bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of an Educational Intervention in Modifying Parental Attitudes About Antibiotic Usage in Children
Authors: Taylor James A. , Kwan-Gett Tao Sheng C. , McMahon Edward M. 
Published: August 2004

Objective. To determine the effectiveness of educational materials in improving the attitudes of parents of young children about the judicious use of antibiotics.Methods. We conducted a randomized controlled trial by recruiting parents of children who were younger than 24 months and being seen for any reason in primary care pediatric offices. At the time of enrollment, study parents indicated their level of agreement with 16 statements, including 9 statements about antibiotic usage and 7 about injury prevention. After being randomized, parents received either a pamphlet and a videotape promoting the judicious use of antibiotics (intervention group) or brochures about effective injury prevention (control group). Six weeks after enrollment, each group received another copy of the pamphlet or brochures and a follow-up questionnaire with the identical 16 statements. Responses on both questionnaires were transformed to an ordinal scale for analysis. Scores on the follow-up questionnaire for each statement about antibiotic use and injury prevention in the 2 groups were compared using linear regression, after controlling for the score obtained for the statement at enrollment.Results. We enrolled a total of 499 eligible parents in the study; 358 (72%) completed the follow-up questionnaires. At study entry, there were no significant differences between parents in the intervention and control groups regarding attitudes for 15 of the 16 statements assessed. However, 6 weeks after receiving the antibiotic educational materials, parents in the intervention group had significantly different attitude scores for 5 of the 9 statements about the antibiotic use. In each case, the scores reflected attitudes that would promote the judicious use of antibiotics. We found significant attitudinal change for statements about the use of antibiotics for specific conditions in children; there were no differences between the 2 groups for more general or theoretical statements about antibiotic use.Conclusions. A simple educational effort was successful in modifying parental attitudes about the judicious use of antibiotics. Information about specific childhood conditions may be more effective in changing attitudes than more general information about antibiotic usage.
Smoking Patterns Among Adolescents With Asthma Attending Upper Secondary Schools: A Community-Based Study
Authors: Precht Dorthe Hansen , Keiding Lis , Madsen Mette 
Published: August 2004

Objective. Smoking among people who have asthma may be a serious health problem. We studied the prevalence of smoking and the relations between smoking and asthma, symptoms, medicine, and gender differences among adolescents with asthma.
Methods. A national cross-sectional study on health and lifestyles was performed in 1996–1997 using a computerized questionnaire in upper secondary schools in Denmark. We included 1887 pupils with asthma (defined as self-reported asthma diagnosed by a physician) and 20 688 controls. Smoking was categorized as daily, occasional, ex-smokers, and never smoked. We adjusted for age, gender, parents’ job and smoking, family type, body mass index, and exercise habits.
Results. In total, 37.7% smoked currently and 16.5% smoked daily; more girls than boys smoked. More pupils with asthma than without smoked daily (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.04–1.33), they smoked significantly more cigarettes daily (10.3 vs 9.6), and more were heavy smokers (≥15 cigarettes daily; adjusted OR: 1.47; 95% CI:1.14–1.91). Furthermore, nearly twice as many pupils who had asthma with symptoms but were not using medicine smoked as pupils who had asthma without symptoms and were using medicine (adjusted OR: 1.84; 95% CI: 0.99–3.41). More boys with asthma than without started smoking before 14 years of age (adjusted OR: 1.75; 95% CI: 1.09–2.81). However, more pupils with asthma had tried to quit (adjusted OR: 1.26; 95% CI: 0.99–1.60). Pupils with and without asthma were occasional smokers and ex-smokers at a similar prevalence.
Conclusions. More pupils with asthma than without smoked daily, and they also smoked more cigarettes per day. This is a major health concern, as adolescents have a high smoking prevalence in Denmark.
The Truth About Language Barriers: One Residency Program’s Experience
Authors: Burbano O’Leary Sonja C. , Federico Steven , Hampers Louis C. 
Published: August 2004

Objective. To describe perceptions of how a lack of house staff Spanish proficiency adversely affects communication with Spanish-speaking families with limited English proficiency (LEP).
Methods. An anonymous, structured questionnaire was administered to the house staff an of urban, university-affiliated children’s hospital that serves a population in which 10%–20% have LEP.
Results. Ninety-four percent (59 of 63) completed the questionnaire. Sixty-eight percent (40 of 59) reported that they spoke little or no Spanish (although 36 of 40 expressed a desire to learn Spanish). Fifty-three percent (21 of 40) of these nonproficient residents reported that they used their inadequate language skills in the care of patients “often” or “every day.” Many of these residents believed that LEP families under their care “never” or only “sometimes” understood their child’s diagnosis (21 of 40), medications (11 of 40), discharge instructions (17 of 40), or follow-up plan (16 of 40). Eighty percent (32 of 40) admitted to avoiding communication with such families. Although all (40 of 40) agreed that hospital interpreters were effective, 30 of 40 nonproficient residents reported use of hospital interpreters “never” or only “sometimes.” Fifty-three percent (21 of 40) of these nonproficient residents reported calling on their proficient colleagues “often” or “every day” for assistance. Thirty-two percent (19 of 59) of residents described themselves as “fluent” or “proficient” in Spanish. Fifty-eight percent (11 of 19) reported that they were asked to interpret for fellow residents “often” or “every day.” Proficient residents estimated that they spent a mean of 2.3 hours per week interpreting for other residents.
Conclusions. Despite a perception that they are providing suboptimal communication, nonproficient residents rarely use professional interpreters. Instead, they tend to rely on their own inadequate language skills, impose on their proficient colleagues, or avoid communication with Spanish-speaking families with LEP.
Breastfeeding, Exposure to Organochlorine Compounds, and Neurodevelopment in Infants
Authors: Ribas-Fitó Núria , Cardo Esther , Sala Maria , Eulàlia de Muga M. , Mazón Carlos , Verdú Antoni , Kogevinas Manolis , Grimalt Joan O. , Sunyer Jordi 
Published: August 2004

Objective. Exposure to organochlorine compounds (OCs) occurs both in utero and through breastfeeding. Levels of hexachlorobenzene (HCB) found in the cord serum of newborns from a population located in the vicinity of an electrochemical factory in Spain were among the highest ever reported. We studied the association between exposure to OCs and breastfeeding on neurodevelopment in the 1-year-old infants of this population.
Methods. A birth cohort including 92 mother-infant pairs was recruited between 1997 and 1999 in 5 neighboring villages (84% of possible recruits). The mental and psychomotor development of each infant was assessed at 13 months using the Bayley and the Griffiths Scales of Infant Development. OCs were measured in cord serum.
Results. Dichlorodiphenyl dichloroethylene (p,p′DDE) cord serum levels were negatively associated with both mental and psychomotor development. For each doubling of a dose of p,p′DDE, we found a resultant decrease of 3.50 points (standard error: 1.39) on the mental scale and 4.01 points (standard error: 1.37) on the psychomotor scale. Exposure to polychlorinated biphenyls was only marginally associated with psychomotor development. Prenatal exposure to HCB had no effect on child neurodevelopment. Long-term breastfeeding was associated with better performance on both the mental and motor scales. Short-term breastfed infants with higher p,p′DDE levels in cord serum were associated with the lowest scores on both the mental and the psychomotor scales.
Conclusions. Prenatal exposure to p,p′DDE was associated with a delay in mental and psychomotor development at 13 months. No association was found for exposure to HCB. Long-term breastfeeding was found to be beneficial to neurodevelopment, potentially counterbalancing the impact of exposure to these chemicals through breast milk.
Paranasal Sinus Findings in Children During Respiratory Infection Evaluated With Magnetic Resonance Imaging
Authors: Kristo Aila , Uhari Matti , Luotonen Jukka , Koivunen Petri , Ilkko Eero , Tapiainen Terhi , Alho Olli-Pekka 
Published: August 2004

Objective. The spreading of acute respiratory infection into the paranasal sinuses in children is poorly defined. The main objective of this study was to evaluate the frequency and spontaneous resolution of paranasal sinus abnormalities in children with acute respiratory infection using magnetic resonance imaging (MRI).
Methods. We examined 60 children with MRI (mean age: 5.7 years) with symptoms of acute respiratory infection. Twenty-six children with major abnormalities in the first MRI scan had a follow-up MRI taken 2 weeks later.
Results. The children had had symptoms of uncomplicated acute respiratory infection for an average of 6 days before the first examination (mean duration: 6.5; standard deviation: 3.0). Approximately 60% of the children had major abnormalities in their maxillary and ethmoidal sinuses, 35% in the sphenoidal sinuses, and 18% in the frontal sinuses. The most common abnormal finding was mucosal swelling. The mean overall MRI scores correlated significantly with the symptom scores (rs = 0.3). Of the individual symptoms, nasal obstruction, nasal discharge, and fever were significantly related to the MRI scores. Among the 26 children with major abnormalities in the first MRI, the findings subsequently improved significantly (mean [standard deviation] score: 12.7 [5.6] to 5.7 [5.2]), irrespective of the resolution of symptoms.
Conclusions. These observations indicate that acute respiratory infection mostly spreads into the paranasal sinuses of children in the form of mucosal edema and that these abnormalities tend to resolve spontaneously without antimicrobial treatment.
Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study
Authors: Linder Nehama , Haskin Orli , Levit Orli , Klinger Gil , Prince Tal , Naor Nora , Turner Pol , Karmazyn Boaz , Sirota Lea 
Published: August 2004

Objective. High-grade intraventricular hemorrhage (IVH) is an important cause of severe cognitive and motor neurologic impairment in very low birth weight infants and is associated with a high mortality rate. The risk of IVH is inversely related to gestational age and birth weight. Previous studies have proposed a number of risk factors for IVH; however, lack of adequate matching for gestational age and birth weight may have confounded the results. The purpose of this study was to identify variables that affect the risk of high-grade IVH, using a retrospective and case-control clinical study.Methods. From a cohort of 641 consecutive preterm infants with a birth weight of &lt;1500 g, 36 infants with IVH grade 3 and/or 4 were identified. A control group of 69 infants, closely matched for gestational age and birth weight, was selected. Maternal factors, labor and delivery characteristics, and neonatal parameters were collected in both groups. Results of cranial ultrasound examinations, whether routine or performed in presence of clinical suspicion, were also collected. Univariate analysis and multivariate logistic regression analysis were performed.Results. High fraction of inspired oxygen in the first 24 hours, pneumothorax, fertility treatment (mostly IVF), and early sepsis were associated with an increased risk of IVH. A higher number of suctioning procedures, a higher first hematocrit, and a relatively low arterial pressure of carbon dioxide during the first 24 hours of life were associated with a lower occurrence. In the multivariate logistic regression model, early sepsis (odds ratio [OR]: 8.19; 95% confidence interval [CI]: 1.55–43.1) and fertility treatment (OR: 4.34; 95% CI: 1.42–13.3) were associated with a greater risk of high-grade IVH, whereas for every dose of antenatal steroid treatment there was a lower risk of high-grade IVH (OR: 0.52; 95% CI: 0.30–0.90) and each decrease in a mmHg unit of arterial pressure of carbon dioxide during the first 24 hours was associated with a lower risk of IVH (OR: 0.91; 95% CI: 0.83–0.98). This multivariate model had a sensitivity of 77%, a specificity of 75%, and a positive predictive value of 76%. The area under the curve derived from the receiver operator characteristic plots is 0.82.Conclusions. Our results confirm that the development of IVH is associated with early sepsis and failure to give antenatal steroid treatment. We propose that fertility treatment (and especially IVF) may be a new risk factor, and more research is needed to assess its role.
Underestimation of Infant Mortality Rates in One Republic of the Former Soviet Union
Authors: Wuhib Tadesse , McCarthy Brian J. , Chorba Terence L. , Sinitsina Tatiana A. , Ivasiv Ivan V. , McNabb Scott J.N. 
Published: August 2004

Objectives. Kazakhstan’s live-birth definition—that dates from the former Soviet Union (FSU) era—differs from that used by the World Health Organization (WHO). We studied the impacts of both live-birth definitions on the computations of the infant mortality rate (IMR) and maternal and child health (MCH) planning in Zhambyl Oblast, Kazakhstan.
Methods. We interviewed caregivers and abstracted medical records to obtain birth weight and age-at-death information on infant deaths in Zhambyl Oblast from November 1, 1996, through October 31, 1997. Using the 2 indicators of birth weight and age at death, we created a matrix delineating the respective contribution to infant death (maternal health, newborn care, or infant care) for the cells. We then calculated the IMR, birth weight-specific IMR (BWS-IMR), and birth weight-proportionate IMR (BWP-IMR) for each cell.
Results. The observed IMR in Zhambyl Oblast, in 1996—using the definition of a live birth from the FSU—was 32 per 1000 live births. The recalculated IMR—using the WHO definition—was 58.7 per 1000 live births. Computed estimates of the contribution to infant death, by the categories of maternal health, newborn care, and infant care, were 10%, 23%, and 67%, respectively, when using the live-birth definition from the Soviet era. These estimates shifted to 24%, 41%, and 35%, respectively, when using the WHO definition, yet only 8% of the Zhambyl Oblast MCH budget was earmarked to maternal health and newborn care, which we estimated accounted for 65% of infant deaths.
Conclusions. The live-birth definition commonly used in the FSU underestimated the IMR and undervalued the contributions to infant death by both maternal health and newborn care. We recommend that all republics of the FSU adopt the WHO live-birth definition so that the IMR can serve as a better indicator for MCH planning.
Rapid Increase in Grip Force After Start of Pamidronate Therapy in Children and Adolescents With Severe Osteogenesis Imperfecta
Authors: Montpetit Kathleen , Plotkin Horacio , Rauch Frank , Bilodeau Nathalie , Cloutier Suzanne , Rabzel Mary , Glorieux Francis H. 
Published: August 2004

Objective. To examine changes in grip force during pamidronate therapy in children and adolescents with severe osteogenesis imperfecta (OI).
Methods. Maximal isometric grip force of the nondominant hand was prospectively determined in 42 patients (age at the start of the study: 7.3–15.9 years; 18 girls) with severe forms of OI. Patients were treated with intravenous pamidronate infusions given in 4 monthly cycles, each cycle consisting of 3 infusions (1 mg pamidronate/kg body wt) on 3 successive days.
Results. At the start of pamidronate therapy, grip force was low compared with age-specific reference data (age z score mean ± standard deviation: −2.7 ± 2.1) but was normal for weight (weight z score: −0.1 ± 1.8). Four months after the first pamidronate infusion cycle, grip force had increased significantly, whether related to age (age z score: −2.0 ± 1.8) or to weight (weight z score: 0.6 ± 1.5). At 2 years after the start of therapy, grip force z scores were not significantly different from the 4-month results.
Conclusions. Maximal isometric grip force markedly increases after a single cycle of intravenous pamidronate in children with severe forms of OI, and this gain in grip force is maintained for at least 2 years.
Trends in Referral to a Single Encopresis Clinic Over 20 Years
Authors: Fishman Laurie , Rappaport Leonard , Schonwald Alison , Nurko Samuel 
Published: August 2004

Objective. To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes.Methods. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes.Results. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for &gt;3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years.Conclusions. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.
Risk Factors for Tuberculosis Infection in Children in Contact With Infectious Tuberculosis Cases in The Gambia, West Africa
Authors: Lienhardt Christian , Sillah Jackson , Fielding Katherine , Donkor Simon , Manneh Kebba , Warndorff David , Bennett Steve , McAdam Keith 
Published: August 2004

Objective. Tuberculosis (TB) infection is highly prevalent in developing countries. As infected children represent a large proportion of the pool from which TB cases will arise, knowledge of the factors that influence TB infection in children are of importance to evaluate transmission of infection in the community and adapt TB control activities. There are limited data on the risk of infection in child populations in developing countries.
Methods. We performed a household contact study in The Gambia (West Africa), in which children who were living in contact with individuals who had proven smear-positive pulmonary TB cases were investigated. A questionnaire was addressed to the mother or caregiver of the child to investigate the presence of various risk factors and assess the degree of exposure of the child to the individual with TB within the household. A tuberculin skin test (TST) was performed on each child. TST sizes ≥5 and 10 mm, respectively, were considered positive.
Results. Households of 206 TB cases were visited, and 384 children aged &lt;5 years were examined. The median age was 2, and 48% were girls. The distribution of TST responses followed a bimodal pattern, with 135 (35%) children presenting a palpable induration. Random effects logistic regression analysis demonstrated that the risk of positive TST response in the child increased with the geographic proximity of the child to the individual with TB within the household and with the degree of activities shared with the individual with TB. It was also associated with the clinical severity of the disease in the index case. Nutritional status and presence of a bacille Calmette-Guérin (BCG) scar were not independent risk factors for TST positivity in this population. On multivariate analysis, the effect of geographic proximity to the individual with TB, household size, and duration of cough in the index case persisted for TST responses ≥5 mm.
Conclusions. In a highly endemic country with high BCG vaccination coverage in Africa, TB infection in children who were in contact with individual with infectious TB was directly related to the intensity of exposure of the child to the individual with TB. Our data suggest that a positive TST in a child reflects most probably TB infection rather than previous BCG vaccination. Contact tracing can play a major role in the control of TB in developing countries.
Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management
Authors: Boudreaux Edwin D. , Emond Stephen D. , Clark Sunday , Camargo Carlos A. ,   Behalf of the Multicenter Airway Research Collaboration Investigators
Published: August 2004

Objective. To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED).Method. We analyzed data from 2 prospective cohort studies performed during 1997–1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge.Results. Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups.Conclusion. Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices.