bluuebunny/crossref_metadata_2025_split huggingface dataset:
Race and Cigarette Smoking Among United States Adolescents: The Role of Lifestyle Behaviors and Demographic Factors
Authors: Faulkner Dorothy L. , Merritt Robert K. 
Published: August 2004

Objective. Cigarette smoking is on the rise among adolescents in the United States. Although both African-American and white adolescents have experienced increases in cigarette smoking over time, the prevalence of smoking has remained consistently lower among African-American adolescents than their white counterparts. The purpose of this study was to determine whether the race differential in the prevalence of cigarette smoking is attributed to differences in selected lifestyle behaviors and demographic factors.
Design. A cross-sectional study was conducted among African-American and white adolescents (aged 12 to 17 years) who participated in the Youth Risk Behavior Survey supplement to the 1992 National Health Interview Survey. Analyses were restricted to those who had complete data on all study variables (n = 5569). Logistic regression analysis was used to estimate the prevalence odds ratios (POR) of current smoking for white adolescents (versus African-American adolescents) before and after adjustment for confounding factors.
Results. The crude POR of current smoking for white adolescents compared with African-American adolescents was 2.8 (95% confidence interval = 2.1 to 3.9). Simultaneous adjustment for confounding factors resulted in a POR of 2.6 (95% confidence interval = 1.8 to 3.7).
Conclusions. Selected lifestyle behaviors and demographic factors do not account for the race differential in the prevalence of adolescent cigarette smoking. This study underscores the need for more research on contributors to the race gap. Such research could advance theoretical understanding of the etiology of cigarette smoking among adolescents and lead to more effective smoking prevention programs for all youths.
Gestational Diabetes and the Risk of Offspring Obesity
Authors: Whitaker Robert C. , Pepe Margaret S. , Seidel Kristy D. , Wright Jeffrey A. , Knopp Robert H. 
Published: August 2004

Background. Intrauterine exposure to the metabolic alterations of maternal diabetes may increase the risk of later obesity. We determined whether offspring of mothers with diet-treated, gestational diabetes mellitus (GDM) have an increased risk of childhood obesity and examined the relationship between childhood obesity and metabolic markers of GDM.
Methods. At a health maintenance organization in Seattle, WA, we reviewed medical records to obtain the life-time height and weight measurements of 524, 8- to 10-year-old children whose mothers had been screened for GDM. Maternal plasma glucose and triglyceride levels were obtained in midgestation 1 hour after ingestion of 50 g of glucose. Those with glucose screening levels ≥7.77 mmol/L (140 mg/dL) underwent a 3-hour, 100-g, oral glucose tolerance test to determine GDM status. Cord serum insulin levels also were obtained at birth. Obesity was defined as an average body mass index between 5 and 10 years of age at or above the 85th percentile for age and sex.
Results. The prevalence of obesity was 19% in the 58 offspring of mothers with diet-treated GDM and 24% in the 257 offspring of mothers with negative glucose screen values. There also was no difference in mean body mass index (adjusted for age and sex) between these two groups of offspring. Among all 524 offspring, there was no significant increase in the rate of offspring obesity according to the quartile of maternal screening glucose, triglyceride, oral glucose tolerance test, or cord serum insulin level.
Conclusion. Prenatal exposure to the metabolic effects of mild, diet-treated GDM does not increase the risk of childhood obesity.
Medications Used by Children With Asthma Living in the Inner City
Authors: Eggleston Peyton A. , Malveaux Floyd J. , Butz Arlene M. , Huss Karen , Thompson Lera , Kolodner Ken , Rand Cynthia S. 
Published: August 2004

Objective. The purpose of the study was to examine medication use reported by families participating in an urban school-based community intervention program and to relate this use to other social and medical variables.
Design. The design of the study was a cross-sectional questionnaire survey.
Setting. Patients and their families recruited from elementary schools in a community setting were interviewed between December 1991 and January 1992.
Participants. A total of 508 children with asthma were identified by school health records and teacher surveys. Their families confirmed the diagnosis and agreed to enter the study. Questionnaires were completed by 392 families.
Intervention. The 392 families participated in a controlled trial of asthma education after providing the data that are the basis of this report.
Results. More than half of the children took two or more medications for asthma. Thirty-one percent took theophylline alone or in combination with an adrenergic agent; 11% took some form of daily antiinflammatory medication, either cromolyn (8%) or inhaled steroids (3%). The pattern of medication use related to measures of severity and to regular visits to physicians or nurses. In general, however, children were undermedicated. A total of 78 children (20%) reported no medication or over-the-counter medication use, although 37% reported asthma severe enough to be associated with ≥20 days of school missed per month, and 37% had had an emergency room visit for asthma in the past 6 months. More than half of children ≥9 years old supervised their own medication.
Conclusions. We concluded that undermedication is common in poor children with asthma living in urban areas. Antiinflammatory medications are used less commonly than in the general population, and theophylline is used more often. School children may be likely to supervise their own medication.
Idiopathic Dilated Cardiomyopathy in Children: Prognostic Indicators and Outcome
Authors: Arola Anita , Tuominen Juhani , Ruuskanen Olli , Jokinen Eero 
Published: August 2004

Objective. To determine the outcome of Finnish children and adolescents with idiopathic dilated cardiomyopathy (IDCM) and factors that might be useful as prognostic indicators.Methodology. The clinical profile and course of 62 Finnish children and adolescents (median age, 13 months; range, 1 day to 20 years) with IDCM in 1980 to 1991 were evaluated to detect factors that might predict outcome. Factors studied included age, gender, family history, previous viral illness, and symptoms and signs at presentation. Furthermore, data on serial electrocardiographic, echocardiographic, and chest x-ray examinations, histologic findings, and treatments were analyzed.Results. During a mean (±SD) follow-up of 3.9 ± 4.5 years (range, 1 day to 25 years), 10 patients (16%) recovered, 17 (27%) had residual disease, 4 (6.4%) underwent heart transplantation, and 31 (50%) died. Infants (&lt;1 year of age) and adolescent (≥15 years of age) male patients with progressing symptoms of left ventricular failure after initiation of medical therapy tended to have the poorest outcome. However, in multivariate analysis, only histologic evidence of endocardial fibroelastosis, clinical signs of right ventricular failure at presentation, and the need for anticoagulative therapy during follow-up, the last an expression of a severely impaired left ventricular systolic function, appeared to be significant predictors of long-term outcome.Conclusions. Our study confirms that the outcome of children with IDCM still remains poor. However, a group of patients, mainly infants, make a full recovery. Adolescent male patients as well as infants suffering from endocardial fibroelastosis with persisting symptoms of congestive heart failure after initiation of medical therapy tend to have the poorest outcome. These patients need a careful follow-up at short time intervals and, in the case of lacking response to medical treatment with resulting growth failure and/or poor quality of life, should be offered urgent heart transplantation.
Fibromyalgia Syndrome in Children and Adolescents: Clinical Features at Presentation and Status at Follow-up
Authors: Siegel David M. , Janeway David , Baum John 
Published: August 2004

Objectives. To 1) describe the characteristic features of fibromyalgia syndrome (FS) in a pediatric population, 2) note similarities and differences with FS in adults, and 3) determine outcome after treatment.
Setting and Design. The Pediatric Rheumatology Clinic at the University of Rochester Medical Center is staffed by two pediatric rheumatologists and serves as a regional subspecialty referral service with ∼450 annual patient visits, of which ∼120 are initial evaluations. A retrospective medical record review from 1989 to 1995 was used to identify and describe the study population, and a structured telephone interview served to determine current status and response to treatment.
Results. A total of 45 subjects were identified (41 female; 42 white; mean age, 13.3 years), of whom 33 were available for telephone interview at a mean of 2.6 years from initial diagnosis (0.1 to 7.6 years). Of a possible 15 symptoms associated with FS, subjects reported a mean of 8, with &gt;90% experiencing diffuse pain and sleep disturbance. Less frequent were headaches (71%), general fatigue (62%), and morning stiffness (53%). The mean cumulative number of tender points summed over all visits was 9.7 (of 18). Telephone interviews showed improvement in most patients, with a mean positive change of 4.8 on a self-rating scale of 1 to 10 comparing current status to worst-ever condition.
Conclusions. FS in patients referred to a pediatric rheumatology clinic is characterized by diffuse pain and sleep disturbance, the latter being more common than that in adults. The mean number of tender points summed over all visits is fewer than the criterion of 11 established for adults at a single visit. The majority of patients improved over 2 to 3 years of follow-up.
Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program
Authors: Weibel Robert E. , Caserta Vito , Benor David E. , Evans Geoffrey 
Published: August 2004

Objective. To determine if there is evidence for a causal relationship between acute encephalopathy followed by permanent brain injury or death associated with the administration of further attenuated measles vaccines (Attenuvax or Lirugen, Hoechst Marion Roussel, Kansas City, MO), mumps vaccine (Mumpsvax, Merck and Co, Inc, West Point, PA), or rubella vaccines (Meruvax or Meruvax II, Merck and Co, Inc, West Point, PA), combined measles and rubella vaccine (M-R-Vax or M-R-Vax II, Merck and Co, Inc, West Point, PA), or combined measles, mumps, and rubella vaccine (M-M-R or M-M-R II, Merck and Co, Inc, West Point, PA), the lead author reviewed claims submitted to the National Vaccine Injury Compensation Program.Methods. The medical records of children who met the inclusion criteria of receiving the first dose of these vaccines between 1970 and 1993 and who developed such an encephalopathy with no determined cause within 15 days were identified and analyzed.Results. A total of 48 children, ages 10 to 49 months, met the inclusion criteria after receiving measles vaccine, alone or in combination. Eight children died, and the remainder had mental regression and retardation, chronic seizures, motor and sensory deficits, and movement disorders. The onset of neurologic signs or symptoms occurred with a nonrandom, statistically significant distribution of cases on days 8 and 9. No cases were identified after the administration of monovalent mumps or rubella vaccine.Conclusions. This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles immunization.
Complicated Parapneumonic Effusions in Children Caused by Penicillin-NonsusceptibleStreptococcus pneumoniae
Authors: Hardie William D. , Roberts Nancy E. , Reising Shirley F. , Christie Celia D. C. 
Published: August 2004

Objective. To describe the clinical characteristics of complicated parapneumonic effusions (CPE) in children caused by Streptococcus pneumoniae nonsusceptible to penicillin (PCN-N) and compare their clinical outcome with CPE caused by penicillin-susceptible (PCN-S) organisms.Design. Children with parapneumonic effusions were identified retrospectively between July 1992 and June 1996. Charts of patients with CPE were reviewed for data obtained at the time of hospital admission. In addition, outpatient charts and/or the families of children with CPE caused by PCN-N S pneumoniae were reviewed to identify specific risk factors associated with PCN-N organisms.Results. Sixty-four cases of CPE were identified during the 4-year period. In 26 cases a bacterial pathogen was recovered, withS pneumoniae accounting for 23 of these isolates (88%). Of the 23 S pneumoniae cases, 17 were PCN-S and 6 cases were nonsusceptible. Complicated parapneumonic effusions caused by PCN-NS pneumoniae occurred in significantly younger patients than CPE that were PCN-S (2.1 years vs 7.9 years). Nonsusceptible effusions also had a higher incidence of bacteremia than PCN-S effusions (100% vs 29%). There were no significant differences between the two groups for duration of chest tube drainage, febrile days, oxygen use, and hospital stay.Conclusion. CPE caused by PCN-N S pneumoniaeis associated with a younger age and higher rate of bacteremia than CPE caused by PCN-S strains. However, there were no significant differences in outcome measures between patients infected with susceptible or nonsusceptible organisms.
Accurate Recognition and Effective Treatment of Ventricular Fibrillation by Automated External Defibrillators in Adolescents
Authors: Atkins Dianne L. , Hartley Lori L. , York Douglas K. 
Published: August 2004

Objectives. To evaluate the accuracy and efficacy of automated external defibrillators (AEDs) in patients &lt;16 years old.Background. AEDs are standard therapy in out-of-hospital resuscitation of adults and have led to higher success rates. Their use in children and adolescents has never been evaluated, despite recommendations from the American Heart Association that they be used in children &gt;8 years of age.Methods. This was a retrospective cohort study of children &lt;16 years old who underwent out-of-hospital cardiac resuscitation and on whom an AED was used during the resuscitation. The setting was rural and urban prehospital emergency medical systems. Patients were identified by review of a database of cardiac arrests maintained by a large surveillance program of these services.Results. AEDs were used to assess cardiac rhythm in 18 patients with a mean age of 12.1 ± 3.7 years. The cardiac rhythms were analyzed 67 times and included ventricular fibrillation (25), asystole/pulseless electrical activity (32), sinus bradycardia (6), and sinus tachycardia (4). The AEDs recognized all nonshockable rhythms accurately and advised no shock. Ventricular fibrillation was recognized accurately in 22 (88%) of 25 episodes and advised or administered a shock 22 times. Sensitivity and specificity for accurate rhythm analysis were 88% and 100%, respectively. One patient with a nonshockable rhythm survived, whereas 3 of 9 patients with ventricular fibrillation survived.Conclusions. These data furnish evidence that AEDs provide accurate rhythm detection and shock delivery to children and young adolescents. AED use is potentially as effective for children as it is for adults.
Injuries to Children in the United States Related to Trampolines, 1990–1995: A National Epidemic
Authors: Smith Gary A. 
Published: August 2004

Study Objective. To describe the epidemiology of trampoline-related injuries among children in the United States.Design. A retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990 through 1995.Results. There were an estimated 249 400 trampoline-related injuries [95% confidence interval (CI), 166 300–332 500] to children 18 years old and younger treated in hospital emergency departments in the United States during the 6-year study period. The number of injuries increased by 98% from 29 600 in 1990 to 58 400 in 1995, with an average of 41 600 (95% CI, 27 700–55 500) injuries per year, or 59.4 injuries per 100 000 United States children per year (95% CI, 39.6–79.3). The median age of injured children was 10 years, and 50% were males. Ninety-three percent of injuries occurred at home. Injuries to the extremities predominated among children of all ages and accounted for more than 70% of all injuries. This study identified several age-specific injury patterns. There was an inverse relationship between age versus the relative frequency of upper extremity injuries, and fractures and dislocations; and there was a direct relationship between age versus lower extremity injuries and soft tissue injury. There was also an inverse relationship between age versus facial injuries, head and neck injuries, and lacerations. Annually, an estimated 1400 children (95% CI, 800–2000), or 2.0 per 100 000 United States children (95% CI, 1.1–2.9), required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-associated injury. Fractures or dislocations accounted for 83% of injuries among admitted or transferred children, and children with a fracture or dislocation were more likely to be admitted or transferred to another hospital (8.4%) than children with other types of injury (relative risk, 10.80; 95% CI, 9.40 &lt; relative risk &lt; 12.29). Among children released home from the emergency department, soft tissue injuries (53%), fractures or dislocations (30%), and lacerations (14%) were the most common injuries treated.Conclusion. Injuries related to trampolines, especially backyard trampolines, are an important cause of pediatric morbidity. These injuries have also resulted in death. The rapid increase in the number of trampoline-related injuries to children during recent years is evidence that current prevention strategies are inadequate. Children should not use trampolines at home, and the sale of trampolines for private recreational use should be stopped.
Proteolysis Associated With Insulin Resistance in Cystic Fibrosis
Authors: Hardin Dana S. , LeBlanc Adrian , Lukenbaugh Sheila , Para Laurie , Seilheimer Dan K. 
Published: August 2004

Objective. We hypothesized that patients with cystic fibrosis (CF) have higher rates of protein breakdown than normal volunteers and that the infusion of insulin would result in less suppression of proteolysis.Methods. Using [1-13C]leucine and a three-step hyperinsulinemic euglycemic clamp, we measured rates of leucine appearance in 29 adult CF patients and 18 matched-control volunteers. The CF patients were characterized by oral glucose tolerance testing and clinical status scoring.Results. The CF patients had significantly increased proteolysis when compared with that of controls (CF, 123 ± 28 μmol/kg/h; controls, 71 ± 15 μmol/kg/h) and rates of proteolysis were significantly different between CF patients with impaired glucose tolerance and diabetes and those CF patients with normal glucose tolerance. Suppression of proteolysis by insulin was less in all CF subgroups than in the controls at peripheral insulin levels of 16 and 29 μU/mL. At peripheral insulin levels of 100 μU/mL, there was no difference in insulin suppression of proteolysis between CF patients and controls. Importantly, basal rates of proteolysis had an inverse relationship with clinical status in CF patients (r = −.76).Conclusions. Our findings indicate that proteolysis is higher in adult CF patients than in controls and that CF patients exhibit resistance to the anabolic effects of insulin on proteolysis. Most significantly, our findings indicate that basal rates of proteolysis inversely correlate with clinical status in CF.
Hepatitis C Virus Infection
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired October 2004.Hepatitis C virus (HCV) has become the most significant cause of chronic liver disease of infectious etiology in the United States. The recognition that HCV can be transmitted perinatally or through blood transfusions warrants particular attention by the pediatrician. The American Academy of Pediatrics recommends screening infants born to HCV-infected mothers and persons with risk factors for HCV infection such as injection drug use, transfusion of ≥1 U of blood or blood products before 1992, or hemodialysis should be screened for anti-HCV. Also, persons who received clotting factor concentrates before 1987, when effective inactivation procedures were introduced, also should be screened. Guidelines for counseling families of HCV-infected children are provided.
Interleukin-6, C-Reactive Protein, and Abnormal Cardiorespiratory Responses to Immunization in Premature Infants
Authors: Pourcyrous Massroor , Korones Sheldon B. , Crouse Dennis , Bada Henrietta S. 
Published: August 2004

Objective. We report our experience with routine immunization of 89 premature infants in the neonatal intensive care unit because 1) a substantial number of them developed abnormal clinical signs, and 2) all but one of those who received diphtheria, tetanus, and whole-cell pertussis (DTwP) vaccine responded with elevations of interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations that are otherwise characteristic of bacterial disease.Methodology. We hypothesized that the elevated IL-6 and CRP levels were solely a response to immunization and that treatment with antibiotics was not necessary. We performed this study in two consecutive parts. In part 1, we prospectively evaluated 79 consecutive premature infants who were immunized with DTwP, Haemophilusb conjugate vaccine, hepatitis B vaccine, and inactivated polio vaccine, (Hib, HBV, and IPV). IL-6 and CRP were determined before immunization and every 12 hours on three occasions after immunization. In part 2, we studied an additional 10 infants who received acellular pertussis vaccine (DTaP) and who, 2 days later, received Hib, HBV, and IPV immunization simultaneously. We followed the same schedule of IL-6 and CRP determinations as in part 1.Results. In part 1, 24 infants (30%) developed abnormal cardiorespiratory signs within 24 hours after immunization. CRP and IL-6 values rose to abnormal levels after immunization in all but one infant; that infant was later shown to have a T-cell abnormality. In part 2, 3 infants had abnormal cardiorespiratory signs after simultaneous immunization with Hib, HBV, and IPV, but not after DTaP. IL-6 and CRP levels remained normal in all 10 infants.Conclusions. Part 1 demonstrates clearly the temporal relationship between IL-6 and CRP increments after DTwP, Hib, HBV, and IPV vaccines. In part 2 (DTaP was substituted for DTwP), there were no elevations of IL-6 or CRP, thus indicating that whole-cell pertussis component of DTwP was responsible for IL-6 and CRP elevations. Abnormal cardiorespiratory signs occurred frequently after immunizations in part 1, but they were unrelated to the magnitude of IL-6 and CRP elevations. The frequency of cardiorespiratory difficulty and its occasional severity suggest a need to monitor premature infants for ∼48 hours after routine immunization.