bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age for Routine Administration of the Second Dose of Measles–Mumps–Rubella Vaccine
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired May 2009.
The purpose of this statement is to inform physicians of a modification in the recommendation of the appropriate age for routine administration of the second dose of measles–mumps–rubella (MMR) vaccine. The implementation of the two-dose measles vaccine schedule has improved the control of measles, but some outbreaks continue to occur in school children, although ≥95% of children in school have received one dose of vaccine. Because most measles vaccine failures are attributable to failure to respond to the first dose, that all children receive two doses of measles-containing vaccine is essential for the control of measles. Routine administration of the second dose of MMR vaccine at school entry (4 to 6 years of age) will help prevent school-based outbreaks. Physicians should continue to review the records of all children 11 to 12 years of age to be certain that they have received two doses of MMR vaccine after their first birthday. Documenting that all school children have received two doses of measles-containing vaccine by the year 2001 will help ensure the elimination of measles in the United States and contribute to the global effort to control and possibly eradicate measles.
Neonatal Hospital Lengths of Stay, Readmissions, and Charges
Authors: Marbella Anne M. , Chetty Veerappa K. , Layde Peter M. 
Published: August 2004

Objective. To evaluate trends in length of hospital stay, hospital charges, and readmission rates of Wisconsin newborns from 1989 through 1994 in light of recent policies requiring earlier discharges after delivery of newborns.Methodology. Two data sources were used: 1) 1989–1994 Hospital Inpatient Discharge Data from the Wisconsin Office of Health Care Information, and 2) 1994 birth certificate and matched infant mortality data from the Wisconsin Center for Health Statistics. Average lengths of stay and average hospital (delivery and readmission) charges were calculated, and readmission rates were estimated for full-term, premature, and sick newborns.Results. There were 368 955 full-term and 26 668 premature newborns in Wisconsin from 1989 through 1994. The average length of stay decreased by 24% in full-term newborns from 1989 through 1994, while average hospital (delivery and readmission) charges rose over 40% during the same period. Average length of stay for premature infants increased by 24% while their hospital delivery charges increased 214% during the study period. Readmission rates halved, yet charges per readmission doubled for full-term infants. More than twice as many full-term newborns were classified as sick in 1994 (43%) compared with 1989 (19%).Conclusions. Managed care efforts to control costs of neonatal care through earlier newborn discharge policies may have limited impact. Physicians or hospitals may be compensating for these policies by classifying more newborns as sick, thereby allowing for longer hospital stays to be reimbursed by the insurance carriers. Premature infants, &lt;7% of the total births, account for half of all hospital delivery charges. Efforts to reduce premature births may have a greater impact on neonatal health care costs than efforts to discharge full-term newborns earlier.
Resident and Family Continuity in Pediatric Continuity Clinic: Nine Years of Observation
Authors: Garfunkel Lynn C. , Byrd Robert S. , McConnochie Kenneth M. , Auinger Peggy 
Published: August 2004

Objective. To assess resident, patient, and family continuity.Background. Continuity clinic is the principal longitudinal primary care experience for pediatric residents. Although it has been a recommendation of the Residency Review Committee for pediatric training for more than 10 years and has been a requirement of the Accreditation Council of Graduate Medical Education since 1989, the extent to which continuity is achieved in this setting has not been reported.Methods. Nine years (1984–1993) of residents' continuity clinic experience in a community hospital affiliate of a university training program were reviewed. Continuity was defined by recurring visits between the same patient/provider pair. The analysis from 57 different residents includes 48 intern (R1) years, 45 level two (R2) years, and 40 level three (R3) years; 32 of these residents completed all 3 years of training (3-year cohort) in the program during the study period. Observations included 89 952 visits by 11 009 patients in 7130 families. Continuity was determined for the resident, patient, and family.Results. Residents saw an annual average of 93, 136, and 144 visits as R1s, R2s, and R3s. Residents saw 60% of their patients fewer than 3 times and nearly 40% only once. In the final year for those in the 3-year cohort, residents saw an average of 149 visits; 53% of the time these R3s had seen their patients once or twice over 3 years. Thirty percent of the patients never saw their primary care physician (PCP) and 72% of patients had fewer than 3 visits with their PCP. One quarter of the families never saw their continuity resident, and 62% saw their continuity resident fewer than 3 times.Conclusions. These data demonstrate a remarkable lack of both resident and patient continuity in the principal clinical activity affording longitudinal primary care experiences during residency training. If more continuity is essential for both primary care of patients and education in general pediatrics, change in the structure of continuity experience is required.
Human Papillomavirus Screening in Pediatric Victims of Sexual Abuse
Authors: Siegfried Elaine , Rasnick-Conley Jane , Cook Sandra , Leonardi Craig , Monteleone James 
Published: August 2004

Objective. To evaluate for the presence of subclinical human papillomavirus (HPV) in cases of suspected sexual abuse in children.Design. Prospective data collection via interviews, physical examination, colposcopic examination, and tissue sampling by a surface swab technique.Setting. A total of 40 pediatric patients ranging in age from 1 to 16 years who were referred to the Special Assessment and Management Clinic at Cardinal Glennon Children's Hospital, St Louis, MO, for probable or confirmed sexual abuse.Interventions. In addition to colposcopic examination for physical signs of abuse, the patients were screened for evidence of sexually transmitted diseases, including syphilis, gonorrhea, andChlamydia. At that time, surveillance sampling of the throat, vaginal introitus, and/or rectum by a simple, rapid surface swab technique was performed to detect the presence of HPV.Measurements. Template DNA was extracted from cotton swabs and analyzed using polymerase chain reaction analysis.Results. Human β-globin sequences were detected in 58 (83%) of 70 specimens obtained from 40 patients, indicating successful processing had occurred. Using a consensus L1 primer-probe set capable of detecting multiple HPV genotypes, 2 (3%) of 58 samples from 2 (5%) of 40 patients were positive for HPV 16. None of the other 56 specimens yielded evidence of HPV. Appropriate positive and negative controls were included in each assay.Conclusions. Our results suggest that subclinical HPV infection is possible, but not commonly associated with sexual abuse in children from St Louis, MO. In this group of children without condyloma, HPV 16 was the only type identified.
Sodium Space and Intravascular Volume: Dietary Sodium Effects in Cystic Fibrosis and Healthy Adolescent Subjects
Authors: Legris Gregory J. , Dearborn Dorr , Stern Robert C. , Geiss Cynthia L. , Hopfer Ulrich , Douglas Janice G. , Doershuk Carl F. 
Published: August 2004

Objective. To assess the physiologic response to salt depletion in subjects with cystic fibrosis (CF) and control male adolescents for sodium balance, sodium space, and stimulation of the renin–angiotensin–aldosterone axis.Design. Seven subjects with CF and six controls received a salt-replete (150 or 290 mmol NaCl per day) diet and then a salt-deplete (10 mmol NaCl per day) diet while in a clinical research center.Results. Space maintenance: CF subjects responded to salt depletion with a greater weight loss than did controls (1.9 vs 0.8 kg) and a decrease in 24Na+ space, whereas controls maintained 24Na+ space. Paired (Na-deplete/Na-replete) blood volumes decreased in subjects with CF, but not in controls. Renin–angiotensin–aldosterone axis stimulation: During salt repletion, subjects with CF had significantly higher aldosterone values than did controls in the afternoon, but not at 7:00 AM. During salt depletion, plasma renin activity and aldosterone increased significantly more in subjects with CF than in controls (renin, 35 vs 13 ng/mL/hour [9.7 vs 3.6 ng·L−1s−1]; aldosterone: 181 vs 101 ng/dL [5021 vs 2802 pmol/L]). Furthermore, the angiotensin antagonist saralasin increased renin much more in subjects with CF (154 vs 36 ng/mL per hour [43 vs 10 ng·L−1 s−1]). Vasomotor functions: Mean arterial pressure was decreased in subjects with CF on both diets and decreased significantly more with low salt only in subjects with CF. During salt depletion, subjects with CF showed enhanced orthostatic tolerance (less heart rate increase with standing) compared with controls, thus obscuring their volume loss. The blood pressure response to an acute infusion of saralasin suggested that in salt-replete subjects with CF, but not in controls, angiotensin receptors were functional in maintaining vascular tone. During salt depletion, angiotensin was more important for maintenance of blood pressure in subjects with CF than in controls, because the saralasin-induced drop in blood pressure was 20%, ie, close to shock levels, in subjects with CF, and only 6% in controls.Conclusion. The data suggest that patients with CF are so successful in compensating for volume depletion by vigorous activation of the renin–angiotensin system that salt depletion/dehydration cannot be recognized easily by routine clinical measurements, eg, capillary refill, serum sodium levels, or tachycardia.
The Effects of a High-protein, Low-fat, Ketogenic Diet on Adolescents With Morbid Obesity: Body Composition, Blood Chemistries, and Sleep Abnormalities
Authors: Willi Steven M. , Oexmann Mary Joan , Wright Nancy M. , Collop Nancy A. , Key L. Lyndon 
Published: August 2004

Objective. To evaluate the efficacy and metabolic impact of a high-protein, low-carbohydrate, low-fat ketogenic diet (K diet) in the treatment of morbidly obese adolescents with initial weights of &gt;200% of ideal body weight.Methods. Six adolescents, aged 12 to 15 years, weighing an average of 147.8 kg (range, 120.6–198.6 kg) and having an average body mass index of 50.9 kg/m2 (39.8–63.0 kg/m2), consumed the K diet for 8 weeks. Daily intake consisted of 650 to 725 calories, which was substantively in the form of protein (80–100 g). The diet was very low in carbohydrates (25 g) and fat (25 g). This was followed by 12 weeks of the K diet plus two carbohydrates (30 g) per meal (K+2 diet).Main Outcome Measures. Anthropometric data and blood and urine were collected at enrollment, during week 1, and at 4-week intervals throughout the course of the study. Resting energy expenditure was measured by indirect calorimetry. Body composition was estimated using dual-energy x-ray absorptiometry, bioelectrical impedance analysis, and urinary creatinine excretion at enrollment and on completion of each phase of the diet. Nocturnal polysomnography and multiple sleep latency testing were conducted at baseline and repeated after an average weight loss of 18.7 kg to determine sleep architecture, frequency and duration of apneas, and daytime sleepiness.Results. Subjects lost 15.4 ± 1.4 kg (mean ± SEM) during the K diet and an additional 2.3 ± 2.9 kg during the K+2 diet. Body mass index decreased 5.6 ± 0.6 kg/m2during the K diet and an additional 1.1 ± 1.1 kg/m2during the K+2 diet. Body composition studies indicated that weight was lost equally from all areas of the body and was predominantly fat. Dual-energy x-ray absorptiometry showed a decrease from 51.1% ± 2.1% body fat to 44.2% ± 2.9% during the K diet and then to 41.6% ± 4.5% during the K+2 diet. Lean body mass was not significantly affected. Weight loss was accompanied by a reduction in resting energy expenditure of 5.2 ± 1.8 kcal/kg of fat-free mass per day. Blood chemistries remained normal throughout the study and included a decrease in serum cholesterol from 162 ± 12 to 121 ± 8 mg/dL in the initial 4 weeks of the K diet. An increase in calcium excretion was accompanied by a decrease in total-body bone mineral content. A paucity of rapid eye movement sleep and excessive slow-wave sleep were seen in all subjects at enrollment. Weight loss led to an increase in rapid eye movement sleep (P &lt; .02) and a decrease in slow-wave sleep (P &lt; .01) to near normal levels.Conclusions. The K diet can be used effectively for rapid weight loss in adolescents with morbid obesity. Loss in lean body mass is blunted, blood chemistries remain normal, and sleep abnormalities significantly decrease with weight loss.
Evaluation of a Diagnostic Approach to Pediatric Interstitial Lung Disease
Authors: Fan Leland L. , Kozinetz Claudia A. , Deterding Robin R. , Brugman Susan M. 
Published: August 2004

Objective. To evaluate the value of a systematic approach to the diagnosis of pediatric interstitial lung disease (ILD).Methods. In this descriptive, observational, prospective study, we evaluated 51 children presenting with ILD of unknown etiology during a 3-year period. Specific clinical information regarding history, physical examination, diagnostic evaluation, and final diagnosis was recorded on each patient.Results. A specific diagnosis was established by history and physical examination alone in 1 patient, noninvasive tests alone in 8 others, and invasive tests, including lung biopsy, in another 26. Of the remaining patients, 8 had a suggestivediagnosis, and 8 had no specific diagnosis.Conclusions. A systematic approach to the diagnosis of pediatric ILD is useful, and not all patients need lung biopsy for diagnosis.
α1-Proteinase Inhibitor Therapy for the Prevention of Chronic Lung Disease of Prematurity: A Randomized, Controlled Trial
Authors: Stiskal Joseph A. , Dunn Michael S. , Shennan Andrew T. , O'Brien Karel K. E. , Kelly Edmond N. , Koppel Robert I. , Cox Diane W. , Ito Shinya , Chappel S. Lesley , Rabinovitch Marlene 
Published: August 2004

Background. An imbalance between increased neutrophil elastase and a decreased antiprotease shield has been suggested as a factor contributing to the development of chronic lung disease (CLD). We hypothesized that administration of α1-proteinase inhibitor (A1PI), also known as α1-antitrypsin, to premature neonates would prevent CLD.Design. A randomized, placebo-controlled, prospective study of A1PI supplementation was performed. Neonates &lt;24 hours of age with birth weights 600–1000 g on respiratory support, and 1001–1250 g with respiratory distress syndrome (RDS) were eligible. Intravenous A1PI (60 mg/kg) or placebo was infused on days 0, 4, 7, and 14. Primary outcome was CLD in survivors, defined as the need for supplemental oxygen on day 28.Results.  A total of 106 patients were recruited. There were no significant differences between groups in birth weight or incidence of RDS. The incidence of CLD in survivors was lower in the treated group, but the difference did not reach statistical significance (relative risk [RR], 0.79; confidence interval [CI], 0.60–1.02). This beneficial trend persisted at 36 weeks corrected gestational age (RR, 0.48; CI, 0.23–1.00). The incidence of pulmonary hemorrhage was lower in the treated group (RR, 0.22; CI, 0.05–0.98). Other complications were not significantly different between groups.Conclusions. In this, the first trial of a protease inhibitor for the prevention of CLD in premature infants, the infusions were well-tolerated. A1PI therapy may impede the development of CLD and appears to reduce the incidence of pulmonary hemorrhage in some neonates born prematurely.
Hunger in Children in the United States: Potential Behavioral and Emotional Correlates
Authors: Kleinman Ronald E. , Murphy J. Michael , Little Michelle , Pagano Maria , Wehler Cheryl A. , Regal Kenneth , Jellinek Michael S. 
Published: August 2004

Objective. Results from a recent series of surveys from 9 states and the District of Columbia by the Community Childhood Hunger Identification Project (CCHIP) provide an estimate that 4 million American children experience prolonged periodic food insufficiency and hunger each year, 8% of the children under the age of 12 in this country. The same studies show that an additional 10 million children are at risk for hunger. The current study examined the relationship between hunger as defined by the CCHIP measure (food insufficiency attributable to constrained resources) and variables reflecting the psychosocial functioning of low-income, school-aged children.Methods. The study group included 328 parents and children from a CCHIP study of families with at least 1 child under the age of 12 years living in the city of Pittsburgh and the surrounding Allegheny County. A two-stage area probability sampling design with standard cluster techniques was used. All parents whose child was between the ages of 6 and 12 years at the time of interview were asked to complete a Pediatric Symptom Checklist, a brief parent-report questionnaire that assesses children's emotional and behavioral symptoms. Hunger status was defined by parent responses to the standard 8 food-insufficiency questions from the CCHIP survey that are used to classify households and children as “hungry,” “at-risk for hunger,” or “not hungry.”Results. In an area probability sample of low-income families, those defined as hungry on the CCHIP measure were significantly more likely to have clinical levels of psychosocial dysfunction on the Pediatric Symptom Checklist than children defined as at-risk for hunger or not hungry. Analysis of individual items and factor scores on the Pediatric Symptom Checklist showed that virtually all behavioral, emotional, and academic problems were more prevalent in hungry children, but that aggression and anxiety had the strongest degree of association with experiences of hunger.Conclusion. Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction than children from the same low-income communities whose families do not report experiences of hunger. Although causality cannot be determined from a cross-sectional design, the strength of these findings suggests the importance of greater awareness on the part of health care providers and public health officials of the role of food insufficiency and hunger in the lives of poor children.
Variations in Transfusion Practice in Neonatal Intensive Care
Authors: Ringer Steven A. , Richardson Douglas K. , Sacher Ronald A. , Keszler Martin , Churchill W. Hallowell 
Published: August 2004

Objective. To compare the transfusion practices between two neonatal intensive care units (NICUs) to assess the impact of local practice styles on the timing, number, and total volume of packed red cell transfusions in very low birth weight infants. To derive multivariate models to describe practice and to identify potential areas for improvement in the future.Methodology. We reviewed phlebotomy losses and transfusion rates between two NICUs (A and B) for 270 consecutive admissions of birth weight &lt;1500 g. We stratified for birth weight and for illness severity by the Score for Neonatal Acute Physiology (SNAP). Measures of short-term outcome were compared. We derived multivariate models to describe and compare the practices in the two NICUs.Results. Patients in NICU A had smaller phlebotomy losses than those in NICU B. A lower percentage of the patients in NICU A (65% vs 87%) received transfusions, but they tended to receive a greater total volume per kg per patient (67 mL/kg vs 54.8 mL/kg). Transfusion timing differed between the NICUs; in NICU A only approximately one-half of their transfusions occurred in the first 2 weeks, whereas in NICU B almost 70% of the transfusions were given in this time period. Multivariate models showed that phlebotomy losses were significantly related to lower gestational age (GA) and higher SNAP. Hospitalization in NICU B resulted in 10.7 cc of additional losses relative to NICU A for a comparable GA and illness severity score. The volume of blood transfused per kilogram of body weight was a function of GA, SNAP, and hospital. Care practices in NICU A added an additional 19 cc of transfused volume in the first 14 days of life, and an additional 26 cc thereafter when adjusted for GA and SNAP. These differences in phlebotomy and transfusion were not associated with differences in the days of oxygen therapy or mechanical ventilation, the oxygen requirement at 28 days, the incidence of chronic lung disease, or the rate of growth by day 28.Conclusions. We identified significant differences in phlebotomy and transfusion practices between two NICUs. We found no differences in short-term outcome, suggesting that the additional use of blood in one of the NICUs was discretionary rather than necessary. Our multivariate models can be used to characterize and quantify transfusion and phlebotomy practices. By predicting which patients are likely to require multiple transfusions, clinicians can target patients for erythropoietin therapy and identify those patients for whom donor exposure can be reduced by a unit of blood for multiple use. The models may help in monitoring changes in practice as they occur.