert Sheri , Gabow Patricia 
Published: August 2004

Objective. To examine differences in health care services utilization between children who are enrolled in the Child Health Insurance Plan (CHIP) and uninsured children and between children before and during their enrollment period in CHIP.Methods. Denver County CHIP enrollment data from 1998 through 2000 were merged with Denver Health utilization data from 1998 through 2000 to determine utilization rates for CHIP-enrolled children at Denver Health (n = 2005). The first method compared the rates of CHIP-enrolled children with those of uninsured children (n = 20 374) during the same time period. The second method compared the utilization of services for children enrolled in CHIP during 1999 before CHIP enrollment (n = 748) and during CHIP enrollment (n = 757). The outcomes measured include emergency, urgent care, specialty care, well-child care, dental visits, and immunizations.Results. For the first method, CHIP children were more likely to have well-child care, dental, and specialty visits and the recommended immunizations than uninsured children. They were less likely to have an emergency care visit than uninsured children. For the second method, before enrolling in CHIP, children had fewer outpatient visits and were less likely to have a well-child care visit than during their enrollment span in CHIP. There was not a significant difference before and during enrollment for the other outcome measures for these children.Conclusions. These results indicate that children who are enrolled in CHIP are more likely to receive preventive care services and less likely to use emergency care than uninsured children, even within a safety net institution, emphasizing the benefits of public insurance programs for children.
Asthma Management and Environmental Tobacco Smoke Exposure Reduction in Latino Children: A Controlled Trial
Authors: Hovell Melbourne F. , Meltzer Susan B. , Wahlgren Dennis R. , Matt Georg E. , Hofstetter C. Richard , Jones Jennifer A. , Meltzer Eli O. , Bernert J. Thomas , Pirkle James L. 
Published: August 2004

Objectives. This study tested the efficacy of coaching to reduce environmental tobacco smoke (ETS) exposure among asthmatic Latino children.Design. After asthma management education, families were randomly assigned to no additional service (control condition) or to coaching for ETS exposure reduction (experimental condition).Setting. The study was conducted in San Diego, California.Participants. Two hundred four Latino children (ages 3–17 years) with asthma participated.Intervention. Approximately 1.5 hours of asthma management education was provided; experimental families also obtained 7 coaching sessions (∼45 minutes each) to reduce ETS exposure.Outcome Measures. Reported ETS exposure and children’s urine cotinine were measured.Results. Parents in the coached condition reported their children exposed to significantly fewer cigarettes than parents of control children by 4 months (postcoaching). Reported prevalence of exposed children decreased to 52% for the coached families, but only to 69% for controls. By month 4, mean cotinine levels decreased among coached and increased among control children. Cotinine prevalence decreased from 54% to 40% among coached families, while it increased from 43% to 49% among controls. However, cotinine levels decreased among controls to the same level achieved by coached families by the 13-month follow-up.Conclusions. Asthma management education plus coaching can reduce ETS exposure more than expected from education alone, and decreases in the coached condition may be sustained for about a year. The delayed decrease in cotinine among controls is discussed.