bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Resident Training in the Diagnosis and Treatment of Acute Otitis Media
Authors: Steinbach William J. , Sectish Theodore C. 
Published: August 2004

Objective. To investigate the presence and characteristics of formalized curricula for pediatric resident education for the diagnosis and treatment of acute otitis media.
Design. A survey was mailed to the program directors of all 224 accredited US and Canadian pediatric residency programs. Questions focused on the development, components, and teaching of any otitis media curriculum. Program directors were also questioned about their approach towards evaluating resident competency of otitis media and their future plans for otitis media-related training.
Results. A total of 144 program directors (64%) responded to the survey. Among respondents, 59% had some form of formalized education related to the diagnosis or treatment of otitis media. These curricula primarily consisted of lectures by general pediatricians &lt;3 times per year.
Conclusions. Although otitis media is the most common disease seen by practicing general pediatricians, the Residency Review Committee in Pediatrics does not mandate formal otitis media-related training. Aside from informal case-by-case education, this survey demonstrated that only slightly more than half of all pediatric residency programs have some formalized resident education of this common pediatric problem, and most of those curricula are infrequent lectures.
A New Look at Myelomeningoceles: Functional Level, Vertebral Level, Shunting, and the Implications for Fetal Intervention
Authors: Rintoul Natalie E. , Sutton Leslie N. , Hubbard Anne M. , Cohen Brian , Melchionni Jeanne , Pasquariello Patrick S. , Adzick N. Scott 
Published: August 2004

Objective. Previous reports have suggested that 80% to 85% of patients who have a myelomeningocele (MMC) and undergo surgical repair after birth develop hydrocephalus and require the placement of a ventricular shunt. However, the rate of shunting as a function of spinal level is not well established. We sought to determine the distribution of postnatally repaired MMC lesions as characterized by both functional and radiologic assessment, as well as the incidence of shunting when patients were categorized according to these 2 methods.
Methods. A retrospective chart review of 297 patients who were born with open MMCs and followed in the spina bifida clinic at the Children’s Hospital of Philadelphia was performed. The presence or absence of a shunt was determined for each patient. Functional spinal level was determined by the best-recorded neurologic examination and vertebral level by spine radiographs.
Results. The overall rate of ventricular shunting was 81%. The level of the lesion significantly affected the incidence of shunting, with more cephalad lesions correlating with higher rates. This was true both for functional and radiologic categorizations. A significantly higher shunt rate was found among patients with sacral lesions when categorized by radiologic rather than functional criteria. In 86% of patients, the functional level was found to be equal to or higher (worse) than the radiologic level.
Conclusions. This study describes the natural history of ventricular shunting in MMC patients with relation to both radiologic and functional criteria. Fetal MMC closure is being performed in some centers in an attempt to decrease the incidence of shunting and to improve leg function in selected patients. The present data may serve as a comparison group and aid in the design and analysis of a prospective trial to assess the efficacy of this new procedure.
Self-Esteem of Adolescents Who Were Born Prematurely
Authors: Saigal Saroj , Lambert Michael , Russ Chad , Hoult Lorraine 
Published: August 2004

Objective. To determine whether there are any differences between the self-esteem of a cohort of adolescents who were extremely low birth weight (ELBW) in comparison with term controls (Cs); and to test the associations between self-esteem and several predefined predictor variables.
Background. Self-esteem is considered to play a significant role in psychological adjustment and scholastic success. Little information exists on how adolescents who were ELBW regard themselves.
Design/Methods. Longitudinal follow-up of a regional cohort of 132/169 (78%) ELBW survivors and 127/145 (88%) sociodemographically matched Cs, born between 1977 and 1982. Measures: Harter Adolescent Self-Perception Profile (1988) with 9 dimensions, including Global Self-Worth, socioeconomic status (Hollingshead), height-for-age and weight-for-age z scores, and Wide Range Achievement Test—Revised (WRAT-R; Reading, Spelling, and Arithmetic). Data Analysis: General linear model multiple analyses of covariance were performed to determine whether significant relationships existed between the 9 self-esteem dimensions and the independent variables of birth weight status and gender, and the covariates of age, socioeconomic status, physical development, and academic achievement.
Results. Global Self Worth was similar for ELBW and Cs (means: 3.1 and 3.2). Multivariate effects revealed no interactions, but significant main effects emerged for birth weight status, gender, weight-for-age z scores, age in months, and for all 3 WRAT-R subtests, all effect sizes medium to large.
Follow-up analysis of covariance revealed medium-size gender effects for athletic competence (means: 3.1 and 2.6), and physical appearance (means: 2.9 and 2.5), where boys rated themselves significantly higher on both domains; and age effects, where older teens rated themselves better for job competence. Significant but small effect sizes emerged for the following: 1) weight-for-age z scores, where heavier youth rated themselves higher on close friendships, 2) gender, where girls had higher ratings for close friendships, 3) birth weight, where Cs rated themselves higher on athletic competence, and 4) WRAT-R math effect, where children with higher math scores rated themselves better on scholastic competence.
Conclusions. Overall, ELBW teenagers do not differ significantly from C teenagers on most dimensions of self-esteem. Gender effects emerged on some Harter domains.
Stature at Time of Diagnosis of Type 1 Diabetes Mellitus
Authors: DiLiberti John H. , Carver Koryn , Parton Elaine , Totka Joan , Mick Gail , McCormick Kenneth 
Published: August 2004

Objective. To assess the stature of children with type 1 diabetes mellitus at diagnosis.
Methods. We collected data from 451 records of children who were examined in a pediatric diabetes clinic and used data from the Third National Health and Nutrition Examination Survey for 10 522 children as control group. Analytical techniques included linear and logistic regression modeling. A semiquantitative meta-analysis evaluated 38 earlier publications that contain information on height at the onset of diabetes.
Results. Children &lt;1 year of age were shorter than their peers by 1 standard deviation, whereas those from 3 years to near puberty were taller by approximately 0.3 standard deviation. Adjusting for parental height caused this difference to disappear for the older children but not for the infants. The meta-analysis results paralleled these observations.
Conclusions. Taller children generally seem to experience increased risk for development of diabetes mellitus type 1, except perhaps during infancy or early adolescence. This observation may have implications regarding pathogenesis of this disorder.
Systemic Activity of Inhaled Steroids in 1- to 3-Year-Old Children With Asthma
Authors: Anhøj Jacob , Bisgaard Anne Marie , Bisgaard Hans 
Published: August 2004

Objective. To study the systemic activity of inhaled steroids in young children.
Methods. Forty children with mild asthma aged 1 to 3 years were studied in a 3-way crossover, randomized, placebo-controlled, double-blind trial. Treatment with inhaled fluticasone propionate, 200 μg twice daily delivered via pressurized metered-dose inhaler (pMDI) and Babyhaler (FP400), was compared with budesonide, 200 μg twice daily delivered via pMDI and NebuChamber (BUD400), and to placebo. The Babyhaler was primed before use. Knemometry was used to detect systemic steroid activity. It was performed with a hand-held knemometer after 1 and 4 weeks of treatment. The increase in lower-leg length within this 3-week period was used as the outcome measure. The intention-to-treat population was analyzed by analysis of variance.
Results. The increases in the lower-leg length during placebo, BUD400, and FP400 treatments were 85, 45, and 34 μm/d, respectively (adjusted mean). The growth in lower-leg length was significantly reduced from both steroid treatments. The difference between BUD400 and placebo was −40 μm/d (n = 25; 95% confidence interval [CI]: −8 to −72). The difference between FP400 and placebo was −51 μm/d (n = 26; 95% CI: −19 to −83). The difference between FP and BUD was −11 μm/d and was not statistically significant (n = 28; 95% CI: 20 to −42).
Conclusion. FP and BUD are both systemically active in children 1 to 3 years old when administered for 4 weeks from their dedicated spacer devices in daily doses of 400 μg with no difference between the 2 steroid regimens. These findings call for studies of clinical side effects from these treatments of preschool children.
Epidemiology of Pediatric Injury—Related Primary Care Office Visits in the United States
Authors: Hambidge Simon J. , Davidson Arthur J. , Gonzales Ralph , Steiner John F. 
Published: August 2004

Objectives. Unintentional injuries are a major cause of childhood mortality and morbidity in the United States. However, there is little epidemiologic information about pediatric injuries seen in primary care settings. The objective of this study was to characterize types and external causes of childhood injuries seen by primary care physicians and to compare the demographic and visit characteristics of children with injury-related visits (IRVs) and non-IRVs.
Methods. A stratified random sample survey of office-based practicing physicians in the National Ambulatory Medical Care Survey (1997 and 1998) was conducted. Injury-related primary care office visits were measured for patients who were &lt;19 years (number of patient visits = 6358).
Results. Visits for childhood injuries composed &gt;10 million primary care office visits per year (a rate of 13.8 visits per 100 person-years). The most common diagnoses assigned to these injuries were open wounds, sprains and strains, contusions, and superficial injuries such as abrasions and splinters. Leading external causes of these injuries were sports and overexertion, accidental falls, natural factors such as bites and stings, and cutting instruments. The single most common cause of pediatric injuries was sports/overexertion. Children who had IRVs were more likely to be older (odds ratio [OR]: 1.10/year of age; 95% confidence interval [CI]: 1.08–1.12), to be male (OR: 1.5; 95% CI: 1.2–1.9), and to reside in the West (OR: 1.9; 95% CI: 1.4–2.6) or in a rural area (OR: 1.4; 95% CI: 1.1–1.9). They were less likely to be Asian (OR: 0.2; 95% CI: 0.1–0.5) or Hispanic (OR: 0.5; 95% CI: 0.3–0.8). At the visit, children with IRVs were more likely to see a physician who was not their primary care physician (OR: 1.8; 95% CI: 1.4–2.3) and to see a family physician rather than a pediatrician (OR: 2.3; 95% CI: 1.8–2.9).
Conclusions. IRVs account for a significant portion of primary care for children in the United States. Identifying potentially preventable external causes of injury and characteristics of children who are more likely to be injured is important both for injury prevention programs and for the education of physicians who care for children.
Behavior and Development of Preschool Children Born to Adolescent Mothers: Risk and 3-Generation Households
Authors: Black Maureen M. , Papas Mia A. , Hussey Jon M. , Hunter Wanda , Dubowitz Howard , Kotch Jonathan B. , English Diana , Schneider Mary 
Published: August 2004

Objective. To investigate whether living in a 3-generation household (grandmother-mother-child) is associated with fewer behavior problems and better cognitive development among preschool children of mothers who gave birth during adolescence and whether it protects children from the behavior and developmental problems associated with maltreatment and maternal depression.Design. Cohort study.Setting. Participants included low-income families recruited from 4 sites: East, Northwest, Midwest, and South, who are part of LONGSCAN, a longitudinal study of children’s health, development, and maltreatment.Participants. One hundred ninety-four mothers who were adolescents (less than age 19) at delivery. Data were gathered when children were 4 to 5 years of age. Twenty-six percent of the children lived in 3-generation households, 39% had a history of maltreatment, and 32% of the mothers had depression scores in the clinical range.Main Outcome Measures. Child behavioral problems were measured with the Child Behavior Checklist, completed by the mother, and child developmental status was assessed with the Battelle Developmental Inventory Screening Test, administered by research assistants.Results. Multiple regression analyses revealed that children who had been reported for maltreatment and had mothers with depressive symptoms had more externalizing behavior problems, compared with children who experienced neither risk or only 1 risk. However, when residential status was considered, children with the greatest number of externalizing behavior problems were those who experienced both maltreatment and maternal depressive symptoms and lived in 3-generation households. Children who had been reported for maltreatment or had mothers with depressive symptoms were more likely to have internalizing problems, compared with children with neither risk. Residential status was not related to children’s internalizing behavior problems or cognitive development.Conclusions. Living in a 3-generation household did not protect preschool children from the behavior problems associated with maltreatment and depression. In contrast, living in a 3-generation household was associated with more behavior problems among the highest risk group of children—those who had been maltreated and had mothers with symptoms of depression. Although 3-generation families may provide an important source of support and stability for adolescent mothers and their infants early in the parenting process, it may not be advisable to rely on 3-generation households as young mothers enter adulthood, particularly among those with a history of maltreatment or depression. Children with the fewest number of behavior problems were living with their mothers in their own household (often with the father), had not been maltreated, and had mothers with few symptoms of depression.
Self-Esteem as a Predictor of Initiation of Coitus in Early Adolescents
Authors: Spencer Jennifer M. , Zimet Gregory D. , Aalsma Matthew C. , Orr Donald P. 
Published: August 2004

Objective. To examine the role of self-esteem in predicting coitus initiation in a population of early adolescents.Methods. Questionnaires assessing coital status, self-esteem, and pubertal maturation were collected from 188 participants who had not engaged in coitus by enrollment. Data were collected longitudinally while the participants were in the seventh and ninth grade. Ages ranged from 12 to 14 (mean: 12.50; standard deviation: 0.57) at Time 1 and from 14 to 16 (mean: 14.30; standard deviation: 0.49) at Time 2.Results. Boys with higher self-esteem ratings at Time 1 were more likely to initiate intercourse by Time 2. Girls with higher self-esteem at Time 1 were more likely to remain virgins than girls with lower self-esteem. Pubertal status was unrelated to initiation of coitus in this sample.Conclusions. Self-esteem, regardless of pubertal status, predicted coitus transition differentially in boys and girls. Results from this longitudinal study seem to fit within traditional problem behavior theory.
Household Composition and Risk of Fatal Child Maltreatment
Authors: Stiffman Michael N. , Schnitzer Patricia G. , Adam Patricia , Kruse Robin L. , Ewigman Bernard G. 
Published: August 2004

Objective. Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment.Methodology. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992–1994. Households were categorized based on adult residents’ relationship to the deceased child. Cases were all maltreatment injury deaths among children &lt;5 years old. Controls were randomly selected from natural-cause deaths during the same period and frequency-matched to cases on age. The main outcome measure was maltreatment death.Results. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6–21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6–12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1–4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8–2.0).Conclusions. Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home.
Placental Features in Preterm Infants With Periventricular Leukomalacia
Authors: Kumazaki Kaori , Nakayama Masahiro , Sumida Yutaka , Ozono Keiichi , Mushiake Sotaro , Suehara Noriyuki , Wada Yoshinao , Fujimura Masanori 
Published: August 2004

Objective. Evaluation of the placenta provides some important insights into pathophysiologic changes that take place during the prenatal and intrapartum process. We investigated the relationship between placental findings and periventricular leukomalacia (PVL) to obtain a better understanding of its cause.Methods. Thirty-two preterm infants with PVL delivered before 34 weeks’ gestation, between 1990 and 1999, were classified into 4 groups according to the onset of brain injury assumed from ultrasonographic presentation and clinical course: 2 Antenatal, 22 Peripartum, 5 Postnatal, and 3 in an unknown time of onset group. We evaluated the gross and histopathologic features of the placentas of each group and compared them with those of a control group matched by birth weight and gestational age in terms of the frequency of major placental findings. Potential confounding factors were controlled in logistic regression analyses.Results. Gross lesions with disturbance of uteroplacental circulation, including massive retroplacental hematoma, extensive infarction or thrombosis, and marked basal or perivillous fibrin deposition, were observed more frequently in the Antenatal + Peripartum combined subgroup than in the controls (41.7% vs 13.7%). Placentas from the Antenatal + Peripartum subgroup also demonstrated a significantly higher frequency of ischemic changes in villi, based on histopathologic examination, as compared with the control group (54.2% vs 13.7%). These associations remained after adjustment for confounding factors in logistic regression analyses (odds ratio: 4.04, 95% confidence interval: 1.40–11.67; and odds ratio: 7.28, 95% confidence interval: 2.50–21.20; respectively). Frequencies of chorioamnionitis and twin placentation tended to be higher in PVL cases than in the controls, although the differences were not statistically significant (46.9% vs 37.9%, 37.5% vs 20.0%, respectively).Conclusions. These results suggest that disturbed placental circulation underlies the development of PVL in the majority of cases with prenatal and peripartum brain injury. In chorioamnionitis cases, certain additional factors were suggested in the genesis of PVL. Thus, placental examination is essential for elucidating the pathophysiologic changes leading to PVL in the perinatal process.
Poor Readability of Written Asthma Management Plans Found in National Guidelines
Authors: Forbis Shalini G. , Aligne C. Andrew 
Published: August 2004

Objective. Written asthma management plans (WAMPs) for patients constitute a key component of current national asthma guidelines, but it is not known whether these plans meet the readability standards (of fifth-grade level or lower) recommended by health education experts. The objective of this study was to assess whether WAMPs presented in national guidelines are written at or below a fifth-grade reading level.Methods. We used readability software to analyze 10 WAMPs. These included 7 from the national guidelines, 1 from the World Health Organization, and 2 local ones.Results. The grade levels for the WAMPs ranged from 4.9 to 9.2. None of the national plans achieved a grade level equal to or below the fifth grade. However, the other plans had grade levels of 4.9, 5.7, and 5.9. The mean grade level for the national plans was 8.1, whereas the mean for the other 3 plans was 5.5. The difference between these 2 sets of WAMPs was significant.Conclusion. WAMPs presented as part of the national guidelines are not written at or below a fifth-grade reading level. However, it is clear from this study that it is possible to achieve this level of readability. Increasing the availability and use of plans that meet recognized readability standards may help to improve asthma outcomes, especially in poor populations in which there is both low literacy and the greatest prevalence and severity of asthma.