bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Decline in US Teen Pregnancy Rates, 1990–1995
Authors: Kaufmann Rachel B. , Spitz Alison M. , Strauss Lilo T. , Morris Leo , Santelli John S. , Koonin Lisa M. , Marks James S. 
Published: August 2004

Objectives.
Estimate pregnancy, abortion, and birth rates for 1990 to 1995 for all teens, sexually experienced teens, and sexually active teens.

Design.
Retrospective analysis of national data on pregnancies, abortions, and births.

Participants.
US women aged 15 to 19 years.

Outcome Measures.
Annual pregnancy, abortion, and birth rates for 1990 to 1995 for women aged 15 to 19 years, with and without adjustments for sexual experience (ever had intercourse), and sexual activity (had intercourse within last 3 months).

Results.
Approximately 40% of women aged 15 to 19 years were sexually active in 1995. Teen pregnancy rates were constant from 1990 to 1991. From 1991 to 1995, the annual pregnancy rate for women aged 15 to 19 years decreased by 13% to 83.6 per 1000. The percentage of teen pregnancies that ended in induced abortions decreased yearly; thus, the abortion rate decreased more than the birth rate (21% vs 9%). From 1988 to 1995, the proportion of sexually experienced teens decreased nonsignificantly.

Conclusions.
After a 9% rise from 1985 to 1990, teen pregnancy rates reached a turning point in 1991 and are now declining. Physicians should counsel their adolescent patients about responsible sexual behavior, including abstinence and proper use of regular and emergency contraception.
Early Developmental Outcome After the Norwood Procedure for Hypoplastic Left Heart Syndrome
Authors: Kern Jeffrey H. , Hinton Veronica J. , Nereo Nancy E. , Hayes Constance J. , Gersony Welton M. 
Published: August 2004

Objective.To assess intellect and adaptive behavior in children with hypoplastic left heart syndrome (HLHS) who had undergone at least two surgical stages of the Norwood procedure.Methods.Fourteen children with HLHS &gt;3 years of age participated in the study. The patients underwent intelligence quotient (IQ) testing, and their parents were interviewed regarding their children's adaptive behavior. Results were compared with those of 10 family controls. Outcomes were studied for possible correlation with perioperative variables.Results.Among the HLHS patients, the median scores for full scale IQ and adaptive behavior were 88 and 91, respectively (normal = 100 ± 15). One child met criteria for mental retardation. Family controls scored generally higher than did HLHS patients, but only differences in adaptive behavior were statistically significant. A negative correlation was found between stage I circulatory arrest time and full scale IQ.Conclusions.Children with HLHS most often function in the low-normal range of intelligence and adaptive behavior. A prolonged circulatory arrest time may result in decreased intellectual function.
Early Versus Late Surfactant Treatment in Preterm Infants of 27 to 32 Weeks' Gestational Age: A Multicenter Controlled Clinical Trial
Authors: Gortner Ludwig , Wauer Roland R. , Hammer Hannes , Stock Gerd-J. , Heitmann Friedhelm , Reiter Hans L. , Kühl Peter G. , Möller Jens C. , Friedrich Hans-J. , Reiss Irwin , Hentschel Roland , Jorch Gerhard , Hieronimi Gertrud , Kuhls Eckhard 
Published: August 2004

Objective.To investigate whether early (&lt;1 hour after birth) surfactant administration would be superior to late treatment (2–6 hours after birth) in preterm infants.Study Design.Randomized controlled multicenter clinical trial.Patients and Methods.Prenatal randomization of all infants of 27 to 32 weeks' gestational age stratified by center after parental informed consent. Early treatment: 100 mg/kg body weight bovine surfactant (SF-RI1, Alveofact; Dr K. Thomae, Biberach, Germany) to infants requiring intubation after birth. Late treatment: identical dosage to infants requiring intubation up to 6 hours of age with the fraction of inspired oxygen &gt;0.4 at 2 to 6 hours after birth. Primary endpoint: the time on mechanical ventilation. Main secondary endpoints: mortality, bronchopulmonary dysplasia, intraventricular hemorrhage ≥grade III, and periventricular leukomalacia. Sample size calculation: at least 280 infants to prove superiority of either approach (α = 0.05; β = 0.90).Results.Enrollment of 317 infants, 154 randomized to early surfactant treatment, 163 to late surfactant treatment. Study infants (all following data intent-to-treat groups: early versus late surfactant) were similar with respect to: gestational age, 29.5 ± 1.6 weeks versus 29.7 ± 1.6 weeks; birth weight, 1227 ± 367 g versus 1269 ± 334 g; and the rate of prenatal corticosteroids, 79.9% versus 72.8%. Duration of mechanical ventilation: 3 days (0–8) versus 2 days (0–6) (median, interquartile); further outcome variables: death or bronchopulmonary dysplasia (day 28) 25.9% versus 23.9%, mortality 3.2% versus 1.8%, intraventricular hemorrhage ≥grade III 6.5% versus 3.7%, and periventricular leukomalacia 5.2% versus 5.5% not differing statistically.Conclusion.In preterm infants with a high rate of prenatal glucocorticoids, early surfactant administration was not found to be superior to late treatment in terms of relevant outcome variables.
Early Sexual Initiation: The Role of Peer Norms
Authors: Kinsman Sara B. , Romer Daniel , Furstenberg Frank F. , Schwarz Donald F. 
Published: August 2004

Objective.To elucidate which components of peer norms influence the process of sexual initiation for young adolescents.Design.Prospective cohort study.Setting.Fourteen elementary and middle schools in an urban public school district.Participants.The 1389 sixth-grade students who completed the questionnaire at the beginning (time 1) and at the end (time 2) of the school year comprise the study sample. Mean age at time 1 was 11.7 years.Results.Of students entering the sixth grade, 30% (n = 416) reported having already initiated sexual intercourse, 5% (n = 74) reported initiating sexual intercourse during the sixth-grade school year (initiated group), and 63% (n = 873) reported not having initiated sexual intercourse by the end of the sixth-grade school year (never group). Demographic comparisons revealed that students in the initiated group were significantly more likely than students in the never group to be older (11.9 years vs 11.6 years), male (58% vs 37%), African-American (70% vs 51%), attending a poorer school (87% vs 85%), and living in an area with a high proportion of single-parent families (45% vs 41%). Self-reports and reports of peers' participation in nonsexual risk behaviors were more common for students in the initiated group. Students in the initiated group were more likely than students in the never group to perceive: 1) a high prevalence of sexual initiation among peers; 2) social gains associated with early sexual intercourse; and 3) younger age of peers' sexual initiation. Students in the never group were more likely to believe that sexually-experienced 12-year-old boys would be negatively stigmatized compared with students in the initiated group. Three predictive models were developed to test the relationship between peer norms and the process of initiation. These models demonstrate that the strongest predictor of sexual initiation in sixth grade is having high intention to do so at the beginning of sixth grade. The strongest predictor of high intention is belief that most friends have already had sexual intercourse. Perceptions of social gain and stigma for sexually-experienced 12-year-old boys act independently of intention to decrease risk of early sexual initiation.Conclusion.Early sexual intercourse is not an unplanned experience for many teens. Decisions about initiation are strongly bound to social context with peers playing an important role in creating a sense of normative behavior. Specific components of peer norms impact the process of sexual initiation in both positive and negative ways. Interventions aimed at delaying the onset of sexual initiation need to focus on cohort norms as well as on an individual's perceptions and behaviors.
Hyperbaric Oxygen Therapy in the Pediatric Patient: The Experience of the Israel Naval Medical Institute
Authors: Waisman Dan , Shupak Avi , Weisz Giora , Melamed Yehuda 
Published: August 2004

The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases.Objective. To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients.Design. A retrospective analysis and review of all records of patients younger than age 18 years.Results. Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischemia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1.4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischemia group (4.3%) underwent limb amputation.Conclusions. We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.
Annual Summary of Vital Statistics—1997
Authors: Guyer Bernard , MacDorman Marian F. , Martin Joyce A. , Peters Kimberley D. , Strobino Donna M. 
Published: August 2004

Many positive trends in the health of Americans continued into 1997. In 1997, the preliminary birth rate declined slightly to 14.6 births per 1000 population, and the fertility rate, births per 1000 women 15 to 44 years of age, was unchanged from the previous year (65.3). These indicators suggest that the downward trend in births observed since the early 1990s may have abated.Fertility rates for white, black, and Native American women were essentially unchanged between 1996 and 1997. Fertility among Hispanic women declined 2% in 1997 to 103.1, the lowest level reported since national data for this group have been available. For the sixth consecutive year, birth rates dropped for teens. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women (32.4%) was unchanged in 1997.The trend toward earlier utilization of prenatal care continued for 1997; 82.5% of women began prenatal care in the first trimester. There was no change in the percentage with late (third trimester) or no care in 1997. The cesarean delivery rate rose slightly to 20.8% in 1997, a reversal of the downward trend observed since 1989. The percentage of low birth weight (LBW) infants rose again in 1997 to 7.5%. The percentage of very low birth weight was up only slightly to 1.41%. Among births to white mothers, LBW increased for the fifth consecutive year, to 6.5%, whereas the rate for black mothers remained unchanged at 13%. Much, but not all, of the rise in LBW for white mothers during the 1990s can be attributed to an increase in multiple births. In 1996, the multiple birth rate rose again by 5%, and the higher-order multiple birth rate climbed by 20%.Infant mortality reached an all time low level of 7.1 deaths per 1000 births, based on preliminary 1997 data. Both neonatal and postneonatal mortality rates declined. In 1996, 64% of all infant deaths occurred to the 7.4% of infants born at LBW. Infant mortality rates continue to be more than two times greater for black than for white infants. Among all the states in 1996, Maine, Massachusetts, and New Hampshire had the lowest infant mortality rates. Despite declines in infant mortality, the United States continues to rank poorly in international comparisons of infant mortality.Expectation of life at birth reached a new high in 1997 of 76.5 years for all gender and race groups combined. Age-adjusted death rates declined in 1997 for diseases of the heart, accidents and adverse affects (unintentional injuries), homicide, suicide, malignant neoplasms, cerebrovascular disease, chronic liver disease and cirrhosis, and diabetes. In 1997, mortality due to HIV infection declined by 47%. Death rates for children from all major causes declined again in 1997. Motor vehicle traffic injuries and firearm injuries were the two major causes of traumatic death. A large proportion of childhood deaths continue to occur as a result of preventable injuries.
The Efficacy of the Ketogenic Diet—1998: A Prospective Evaluation of Intervention in 150 Children
Authors: Freeman John M. , Vining Eileen P. G. , Pillas Diana J. , Pyzik Paula L. , Casey Jane C. , Kelly LCSW; and Millicent T. 
Published: August 2004

Objective.The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet developed in the 1920s for the treatment of children with difficult to control seizures. Despite advances in both the pharmacotherapy and the surgery of epilepsy, many children continue to have difficult-to-control seizures. This prospective study sought to determine the ketogenic diet's effectiveness and tolerability in children refractory to today's medications.Methods.One hundred fifty consecutive children, ages 1 to 16 years, virtually all of whom continued to have more than two seizures per week despite adequate therapy with at least two anticonvulsant medications, were prospectively enrolled in this study, treated with the ketogenic diet, and followed for a minimum of 1 year. Seizure frequency was tabulated from patients' daily seizure calendars and seizure reduction calculated as percentage of baseline frequency. Adverse events and reasons for diet discontinuation were recorded.Results.The children (mean age, 5.3 years), averaged 410 seizures per month before the diet, despite an exposure to a mean of 6.2 antiepileptic medications. Three months after diet initiation, 83% of those starting remained on the diet and 34% had &gt;90% decrease in seizures. At 6 months, 71% still remained on the diet and 32% had a &gt;90% decrease in seizures. At 1 year, 55% remained on the diet and 27% had a &gt;90% decrease in seizure frequency. Most of those discontinuing the diet did so because it was either insufficiently effective or too restrictive. Seven percent stopped because of intercurrent illness.Conclusions.The ketogenic diet should be considered as alternative therapy for children with difficult-to-control seizures. It is more effective than many of the new anticonvulsant medications and is well tolerated by children and families when it is effective.
Clinical Characteristics and Outcome of Children With Pneumonia Attributable to Penicillin-susceptible and Penicillin-nonsusceptibleStreptococcus pneumoniae
Authors: Tan Tina Q. , Mason Edward O. , Barson William J. , Wald Ellen R. , Schutze Gordon E. , Bradley John S. , Arditi Moshe , Givner Laurence B. , Yogev Ram , Kim Kwang Sik , Kaplan Sheldon L. 
Published: August 2004

Objective.
To compare the clinical characteristics, treatment, and outcome of pediatric patients with pneumonia attributable to isolates of Streptococcus pneumoniae that were either susceptible or nonsusceptible to penicillin.

Design.
Multicenter, retrospective study.

Setting.
Eight children's hospitals in the United States.

Participants.
Two hundred fifty-four children with pneumococcal pneumonia identified from patients enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study during the 3-year period from September 1, 1993 to August 31, 1996.

Outcome Measures.
Demographic and clinical variables including necessity for and duration of hospitalization, frequency of chest tube placement, antimicrobial therapy, susceptibility of isolates, and clinical outcome.

Results.
There were 257 episodes of pneumococcal pneumonia that occurred in 254 patients. Of the 257 isolates, 22 (9%) were intermediate and 14 (6%) were resistant to penicillin; 7 (3%) were intermediate to ceftriaxone and 5 (2%) were resistant to ceftriaxone. There were no differences noted in the clinical presentation of the patients with susceptible versus nonsusceptible isolates. Twenty-nine percent of the patients had a pleural effusion. The 189 (74%) hospitalized patients were more likely to have an underlying illness, multiple lung lobe involvement, and the presence of a pleural effusion than nonhospitalized patients. Fifty-two of 72 hospitalized patients with pleural effusions had a chest tube placed, and 27 subsequently underwent a decortication drainage procedure. Eighty percent of the patients treated as outpatients and 48% of the inpatients received a parenteral second or third generation cephalosporin followed by a course of an oral antimicrobial agent. Two hundred forty-eight of the patients (97.6%) had a good response to therapy. Six patients died; however, only 1 of the deaths was related to the pneumococcal infection.

Conclusion.
The clinical presentation and outcome of therapy did not differ significantly between patients with penicillin-susceptible versus those with nonsusceptible isolates ofS pneumoniae. Hospitalized patients were more likely to have underlying illnesses, multiple lobe involvement, and the presence of pleural effusions than patients who did not require hospitalization. In otherwise normal patients with pneumonia attributable to penicillin-resistant pneumococcal isolates, therapy with standard β-lactam agents is effective.
Inhaled Nitric Oxide Does Not Affect Adenosine 5′-Diphosphate-dependent Platelet Activation in Infants With Persistent Pulmonary Hypertension of the Newborn
Authors: Christou Helen , Magnani Barbarajean , Morse David S. , Allred Elizabeth N. , Van Marter Linda J. , Wessel David L. , Kourembanas Stella 
Published: August 2004

Objective.
To investigate the effect of inhaled nitric oxide (NO) treatment in newborns with persistent pulmonary hypertension on adenosine 5′-diphosphate (ADP)-dependent platelet activation.

Methods.
After parental informed consent, infants with persistent pulmonary hypertension of the newborn were randomly assigned to receive conventional treatment (control group) or treatment with 40 parts per million of inhaled NO. Platelet activation was measured at time of entry and 30 minutes later by surface expression of P-selectin in response to increasing concentrations of the agonist ADP (0, 2, 5, 10, and 20 μM) using fluorescence-activated flow cytometry.

Results.
We examined 11 infants in the inhaled NO group and 13 in the control group. P-selectin expression, quantified as mean fluorescence, was not significantly different in the two groups of patients at baseline. Median percent change from baseline fluorescence was assessed using the Wilcoxon matched-pairs signed-rank test. At 30 minutes after enrollment there were no statistically significant changes from baseline fluorescence in either group of patients and at all ADP concentrations.

Conclusion.
Thirty minutes of exposure to 40 ppm of inhaled NO does not inhibit ADP-dependent platelet activation as measured by surface expression of P-selectin in infants with persistent pulmonary hypertension of the newborn.
Depressive Symptoms in Inner-city Mothers of Young Children: Who Is at Risk?
Authors: Heneghan Amy M. , Silver Ellen Johnson , Bauman Laurie J. , Westbrook Lauren E. , Stein Ruth E. K. 
Published: August 2004

Objective.To identify factors associated with depressive symptoms in inner-city mothers of young children.Design.A cross-sectional survey was administered to a convenience sample of English-speaking mothers attending a well-child visit for a child aged 6 months to 3 years in a hospital-based, inner-city, general pediatric clinic. The maternal interview collected data on sociodemographic characteristics, and mothers' health and financial status. Mothers completed the Psychiatric Symptom Index (PSI), a 29-item checklist shown to have very good validity and reliability in a multicultural population. A total score of ≥20 represents high levels of symptoms; scores ≥30 strongly suggest major depression.Results.Two hundred seventy-nine mothers completed the PSI. Mothers ranged in age from 14 to 48 years (mean, 27 years). Seventy-one percent were unmarried; 57% received public assistance. Forty-two percent of mothers were Hispanic, 40% black, 9% white, and 10% mixed or other races. Forty-eight percent were foreign-born. Twenty-four percent reported having a medical condition; 6% had activity limitation because of illness. The mean PSI score was 19; 18% of mothers had a PSI score ≥30 and 39% scored ≥20. PSI scores did not vary by age, race, birthplace, educational level, employment, marital status, or family composition. PSI scores were higher for mothers receiving public assistance (21 vs 17), with self-reports of poor or fair financial status (22 vs 15) and poor health status (52 vs 17). Mothers with activity limitations because of illness had significantly higher PSI scores (34 vs 18). Multiple regression analyses confirmed the independent relationships of these maternal characteristics to high PSI scores.Conclusions.Depressive symptoms in inner-city mothers of young children are common. In this population of women with many risk factors, traditional sociodemographic risk factors did not successfully identify those who are depressed. However, mothers' self-reports of poor financial status, health status, or activity limitation because of illness were associated with higher levels of depressive symptoms. These findings may assist clinicians in distinguishing which mothers are likely to be depressed when almost all are at high risk.