bluuebunny/crossref_metadata_2025_split huggingface dataset:
Otitis Media in Early Childhood in Relation to Preschool Language and School Readiness Skills Among Black Children
Authors: Roberts Joanne E. , Burchinal Margaret R. , Jackson Sandra C. , Hooper Stephen R. , Roush Jackson , Mundy Martha , Neebe Eloise C. , Zeisel Susan A. 
Published: August 2004

Objective.
To examine whether otitis media with effusion (OME) and associated hearing loss (HL) during the first 5 years of life were related to children's language skills during the preschool years and to school readiness skills at entry to kindergarten.

Methods.
In a prospective study, the ears of 85 black children primarily from low-income families and recruited from community-based childcare programs were repeatedly examined from 6 months to 5 years of age for the presence of OME and from 6 months to 4 years of age for HL when well and ill with OME. Assessments were made annually of the children's child-rearing environments at home and in childcare, and children's language skills between 3 and 5 years of age and readiness skills in literacy and math were evaluated at entry into kindergarten.

Results.
Children had either bilateral or unilateral OME ∼30.4% and HL 19.6% of the observation time. OME and associated HL were significantly positively correlated with some measures of expressive language at 3 and 4 years of age; however, these direct relationships were no longer significant when the child's gender, socioeconomic status, maternal educational level, and the responsiveness and support of the home and childcare environments were also considered. Further, both OME and HL were moderately correlated with school readiness skills at entry to school, with children having more OME scoring lower in verbal math problems and with children with more HL scoring lower in math and recognizing incomplete words. These associations continued to remain significant even after partialing out the child and family background factors.

Conclusions.
There was not a significant relationship between children's early OME history or HL and language skills during the preschool years. However, children with more frequent OME had lower scores on school readiness measures. These associations were moderate in degree, however, and the home environment was more strongly related to academic outcomes than was OME or HL. These results should be interpreted cautiously when generalizing to other populations.
Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents With End-Stage Renal Disease
Authors: Furth Susan L. , Garg Pushkal P. , Neu Alicia M. , Hwang Wenke , Fivush Barbara A. , Powe Neil R. 
Published: August 2004

Context.
Renal transplantation is the treatment of choice for pediatric patients with end-stage renal disease (ESRD). Black patients wait longer for kidney transplants than do white patients.

Objective.
To determine whether the increased time to transplantation for black pediatric patients is attributable not only to a shortage of suitable donor organs, but also to racial differences in the time from a child's first treatment for ESRD until activation on the cadaveric kidney transplant waitlist.

Design.
National longitudinal cohort study.

Setting.
US Medicare-eligible, pediatric ESRD population.

Patients.
Children and adolescents ≤19 years old at the time of their first dialysis for ESRD between 1988 and 1993, followed through 1996. Patients who received living donor renal transplants were excluded from study.

Main Outcome Measures.
Time from first dialysis for ESRD until activation on the kidney transplant waiting list, relative hazard of activation on the waiting list for black compared with white pediatric patients.

Results.
Comparisons of the time from first dialysis for ESRD to waitlisting among the 2162 white (60.7%) and 1122 black (31.5%) patients studied using survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up. In multivariate analysis, even after controlling for patient age, gender, socioeconomic status, geographic region, incident year of renal failure, and cause of ESRD, blacks were 12% less likely to be waitlisted than were whites at any point in time (relative hazard: .88: 95% confidence interval: .79–.97).

Conclusions.
Racial disparities in access to the renal transplant waiting list exist in pediatrics. Whether these disparities are attributable to differences in time of presentation to a nephrologist, physician bias in identification of transplant candidates, or patient preferences warrants further study.
Biphasic Anaphylactic Reactions in Pediatrics
Authors: Lee Joyce M. , Greenes David S. 
Published: August 2004

Objectives.
The objectives of this study were to: 1) determine the incidence of biphasic reactions in children with anaphylaxis; 2) establish what risk factors can predict progression to a biphasic reaction; and 3) assess the utility of inpatient observation for patients whose anaphylaxis appears to have resolved.

Methods.
We performed a retrospective analysis of all children admitted to Children's Hospital inpatient service between 1985 and 1999 with acute anaphylaxis. Data were collected from the medical records regarding past medical history, presenting signs and symptoms, treatment, and hospital course. Patients were considered to have resolution of anaphylaxis if they were documented to have cessation of all symptoms and needed no therapy for at least 1 hour. Biphasic reactions were defined as a worsening of symptoms requiring new therapy after resolution of anaphylaxis. Significant biphasic reactions were defined as those requiring oxygen, vasopressors, intubation, subcutaneous epinephrine, or unscheduled bronchodilator treatments. Patients were considered to benefit from a 24-hour observation period if they had a significant biphasic reaction within 24 hours of admission.

Results.
Of 108 anaphylactic episodes, 2 (2%) were fatal, and 1 (1%) was a protracted anaphylactic reaction. Among the remaining 105 children with resolution of anaphylaxis, 6 (6%) [95% confidence (CI): 2, 12] had biphasic reactions, of which 3 (3%) [95% CI: .6, 8] were significant. Of those who had a biphasic reactions, the median time from the onset of symptoms to the initial administration of subcutaneous epinephrine was 190 minutes, versus 48 minutes for those without a biphasic reaction. Patients with or without biphasic reactions did not differ significantly in the incidence of initial epinephrine use, initial steroid use, or serious respiratory or cardiovascular symptoms on initial presentation. Two of 105 (2%) [95% CI: .2, 7] patients clinically benefitted from a 24-hour observation period.

Conclusions.
We found an overall incidence of biphasic reactions of 6%, and an incidence of significant biphasic reactions of 3%, among pediatric patients admitted with anaphylaxis. Delayed administration of subcutaneous epinephrine was associated with an increased incidence of biphasic reactions. Approximately 2% of patients with anaphylaxis potentially benefitted from a 24-hour period of observation after symptoms had resolved.
Environmental Tobacco Smoke Exposure Among Urban Children
Authors: Hopper John A. , Craig Kelly A. 
Published: August 2004

Background.Environmental tobacco smoke (ETS) exposure is a well-known health hazard for children. Poor urban children may be at increased risk of exposure from nonparental sources of tobacco smoke. The unique problems of ETS exposure in urban children have previously not been well-defined.Objectives.This study was conducted: 1) to identify the sources of ETS exposure for children attending a hospital-based pediatric resident practice; and 2) to examine caregivers' perceptions of the pediatrician's role and action in addressing ETS exposure.Design.Questionnaires were administered to a convenience sample of 174 caregivers of children visiting a children's hospital-based resident practice. A structured face-to-face interview was used.Results.All caregivers agreed to participate in the study. Most of the caregivers interviewed were mothers (87.9%). Although only 14% of caregivers were smokers, 49.4% reported caring for at least 1 smoke-exposed child. Most smoke exposure occurred in the home; smoking is allowed in the home of 75% of the children who live with a smoker (48/64). Thirty-four percent of the caregivers who reported no smoking in the home reported having a child who spends time in homes where other people smoke. Most exposure outside the home occurred at a grandparent's home. A ban on smoking in the home did not eliminate a child's risk of residential smoke exposure but did predict whether smoking occurred in the same room as the child. All caregivers reported believing that tobacco smoke is harmful. Approximately one half of caregivers who smoke (54.2%) would like smoking cessation advice from the child's pediatrician. Interest in receiving advice on helping others quit smoking was also high (51.3%) among nonsmoking caregivers who cared for a smoke-exposed child.Conclusions.Nonparental sources of ETS exposure are reported to be common in urban children. Children may be exposed to tobacco smoke even in homes where smoking is banned. Many caregivers would like help from pediatricians in reducing children's exposure to tobacco smoke.
Relations of Parental Obesity Status to Physical Activity and Fitness of Prepubertal Girls
Authors: Treuth Margarita S. , Butte Nancy F. , Puyau Maurice , Adolph Anne 
Published: August 2004

Objective.
To determine whether physical activity and fitness differ among normal-weight-for-height, multiethnic, prepubertal girls whose parents are lean, obese, or both.

Setting.
Conducted in Houston, Texas.

Study Participants.
Normal-weight white, black, and Hispanic prepubertal girls (mean age ± standard deviation: 8.5 ± .4 years) participated in this study. Girls were recruited according to parental leanness or obesity defined as follows: girls with 2 lean parents (LN group; n = 30); girls with 2 obese parents (OB group; n = 27); and girls with 1 lean and 1 obese parent (LNOB group; n = 44).

Intervention.
Each child wore a heart rate monitor for two 24-hour periods, underwent a treadmill exercise test, answered an activity questionnaire, and completed energy expenditure measurements by basal calorimetry and doubly labeled water.

Outcome Measures.
The amount of time spent above 125% and 150% of basal heart rate (BHR) was calculated during each 24-hour period (n = 84). Fitness (n = 97), habitual physical activity (n = 101), and physical activity level (PAL = total energy expenditure/basal metabolic rate; n = 101) were also measured.

Results.
The times spent above 125% and 150% of BHR were similar among LN, LNOB, and OB groups. Black girls spent less time than did white girls on the weekend above 125% BHR and above 150% BHR. No significant familial or ethnic differences in peak oxygen consumption or habitual physical activity were observed. PALs were as follows: LN = 1.6 ± .21; LNOB = 1.64 ± .27; OB = 1.58 ± .20; white = 1.63 ± .23; black = 1.58 ± .24; and Hispanic = 1.65 ± .25. PAL was related to time spent above 125% BHR and 150% BHR (r = .31,.39).

Conclusions.
Physical activity and fitness of normal-weight prepubertal girls predisposed to obesity did not differ from girls without a family history of obesity. obesity, children, energy metabolism, exercise, heart rate monitoring.
Aerobic Fitness, Not Energy Expenditure, Influences Subsequent Increase in Adiposity in Black and White Children
Authors: Johnson Maria S. , Figueroa-Colon Reinaldo , Herd Sara L. , Fields David A. , Sun Min , Hunter Gary R. , Goran Michael I. 
Published: August 2004

Background.
Low levels of energy expenditure and aerobic fitness have been hypothesized to be risk factors for obesity. Longitudinal studies to determine whether energy expenditure influences weight gain in whites have provided conflicting results. To date, no studies have examined this relationship in blacks or whether aerobic fitness influences weight gain in white or black children.

Methods.
One hundred fifteen children, 72 white (55 girls and 17 boys) and 43 black (24 girls and 19 boys) were recruited for this study. Aerobic fitness, resting, total, and activity-related energy expenditure and body composition were measured at baseline. The children returned annually for 3 to 5 repeated measures of body composition. The influence of the initial measures of energy expenditure and fitness on the subsequent rate of increase in adiposity was examined, adjusting for initial body composition, age, ethnicity, gender, and Tanner stage. Because 20 children did not attain maximum oxygen consumption, the sample size for the combined analysis was 95.

Results.
Initial fat mass was the main predictor of increasing adiposity in this cohort of children, with greater initial fat predicting a higher rate of increase of adiposity. There was also a significant negative relationship between aerobic fitness and the rate of increasing adiposity (F1,82 = 3.92). With every increase of .1 L/minute of fitness, there was a decrease of .081 kg fat per kg of lean mass gained. None of the measures of energy expenditure significantly predicted increasing adiposity in white or black children.

Conclusions.
Initial fat mass was the dominant factor influencing increasing adiposity; however, aerobic fitness was also a significant independent predictor of increasing adiposity in this cohort of children. Resting, total, or activity-related energy expenditure did not predict increasing adiposity. It seems that aerobic fitness may be more important than absolute energy expenditure in the development of obesity in white or black children. energy expenditure, fitness, longitudinal, obesity.
Infant Immunization With Acellular Pertussis Vaccines in the United States: Assessment of the First Two Years' Data From the Vaccine Adverse Event Reporting System (VAERS)
Authors: Braun M. Miles , Mootrey Gina T. , Salive Marcel E. , Chen Robert T. , Ellenberg Susan S. ,   the VAERS Working Group
Published: August 2004

Objective.To evaluate the safety of infant immunization with acellular pertussis vaccines in the United States.Background.The US Food and Drug Administration approved the first acellular pertussis vaccine for use in infants in the United States on July 31, 1996.Outcome Measures.Adverse events in the United States after infant immunization with pertussis-containing vaccines, representing temporal (but not necessarily causal) associations between vaccinations and adverse events.Data Source.Reports to the Vaccine Adverse Event Reporting System (VAERS), a passive national surveillance system.Design.Reports concerning infant immunization against pertussis between January 1, 1995 (when whole-cell vaccine was in exclusive use) and June 30, 1998 (when acellular vaccine was in predominant use) were analyzed, if the reports were entered into the VAERS database by November 30, 1998.Results.During the study, there were 285 reports involving death, 971 nonfatal serious reports, and 4514 less serious reports after immunization with any pertussis-containing vaccine. For 1995 there were 2071 reports; in 1996 there were 1894 reports; in 1997 there were 1314 reports, and in the first half of 1998 there were 491 reports. Diphtheria-tetanus-pertussis vaccine (DTP) was cited in 1939 reports, diphtheria–tetanus–whole-cell pertussis–Haemophilus influenzae type b vaccine (DTPH) in 2918 reports, and diphtheria-tetanus-acellular pertussis vaccine (DTaP) in 913 reports. The annual number of deaths during the study was 85 in 1995, 82 in 1996, 77 in 1997, and 41 in the first half of 1998. The annual number of reported events categorized as nonfatal serious (defined as events involving initial hospitalization, prolongation of hospitalization, life-threatening illness, or permanent disability) to VAERS for all pertussis-containing vaccines declined: 334 in 1995, 311 in 1996, 233 in 1997, and 93 in the first half of 1998. Similarly, the annual number of less serious reports to VAERS for pertussis-containing vaccines declined: 1652 in 1995, 1501 in 1996, 1004 in 1997, and 357 in the first half of 1998. A comparison of the adverse event profiles (proportional distributions) for DTaP, DTP, and DTPH, as well as an analysis of specific adverse events considered in a 1991 Institute of Medicine report on the safety of diphtheria-tetanus-pertussis vaccine, did not identify any new, clear safety concerns.Conclusions.These findings reflect the administration of millions of doses of acellular pertussis vaccine and are reassuring with regard to the safety of marketed acellular pertussis vaccines. VAERS data, although subject to the limitations of passive surveillance, support the prelicensure data with regard to the safety of the US-licensed acellular pertussis vaccines that we evaluated.
Sources of Infection Among Persons With Acute Hepatitis A and No Identified Risk Factors During a Sustained Community-Wide Outbreak
Authors: Staes Catherine Janes , Schlenker Thomas L. , Risk Ilene , Cannon Kyle G. , Harris Heath , Pavia Andrew T. , Shapiro Craig N. , Bell Beth P. 
Published: August 2004

Context.
Hepatitis A is a common vaccine-preventable disease in the United States. Most cases occur during community-wide outbreaks, which can be difficult to control. Many case-patients have no identified source.

Objective.
To identify foodborne and household sources of hepatitis A during a community-wide outbreak.

Design.
Serologic and descriptive survey.

Setting.
Salt Lake County, Utah.

Participants.
A total of 355 household contacts of 170 persons reported with hepatitis A during May 1996 to December 1996, who had no identified source of infection; and 730 food handlers working in establishments where case-patients had eaten.

Main Outcome Measure.
Prevalence of immunoglobulin M antibodies to hepatitis A virus (IgM anti-HAV) among household and food service contacts.

Results.
Overall, 70 household contacts (20%) were IgM anti-HAV-positive, including 52% of children 3 to 5 years old and 30% of children &lt;3 years old. In multivariate analysis, the presence of a child &lt;3 years old (odds ratio [OR]: 8.8; 95% confidence limit [CL]: 2.1,36) and a delay of ≥14 days between illness onset and reporting (OR: 7.9; 95% CL: 1.7,38) were associated with household transmission. Of 18 clusters of infections linked by transmission between households, 13 (72%) involved unrecognized infection among children &lt;6 years old. No food handlers were IgM anti-HAV-positive.

Conclusion.
During a community-wide outbreak, HAV infection among children was common, was frequently unrecognized, and may have been an important source of transmission within and between households. Transmission from commercial food establishments was uncommon. Ongoing vaccination of children may prevent future outbreaks.
Late-Onset Neutropenia in Very Low Birth Weight Infants
Authors: Omar Said A. , Salhadar Alaa , Wooliever Diane E. , Alsgaard Patricia K. 
Published: August 2004

Background.Neutropenia, defined as absolute neutrophil count (ANC) &lt;1500/mm3, affects 6% to 58% of premature infants in the first week of life. This early-onset neutropenia in premature infants has previously been correlated with sepsis, maternal hypertension, severe asphyxia, and periventricular hemorrhage. Late-onset neutropenia, defined as ANC &lt;1500/mm3 at a postnatal age of ≥3 weeks, has not been previously reported.Objectives.The purposes of this study were to determine the prevalence of late-onset neutropenia in very low birth weight (VLBW) infants and to examine the factors that may be associated with this phenomenon.Methods.A weekly complete blood cell count (CBC) was performed routinely in all premature infants with birth weight ≤1500 g (n = 225) admitted to the neonatal intensive care in a 3-year period who survived until discharge. CBC and differentials were recorded at day 1, day 3, and then weekly until discharge. The clinical data of the study infants were collected by reviewing the medical records retrospectively.Results.Late-onset neutropenia was detected in 51 infants (22%). In both neutropenic (n = 51) and nonneutropenic infants (n = 174), ANC increased postnatally, remained above 5000/mm3 for the first 3 weeks of life, and had a marked decrease at ∼4 weeks of age. Thereafter, ANC decreased to a level of ∼1400/mm3 in the neutropenic infants and 4000/mm3 in the nonneutropenic infants. The neutropenic infants had a significantly lower nadir ANC, lower hemoglobin, and higher reticulocyte count than did the nonneutropenic infants with similar platelet counts. None of the study infants received erythropoietin during their hospitalization. This late-onset neutropenia occurred at postnatal age of 6 ± 2 weeks (range: 3–10 weeks). The duration of neutropenia was 1.7 ± .7 weeks (range: 1–3 weeks). All of the neutropenic infants had anemia of prematurity with high reticulocyte count and normal platelet count. The neutropenic infants were stable, growing on full oral feedings, and had no signs or symptoms of sepsis. No adverse effects of late-onset neutropenia were apparent in these infants.Conclusion.Late-onset neutropenia is a common incidental finding in stable, growing VLBW infants that has not been previously reported. Late-onset neutropenia is a phenomenon that occurs in anemic premature infants who have marked reticulocytosis. Normal regulation of hematopoiesis is accompanied by a balance between colony-stimulating factors, such as erythropoietin and granulocyte colony-stimulating factor, which regulate erythropoiesis and granulopoiesis. We speculate that imbalance of these factors with increased reticulocytopoiesis in response to anemia of prematurity may explain this phenomenon. We recommend avoiding institution of aggressive, potentially harmful therapy for this phenomenon in healthy, growing VLBW infants.