bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in Admission Threshold Explains Stable Asthma Hospitalization Rates
Authors: Russo Mark J. , McConnochie Kenneth M. , McBride John T. , Szilagyi Peter G. , Brooks Ann Marie , Roghmann Klaus J. 
Published: August 2004

Background.Asthma morbidity and mortality has increased substantially in recent years, but asthma hospitalization rates among many geographic and sociodemographic groups have remained stable. Observations on asthma hospitalization rates and severity of acute episodes might provide valuable insight into the functioning of the health care system during this period of health care reform.Objective.To analyze changes between 1991 and 1995 in childhood asthma hospitalization rates and severity of acute episodes.Design and Methods.All 29 329 hospitalizations, including 2028 for asthma, for the 198 893 children (&lt;19 years of age) in Monroe County (Rochester), New York, were studied during this 5-year period. Severity was determined by hospital record review on a 22% random sample. Using the worst oxygen saturation (Sao2) during the first 24 hours of hospitalization as the primary index of severity, episodes were categorized as mild (0 to ≥95), moderate (90 to 94), or severe (&lt;90).Results.Hospitalization rates are expressed as hospitalizations per 1000 child-years. The overall asthma hospitalization rate was 2.04 (95% confidence interval, 1.95–2.13). The overall annual asthma hospitalization rate remained relatively stable from 1991 (1.90) to 1995 (2.31), whereas the hospitalization rates for severe asthma rose 270%—from 0.57 to 1.55—during this period. Simultaneously, the hospitalization rates for mild asthma decreased from 0.26 to 0.12. As a proportion of all asthma hospitalizations between 1991 and 1995, severe episodes increased from 31.5% to 60.4%; conversely, mild episodes decreased from 14.1% to 4.7%.Conclusions.Severity increased significantly among children hospitalized for asthma while the overall asthma hospitalization rate remained stable. It seems that the health care system in this community has responded to an increase in severity of asthma by raising the severity threshold for admission.
Dietary Long-Chain Polyunsaturated Fatty Acids Do Not Influence Growth of Term Infants: A Randomized Clinical Trial
Authors: Makrides Maria , Neumann Mark A. , Simmer Karen , Gibson Robert A. 
Published: August 2004

Objective.To determine if dietary long-chain polyunsaturated fatty acids (LCPUFA) affect the growth of formula-fed infants relative to breastfed infants.Methods.A randomized, double-blind trial of three formula-fed groups and a parallel reference group of breastfed infants was conducted. The three treatments were a placebo (no LCPUFA), docosahexaenoic acid (DHA) supplemented, and DHA plus arachidonic acid supplemented formulas fed for 12 months. Infant weight, length, head circumference, and fatty acid status were assessed at 6, 16, 34 weeks, and 1 year of age. Anthropometrics were repeated at 2 years of age.Results.There were no differences between the randomized formula groups for weight, length, or head circumference even after adjustment for gender, gestational age, and the actual age at assessment. Post hoc regressions demonstrated a small negative association between DHA status at 16 weeks of age and weight at 1 and 2 years.Conclusions.Dietary LCPUFA do not influence growth of healthy term infants to a clinically significant degree.
Early Dexamethasone Therapy and Blood Cell Count in Preterm Infants
Authors: Peng Ching T. , Lin Hong C. , Lin Yuh J. , Tsai Chang H. , Yeh Tsu F. 
Published: August 2004

Objective.To assess the effects of early postnatal dexamethasone therapy on hematologic values in preterm infants.Materials and Methods.We reviewed the hematologic data of 179 preterm infants who participated in a double-blind clinical trial of early postnatal dexamethasone therapy (&lt;12 hours after birth) for the prevention of chronic lung disease. One group (86 infants) received saline and the other group (93 infants) received dexamethasone. Dexamethasone was given intravenously every 12 hours in tapering doses: 0.25 mg/kg on days 1 to 7, 0.12 mg/kg on days 8 to 14, 0.05 mg/kg on days 15 to 21, and 0.02 mg/kg on days 21 to 28. Blood samples were obtained on days 0, 3, 7, 10, 14, 21, and 28. None of the infants received prenatal steroid therapy.Results.Multiple regression analysis revealed significant differences in the values versus time curves of the white blood cell, neutrophil, lymphocyte, basophil, and eosinophil counts between the two groups. The white blood cell count was significantly higher in the dexamethasone group on days 7 through 14, and this was associated with significantly higher numbers of segmented neutrophils and band forms and significantly lower numbers of lymphocytes and eosinophils. The hematocrit and platelet counts were similar in the two groups throughout most of the trial. Except for platelet count, steroid therapy did not alter the hematologic values for infants with bacteremia.Conclusion.Dexamethasone affects white blood cell, segmented neutrophil, lymphocyte, basophil, and eosinophil counts in neonates. This should be taken into consideration when evaluating preterm infants who are receiving dexamethasone. early dexamethasone therapy; neonatal blood count; preterm infant; respiratory distress syndrome.
Effects of Prenatal Steroids on Water and Sodium Homeostasis in Extremely Low Birth Weight Neonates
Authors: Omar Said A. , DeCristofaro Joseph D. , Agarwal Bajrang I. , La Gamma Edmund F. 
Published: August 2004

Objective.We sought to determine if prenatal steroid (PNS) treatment affects water and sodium (Na) balance in extremely low birth weight infants (&lt;1000 g).Methods.PNS treatment enhances lung maturation in preterm infants and induces maturation of renal tubular function and adenylate cyclase activity in animals. We compared water and Na homeostasis for the first week of life in those infants whose mothers received steroids before delivery (PNS: n = 16) to those who did not (nonsteroid group [NSG]: n = 14). The data were collected prospectively, but PNS treatment was not given in a randomized manner. Fluids were initiated at 100 to 125 mL/kg/d and adjusted every 8 to 12 hours to allow a daily weight loss of ≤4% of birth weight and to maintain normal serum electrolytes. Weight, serum and urine electrolytes, and urine output were frequently measured and fluid intake was adjusted by increasing the amount of free water to achieve these goals.Results.When using our fluid management protocol, the percent weight loss in both groups was equivalent during each of the 7 days (15% PNS vs 17% NSG maximum loss) as well as the cumulative urine output at 1 week of age (663 mL/kg/wk PNS vs 681 mL/kg/wk NSG). PNS infants had a higher urine output on the first 2 days of life and a lower daily fluid intake for the first week. PNS infants also had significantly less insensible water loss for each of the first 4 days of life. The PNS group had a significantly lower mean peak serum Na of 138 ± 1 mmol/L vs 144 ± 2 mmol/L and none had a peak serum Na &gt;150 mmol/L compared with 36% of the NSG infants. PNS infants had a higher cumulative Na excretion at day 2 of life (10 ± 2 mmol/kg vs 6 ± 1 mmol/kg) but a less negative cumulative Na balance at 1 week (−10 mmol/kg vs −14 mmol/kg).Conclusion.PNS treatment was associated with lower estimated insensible water loss, a decreased incidence of hypernatremia, and an earlier diuresis and natriuresis in extremely low birth weight neonates. We speculate that PNS effects these changes through enhancement of epithelial cell maturation improving skin barrier function. PNS treatment may also enhance lung Na,K-ATPase activity leading to an earlier postnatal reabsorption of fetal lung fluid increasing extracellular volume expansion to help prevent hypernatremia.
For-Profit Versus Not-for-Profit Dialysis Care for Children With End Stage Renal Disease
Authors: Furth Susan L. , Hwang Wenke , Neu Alicia M. , Fivush Barbara A. , Powe Neil R. 
Published: August 2004

Objective.
Over the last 2 decades, for-profit dialysis units have become the most common providers of renal replacement therapy for adults with end stage renal disease (ESRD) and have had an increasing role in the dialysis of children. We undertook a study to determine whether dialysis facility profit status influences the choice of dialysis therapy in the pediatric population.

Design.
Cross-sectional study of national data from the Health Care Financing Administration.

Setting.
Free-standing and hospital-based outpatient dialysis facilities in the United States.

Patients.
A total of 1568 children and adolescents (≤19 years of age) eligible for US Medicare ESRD benefits in 1994.

Outcome Measures.
The association between dialysis modality choice and the profit status of the facility. Crude associations were estimated by the OR of a patient being treated with peritoneal dialysis (PD) versus hemodialysis at nonprofit versus for-profit facilities. Adjusted associations were estimated using logistic regression analysis.

Results.
In bivariate analysis, children with ESRD dialyzed at nonprofit facilities were nearly three times as likely as those at for-profit facilities to be on PD (OR: 2.9; 95% CI: 2.3,3.6). In multivariate analysis, after controlling for patient age, sex, race, cause and duration of ESRD, free-standing versus hospital-based facility, and the pediatric expertise of the facility, patients at nonprofit facilities were more than twice as likely as those dialyzed at for-profit facilities to be on PD (OR: 2.3; 95% CI: 1.6,3.4). After taking into account the clustering of patients within facilities, the association between nonprofit status and the use of PD persisted (OR: 2.2; 95% CI: 1.5,3.2).

Conclusions.
Children with ESRD treated at nonprofit facilities are more likely to receive PD than are those treated at for-profit facilities even after controlling for other patient and facility characteristics. This finding suggests that clinical decision making for pediatrics may be influenced by the ownership of the health care facility in which the patient is treated.
Neurologic, Neurocognitive, and Brain Growth Outcomes in Human Immunodeficiency Virus-Infected Children Receiving Different Nucleoside Antiretroviral Regimens
Authors: Raskino Claire , Pearson Deborah A. , Baker Carol J. , Lifschitz Marta H. , O'Donnell Karen , Mintz Mark , Nozyce Molly , Brouwers Pim , McKinney Ross E. , Jimenez Eleanor , Englund Janet A. ,   for the Pediatric AIDS Clinical Trials Group 152 Study Team
Published: August 2004

Objectives.To compare the impact of three different nucleoside reverse transcriptase inhibitor regimens, zidovudine (ZDV) monotherapy, didanosine (ddI) monotherapy, and ZDV plus ddI combination therapy, on central nervous system (CNS) outcomes in symptomatic human immunodeficiency virus (HIV)-infected children.Methods.Serial neurologic examinations, neurocognitive tests, and brain growth assessments (head circumference measurements and head computed tomography or magnetic resonance imaging studies) were performed in 831 infants and children who participated in a randomized double-blind clinical trial of nucleoside reverse transcriptase inhibitors. The Pediatric AIDS Clinical Trials Group study 152 conducted between 1991 and 1995 enrolled antiretroviral therapy-naive children. Subjects were stratified by age (3 to &lt;30 months of age or 30 months to 18 years of age) and randomized in equal proportions to the three treatment groups.Results.Combination ZDV and ddI therapy was superior to either ZDV or ddI monotherapy for most of the CNS outcomes evaluated. Treatment differences were observed within both age strata. ZDV monotherapy showed a modest statistically significant improvement in cognitive performance compared with ddI monotherapy during the initial 24 weeks, but for subsequent protection against CNS deterioration no clear difference was observed between the two monotherapy arms.Conclusions.Combination therapy with ZDV and ddI was more effective than either of the two monotherapies against CNS manifestations of human immunodeficiency virus disease. The results of this study did not indicate a long-term beneficial effect for ZDV monotherapy compared with ddI monotherapy.
Identification of Risk Factors in Rat Bite Incidents Involving Humans
Authors: Hirschhorn Randall B. , Hodge Robert R. 
Published: August 2004

Objective.
This study sought to assess the occurrence of rat bites within an urban population and examine the demographic characteristics to determine whether risk factors can be identified.

Methods.
An observational epidemiologic study was used to collect rat bite data from 1974 to 1996 and plot the incidence of rat bites and factors relating to the characteristics of the victim, circumstances of the bite, and the environmental conditions present at the time and the location of the bite. Comparison between the first 10 years and the last 12 years was made to gauge changes in the incidence of rat bites.

Results.
A total of 622 rat bite cases were confirmed, with incidence gradually decreasing each year. Rat bites primarily affected children 5 years of age and younger. The majority of bites were inflicted on the face and hands and occurred in the bedroom between midnight and 8 am. Physical condition of the structure in which the bite occurred and adjoining structures were significant factors in rat bite incidents. Most bites occurred in the warmer months.

Conclusion.
Risk factors for potential rat bite victims still exist and can be identified for additional planning of intervention and prevention strategies.
Zinc Protoporphyrin/Heme Ratio for Diagnosis of Preanemic Iron Deficiency
Authors: Rettmer Rebecca L. , Carlson Timothy H. , Origenes Maurice L. , MD Jr, , Jack Rhona M. , Labbé Robert F. 
Published: August 2004

Objective.
Iron deficiency anemia is known to impair cognitive and psychomotor development. The zinc protoporphyrin/heme (ZPP/H) ratio is a simple, accurate, and sensitive laboratory screening test that detects early iron depletion before the onset of anemia. The objective of this work was to evaluate this test in a primary pediatric practice setting.

Methods.
The iron status of a cohort of 361 children was screened during routine examinations at a community pediatric practice. Whole blood hemoglobin concentration, hematocrit ratio, serum transferrin saturation, ferritin concentration, and the ZPP/H ratio were measured. The ZPP/H ratio then was evaluated as a single indicator of iron status by comparing it with other tests for detecting the onset of iron deficiency and for monitoring recovery after iron supplementation.

Results.
Significant age- and sex-related differences in the ZPP/H ratio were found. In this cohort, serum ferritin concentration and the ZPP/H ratio independently identified the same fraction of iron-deficient patients (3%–4%), and both tests were more specific than was either hemoglobin or hematocrit. A concordance of three iron status parameters changed the prediction of iron deficiency to ≤1%. Children &lt;3 years of age and adolescent girls had significantly higher ZPP/H results.

Conclusion.
The prevalence of iron deficiency anemia in the typical healthy American pediatric population is low, but iron deficiency without anemia remains relatively common at some stages of development. Increase in the ZPP/H ratio is demonstrated to be a sensitive, specific, and cost-effective test for identifying preanemic iron deficiency in a community pediatric practice. anemia, nutrition, development.
Prognostication and Certainty in the Pediatric Intensive Care Unit
Authors: Marcin James P. , Pollack Murray M. , Patel Kantilal M. , Sprague Bruce M. , Ruttimann Urs E. 
Published: August 2004

Objective.Prognostication is central to developing treatment plans and relaying information to patients, family members, and other health care providers. The degree of confidence or certainty that a health care provider has in his or her mortality risk assessment is also important, because a provider may deliver care differently depending on their assuredness in the assessment. We assessed the performance of nurse and physician mortality risk estimates with and without weighting the estimates with their respective degrees of certainty.Methods.Subjective mortality risk estimates from critical care attendings (n = 5), critical care fellows (n = 9), pediatric residents (n = 34), and nurses (n = 52) were prospectively collected on at least 94% of 642 eligible, consecutive admissions to a tertiary pediatric intensive care unit (PICU). A measure of certainty (continuous scale from 0 to 5) accompanied each mortality estimate. Estimates were evaluated with 2 × 2 outcome probabilities, the κ statistic, the area under the receiver operating characteristics curve, and the Hosmer and Lemeshow goodness-of-fit χ2 statistic. The estimates were then reevaluated after weighting predictions by their respective degree of certainty.Results.Overall, there was a significant difference in the predictive accuracy between groups. The mean mortality predictions from the attendings (6.09%) more closely approximated the true mortality rate (36 deaths, 5.61%) whereas fellows (7.87%), residents (10.00%), and nurses (16.29%) overestimated the mean overall PICU mortality. Attendings were more certain of their predictions (4.27) than the fellows (4.01), nurses (3.79), and residents (3.75). All groups discriminated well (area under receiver operating characteristics curve range, 0.86–0.93). Only PICU attendings and fellows did not significantly differ from ideal calibration (χ2). When mortality predictions were weighted with their respective certainties, their performance improved.Conclusions.The level of medical training correlated with the provider's ability to predict mortality risk. The higher the level of certainty associated with the mortality prediction, the more accurate the prediction; however, high levels of certainty did not guarantee accurate predictions. Measures of certainty should be considered when assessing the performance of mortality risk estimates or other subjective outcome predictions.
Contributors to Violent Behavior Among Elementary and Middle School Children
Authors: Singer Mark I. , Miller David B. , Guo Shenyang , Flannery Daniel J. , Frierson Tracy , Slovak Karen 
Published: August 2004

Objective.
To examine the relative contributions of exposure to violence, parental monitoring, and television-viewing habits to children's self-reported violent behaviors. The study hypothesized that: 1) children's exposure to violence would be associated positively with self-reported violent behaviors; 2) parental monitoring would be associated negatively with children's violent behaviors; and 3) the number of daily television-viewing hours and a preference for watching violent television shows would be associated positively with children's violent behaviors.

Methods.
The study used a survey design with an anonymous self-report questionnaire administered to students (grades 3–8) in 11 public schools. A total of 2245 students participated in the study, representing 80% of the students attending the participating schools during the survey. The subjects were from 7 to 15 years of age; 51% were male, 57% were white, 33% percent were black, and 5% were Hispanic.

Results.
Hierarchical multiple regression analysis of the total sample revealed that the combination of demographic variables, parental monitoring, television-viewing habits, and exposure to violence explained 45% of students' self-reported violent behaviors. Violence exposure and parental monitoring were the most influential contributors in explaining children's violent behaviors, accounting for 24% and 5% of the variance in violent behaviors, respectively.

Conclusions.
All three hypotheses were supported. A significant association was demonstrated linking violence exposure, lack of parental monitoring, and television-viewing habits with children's self-reported violent behaviors within a diverse sample of elementary and middle school students. Our findings support the importance of parental monitoring of children and emphasize the need to identify and to provide services to youth who are exposed to violence.
Child Sexual Behavior Inventory: A Dutch-speaking Normative Sample
Authors: Schoentjes Eric , Deboutte Dirk , Friedrich William 
Published: August 2004

Objectives.
To describe normative sexual behavior in Dutch-speaking children; to assess the frequencies of different types of sexual behaviors reported in children by their parents; to analyze the relation of these sexual behaviors to demographic, personal, familial, and general behavioral variables; and to compare the Dutch-speaking sample with American samples.

Method.
Nine hundred seventeen children (2–12 years of age), screened to exclude sexual abuse, were rated by their caregiver via parent report consisting of the translated Dutch version of the Child Sexual Behavior Inventory, the Child Behavior Checklist, a life event checklist, and a questionnaire assessing family nudity and parental attitudes regarding sexuality.

Results.
Frequencies of a wide variety of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old children are presented. Sexual behavior was found to be related to the child's age, maternal education, family nudity, and parental attitudes toward sexuality. The positive relation to general behavioral problems was confirmed. Findings were primarily similar to previously published American studies.

Conclusion.
Our study confirms that sexual behavior in children is varied and related to developmental, personal, and familial factors. The relative frequency of the wide variety of sexual behaviors in a Dutch-speaking normative sample is comparable to American samples.
Privacy Protection of Health Information: Patient Rights and Pediatrician Responsibilities
Authors:   Pediatric Practice Action Group and Task Force on Medical Informatics
Published: August 2004

This Policy Statement was retired January 2006.
Pediatricians and pediatric medical and surgical subspecialists should know their legal responsibilities to protect the privacy of identifiable patient health information. Although paper and electronic medical records have the same privacy standards, health data that are stored or transmitted electronically are vulnerable to unique security breaches. This statement describes the privacy and confidentiality needs and rights of pediatric patients and suggests appropriate security strategies to deter unauthorized access and inappropriate use of patient data. Limitations to physician liability are discussed for transferred data. Any new standards for patient privacy and confidentiality must balance the health needs of the community and the rights of the patient without compromising the ability of pediatricians to provide quality care.