bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perineal Group A Streptococcal Disease in a Pediatric Practice
Authors: Mogielnicki Nancy P. , Schwartzman Joseph D. , Elliott John A. 
Published: August 2004

Objective.This study was designed to document the frequency and define the clinical, epidemiologic, and microbiologic characteristics of perineal disease caused by group A β-hemolytic streptococci (GAS) in a pediatric practice in which increased numbers of cases had been observed.Methods.Clinical, epidemiologic, and microbiologic data were collected on all culture-confirmed cases of perineal GAS disease during the calendar year 1997. GAS isolates from clinical cases and a comparison group of children with GAS pharyngitis were analyzed by T typing, emm gene analysis, and pulsed-field gel electrophoresis (PFGE).Results.Twenty-three cases of GAS perineal disease were diagnosed during 4530 office visits in 1997. Thirteen cases had perianal disease, 8 had vulvovaginal infection, and 2 were infected at both sites. No cases of penile disease were identified. Infections peaked in late winter and early spring and affected children with an average age of 5 years with a range of perineal, gastrointestinal, and genitourinary symptoms. Analysis of T and emm types showed the majority (82%) of perineal isolates to be T 28emm 28, showing 2 closely related PFGE patterns. In contrast, the pharyngeal isolates were distributed among 6 different T and emm types.Conclusion.Perineal infection caused by GAS may be a relatively common diagnosis in a pediatric or family practice setting. There may be specific GAS types that have a tropism for perineal tissues but the mechanism of infection is yet to be established.
Brainstem Maturation in Premature Infants as a Function of Enteral Feeding Type
Authors: Amin Sanjiv B. , Merle Kathleen S. , Orlando Mark S. , Dalzell Larry E. , Guillet Ronnie 
Published: August 2004

Objective.To determine whether brainstem maturation as measured by brainstem auditory-evoked responses (BAERs) in preterm infants is a function of dietary intake.Study Design.We obtained serial BAERs on infants 28 to 32 weeks' gestation at birth, cared for in the neonatal intensive care unit of a regional referral center in Upstate New York. Waveforms were analyzed for replicability and for the presence of waves III and V. Absolute and interwave latencies were measured. Baseline and follow-up BAER measurements were compared, and the rates of change were calculated. Patient charts were reviewed for type of enteral feeding during the interval between BAERs. Student's t test was used to analyze continuous variables and χ2 analysis was used to analyze categorical variables.Results.Data from 37 study infants (17 fed breast milk and 20 fed commercial premature formula) revealed that there was no difference in absolute latencies of waves III and V at baseline; however, the rates of decrease of absolute latencies over the study interval were significantly greater in infants receiving human milk.Conclusions.Infants fed breast milk have faster brainstem maturation, compared with infants fed formula, based on the rate of maturation of BAERs. This effect may be attributable to the constituent composition of breast milk, compared with synthetic formulas.
Policy Statement: Recommendations for the Prevention of Pneumococcal Infections, Including the Use of Pneumococcal Conjugate Vaccine (Prevnar), Pneumococcal Polysaccharide Vaccine, and Antibiotic Prophylaxis
Authors:   Committee on Infectious Diseases
Published: August 2004

Heptavalent pneumococcal conjugate vaccine (PCV7) is recommended for universal use in children 23 months and younger, to be given concurrently with other recommended childhood vaccines at 2, 4, 6, and 12 to 15 months of age. For children 7 to 23 months old who have not received previous doses of PCV7, administration of a reduced number of doses is recommended. Two doses of PCV7 are recommended for children 24 to 59 months old at high risk of invasive pneumococcal infection—including children with functional, anatomic, or congenital asplenia; infection with human immunodeficiency virus; and other predisposing conditions—who have not been immunized previously with PCV7. Recommendations have been made for use of 23-valent pneumococcal polysaccharide (23PS) vaccine in high-risk children to expand serotype coverage. High-risk children should be given vaccines at the earliest possible opportunity. Use of antibiotic prophylaxis in children younger than 5 years with functional or anatomic asplenia, including children with sickle cell disease, continues to be recommended. Children who have not experienced invasive pneumococcal infection and have received recommended pneumococcal immunizations may discontinue prophylaxis after 5 years of age.
The safety and efficacy of PCV7 and 23PS in children 24 months or older at moderate or lower risk of invasive pneumococcal infection remain under investigation. Current US Food and Drug Administration indications are for administration of PCV7 only to children younger than 24 months. Data are insufficient to recommend routine administration of PCV7 for children at moderate risk of pneumococcal invasive infection, including all children 24 to 35 months old, children 36 to 59 months old who attend out-of-home care, and children 36 to 59 months old who are of Native American (American Indian and Alaska Native) or African American descent. However, all children 24 to 59 months old, regardless of whether they are at low or moderate risk, may benefit from the administration of pneumococcal immunizations. Therefore, a single dose of PCV7 or 23PS vaccine may be given to children 24 months or older. The 23PS is an acceptable alternative to PCV7, although an enhanced immune response and probable reduction of nasopharyngeal carriage favor the use of PCV7 whenever possible.
Pioneers in the Scientific Study of Neonatal Jaundice and Kernicterus
Authors: Hansen Thor Willy Ruud 
Published: August 2004

Neonatal jaundice must have been noticed by caregivers through the centuries, but the scientific description and study of this phenomenon seem to have started in the last half of the 18th century. In 1785 Jean Baptiste Thimotée Baumes was awarded a prize from the University of Paris for his work describing the clinical course in 10 jaundiced infants.
The work by Jaques Hervieux, which he defended for his doctor of medicine degree in 1847, was, in many respects, a landmark. He had autopsied 44 jaundiced infants and apparently had clinical observations on many others. His descriptions of pathoanatomical findings were very detailed and systematic. A number of his clinical observations are still thought to be accurate today, such as the essentially benign nature of neonatal jaundice in most cases, the appearance of neonatal jaundice during the first 2 to 4 days of life as well as its disappearance within 1 to 2 weeks, and the cephalocaudal progression of jaundice. He described jaundice of the brain in 31 of his 44 autopsied cases, with variable intensity of staining.
Johannes Orth was an assistant to the famous Virchow in Berlin, when in 1875 he published the results of an autopsy of a jaundiced term infant. The brain was notable for an intense yellow staining of the basal ganglia, the wall of the third ventricle, the hippocampus, and the central parts of the cerebellum. While the contribution of Orth was limited to this single case report, in 1903 Christian Schmorl presented the results of his autopsies of 120 jaundiced infants to the German Society for Pathology. All of these infants' brains were jaundiced, but only 6 cases demonstrated a staining phenomenon similar to that previously described by Orth. Schmorl coined the term kernicterus (jaundice of the basal ganglia) for this staining pattern.
Although the following century of scientific study has added an enormous amount of information about the epidemiology and pathophysiology of neonatal jaundice and kernicterus, the contributions of Hervieux, Orth, and Schmorl will undoubtedly continue to be seen as historical landmarks in our quest for understanding of these phenomena.
Booster Seat Use and Reasons for Nonuse
Authors: Ramsey Ann , Simpson Evan , Rivara Frederick P. 
Published: August 2004

Background.
Many children 4 to 9 years old are inappropriately restrained in vehicles and are at risk for injury in crashes.

Objectives.
This study was undertaken to determine the rate of booster seat use and the reasons for nonuse.

Methods.
Observations were conducted at a random sample of day care centers, and drivers of unrestrained children 4 to 8 years old were interviewed to determine the reasons for lack of booster seat use.

Results.
Observations were conducted on 149 children. Shoulder belt use significantly increased with the age of the child; 28.3% of 4-year-olds and 70.0% of 6- to 8-year-olds used lap–shoulder belts. Overall, 27.7% of children in the target age group used booster seats; only 10% of children 6 to 8 years old were restrained with booster seats. Booster seat use decreased when there were 3 or more passengers in the vehicle. The most common reason for lack of booster seat use was that parents thought the child was large enough to use the regular lap–shoulder belt system, or problems with attempting to use the seat in the vehicle. More than one half of parents who were not using booster seats at the time of the survey reported owning seats.

Conclusion.
This study indicates that parental misconceptions about size and safety of regular restraint equipment are the most common reason that children are not appropriately restrained in vehicles. This information can be used to guide community intervention programs.
Early Cognitive and Motor Development Among Infants Born to Women Infected With Human Immunodeficiency Virus
Authors: Chase Cynthia , Ware Janice , Hittelman Joan , Blasini Ileana , Smith MPH∥; Renee , Llorente Antolin , Anisfeld Elizabeth , Diaz Clemente , Fowler Mary Glenn , Moye Jack , Kaligh Leslie I. ,   for the Women and Infants Transmission Study Group
Published: August 2004

Objective.
To examine the frequency, timing, and factors associated with abnormal cognitive and motor development during the first 30 months of life in infants born to women infected with human immunodeficiency virus type 1 (HIV-1).

Methods.
Serial neurodevelopmental assessment was performed with 595 infants born to women infected with HIV-1 in a multicenter, prospective, natural history cohort study. Survival analysis methods were used to evaluate 6 outcome events related to abnormal cognitive and motor growth (time to confirmed drop of 1 SD, time to first score &lt;69, and time to confirmed drop of 2 SD) in Bayley Scales of Infant Development Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores among infected (n = 114) and uninfected (n = 481) infants. Proportional hazards modeling was used to evaluate the effects of HIV infection status, prematurity, prenatal exposure to illicit drugs, maternal educational attainment, and primary language.

Results.
HIV-1 infection was significantly associated with increased risk for all outcome events related to abnormal mental and motor growth. Differences between infected and uninfected infants were apparent by 4 months of age. Prematurity was associated with increased risk for MDI &lt;69 and PDI &lt;69. Maternal education of &lt;9 completed years was associated with increased risk for MDI &lt;69. Neither prenatal exposure to illicit drugs nor primary language other than English was associated with abnormal development.

Conclusion.
A significant proportion of infants with HIV-1 infection show early and marked cognitive and motor delays or declines that may be important early indicators of HIV disease progression. These abnormalities are independent of other risk factors for developmental delay.
Association of Adolescent Cigar Use With Other High-Risk Behaviors
Authors: Frazier A. Lindsay , Fisher Laurie , Camargo Carlos A. , Tomeo Catherine , Colditz Graham 
Published: August 2004

Objectives.To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use.Methods.A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires.Results.The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2–32.3; boys, OR: 21.3; 95% CI: 17.1–26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4.5–12.4; boys, OR: 13.0; 95% CI: 9.8–17.4), and alcohol (girls, OR: 6.6; 95% CI: 4.8–9.1; boys, OR: 6.8; 95% CI: 5.3–8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9–16.9; boys, OR: 34.8; 95% CI: 19.4–62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item.Conclusions.Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.
Determination of Up-to-Date Vaccination Status for Preschool-Aged Children: How Accurate Is Manual Assessment Conducted by Paraprofessional Staff?
Authors: Shefer Abigail , Webb Elisa , Wilmoth Terri 
Published: August 2004

Background.Accurate identification of underimmunized children is needed to determine which children need vaccination. Previous studies have found the accuracy of manually determining the immunization status from a personal vaccination record to be low (&lt;50%).Objective.To determine the accuracy of manual immunization status assessment for preschool-aged children.Subjects and Setting.Children ≤32 months old (n = 21 263) seen over 1 year at 12 women, infants, and children (WIC) sites in San Diego, California. Age at evaluation was between 0 and 24 months.Methods.Paraprofessional immunization specialists conducted manual immunization status assessment using the WIC client's personal vaccination record. Immunization status as recorded in the WIC record was compared with computerized assessment (the gold standard).Measures and Results.For all patient encounters, 29 078 (80%) of 36 368 were assessed correctly; manual assessment outcome was not recorded in the WIC record for 2171 (6%) of encounters. Accuracy varied by WIC site (range: 70%–90%). The sensitivity at correctly identifying an underimmunized child per encounter was 53.6%; the specificity at correctly identifying a fully vaccinated child per encounter was 89.4%. The 3 most common vaccines that were incorrectly assessed in identifying an underimmunized child were Haemophilus influenzae type b (43%), hepatitis B (37%), and diphtheria-tetanus toxoids and (cellular or acellular) pertussis vaccine (24%). Children with no outcome as recorded in the WIC record were 5 times as likely to be up-to-date.Conclusions.Manual immunization assessment was specific but only moderately sensitive at identifying underimmunized children. Thus, many underimmunized children will by missed but only 10% of children will be referred inappropriately.
Barriers to Asthma Care in Urban Children: Parent Perspectives
Authors: Mansour Mona E. , Lanphear Bruce P. , DeWitt Thomas G. 
Published: August 2004

Background.Despite improved treatment regimens for asthma, the prevalence and morbidity from asthma are increasing, especially among underserved, minority children.Objective.The purpose of this study was to identify barriers to the treatment of asthma among urban, minority children as perceived by parents.Methods.Parents were recruited from 4 schools located in low-income, urban areas with high rates of asthma hospitalizations. Focus groups involving parents of children 5 to 12 years old with asthma were conducted using a standardized questionnaire. Parents' comments were analyzed to identify barriers, and 3 independent raters coded parents' comments to assess reliability of interpretation.Results.Forty parents who represented 47 children participated in the focus groups. All parents described their racial background as black. Parents' average age was 36.8 years, 92% were females, 70% were nonmarried, and 38% had less than a high school education. Forty-five percent of children had intermittent or mild asthma and 55% had moderate to severe asthma. The most frequent types of barriers identified by parents were patient or family characteristics (43%), followed by environmental (28%), health care provider (18%), and health care system (11%). Parents were specifically concerned about the use, safety and long-term complications of medications, the impact of limitation of exercise on their child's quality of life, and their own quality of life.Conclusions.In contrast with the widespread beliefs that access to medical care, health insurance, and continuity of care are the major barriers to quality asthma care, the barriers most frequently reported by parents were related to patient and family characteristics, health beliefs, or to their social and physical environment. To improve asthma management and health outcomes for urban, minority children with asthma, it is critical to tailor education about asthma and its treatment, and address quality of life issues for both children and parents.
Effects of Negative Life Events on Immune Suppression in Children and Youth Infected With Human Immunodeficiency Virus Type 1
Authors: Howland Lois C. , Gortmaker Steven L. , Mofenson Lynne M. , Spino Cathie , Gardner Jane D. , Gorski Heather , Fowler Mary Glenn , Oleske James 
Published: August 2004

Objectives.To evaluate the association of negative stressful life events experienced over 12 months and the risk of moderate to severe immune suppression among children and youth infected with human immunodeficiency virus type 1 (HIV-1).Methods.Longitudinal study of 618 HIV-1-infected children, baseline ages 1 to 20 years (mean age: 6.4 years), who completed 52 weeks of participation in the Pediatric Late Outcomes Study (Pediatric AIDS Clinical Trials Group Protocol 219). Severity of immune suppression was indicated by the Centers for Disease Control and Prevention Pediatric HIV Disease Classification System, based on CD4 percentages. The total number of negative life events—categorized as none, 1, or &gt;1 life event reported as having occurred in the previous 12 months (previous 6 months for children &lt;3 years of age)—was the predictor variable. Multiple logistic regressions were estimated to assess the relationship of negative life events and immune suppression at outcome, controlling for baseline measures of immune suppression, continuous CD4%, negative life events, age, race/ethnicity, gender, primary caretaker, education level of caretaker, and acquired immunodeficiency syndrome status.Results.At week 52, 379 subjects (61% of total study population) had moderate to severe immune suppression. Of 275 children with normal immune function at baseline, 68 (24.7%) subsequently developed moderate to severe suppression levels by week 52 of follow-up. Of 343 children with immune suppression at baseline, 32 (9.2%) had recovered to normal CD4% levels by week 52. More than 1 negative life event was associated with an increased risk (prevalence) of immune suppression (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.44,5.31), controlling for baseline CD4%, total life events, and other covariates. Children without immune suppression at baseline who experienced &gt;1 negative life event had an increased incidence of immune suppression (OR: 2.93; 95% CI: 1.34,6.39), controlling for baseline covariates.Conclusions.Results indicate that negative stressful life events increase the risk of children with HIV-1 infection having impaired immune function. Further research is needed to identify potential mechanisms of the relationship between stressful life events and impaired immune function. These mechanisms include psychoneuroendocrinologic response and difficulties in adherence to therapy after exposure of a child to major negative life events.
Functional Limitations and Special Health Care Needs of 10- to 14-Year-Old Children Weighing Less Than 750 Grams at Birth
Authors: Hack Maureen , Taylor H. Gerry , Klein Nancy , Mercuri-Minich Nori 
Published: August 2004

Objective.To examine the health status, functioning, and special health care needs of children 10 to 14 years old weighing &lt;750 g at birth.Methods.We compared outcomes of a regional cohort of 59 children born from 1982 through 1986 weighing &lt;750 g at birth (mean: 665 g; gestational age: 26 weeks) to matched groups of 54 children weighing 750 to 1499 g at birth and 49 children born at term. Assessments of limitations in functioning, compensatory dependence and needs for services above routine, at a mean age of 11 years, were based on responses to maternal questionnaires. Rates of these outcomes were compared between groups using logistic regression analyses that controlled for gender and social risk.Results.Children weighing &lt;750 g at birth had significantly higher rates of functional limitations, greater compensatory dependence, and need for services above routine than the other 2 groups. Compared with children born at term, the odds ratio for mental or emotional delay was 4.7 (95% confidence interval [CI]: 2.0–11.0), for restrictions in activity, 5.1 (CI: 1.6–16.3) and for blindness or difficulty seeing 3.9 (CI:1.3–11.4). With the exception of 3% of children who were severely impaired, the only compensatory aid that differentiated the children weighing &lt;750 g at birth from the children born at term was the greater need for glasses (odds ratio [OR]: 2.8 [CI: 1.3–6.3]). Increased services above routine included special education (OR: 5.0 [CI: 2.1–11.7]), counseling (OR: 4.8 [CI: 1.0–23.1]) and special arrangements in school (OR: 9.5 [C.I. 2.1–43.6]).Conclusion.Parents and educators need to be informed of the potential for disability and special health care needs of children weighing &lt;750 g at birth.