bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does an Isolated History of Loss of Consciousness or Amnesia Predict Brain Injuries in Children After Blunt Head Trauma?
Authors: Palchak Michael J. , Holmes James F. , Vance Cheryl W. , Gelber Rebecca E. , Schauer Bobbie A. , Harrison Mathew J. , Willis-Shore Jason , Wootton-Gorges Sandra L. , Derlet Robert W. , Kuppermann Nathan 
Published: August 2004

Background. A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma.Objective. We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma.Methods. We prospectively enrolled children &lt;18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for &gt;1 week, persistent neurologic deficits, or hospitalization for ≥2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI (“isolated” LOC and/or amnesia).Results. Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention.Conclusions. Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI.
Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School
Authors: Phillips Lynelle , Carlile John , Smith Diane 
Published: August 2004

Objectives. 1) Demonstrate the importance of maintaining a tuberculosis (TB) control program even in low-incidence areas by studying a TB-contact investigation of a highly infectious high school student in rural Missouri, and 2) discuss factors that perpetuated or contained this school-based outbreak.
Methods. A case review of the index patient, a 15-year-old high school student, established estimates of his level and duration of infectiousness. Contact investigations of his household (n = 5), high school (n = 781), and school bus (n = 67) were administered according to guidelines established by the Centers for Disease Control and Prevention. High school students were stratified further based on classroom exposure, and relative risks were calculated for each risk group.
Results. The case review revealed that the index patient had evidence of a pulmonary cavity on chest radiograph 6 months before his TB diagnosis. Of the 5 household contacts, all were infected and 3 (60%) had developed active TB disease. Of the 781 high school students sought for TB screening, 559 (72%) completed testing, and 58 (10%) were PPD-positive. Sixty-seven bus riders were sought for testing and 7 (19%) were purified protein derivative (PPD)-positive, with 1 bus rider subsequently diagnosed with active disease.
Risks were calculated based on classroom and bus exposure to the patient. The relative risks for a positive PPD were 3.2 for attending any class with the patient (n = 25), 4.2 for classes with less ventilation (n = 21), and 5.7 for ≥3 classes (n = 7) with the patient. A total of 62 students started treatment for latent TB infection, and 49 have completed it. Forty-two of these students received directly observed therapy through the local public health agency and the high school.
Conclusion. This investigation demonstrated widespread adult-type transmission from a pediatric TB case with a 6-month delay in diagnosis. Several actions contributed to the success of this investigation, including rapidly mobilizing the public health system, centralizing follow-up, and on-site testing and treatment with directly observed therapy. Pediatricians need to maintain awareness of TB and risk factors in children, even in low-incidence areas. Prompt diagnosis would have reduced the severity of illness in the patient and potentially prevented widespread school-based transmission. Public health authorities must maintain an infrastructure to respond to large TB outbreaks.
During Toilet Training, Constipation Occurs Before Stool Toileting Refusal
Authors: Blum Nathan J. , Taubman Bruce , Nemeth Nicole 
Published: August 2004

Background. Previous studies demonstrated that constipation and painful defecation are associated with stool toileting refusal (STR), but whether they are the result of STR or occur before this behavior is not known.Objective. To determine whether constipation and painful defecation occur as a result of STR or occur before STR.Methods. Three hundred eighty children between 17 and 19 months of age participated in a prospective longitudinal study of toilet training. Children were monitored with telephone interviews every 2 to 3 months until the completion of daytime toilet training. Information obtained in follow-up interviews included parents' reports on the presence and frequency of hard bowel movements, painful defecation, and child toilet training behaviors. Children were defined as completing daytime toilet training when they were experiencing &lt;4 urine accidents per week and ≤2 episodes of fecal soiling per month. Children were defined as having frequent hard bowel movements if the parents reported a hard bowel movement approximately once per week in ≥2 follow-up telephone interviews or more than once per week in 1 follow-up telephone interview.Results. The mean age at the completion of daytime toilet training was 36.8 ± 6.1 months (range: 22–54 months). Ninety-three children (24.4%) developed STR. Parents of children who developed STR, in comparison with the rest of the sample, were more likely to report that the child had experienced hard bowel movements (67.7% vs 50.9%), frequent hard bowel movements (29.0% vs 14.3%), and painful defecation (41.9% vs 27.9%). Of the children who experienced both STR and hard bowel movements, 93.4% demonstrated constipation before the onset of STR. In that group, parents reported hard bowel movements at almost one-half of all follow-up telephone interviews before the onset of STR. Of the children who experienced both STR and painful defecation, 74.4% experienced the first episode of painful defecation before the onset of STR. Children with frequent hard bowel movements demonstrated a longer duration of STR (9.0 ± 6.5 vs 4.8 ± 3.0 months).Conclusions. When hard bowel movements or painful defecation is associated with STR, the first episode of constipation usually occurs before the STR. The fact that hard bowel movements frequently occur before the onset of STR suggests that for many of these children constipation is a chronic problem that is not being treated effectively. Therefore, hard bowel movements and painful defecation are factors that potentially contribute to the STR and for the majority of children are not caused solely by the STR behavior. Additional studies are needed to determine whether earlier and more effective treatment of constipation could decrease the incidence of STR.
Maternal Depressive Symptoms and Infant Health Practices Among Low-Income Women
Authors: Chung Esther K. , McCollum Kelly F. , Elo Irma T. , Lee Helen J. , Culhane Jennifer F. 
Published: August 2004

Objectives. To determine the relationships between maternal depressive symptoms and the use of infant health services, parenting practices, and injury-prevention measures.Methods. A prospective, community-based survey of women attending Philadelphia public health centers between February 2000 and November 2001 was conducted. Women were surveyed at 3 time points before and after parturition. Depressive symptoms were determined with the Center for Epidemiologic Studies Depression Scale at each time point. We studied 6 outcomes, clustered into 3 categories: 1) infant health service use (adequate well-child care and ever being hospitalized); 2) parenting practices (breastfeeding for ≥1 month and use of corporal punishment); and 3) injury-prevention measures (having a smoke alarm and using the back sleep position).Results. The sample consisted of 774 largely single (74%), uninsured (63%), African American (65%) women, with a mean age of 24 ± 6 years and a mean annual income of $8063. Forty-eight percent of women had depressive symptoms at 1 or 2 time points (ever symptoms) and 12% had depressive symptoms at all points (persistent symptoms). Compared with women who never had depressive symptoms (without symptoms), women with persistent symptoms were nearly 3 times as likely to have their child ever hospitalized (adjusted odds ratio: 2.89; 95% confidence interval: 1.61–5.07) and twice as likely to use corporal punishment (adjusted odds ratio: 1.90; 95% confidence interval: 1.08–3.34). Mothers with persistent depressive symptoms were nearly three-quarters less likely to have smoke alarms in their homes (adjusted odds ratio: 0.28; 95% confidence interval: 0.11–0.70) and one-half as likely to use the back sleep position (adjusted odds ratio: 0.56; 95% confidence interval: 0.35–0.91), compared with women without symptoms. There was no association between maternal depressive symptoms and infant receipt of well-child care or the likelihood of breastfeeding for ≥1 month.Conclusions. Maternal depressive symptoms persisting from the prepartum to postpartum periods were associated with increased risks of infant hospitalization and use of corporal punishment and with lower likelihood of having a smoke alarm and using the back sleep position. Additional efforts are needed to identify and evaluate mothers with depressive symptoms to improve the health and safety of young infants.
Psychiatric Hospitalizations Among Children and Youths With Human Immunodeficiency Virus Infection
Authors: Gaughan Denise M. , Hughes Michael D. , Oleske James M. , Malee Kathleen , Gore Carol A. , Nachman Sharon ,   for the Pediatric AIDS Clinical Trials Group 219C Team
Published: August 2004

Objective. Psychiatric manifestations of pediatric human immunodeficiency virus (HIV) infection have been described. However, data on severe sequelae requiring hospitalization among this population have not been reported.
Methods. The Pediatric Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group (PACTG) 219C is a prospective cohort study designed to examine long-term outcomes among HIV-infected children and HIV-uninfected infants born to HIV-infected women. Children with HIV infection who have enrolled in PACTG 219C are examined quarterly, with collection of clinical and laboratory data. Hospitalizations and diagnoses for all participants between September 2000 (when enrollment into PACTG 219C was started) and December 2002 were reviewed.
Results. Among 1808 HIV-infected participants who were &lt;15 years of age at the last visit date, 25 children had been hospitalized for psychiatric manifestations, 8 before enrollment into PACTG 219C. Seventeen children were hospitalized during 2757 person-years of follow-up monitoring after entry into PACTG 219C, which represents an incidence of 6.17 cases per 1000 person-years (95% confidence interval: 3.59–9.87 cases per 1000 person-years). This was significantly higher than the incidence of 1.70 cases per 1000 person-years (95% confidence interval: 1.67–1.72 cases per 1000 person-years) in the general pediatric population &lt;15 years of age, as reported in the 2000 National Hospital Discharge Survey, yielding a relative rate of 3.62 (95% confidence interval: 2.11–5.80). A total of 32 HIV-infected children, regardless of age, were hospitalized because of psychiatric illnesses. The majority of patients were admitted because of depression (n = 16) or behavioral disorders (n = 8). Fifteen (47%) underwent multiple psychiatric hospitalizations. The median age at the first psychiatric hospitalization was 11 years (range: 4–17 years); all patients had been perinatally infected. Knowledge of HIV seropositivity status and having experienced a significant life event were both significantly associated with an increased risk of psychiatric hospitalization (hazard ratios of 6.13 and 3.04, respectively). No psychiatric hospitalizations were observed among the 1021 HIV-uninfected members of the cohort.
Conclusions. Children with HIV/AIDS are at increased risk for psychiatric hospitalizations during childhood and early adolescence, compared with the general pediatric population. Knowledge of HIV seropositivity status and recent significant life events were significantly associated with increased risks of admission in this population.
Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants &lt;30 Weeks’ Gestation
Authors: Dani Carlo , Bertini Giovanna , Pezzati Marco , Cecchi Alessandra , Caviglioli Cosimo , Rubaltelli Firmino F. 
Published: August 2004

Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).Methods. A prospective randomized study was conducted, in which infants &lt;30 weeks’ gestation were randomized to the SURF-NCPAP group or the SURF-MV group.Results. At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit.
Plasma C-Reactive Protein Levels Among Children With Sleep-Disordered Breathing
Authors: Tauman Riva , Ivanenko Anna , O'Brien Louise M. , Gozal David 
Published: August 2004

Introduction. Levels of C-reactive protein (CRP), an important serum marker of inflammation with major implications for cardiovascular morbidity and atherogenesis, are elevated among adult patients with sleep-disordered breathing (SDB). We hypothesized that elevated CRP plasma levels would also be present among children with SDB.Methods. Eighty-one children (mean age: 9.3 ± 3.7 years) underwent polysomnographic evaluations. Samples for plasma CRP level and lipid profile determinations were drawn the next morning.Results. Because plasma CRP levels were not normally distributed in this cohort, logarithmic transformation was applied. Log plasma CRP levels were significantly higher in the SDB group (obstructive apnea/hypopnea index [AHI] of ≥5), compared with the mild SDB group (AHI of ≥1 and &lt;5) and the control group (AHI of &lt;1). Significant positive correlations were found between log CRP levels and AHI (r = .53) and arousal index (r = .28), whereas an inverse correlation was found between the lowest nocturnal arterial oxygen saturation and log CRP levels (r = −.47). These correlations persisted after exclusion of outliers. Moreover, 94% of the children with elevated log CRP levels reported excessive daytime sleepiness and/or learning problems, compared with 62% of the children with normal log CRP levels.Conclusions. Plasma CRP levels were increased among some children with SDB and were correlated with AHI, arterial oxygen saturation nadir, and arousal index measures. These changes were particularly prominent among children who were sleepy or presented with neurobehavioral complaints. The intermittent hypoxemia and sleep fragmentation of SDB may underlie inflammatory responses, the magnitude of which may ultimately lead to the cardiovascular, cognitive, and behavioral morbidities of SDB.
A Brief Screening Questionnaire for Infant Sleep Problems: Validation and Findings for an Internet Sample
Authors: Sadeh Avi 
Published: August 2004

Objective. To develop and validate (using subjective and objective methods) a brief infant sleep questionnaire (BISQ) that would be appropriate for screening in pediatric settings.Design. Two studies were performed to assess the properties of the BISQ. Study I compared BISQ measures with sleep diary measures and objective actigraphic sleep measures for clinical (N = 43) and control (N = 57) groups of infants (5–29 months of age). The second study was based on an Internet survey of 1028 respondents who completed the BISQ posted on an infant sleep web site.Results. In study I, BISQ measures were found to be correlated significantly with sleep measures derived from actigraphy and sleep diaries. BISQ measures (number of night wakings and nocturnal sleep duration) were the best predictors for distinguishing between clinical and control samples. High test-retest correlations (r &gt; .82) were demonstrated for BISQ measures for a subsample of 26 infants. Study II provided a developmental perspective on BISQ measures. The study demonstrated that BISQ measures derived from a large Internet survey provided developmental and sleep ecology-related findings that corresponded to the existing literature findings on sleep patterns in early childhood.Conclusions. The findings provide psychometric, clinical, and ecologic support for the use of the BISQ as a brief infant sleep screening tool for clinical and research purposes. Potential clinical cutoff scores are provided.
Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections
Authors: Luo Feng , Leckman James F. , Katsovich Liliya , Findley Diane , Grantz Heidi , Tucker Daniel M. , Lombroso Paul J. , King Robert A. , Bessen Debra E. 
Published: August 2004

Background. It has been proposed that infection by group A β-hemolytic streptococci (GABHS) can trigger acute symptom exacerbations among patients with Tourette’s syndrome (TS) or obsessive-compulsive disorder (OCD), via autoimmune mechanisms.Objective. To examine the temporal relationship between newly acquired GABHS infections (and other immunologic indices) and acute exacerbations of tics and obsessive-compulsive symptoms.Methods. Pediatric patients (7–17 years of age) with TS and/or OCD (N = 47) and healthy control subjects (N = 19) were prospectively monitored for newly acquired GABHS infections, nonspecific markers of acute inflammatory responses, and D8/17-reactive cells (a marker of rheumatic fever). Objective monthly ratings of tic and obsessive-compulsive symptom severity were used to determine the timing of symptom exacerbations.Results. The overall rate of acute exacerbations of neuropsychiatric symptoms was 0.56 exacerbations per patient per year. The average rate of new GABHS infections, using a stringent definition, was 0.42 infections per subject per year among patients, compared with 0.28 infections per subject per year for control subjects. The association between symptom exacerbations and new GABHS infections among patients was no greater than that expected on the basis of chance. At baseline, patients demonstrated significantly higher levels of D8/17-reactive cells and neopterin, compared with control subjects, but there was no consistent pattern of change when exacerbation time points were compared with baseline or follow-up time points.Conclusions. The results suggest no clear relationship between new GABHS infections and symptom exacerbations in an unselected group of patients with TS and/or OCD.
Heat Stress and Sudden Infant Death Syndrome Incidence: A United States Population Epidemiologic Study
Authors: Scheers-Masters Joshua R. , Schootman Mario , Thach Bradley T. 
Published: August 2004

Objectives. To determine the role of heat stress in sudden infant death syndrome (SIDS) by examining the SIDS rates during periods of extreme environmental temperatures in a period when most infants were placed prone for sleep.Design. A retrospective study of SIDS rates and mortality rates attributable to excessive environmental heat in relationship to climatologic temperature was performed. Data were collected for each of 454 counties in 4 states (Arkansas, Georgia, Kansas, and Missouri) from May 1 to September 30, 1980, and were then summed to yield the mortality rates for each 5°F (2.8°C) temperature range.Results. χ2 analyses revealed significant relationships for heat-related mortality rates and both the maximal daily temperature and mean daily temperature but demonstrated no such relationships for SIDS rates. No association between SIDS rates and heat-related mortality rates was found with Spearman’s ranked correlation, for either the maximal daily temperature or the mean daily temperature.Conclusions. On the basis of our findings of no significant association between SIDS and either measure of temperature during periods of high heat stress-related death rates, it seems unlikely that the heat stress associated with the combination of prone sleep positions and elevated environmental temperatures has a significant role in the development of SIDS.