bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of UniversalHaemophilus influenzaeType b Vaccination Starting at 2 Months of Age in the United States: An Economic Analysis
Authors: Zhou Fangjun , Bisgard Kristine M. , Yusuf Hussain R. , Deuson Robert R. , Bath Sue K. , Murphy Trudy V. 
Published: August 2004

Objective. To evaluate the economic impact of universal Haemophilus influenzae type b (Hib) vaccination starting at 2 months of age.Methods. Decision-tree-based analysis was conducted of a hypothetical US birth cohort of 3 815 469 infants using population-based vaccination coverage and disease incidence data. All costs were estimated from both the direct cost (medical and nonmedical) and societal perspectives. Net present value, cost-effectiveness ratios, and benefit-cost ratios of the US Hib vaccination program were evaluated.Results. The results of these analyses showed that the universal vaccination program using the Hib conjugate vaccines in the United States in 2000 was cost-saving from both the direct and societal perspectives, with the benefit of the Hib vaccination program (net present value) from the direct cost and societal perspectives of $0.95 billion and $2.09 billion, respectively. Without a Hib vaccination program, the direct and societal costs of Hib invasive cases would be $1.35 billion and $2.58 billion, respectively. The direct and societal costs of the Hib vaccination program were estimated at $0.39 billion and $0.48 billion, respectively. The direct and societal benefit-cost ratios for the Hib vaccination program were 3.4 and 5.4, respectively. Varying the proportion of vaccines purchased and administered in the public versus the private sector and the proportion of combination vaccine versus monovalent vaccine administered did not have much effect on the results.Conclusions. Regardless of the perspective (direct cost or societal) and the assumptions used, the benefit-cost ratios of the US vaccination program are &gt;1.0. Potential changes in the program, including use of more or less Hib combination vaccines, would not significantly alter the benefit-cost ratio. The national Hib vaccination program is highly cost beneficial and results in substantial cost savings.
Safety of the Trivalent, Cold-Adapted Influenza Vaccine in Preschool-Aged Children
Authors: Piedra Pedro A. , Yan Lihan , Kotloff Karen , Zangwill Ken , Bernstein David I. , King James , Treanor John , Munoz Flor , Wolff Mark , Cho Iksung , Mendelman Paul M. , Cordova Julie , Belshe Robert B. 
Published: August 2004

Objective. To provide additional information on the safety of trivalent, cold-adapted influenza vaccine (CAIV-T) in children.
Methods. Children 15 to 71 months of age were enrolled in a multicenter, prospective, randomized, double-blind, and placebo-controlled trial to receive by nasal spray CAIV-T or placebo. In year 1 (1996–1997), 1314 were enrolled in the 2-dose cohort and 288 were enrolled in the 1-dose cohort. In year 2 (1997–1998), 1358 of the original participants received 1 dose of vaccine or placebo according to their original treatment group assignment. In year 3 (1998–1999) and year 4, the trial continued as an open-label safety trial of CAIV-T. A total of 642 and 549 children enrolled in years 3 and 4, respectively, received their third and fourth sequential annual doses of CAIV-T. Measured were 1) the occurrence of specific respiratory, gastrointestinal and systemic symptoms, unexpected symptoms (not specified in the diary card), and use of medications within the first 10 days after vaccination; 2) the occurrence of an acute illness and use of medication within 11 to 42 days after vaccination; and 3) the occurrence of serious adverse events within 42 days after vaccination.
Results. The adjusted odd ratios of specific respiratory and gastrointestinal symptoms during the 10 days after vaccination were determined in years 1 and 2. Runny nose or nasal congestion, vomiting, muscle aches, and fever were significantly associated with the first dose of CAIV-T. With the second dose, runny nose was the only symptom that was associated with CAIV-T. In year 2, CAIV-T did not cause excess in any of the specific respiratory and gastrointestinal symptoms. In years 3 and 4, specific respiratory and gastrointestinal symptoms were comparable to that observed in year 2. A CAIV-T–associated symptom was most likely to occur on day 2 with the first dose of vaccine. The occurrence of unexpected symptoms was primarily of the gastrointestinal system. Approximately 6% of CAIV-T and 3.6% of placebo recipients had a gastrointestinal symptom. CAIV-T seemed to be associated with a mild excess in abdominal pain and vomiting only with the first vaccine dose. A statistically significant increase in the use of analgesics/antipyretics was detected only with the first dose in CAIV-T vaccinees compared with placebo recipients (23.5% vs 16.6%). Between days 11 and 42, CAIV-T use was not associated with an excess of illness, otitis media, or use of medication. None of the 6 serious adverse events in CAIV-T recipients in years 1 to 4 was attributed to the vaccine.
Conclusions. CAIV-T was safe in children. Mild respiratory, gastrointestinal, and systemic symptoms of short duration were observed in a minority of children and primarily with the first vaccine dose. Sequential annual doses of CAIV-T were well tolerated.
Otitis Media in Early Childhood in Relation to Children’s School-Age Language and Academic Skills
Authors: Roberts Joanne E. , Burchinal Margaret R. , Zeisel Susan A. 
Published: August 2004

Objective. To examine whether otitis media with effusion (OME) and associated hearing loss during the first 4 years of life are related to the language development and academic achievement of children between 4 years of age and second grade.
Methods. In a prospective cohort study, 83 black children, primarily from low-income families and recruited from community-based child care programs, were examined repeatedly between the ages of 6 months and 4 years for the presence of OME and hearing loss, both when well and when ill with OME. Children’s child-rearing environments at home were assessed annually from infancy through second grade, whereas children’s language and academic skills were assessed repeatedly between 4 years of age and second grade.
Results. We did not find in our longitudinal analyses a relationship between OME and hearing loss during the first 4 years of life and later academic skills in early reading and recognition of words heard. We did find that children with greater incidence of OME and hearing loss during the first 4 years of life scored lower in verbal math problems between kindergarten and second grade, even after partialing out important background factors. Children with more OME tended to score lower in math at the younger ages but caught up once they entered school. Follow-up analyses indicated also that children with more OME during the first 2 years of life scored lower in expressive language during the preschool and early elementary school years but caught up by second grade. In contrast, children from homes that were rated as more stimulating and responsive scored higher on every measure of language and academic skills than did children from less responsive homes. The home environment was related more strongly to all of the outcomes examined than was OME or hearing loss.
Conclusions. There was no evidence of a significant relationship between a history of OME or hearing loss and children’s later academic skills in reading or word recognition during the early elementary school years. Children with greater incidence of OME and hearing loss scored lower in math and expressive language at the younger ages but caught up in math with their peers on entering school and in expressive language by second grade. Furthermore, a child’s home environment was more related to early math and expressive language skills than was OME or hearing loss, and the home environment continued to be predictive of all of the language and academic outcomes through second grade. These study results should be interpreted cautiously when generalizing to other populations.
The Effect of Antibiotic Rotation on Colonization With Antibiotic-Resistant Bacilli in a Neonatal Intensive Care Unit
Authors: Toltzis Philip , Dul Michael J. , Hoyen Claudia , Salvator Ann , Walsh Michele , Zetts Laura , Toltzis Hasida 
Published: August 2004

Objective. This study was designed to test whether rotation of antibiotics can reduce colonization with resistant Gram-negative bacilli in a neonatal intensive care unit (NICU).
Methods. A monthly rotation of gentamicin, piperacillin-tazobactam, and ceftazidime was compared with unrestricted antibiotic use in side-by-side NICU populations (rotation team vs control team). Pharyngeal and rectal samples were obtained 3 times a week and tested for Gram-negative bacilli resistant to each of the rotation antibiotics. Pulsed-field gel electrophoresis analysis determined the numbers of genetically discordant resistant organisms on each team. The association between colonization with a resistant bacillus (the primary outcome) and team assignment was tested.
Results. A total of 1062 infants were studied during a 1-year period. A total of 10.7% infants on the rotation team versus 7.7% on the control team were colonized with a resistant bacillus. No interteam differences were distinguishable when the numbers of genetically discordant resistant organisms were normalized to the total number of team admissions. The incidence of nosocomial infection and mortality also were similar across teams.
Conclusion. These data indicate that rotation of parenteral antibiotics according to the applied protocol has no detectable effect in decreasing the reservoir of resistant Gram-negative bacilli in a tertiary-care NICU.
Development and Validation of a Multivariable Predictive Model to Distinguish Bacterial From Aseptic Meningitis in Children in the Post-Haemophilus influenzae Era
Authors: Nigrovic Lise E. , Kuppermann Nathan , Malley Richard 
Published: August 2004

Context. Children with meningitis are routinely admitted to the hospital and administered broad-spectrum antibiotics pending culture results because distinguishing bacterial meningitis from aseptic meningitis is often difficult.
Objective. To develop and validate a simple multivariable model to distinguish bacterial meningitis from aseptic meningitis in children using objective parameters available at the time of patient presentation.
Design. Retrospective cohort study of all children with meningitis admitted to 1 urban children’s hospital from July 1992 through June 2000, randomly divided into derivation (66%) and validation sets (34%).
Patients. Six hundred ninety-six previously healthy children aged 29 days to 19 years, of whom 125 (18%) had bacterial meningitis and 571 (82%) had aseptic meningitis.
Intervention. Multivariable logistic regression and recursive partitioning analyses identified the following predictors of bacterial meningitis from the derivation set: Gram stain of cerebrospinal fluid (CSF) showing bacteria, CSF protein ≥80 mg/dL, peripheral absolute neutrophil count ≥10 000 cells/mm3, seizure before or at time of presentation, and CSF absolute neutrophil count ≥1000 cells/mm3. A Bacterial Meningitis Score (BMS) was developed on the derivation set by attributing 2 points for a positive Gram stain and 1 point for each of the other variables.
Main Outcome Measure. The accuracy of the BMS when applied to the validation set.
Results. A BMS of 0 accurately identified patients with aseptic meningitis without misclassifying any child with bacterial meningitis in the validation set. The negative predictive value of a score of 0 for bacterial meningitis was 100% (95% confidence interval: 97%–100%). A BMS ≥2 predicted bacterial meningitis with a sensitivity of 87% (95% confidence interval: 72%–96%).
Conclusions. The BMS accurately identifies children at low (BMS = 0) or high (BMS ≥2) risk of bacterial meningitis. Outpatient management may be considered for children in the low-risk group.
Impact of a Health Maintenance Organization Hospitalist System in Academic Pediatrics
Authors: Landrigan Christopher P. , Srivastava Rajendu , Muret-Wagstaff Sharon , Soumerai Stephen B. , Ross-Degnan Dennis , Graef John W. , Homer Charles J. , Goldmann Donald A. 
Published: August 2004

Objective. Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization’s (HMO’s) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents’ ratings of care.
Design. Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents’ ratings of care and mortality, readmission, and follow-up rates.
Results. Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% ($217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates.
Conclusions. A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems.
Self-Assessment of Pubertal Stage in Overweight Children
Authors: Bonat Sandra , Pathomvanich Annatura , Keil Margaret F. , Field Alison E. , Yanovski Jack A. 
Published: August 2004

Objective. For those with normal body habitus, self-assessments have been reported to yield Tanner stage ratings similar to those found by actual examinations. Little is known about whether such self-assessments are accurate in obese children. We therefore determined the reliability of Tanner stage self-assessments in both nonobese and obese children.Methods. We studied 244 children age 6 to 12 years, 135 girls and 109 boys, 41% of whom were obese (body mass index ≥95th percentile for age and gender). Girls rated both breast and pubic hair development and boys rated pubic hair development using a standardized series of drawings accompanied by explanatory text. After self-ratings were completed, a pediatric endocrinologist or trained nurse practitioner who was blinded to subjects’ self-ratings examined each subject.Results. Self-ratings of breast Tanner stage were concordant with actual stage in 48%, overestimated in 25%, and underestimated in 27% of nonobese girls. By contrast, breast Tanner stage was overestimated by 38% of obese girls and was underestimated by only 12%. On average, obese girls overestimated actual Tanner breast stage by 0.47 ± 0.9 stages. Pubic hair ratings were largely concordant with actual pubic hair stage in both obese and nonobese girls. Both nonobese and obese boys significantly overestimated actual Tanner pubic hair stage, by 0.51 ± 1.1 stages and 0.31 ± 0.8 stages, respectively.Conclusions. We conclude that, in children 6 to 12 years of age, self-assessment cannot be used to determine reliably the breast Tanner stage of obese girls or the pubic hair stage of boys.
Ultrasonography Is Unnecessary in Evaluating Boys With a Nonpalpable Testis
Authors: Elder Jack S. 
Published: August 2004

Objective. An inguinal sonogram often is obtained in boys with a nonpalpable testis to “localize” the testis, ie, determine whether the testis is present. The results of ultrasonography in boys with a nonpalpable testis were analyzed.
Methods. The records of boys who were referred to a pediatric urology center with a diagnosis of nonpalpable testis and who had undergone inguinal sonography were reviewed. The results of sonography were compared with findings in the office as well as surgical findings.
Results. A total of 62 boys who were referred with a diagnosis of a nonpalpable testis and who had undergone a sonogram were reviewed. The sonogram was ordered by the primary care physician in 51 boys (82%) and by a general urologist in 11 cases (18%). The testis was identified by sonography in 12 (18%) of 66 cases, and all were localized to the inguinal canal. Physical examination by a pediatric urologist showed that 6 were in the scrotum and 6 were in the inguinal canal or perineum. Of the 54 testes that were not localized by the sonogram, 33 (61%) were palpable and 21 (39%) were nonpalpable. Of the truly nonpalpable testes, laparoscopy and abdominal/inguinal exploration identified the testis as abdominal in 10 cases and atrophic secondary to spermatic cord torsion in 11 cases.
Conclusion. Sonography is unnecessary in boys with a nonpalpable testis, because it rarely if ever localizes a true nonpalpable testis, and it does not alter the surgical approach in these patients.
Topical Anesthetics for Intravenous Insertion in Children: A Randomized Equivalency Study
Authors: Kleiber Charmaine , Sorenson Mark , Whiteside Kathy , Gronstal B. Ann , Tannous Raymond 
Published: August 2004

Objectives. Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children’s hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max.
Methods. Thirty well children (14 girls and 16 boys) who were between the ages of 7 and 13 years volunteered to have EMLA applied to the dorsal aspect of 1 hand for 60 minutes and ELA-Max applied to the other hand for 30 minutes. Right and left hands were randomized to treatment type and order of intravenous (IV) insertion. Clinical Research Center nurses, blind to the anesthetic randomization, attempted to insert a 22-gauge Teflon IV catheter into a vein in each hand. The children rated pain during IV insertion on the Oucher scale, and the nurse rated the difficulty of the insertion.
Results. There was no significant difference in pain ratings for hands that were treated with EMLA (mean: 20.5) or with ELA-Max (mean: 24), and there was no difference for the difficulty of vein cannulation. Children’s preprocedure state anxiety was positively associated with pain ratings.
Conclusions. ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.
Predictors of Hearing Loss in Children With Symptomatic Congenital Cytomegalovirus Infection
Authors: Rivera Lisa B. , Boppana Suresh B. , Fowler Karen B. , Britt William J. , Stagno Sergio , Pass Robert F. 
Published: August 2004

Objective. Congenital cytomegalovirus (CMV) infection is a major cause of sensorineural hearing loss (SNHL) and neurologic impairment in children. Although the majority of children with symptomatic congenital CMV infection develop hearing loss, many symptomatic infants have normal hearing. The purpose of this study was to identify indicators present in the newborn period that have predictive value for the development of hearing loss in children with symptomatic congenital CMV infection.Methods. Of the 190 children who had symptomatic congenital CMV infection and were born between 1966 and 1997 and enrolled in a follow-up study, hearing outcome was known for 180 children. Follow-up data were analyzed using univariate and multivariate logistic regression analyses to determine the specific demographic, newborn clinical, and laboratory findings predictive of hearing loss. The amount of infectious CMV in urine was quantified in a subset of 21 children who were born between 1994 and 1998.Results. The presence of intrauterine growth retardation, petechiae, hepatosplenomegaly, hepatitis, thrombocytopenia, and intracerebral calcifications was associated with the development of hearing loss on univariate analysis. The presence of microcephaly and other neurologic abnormalities was not predictive of hearing loss. Logistic regression analysis revealed that only petechiae and intrauterine growth retardation independently predicted hearing loss. None of the demographic and other newborn findings predicted progressive hearing loss. The children who developed hearing loss had higher urine CMV titers during infancy than those with normal hearing.Conclusion. In children with symptomatic congenital CMV infection, evidence of disseminated infection with or without the presence of neurologic involvement at birth was predictive of the development of hearing loss. However, it was not possible to identify factors that are independently predictive of the development of progressive hearing loss.