bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Valproate, Carbamazepine, and Oxcarbazepine on Growth and Sexual Maturation in Girls With Epilepsy
Authors: Rättyä Johanna , Vainionpää Leena , Knip Mikael , Lanning Peter , Isojärvi Jouko I. T. 
Published: August 2004

Objective.
Antiepileptic drugs (AEDs) have endocrine effects that may interfere with growth and sexual maturation in children. The aim of this study was to evaluate the effects of AEDs on growth and pubertal development in girls with epilepsy.

Study Design.
Forty girls taking valproate (VPA), 19 girls taking carbamazepine (CBZ), and 18 girls taking oxcarbazepine (OXC) for epilepsy and 49 healthy control girls participated in the study, which included a cross-sectional clinical examination when the girls were 8 to 18 years old and a longitudinal growth analysis from the age of 1 year.

Results.
VPA, CBZ, or OXC did not affect linear growth or pubertal development in girls with epilepsy. However, the patients taking VPA gained weight, and an increase in relative weight was seen in girls who started their medication before as well as during puberty. The body mass index of the VPA-treated girls (19.8 ± 4.8 kg/m2) was higher than that of the control girls (18.0 ± 2.5 kg/m2) at clinical examination. The weight of the girls taking CBZ or OXC for epilepsy was similar to that of the control girls. Plasma insulin-like growth factor-I (IGF-I) levels were higher in girls treated with CBZ and OXC than in the control girls, but AEDs did not affect fasting serum insulin, IGF-binding protein-1, or IGF-binding protein-3 concentrations in girls on VPA, CBZ, or OXC medication during the period of exposure (average 2.8, 4.1, and 1.9 years, respectively) in this study.

Conclusions.
AEDs do not seem to have any adverse effects on linear growth or sexual maturation in girls with epilepsy. VPA-related weight gain can be seen already in prepuberty and it is not associated with hyperinsulinemia in these young patients. The clinical significance of high circulating concentrations of IGF-I in patients taking CBZ or OXC remains to be defined.
Are All Growth-restricted Newborns Created Equal(ly)?
Authors: Kramer Michael S. , Platt Robert , MSc Hong Yang , McNamara Helen , Usher Robert H. 
Published: August 2004

Background.
Previous etiologic studies have defined intrauterine growth restriction (IUGR) based on a single cutoff.

Objective.
To assess the relative importance of known etiologic determinants for different degrees (mild versus severe) and timing (preterm versus term) of fetal growth restriction.

Design.
Hospital-based cohort study.

Setting.
Tertiary-care university hospital.

Participants.
Sixty-five thousand two hundred eighty inborn singleton infants without major congenital anomalies delivered between January 1, 1978 and March 31, 1996.

Measurements.
Comparison of adjusted odds ratios (ORs) and 95% confidence intervals for mild IUGR (defined as birth weight 75% to &lt;85% of the mean for gestational age, the latter cutoff equivalent to the 9.9th percentile for this cohort) and severe IUGR (&lt;75% of mean, or 2.3rd percentile), after controlling for maternal age, education, marital status, and other potential determinants by means of multiple logistic regression.

Results.
Maternal prepregnancy overweight (body mass index [BMI] &gt;26.0–29.0 kg/m2) and obesity (BMI &gt;29.0 kg/m2) had stronger protective effects against mild IUGR than against severe IUGR, but most of the determinants showed the opposite pattern. This was especially true for pathologic determinants; ORs (and 95% confidence intervals) for severe versus mild IUGR were 18.5 (14.5–23.8) vs 4.6 (3.6–5.8) for severe pregnancy-induced hypertension (PIH), 3.5 (2.2–5.5) vs 2.3 (1.5–3.4) for prepregnancy hypertension, and 3.4 (2.9–3.9) vs 2.2 (2.0–2.4) for smoking ≥11 cigarettes/day. Primiparity, short stature, prepregnancy BMI, maternal weight gain, and cigarette smoking had significantly larger effects on term IUGR, whereas the effect of severe PIH was more than twice as large for preterm IUGR (OR = 9.7 [7.3–13.0]) as for term IUGR (OR = 4.0 [3.0–5.3]).

Conclusion.
Pathologic determinants of IUGR such as prepregnancy and PIH and cigarette smoking predispose to more severe fetal growth retardation, and PIH in particular seems to do so before 37 weeks. Growth-restricted newborns are not, therefore, all created equal(ly).
More Awakenings and Heart Rate Variability During Supine Sleep in Preterm Infants
Authors: Goto Kazuya , Mirmiran Majid , Adams Marian M. , Longford Robyn V. , Baldwin Roger B. , Boeddiker Margaret A. , Ariagno Ronald L. 
Published: August 2004

Objective.The Task Force of The American Academy of Pediatrics (1996) recommends the nonprone sleeping position for asymptomatic preterm infants to prevent sudden infant death syndrome. The mechanism by which the nonprone sleeping position reduces the rate of sudden infant death syndrome is unclear for full-term infants and the precise effect of sleeping position on sleep and cardiorespiratory characteristics has never been addressed in preterm infants. The purpose of the present study was to clarify the effect of sleeping position on sleep and cardiorespiratory characteristics in preterm infants at an age when they are ready for discharge.Study Design.Sixteen asymptomatic preterm infants were studied in both supine and prone sleeping positions at 36.5 ± 0.6 weeks' postconceptional age using videosomnography. Sleep, respiratory, and heart rate characteristics were compared between the two positions using each infant as his/her own control.Results.More awakenings (ie, arousals ≥60 seconds) were seen during all sleep states in the supine sleeping position but overall the total sleep and percent sleep state were not affected by sleeping position. After each feeding, the first quiet sleep was significantly shorter, with more heart rate variability and awakenings in the supine position. There were no significant differences in the occurrence of arousals (&lt;60 seconds) or the incidence or severity of apnea and periodic breathing. No clinically significant apnea (≥15 seconds), bradycardia, or oxygen desaturations were seen.Conclusion.In 36-week-postconceptional age preterm infants, the supine sleeping position had less quiet sleep and was associated with greater heart rate variability during the first sleep cycle after the feeding. More awakenings were seen during all sleep states in the supine position. These data support the American Academy of Pediatrics recommendation for “Back to Sleep” for asymptomatic preterm infants because more awakenings and lower threshold for arousal may provide some benefit for the infant responding to a life-threatening event. However, further studies are needed to address positional effect on the physiologic measures in preterm infants at older ages (later stages of development). Precisely what constitutes the most healthy or advantageous sleep for newborn infants remains an important question.
High Glycemic Index Foods, Overeating, and Obesity
Authors: Ludwig David S. , Majzoub Joseph A. , Al-Zahrani Ahmad , Dallal Gerard E. , Blanco Isaac , Roberts Susan B. 
Published: August 2004

Objective.
The prevalence of obesity has increased dramatically in recent years. However, the role of dietary composition in body weight regulation remains unclear. The purpose of this work was to investigate the acute effects of dietary glycemic index (GI) on energy metabolism and voluntary food intake in obese subjects.

Methods.
Twelve obese teenage boys were evaluated on three separate occasions using a crossover study protocol. During each evaluation, subjects consumed identical test meals at breakfast and lunch that had a low, medium, or high GI. The high- and medium-GI meals were designed to have similar macronutrient composition, fiber content, and palatability, and all meals for each subject had equal energy content. After breakfast, plasma and serum concentrations of metabolic fuels and hormones were measured. Ad libitum food intake was determined in the 5-hour period after lunch.

Results.
Voluntary energy intake after the high-GI meal (5.8 megajoule [mJ]) was 53% greater than after the medium-GI meal (3.8 mJ), and 81% greater than after the low-GI meal (3.2 mJ). In addition, compared with the low-GI meal, the high-GI meal resulted in higher serum insulin levels, lower plasma glucagon levels, lower postabsorptive plasma glucose and serum fatty acids levels, and elevation in plasma epinephrine. The area under the glycemic response curve for each test meal accounted for 53% of the variance in food intake within subjects.

Conclusions.
The rapid absorption of glucose after consumption of high-GI meals induces a sequence of hormonal and metabolic changes that promote excessive food intake in obese subjects. Additional studies are needed to examine the relationship between dietary GI and long-term body weight regulation. glycemic index, obesity, dietary carbohydrate, diets, insulin.
The Effects of Early Pacifier Use on Breastfeeding Duration
Authors: Howard Cynthia R. , Howard Fred M. , Lanphear Bruce , deBlieck Elisabeth A. , Eberly Shirley , Lawrence Ruth A. 
Published: August 2004

Objective.
To evaluate the effects of pacifier use and the timing of pacifier introduction on breastfeeding duration, problems, and frequency.

Methods.
A cohort of 265 breastfeeding mother–infant dyads was followed prospectively. Maternal interviews were conducted at delivery, 2, 6, 12, and 24 weeks, and thereafter every 90 days until breastfeeding ended. Information was obtained regarding pacifier use, infant feeding, use of supplemental foods and breastfeeding frequency, duration, and problems. The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models. The effect of the timing of pacifier introduction (≤2 weeks and ≤6 weeks) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling.

Results.
A total of 181 mothers (68%) introduced a pacifier before 6 weeks. In adjusted analyses, pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full (hazard ratio, 1.53; 95% confidence interval: 1.15, 2.05) and overall (hazard ratio, 1.61; 95% confidence interval: 1.19,2.19) breastfeeding. Women who introduced pacifiers tended to breastfeed their infants fewer times per day, with significant differences noted at 2 (8.1 ± 2.6 vs 9.0 ± 2.3) and 12 weeks' (6.3 ± 2.0 vs 7.4 ± 1.6) postpartum. At 12 weeks postpartum, women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies. Pacifier use begun either before 2 weeks or before 6 weeks' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months.

Conclusions.
Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding. Breastfeeding duration in the first 3 months' postpartum, however, was unaffected by pacifier use. Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding. Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants.
Identification of Attentional and Hyperactivity Problems in Primary Care: A Report From Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network
Authors: Wasserman Richard C. , Kelleher Kelly J. , Bocian Alison , Baker Alison , Childs George E. , Indacochea Fernando , Stulp Clydette , Gardner William P. 
Published: August 2004

Objectives.To 1) determine the frequency of identification of attentional and hyperactivity problems (AHPs) by clinicians, and 2) examine whether minority children or children from less well-educated, lower-income, or lower-functioning families would be more likely to be identified as having AHPs.Design.Prospective cohort study of 22 059 consecutive children 4 to 15 years of age being seen for acute, chronic, and health supervision visits.Setting.Practices of 401 pediatric and family practice clinicians in 44 states, Puerto Rico, and 4 Canadian provinces.Methods.Parent questionnaires included demographic information and the Pediatric Symptom Checklist. Clinician questionnaires categorized psychosocial problems and addressed how assessment of problems was made. Analyses compared children with newly identified AHPs with those with other newly identified psychosocial problems.Results.Clinicians identified behavior problems in 18.7% of children, with 9.2% of the entire sample identified as having AHPs. Among those with newly assessed AHPs, clinicians identified minority children and those from low-income or poorly functioning families as having AHPs at the same rate as other children. However, even after controlling for symptoms, males were more likely than females (odds ratio, 2.81) to be identified as having AHPs. Older clinicians were significantly more likely to identify children as having AHPs (odds ratio, 2.09). In assessing AHPs, clinicians used standardized tools such as behavioral questionnaires for only 36.9% of children, and Diagnostic and Statistical Manual criteria for 38.3% of children.Conclusions.AHPs are highly prevalent in primary care practice. Clinicians do not appear predisposed to label children from disadvantaged backgrounds as having AHPs. Primary care assessment of AHPs lacks standardization.
The Relationship Between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior
Authors: Mangione-Smith Rita , McGlynn Elizabeth A. , Elliott Marc N. , Krogstad Paul , Brook Robert H. 
Published: August 2004

Context.Despite growing concern over the escalating antimicrobial resistance problem, physicians continue to inappropriately prescribe. It has been suggested that a major determinant of pediatrician antimicrobial prescribing behavior is the parental expectation that a prescription will be provided.Objectives.To explore the extent to which parental previsit expectations and physician perceptions of those expectations are associated with inappropriate antimicrobial prescribing; and to explore the relationship between fulfillment of expectations and parental visit-specific satisfaction.Design.Previsit and postvisit survey of parents and postvisit survey of physicians.Setting.Two private pediatric practices, one community based and one university based.Participants.Ten physicians (response rate = 77%), and a consecutive sample of 306 eligible parents (response rate = 86%) who were attending sick visits for their children between October 1996 and March 1997. Parents were screened for eligibility in the waiting rooms of the two practices and were invited to participate if they spoke and read English and their child was 2 to 10 years old, had a presenting complaint of ear pain, throat pain, cough, or congestion, was off antimicrobial therapy for the past 2 weeks, and was seeing one of the participating physicians.Main Outcome Measures.Antimicrobial prescribing decision, probability of assigning a bacterial diagnosis, and parental visit-specific satisfaction.Results.Based on multivariate analysis, physicians' perceptions of parental expectations for antimicrobials was the only significant predictor of prescribing antimicrobials for conditions of presumed viral etiology; when physicians thought a parent wanted an antimicrobial, they prescribed them 62% of the time versus 7% of the time when they did not think the parent wanted antimicrobials. However, physician antimicrobial prescribing behavior was not associated with actual parental expectations for receiving antimicrobials. In addition, when physicians thought the parent wanted an antimicrobial, they were also significantly more likely to give a bacterial diagnosis (70% of the time versus 31% of the time). Failure to meet parental expectations regarding communication events during the visit was the only significant predictor of parental satisfaction. Failure to provide expected antimicrobials did not affect satisfaction.Conclusions.The antibiotic resistance epidemic should lead to immediate replication of this study in a larger more generalizable population. If inaccurate physician perceptions of parent desires for antimicrobials for viral infections are confirmed, then an intervention to change the way physicians acquire this set of perceptions should be undertaken.
Is Greater Continuity of Care Associated With Less Emergency Department Utilization?
Authors: Christakis Dimitri A. , Wright Jeffrey A. , Koepsell Thomas D. , Emerson Scott , Connell Frederick A. 
Published: August 2004

Background.
The benefits of continuity of care (COC) have not been firmly established for pediatric patients.

Objective.
To assess whether greater COC is associated with lower emergency department (ED) utilization.

Setting.
Outpatient teaching clinic at Children's Hospital and Regional Medical Center, Seattle, WA.

Patients.
All 785 Medicaid managed care children ages 0 to 19 years followed at Children's Hospital and Regional Medical Center between 1993 to 1997 who had at least four outpatient visits.

Methods.
Retrospective claims-based analysis. COC was quantified based on the number of different care providers in relation to the number of clinic visits.

Results.
Attending COC was significantly greater than resident COC. In a multiple event survival analysis, compared with those patients in the lowest tertile of attending COC, those in the middle tertile had 30% lower ED utilization (hazard ratio 0.70 [0.53–0.93]) and those in the highest tertile had 35% lower ED use (hazard ratio 0.65 [0.50–0.80]). Resident COC was not significantly associated with ED use.

Conclusion.
Greater COC with attending physicians in outpatient teaching clinics is associated with lower ED utilization.
Ipratropium Bromide Added to Asthma Treatment in the Pediatric Emergency Department
Authors: Zorc Joseph J. , Pusic Martin V. , Ogborn C. Jean , Lebet Ruth , Duggan Anne K. 
Published: August 2004

Objective.
To determine if the addition of ipratropium bromide to the emergency department (ED) treatment of childhood asthma reduces time to discharge, number of nebulizer treatments before discharge, and the rate of hospitalization.

Methods.
Patients &gt;12 months of age were eligible if they were to be treated according to a standardized ED protocol for acute asthma with nebulized albuterol (2.5 mg/dose if weight &lt;30 kg, otherwise 5 mg/dose) and oral prednisone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to receive either ipratropium (250 μg/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assignment. Records were reviewed to determine the length of time to discharge home from the ED, number of doses of albuterol given before discharge, and the number of patients admitted to the hospital.

Results.
Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Among patients discharged from the ED, ipratropium group subjects had 13% shorter treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer total albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%).

Conclusions.
The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge.
Atypical Chronic Lung Disease Patterns in Neonates
Authors: Charafeddine Lama , D'Angio Carl T. , Phelps Dale L. 
Published: August 2004

Objective.To determine, in the postsurfactant era, the incidence and clinical characteristics of infants with atypical versus traditionally defined bronchopulmonary dysplasia (BPD) among premature infants with birth weights &lt;1251 g.Design.Retrospective cohort study.Setting.A single regional neonatal intensive care unit (level III/IV).Patients.Two hundred thirty-two premature infants &lt;1251 g at birth consecutively admitted during a 2-year period.Main Outcome Measure.Incidence of classic BPD and atypical chronic lung disease (CLD) (occurring without preceding respiratory distress or after recovery from respiratory distress).Results.Among 177 infants &lt;1251 g who survived to 28 days, 27 (15%) had atypical CLD and 61 (34.5%) had classic BPD. Atypical CLD infants were significantly heavier and more mature than classic BPD infants (mean birth weights, 922 ± 152 g vs 854 ± 173 g; and mean gestational age, 26.8 ± 1.3 weeks vs 26.1 ± 1.6 weeks). Median duration of ventilator support (31 days; range, 2 to 127 vs 42 days; range, 4–145 days) and oxygen therapy (30 days; range, 11 to 163 vs 48 days; range, 19–180 days) were shorter in atypical CLD infants than in classic BPD infants.Conclusion.Atypical CLD comprised 31% of total cases of CLD. Atypical CLD appears to be less severe than classic BPD. These data suggest that initial, acute lung injuries are not the sole antecedents of neonatal CLD.
Vagal Nerve Stimulation in Epileptic Encephalopathies
Authors: Parker Alasdair P. J. , Polkey Charles E. , Binnie Colin D. , Madigan Catherine , Ferrie Colin D. , Robinson Richard O. 
Published: August 2004

Objective.
To study the effect of vagal nerve stimulation (VNS) in children with epileptic encephalopathies.

Methods and Materials.
All children receiving VNS during a 2-year period at our center were studied prospectively for changes in seizure frequency, electroencephalogram (EEG), adaptive behavior, quality of life, and where appropriate, verbal/nonverbal performance. Assessments were made before and for at least 1 year after implant.

Results.
Sixteen children were studied. One device was removed because of infection. Of the remaining 15 children, 4 had a &gt;50% reduction and 2 had a &gt;50% increase in seizure frequency at 1 year after implant. Median reduction in seizure frequency was 17%. There was no trend toward improvement of the EEG or adaptive behavior. Quality of life was unchanged in most areas, except in perceived treatment side effects and general behavior that were improved. In 6 children undergoing further assessment, there was a significant improvement in verbal performance; this did not correlate with reduction in seizure frequency.

Conclusion.
VNS did not significantly improve seizure frequency, severity, adaptive behavior, or the EEG during the first year of treatment for the group as a whole, although 4 children (27%) had a worthwhile reduction in seizure frequency. There were significant improvements in perceived treatment side effects and general behavior.