bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Annual Tuberculosis Screening by Mantoux Test in Children Considered to be at High Risk: Results From One Urban Clinic
Authors: Serwint Janet R. , Hall Barbara S. , Baldwin Robert M. , Virden Jane M. 
Published: August 2004

Background. In January 1994, the American Academy of Pediatrics recommended that annual screening with the purified protein derivative tuberculin skin test, Mantoux method, be used for tuberculosis screening in high-risk children. This test has a better sensitivity and specificity than the previously used multiple puncture test, and patients need to return for a reading done by palpation by a health care professional.Objective. To estimate the prevalence of reactivity to purified protein derivative tuberculin in an urban primary care clinic whose patients meet high-risk criteria and to determine if annual screening is warranted, to determine the adherence to return to the clinic for reading of the skin test, and to describe the characteristics of patients who have tuberculosis infection and disease.Research Design. Cross-sectional study.Setting. Inner-city, hospital-based primary care pediatric clinic in Baltimore, MD.Subjects. A total of 1433 consecutive children attending this clinic from March through September, 1994, who were at risk for tuberculosis because of frequent exposure to poor and medically indigent city dwellers.Methods. The Mantoux test (5TU intradermal injection of purified protein derivative) was administered to children at annual health supervision visits. Patients were tracked to determine those who returned for a reading by a health care professional and find those with a positive Mantoux test. The charts of children with a positive test were reviewed.Results. Five hundred seventy-three (40%) patients returned for a reading by a health care professional. Five patients had a positive Mantoux test, giving a prevalence rate of 0.8% of reactivity to purified protein derivative tuberculin. One child with a positive Mantoux test also had chest radiograph findings consistent with tuberculosis disease but was asymptomatic.Conclusions. In our city with a low prevalence of disease, children whose only risk factor for tuberculosis was exposure to poor and medically indigent city dwellers did not represent a high-risk group. Our results are supportive of the 1996 American Academy of Pediatrics screening statement that annual screening is not warranted. Sixty percent of children did not return for a reading of the Mantoux test by a health care professional. Alternative strategies that are more convenient for parents are needed to obtain accurate readings by health care professionals when skin testing is deemed necessary.
Immunogenicity of Hepatitis B Vaccine in Preterm Infants
Authors: Kim Susan C. , Chung Esther K. , Hodinka Richard L. , DeMaio John , West David J. , Jawad Abbas F. , Watson Barbara 
Published: August 2004

Objective. To determine the immunogenicity of hepatitis B vaccine in preterm infants when the first dose of vaccine is delayed until hospital discharge.
Methods. One hundred two preterm infants (23 to 36 weeks' gestational age) born to hepatitis B surface antigen-negative mothers were enrolled. Immunization was initiated just before hospital discharge with subsequent doses 1 and 6 months later. Serum specimens were obtained before the administration of each vaccine dose and 3 months after the last dose and were tested for antibody to hepatitis B surface antigen (antiHBs).
Results. Eighty-seven infants (85%) completed the study. Ninety percent (n = 78) of infants who completed the study seroconverted (antiHBs ≥10 mIU/mL); 10% (n = 9) remained seronegative at study completion. The geometric mean antibody titer to hepatitis B surface antigen for infants who seroconverted was 200 mIU/mL. Nonresponders (NR) differed from responders (R) in birth weight (NR = 2090 g, R = 1560 g) gestational age (NR = 33 weeks, R = 31 weeks), and weight gain before vaccine initiation (NR = 244 g, R = 633 g). There were no differences in weight or age at vaccine initiation, Apgar scores, interval between vaccine doses, or bacterial infections, steroid use, or transfusions before vaccine initiation.
Conclusions. Ninety percent of preterm infants responded to hepatitis B vaccine when the first dose of vaccine was delayed until hospital discharge. Nonresponders were more likely to be preterm infants of higher birth weight and higher gestational age, and to have gained less weight before vaccine initiation.
High Endothelin-1 in the Airways of Preterm Infants Is Associated With Less Severe Respiratory Distress During the Early Postnatal Period
Authors: Andersson Sture , Merritt T. Allen , Orpana Arto , Viinikka Lasse , Ylikorkala Olavi 
Published: August 2004

Objective. To study the relationship between endothelin-1 (ET-1) in the airways and respiratory distress in preterm infants.
Methods. ET-1 was determined in 60 tracheal aspirates from 11 preterm intubated infants (gestational age 28.0 ± 2.5 weeks) during the first week of life.
Results. The concentration of ET-1 of the aspirates was 6 to 2760 pg/mL (median 293 pg/mL). Negative correlations existed between mean log ET-1 and mean airway pressure (R2 = .812) and fraction of inspired oxygen (R2 = .591), whereas a positive correlation was found between the arteriolar/alveolar oxygenation ratio within 3 hours of birth and mean log ET-1 on the first day (R2 = .555).
Conclusion. The association of high ET-1 in the airways with less severe respiratory distress in the early postnatal period may be attributable to effects of ET-1 on surfactant secretion or development of airway epithelium.
Tinea Capitis in California Children: A Population-based Study of a Growing Epidemic
Authors: Lobato Mark N. , Vugia Duc J. , Frieden Ilona J. 
Published: August 2004

Objectives. To describe trends in tinea capitis incidence among California children and to determine subpopulations at increased risk.Design. Retrospective population-based study.Setting. California, 1984 through 1993.Population. Children &lt;10 years of age enrolled in Medi-Cal.Outcome Measures. California Medi-Cal provider data for first-time prescriptions of oral griseofulvin suspension were used to estimate annual incidence of tinea capitis and calculate risk ratios.Results. From 1984 through 1993, the incident rate for prescriptions of oral griseofulvin suspension increased by 84.2% for all children, 140.4% for white children, and 209.7% for African-American children. In 1993, incidence rates (per 10 000 enrolled) were 252.1 claimants for African-American children, 23.1 for white, 17.5 for Hispanic, and 14.3 for Asian/Pacific Islander. The highest rate by location was San Francisco County (172.2). In age groups &lt;5 years and 5 to 9 years, African-American children were 13.1 and 17.6 times more likely to be prescribed griseofulvin than Hispanic children. Since 1987, incidence rates for children 5 to 9 years of age were higher compared with children ages &lt;5 years.Conclusions. Tinea capitis is epidemic among California children with higher rates in the northern counties studied. African-American children are the most affected by this epidemic; however, white children have also experienced increased rates.
Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?
Authors: Johnson Candice E. , Whitwell Judy K. , Pethe Kalpana , Saxena Kapil , Super Dennis M. 
Published: August 2004

Objectives. To determine: (1) whether a lumbar puncture (LP) is indicated in asymptomatic full-term newborns delivered by mothers at risk of intrapartum sepsis; and (2) whether gentamicin improves bacterial coverage for such newborns when used with ampicillin.
Design. A retrospective chart review from 1987 through 1993 of all newborns with positive blood and/or cerebrospinal fluid cultures in the first 7 days of life.
Methods. Pregnant women were screened in the second trimester for group B streptococci and given ampicillin during labor if two or more risk factors were present: group B streptococci colonization, maternal fever or leukocytosis, rupture of membranes at more than 18 hours, foul-smelling amniotic fluid, and fetal tachycardia. After sepsis evaluation (LP, blood culture, white blood cell count, and differential), asymptomatic infants received ampicillin and gentamicin for 48 to 72 hours unless cultures grew pathogens.
Results. Of approximately 24 452 full-term births in 7 years, 7% (1712) had evaluations for symptoms of sepsis, and 14% (3423) were asymptomatic but had evaluations for maternal risk factors. There were 11 cases of meningitis, all involving symptomatic newborns; 10 of these 11 had positive blood cultures for the same organism. In asymptomatic infants, none of the 3423 had meningitis (95% confidence interval, 0 to 0.0008), although 35 grew contaminants. Of 73 pathogens isolated from blood or cerebrospinal fluid, 7 (9.5%) were resistant to ampicillin. Addition of gentamicin provided coverage for only 2 of these 7 pathogens. Of 5135 infants who received ampicillin and gentamicin, only 2 required gentamicin for improved coverage.
Conclusions. (1) LP is unnecessary in asymptomatic full-term newborns. (2) Empiric coverage for asymptomatic newborns with maternal risk factors need not include gentamicin at all hospitals, because it only improved the coverage of ampicillin alone from 90% to 93% of pathogens, but it exposed more than 5000 infants to the side effects of gentamicin. (3) The presence of leukopenia (&lt;5000 white blood cells/mm3) is highly predictive of bacteremia. newborn, lumbar puncture, meningitis.
Physicians’ Opinions on Compensation for Telephone Calls
Authors: Sorum Paul Clay , Mallick Rajiv 
Published: August 2004

Objectives. To describe the attitudes of pediatricians and other physicians practicing in a fee-for-service environment toward compensation for telephone encounters with patients.Design. Survey by mail.Participants. The 67 pediatric and 634 other private physicians and medical school faculty of Albany County, NY.Results. A total of 479 of all the physicians (68.3%) and 55 of the pediatricians (82.1%) returned the questionnaire. Of these, 69.9% of the total (95% confidence interval, 65.5% to 74.1%) and 58.2% of the pediatricians (95% confidence interval, 44.1% to 71.3%) indicated physicians should be compensated for calls with patients, especially for after-hours calls. This opinion was significantly associated with greater concern about liability for calls, more negative sentiments about after-hours calls, and a longer reported duration of calls. After adjusting for these factors, surgeons and pediatricians were significantly less likely to favor compensation than the group as a whole. Pediatricians in favor of compensation suggested charging a mean of $9.18 (SD $5.05) for 1 to 5 min, $14.00 (SD $8.87) for 6 to 10 min, and $22.27 (SD $12.62) for &gt;10 min. Pediatricians reported documenting in patients’ charts a mean of 35.3% (SD 39.9%) of after-hours calls.Conclusions. In a mostly noncapitated environment, the majority of pediatricians and other physicians favor compensation for telephone calls with patients. Some specialists, in particular pediatricians and surgeons, are, however, less likely to support this. Additional research into the reasons for these interspecialty differences may help to guide policy decisions on the financing of health care. telephone calls, physician compensation, physician opinion, health care system, survey.
Nasopharyngeal Carriage of Penicillin-resistantStreptococcus pneumoniaein Children With Sickle Cell Disease
Authors: Daw Najat C. , Wilimas Judith A. , Wang Winfred C. , Presbury Gerald J. , Joyner Royce E. , Harris Sylvia C. , Davis Yvonne , Chen Gang , Chesney P. Joan 
Published: August 2004

Objective. We studied the prevalence of nasopharyngeal (NP) carriage, antimicrobial susceptibilities, and serotypes of Streptococcus pneumoniae (SP) in children with sickle cell disease (SCD) in the Mid-South. In addition, we examined risk factors for NP carriage of penicillin-resistant SP (PRSP).Study Design. Between July 1994 and December 1995, we obtained NP cultures from 312 children with SCD followed at the Mid-South Sickle Cell Center, 208 (67%) of whom were receiving penicillin prophylaxis.Results. Among the 312 patients, colonization with SP occurred in 42 (13%), 30 (71%) of whom were receiving penicillin prophylaxis. Twenty-three of the 42 SP isolates (55%) were resistant to penicillin; 5 of the 23 (22%) were highly resistant. PRSP organisms were also resistant to cefotaxime (43%), trimethoprim-sulfamethoxazole (57%), and erythromycin (22%). Serotypes 6A, 6B, 14, 19A, and 23F accounted for 19 (90%) of 21 resistant strains. Children who were treated with antibiotics during the preceding month were more likely to carry PRSP than children who were not treated.Conclusions. There is a high prevalence of NP carriage of PRSP in children with SCD in the Mid-South, which raises concerns regarding the continued effectiveness of penicillin prophylaxis in these children. Further studies on the antimicrobial susceptibilities of resistant organisms and the relationship between NP carriage of SP and invasive disease are needed before developing new recommendations for prophylaxis and treatment. Streptococcus pneumoniae, penicillin resistance, colonization, sickle cell disease.
Statewide Assessment of Lead Poisoning and Exposure Risk Among Children Receiving Medicaid Services in Alaska
Authors: Robin Laura F. , Beller Michael , Middaugh John P. 
Published: August 2004

Objective. Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) ≥10 μg/dL (≥0.48 μmol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska.Design. Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions.Setting. Eight urban areas and 25 rural villages throughout Alaska.Patients. Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid.Outcome Measure(s). Determination of BLL and responses to verbal-risk assessment questions.Results. BLLs ranged from &lt;1 μg/dL (&lt;0.048 μmol/L) to 21 μg/dL (1.01 μmol/L) (median, 2.0 μg/dL or 0.096 μmol/L). The geometric mean BLLs for rural and urban children were 2.2 μg/dL (0.106 μmol/L) and 1.5 μg/dL (0.072 μmol/L), respectively. Six (0.6%) children had a BLL ≥10 μg/dL; only one child had a BLL ≥10 μg/dL (11 μg/dL or 0.53 μmol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL ≥10 μg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was &lt;1%.Conclusions. In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL ≥10 μg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations. lead poisoning, child health services, mass screening, government regulations, Medicaid.
Growth Until 3 Years of Age in a Prospective, Randomized Trial of a Diet With Reduced Saturated Fat and Cholesterol
Authors: Niinikoski Harri , Lapinleimu Helena , Viikari Jorma , Rönnemaa Tapani , Jokinen Eero , Seppänen Ritva , Terho Pirjo , Tuominen Juhani , Välimäki Ilkka , Simell Olli 
Published: August 2004

Objective. Modification of fat intake in childhood may decrease children's future risk for atherosclerosis. Excessive changes in fat intake have been linked with possible growth failure. This study evaluates the effects of a low–saturated fat diet on growth during the first 3 years of life.Design. Half of 1062 healthy infants were randomized at 7 months of age to the intervention group (n = 540) to receive at 1- to 6-month intervals individualized dietary counseling aimed at reducing their exposure to atherosclerosis risk factors. Five hundred twenty-two children served as control children. Growth and serum lipids were measured regularly, and nutrient intakes were analyzed using 3- to 4-day food records at 5- to 12-month intervals.Results. The intervention children consistently consumed slightly less energy than did the control children. The mean fat intake of children in both groups was lower than expected, especially during the first 2 years of life (29.0 [SD, 4.7] percentage of energy intake [E%] and 28.8 [4.1] E% in the intervention and control children, respectively, at 8 months, formula-fed children only). At 13, 24, and 36 months, fat intake in the intervention and control children accounted for 26.2 (6.0) and 27.9 (4.9) E%, 29.9 (5.0) and 32.8 (4.8) E%, and 30.8 (4.9) and 33.2 (4.6) E%, respectively. From 13 to 36 months, the baseline adjusted mean serum cholesterol concentration was lower in the intervention children than the control children (95% confidence interval for the difference between means, −0.27 to −0.12 mmol/L). The true mean of the height of the boys in the intervention group during the trial was at most 0.34 cm more or 0.57 cm less (95% confidence interval), and the weight was at most 0.19 kg more or 0.22 kg less than that of the control boys. The respective values for girls were at most 0.77 cm more or 0.16 cm less and at most 0.42 kg more or 0.04 kg less. The numbers of slim children were similar in both groups.Conclusions. Fat intake by young children is markedly lower than assumed. A supervised low–saturated fat, low-cholesterol diet has no influence on growth during the first 3 years of life.
Inhaled Glucocorticoid Therapy of Childhood Asthma Is Associated With Reduced Peripheral Blood T Cell Activation and ‘Th2-Type’ Cytokine mRNA Expression
Authors: Gemou-Engesaeth Vasso , Bush Andy , Kay A. Barry , Hamid Qutayba , Corrigan Chris J. 
Published: August 2004

Objective. To investigate the role of activated T cells and their cytokine products in the pathogenesis of childhood asthma.Methods. PBMC were obtained from 17 symptomatic asthmatic children (age 7 to 15 yr) and 7 nonasthmatic controls matched for age and atopic status. Asthmatics were placed in 2 groups with initial prebronchodilator FEV1 &lt;75% (Group I, n = 9) or ≥75% (Group II, n = 8) predicted. Expression of activation markers on peripheral blood T cells (asthmatics), and expression of cytokine mRNA (asthmatics and controls) were measured using flow cytometry and in situ hybridization respectively. Measurements were repeated in the asthmatics 3 to 6 months later following initiation or escalation of inhaled GC therapy for control of symptoms.Results. The more severe (Group I) as compared with the milder (Group II) asthmatics showed evidence of increased peripheral blood T cell activation, with elevated percentages of CD4 cells expressing the activation markers CD25 and HLA-DR, and CD8 cells expressing CD25. Elevated percentages of CD4 cells also expressed CD45RO, consistent with ongoing cellular activation. The asthmatics had higher percentages of PBMC expressing mRNA encoding IL-5, IL-4, GM-CSF and IL-2, but not IFN-γ, as compared with controls. The percentages of PBMC expressing IL-5 mRNA correlated with disease severity (% predicted FEV1). During follow up, patients in both groups required increased mean daily dosages of inhaled GC. In Group I this was associated with improvements in PEFR, FEV1 and night time wheeze and reduced percentages of CD4/CD25 and CD4/HLA-DR peripheral blood T cells. Reductions in the percentages of CD4/CD25 T cells correlated with improvements in baseline FEV1. Group II patients showed improvement in FEV1 and day time cough and wheeze but no significant changes in PEFR, other symptoms or peripheral blood T cell marker expression. Increased GC therapy of both groups taken together was associated with significant reductions in the percentages of PBMC expressing mRNA encoding IL-5, IL-4 and IL-2 and an increase in those expressing IFN-γ mRNA.Conclusions. Compared with controls, children with symptomatic asthma have higher percentages of activated peripheral blood T cells synthesising cytokines believed to regulate bronchial mucosal eosinophilic inflammation. Clinical improvement with increased inhaled GC therapy is associated with reduced T cell activation and cytokine mRNA expression.
Pediatric Injury Prevention Counseling Priorities
Authors: Cohen Lisa R. , Runyan Carol W. , Downs Stephen M. , Bowling J. Michael 
Published: August 2004

Objective. Child health care providers have a unique opportunity to conduct injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that prevention strategies of higher priority be discussed before lower priority strategies. Our aim was to assess consensus among experts about the prioritization of prevention strategies for office based injury prevention counseling for parents of children under age two.Design. We used a modified Delphi technique with 23 childhood injury prevention experts nationwide. Participants were blinded to the identities of each other.Measures. The first questionnaire, distributed via facsimile transmission, consisted of open ended questions about prevention strategies participants believe should be included and their prioritization methods. The second questionnaire was closed ended and based on the results of the first.Results. Seventeen injury problems and 21 prevention strategies were suggested for counseling. Participants emphasized environmental strategies over more active, educational ones. Motor vehicle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temperature, and pool fencing also received high priority ratings. Participants based their decisions on the severity of the injury, the frequency with which the injury occured, and the availability of environmental strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb information led them to suggest limiting, to fewer than four, the number of prevention strategies addressed at any one visit.Conclusions. This study illustrates areas of consensus as well as unresolved dilemmas about pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. Meanwhile, clinicians can use the findings of this study to derive their own judgments.