bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sports Injuries: An Important Cause of Morbidity in Urban Youth
Authors: Cheng Tina L. , Fields Cheryl B. , Brenner Ruth A. , Wright Joseph L. , Lomax Tracie , Scheidt Peter C. ,   the District of Columbia Child/Adolescent Injury Research Network#
Published: August 2004

Introduction.
Sports injuries account for substantial morbidity and medical cost. To direct intervention, a population-based study of the causes and types of sports injuries was undertaken.

Method.
An injury surveillance system was established at all trauma center hospitals that treat residents 10 to 19 years old in the District of Columbia and the Chief Medical Examiner's Office. Medical record abstractions were completed for those seen in an emergency department, admitted to the hospital, or who died from injury June 1996 through June 1998.

Findings.
Seventeen percent (n = 2563) of all injuries occurred while participating in 1 of 6 sports (baseball/softball, basketball, biking, football, skating, and soccer) resulting in an event-based injury rate of 25.0 per 1000 adolescents or 25.0/1000 population year. Rates were higher in males for all sports. The most common mechanisms were falls (E880–888) and being struck by or against objects (E916–918). Hospitalization was required in 2% of visits and there were no deaths. Of those requiring hospitalization, 51% involved other persons, 12% were equipment-related, and 8% involved poor field/surface conditions. Of all baseball injuries, 55% involved ball or bat impact often of the head. Basketball injuries included several injuries from striking against the basketball pole or rim or being struck by a falling pole or backboard. Biking injuries requiring admission included 2 straddle injuries onto the bike center bar and collision with motor vehicles. Of all football injuries, 48 (7%) involved being struck by an opponent's helmet and 63 (9%) involved inappropriate field conditions including falls on or against concrete, glass, or fixed objects. In soccer there were 4 goal post injuries and a large proportion of intracranial injuries. There were 51 probable or clear assaults during sports and an additional 30 to 41 injuries from baseball bat assaults.

Conclusions.
Many sports including noncontact sports involved injuries of the head suggesting the need for improved head protection. Injuries involving collisions with others and assaults point to the need for supervision and enforcement of safety rules. The 16% of sports injury visits and 20% of hospitalizations related to equipment and environmental factors suggest that at least this proportion of injury may be amenable to preventive strategies. Design change may be warranted for prevention of equipment-related injuries. The many injuries involving inappropriate sports settings suggest the need for and use of available and safe locations for sports.
Effect of Infection Control Measures on the Frequency of Upper Respiratory Infection in Child Care: A Randomized, Controlled Trial
Authors: Roberts Leslee , PhD Epid, , Smith Wayne , Jorm Louisa , PhD BVSc, MSc(Epid), , Patel Mahomed , Douglas Robert M. , McGilchrist Charles 
Published: August 2004

Background.Acute upper respiratory infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of respiratory infections in child care could be reduced by improved infection control procedures.Methods.We performed a cluster, randomized, controlled trial of an infection control intervention conducted in child care centers in 1 city in Australia. The intervention was training of child care staff about transmission of infection, handwashing, and aseptic nosewiping technique. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks.Results.There were 311 child-years of surveillance for respiratory symptoms. By multivariable analysis, there was no significant reduction in colds in intervention center children across the full age range. However, a significant reduction in respiratory illness was present in children 24 months of age and younger. When compliance with infection control practices was high, colds in these children were reduced by 17%.Conclusions.This trial supports the role of direct transmission of colds in young children in child care. The ability of infection control techniques to reduce episodes of colds in children in child care was limited to children 24 months of age and under.
Hypothalamic-Pituitary-Adrenal Function and Glucocorticoid Sensitivity in Atopic Dermatitis
Authors: Ellison Julie A. , Patel Leena , Ray David W. , David PhD‡; Timothy J. , Clayton Peter E. 
Published: August 2004

Objectives.Topical glucocorticoids (GCs) fail to produce a clinical response in some children with atopic dermatitis (AD), suggesting that GC resistance may be present. To determine whether such resistance is generalized or specific to diseased skin, hypothalamic-pituitary-adrenal (HPA) axis function has been assessed in children with moderate to severe AD, who showed a variable response to treatment with topical GC.Study Design.Thirty-five patients (.7–18.7 years old; median: 9.3 years) with AD requiring topical GCs from infancy underwent a low-dose adrenocorticotrophin hormone (ACTH; Synacthen) test (LDST) (500 ng/1.73 m2 ACTH). Groups 1 (7 patients), 2 (17 patients), and 3 (4 patients) used mild, moderate, or potent/very potent topical preparations, respectively. Group 4 (7 boys with severe, treatment-resistant disease) had received GC in at least 1 form (inhaled ± intranasal ± oral) in addition to varying potencies of topical GC. Fourteen healthy subjects (3.8–17.3 years old) served as control subjects. Group 4 patients had a daytime plasma cortisol profile and 08.00 hours measurement of plasma ACTH and its precursors.Results.The response to ACTH for groups 1 and 2 did not differ from that of control subjects. Group 3 had lower peak, increment, and area under curve cortisol responses than those in controls, whereas group 4 had lower baseline, peak, and area under curve cortisol responses. Eight patients failed the LDST (peak cortisol &lt;500 nmol/L and increment &lt;200 nmol/L): controls = 0/14, group 1 = 0/7, group 2 = 1/17, group 3 = 4/4, and group 4 = 3/7. Treatment score (based on GC potency, area treated, and duration) was the only factor to influence peak cortisol response on LDST (r2 = 24%). In group 4, only 1 of 7 patients had a cortisol profile within the normal range but he failed the LDST. In the 5 subjects with an 08.00 hours cortisol &lt;300 nmol/L, the matched ACTH level was inappropriately low.Conclusions.HPA suppression was rarely found in children or adolescents with moderate to severe AD who used mild or moderately potent topical GCs over many years. However, HPA suppression was common in those receiving potent topical GC preparations or a combination of GC routes of administration. In those with severe AD, evidence of HPA suppression but lack of clinical response to GC treatment excluded significant generalized GC resistance. This would suggest that localized resistance to GCs within the diseased skin may be part of the aetiopathogenesis of severe AD.
Sibling Vesicoureteral Reflux in Multiple Gestation Births
Authors: Kaefer Martin , Curran Michael , Treves S. Ted , Bauer Stuart , Hendren W. Hardy , Peters Craig A. , Atala Anthony , Diamond David , Retik Alan 
Published: August 2004

Background.
Vesicoureteral reflux (VUR) is the most commonly inherited disease of the genitourinary tract. Although the majority of evidence supports a genetic cause, the tendency for this condition to spontaneously improve over time has made it difficult to determine the actual mode of transmission. We report the incidence of VUR in siblings of multiple gestation births and for the first time compare the relative incidence of reflux between identical and fraternal twins.

Methods.
A database consisting of all radionuclide cystograms and voiding cystourethrograms performed between the years 1986 and 1996 was searched for multiple gestation births. The medical records of each patient were evaluated for age at presentation, zygosity, reflux grade, and time to resolution. Children with secondary causes of VUR (eg, posterior urethral valves) were excluded. Triplets were treated as 2 pairs of twins for statistical analysis.

Results.
Forty-six pairs met the inclusion criteria (31 dizygotic and 15 monozygotic). Overall, 23 (50%) of 46 siblings of index cases had demonstrable VUR. Comparison of VUR prevalence between identical and nonidentical twins was revealing with 80% (12/15) of identical twins and 35% (11/31) of fraternal twins having VUR. When only the youngest individuals in each group were considered, 100% (7/7) of the monozygotics and 50% (5/10) of the dizygotics demonstrated this trait.

Conclusions.
High concordance for VUR in identical twin siblings supports a genetic basis for the transmission of this disease. Results obtained from fraternal twin siblings provides convincing evidence that this trait is transmitted in an autosomal dominant fashion.
Patient Care Guidelines in Pediatrics
Authors: Yetman Robert J. 
Published: August 2004

The increase in availability of patient care guidelines is consistent with the expansion of managed care health care systems and enhanced efforts of health care providers to deliver evidence-based patient care. When used effectively, guidelines support: 1) the reduction of unexplained variation in health care practice; 2) education of practitioners and health care delivery systems; and 3) the continuous improvement in processes that improve patient outcomes. It is with these goals in mind that Milliman and Robertson released its latest publication of Health Care Management Guidelines entitled Pediatric Health Status Improvement and Management (HSIM). This publication contains comprehensive information on many aspects of pediatric care, from the prenatal period through adolescence, from preventive medicine through chronic care.
Like other Milliman and Robertson Health Care Management Guidelines publications, Pediatric HSIM offers both treatment guides and benchmarks that enable health care professionals to provide optimal levels of care and to measure their performance against peers. The primary focus of Pediatric HSIM is on wellness across a child's lifetime, an objective that fits well with our goal as providers of care to children of keeping patients healthy through preventive medicine.
Soothing Pain-Elicited Distress in Chinese Neonates
Authors: Bo Luk Kar , MN BN, , Callaghan Patrick 
Published: August 2004

Objective.
To test the effect of nonnutritive sucking (NNS), music therapy (MT), and combined NNS and MT (NNS + MT), versus no intervention, on heart rate, transcutaneous oxygen (TcPao2) levels, and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure.

Methodology.
A within-subjects, counter-balancing, repeated-measures design conducted in a government-funded hospital in Hong Kong, comparing TcPao2 levels, heart rate, and pain behavior outcomes in 27 neonates.

Results.
Repeated-measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions (Wilk's λ = .142; F[3,27] = 31.82; η2 = .47). One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonates' heart rate (Wilk's λ = .647; F[2,27] = 18.93; η2 = .35), improved their TcPao2 levels (Wilk's λ = .481;F [2,27] = 37.42; η2 = .51), and reduced their pain behavior (Wilk's λ = .312; F [2,27] = 76.42; η2 = .68). Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates' TcPao2 levels and pain behavior; MT alone had the strongest effect on neonates' heart rate.

Conclusions.
Health professionals using NNS + MT when doing heel-sticks can improve the TcPao2 levels of neonates and reduce their pain. Using MT alone can improve the heart rate of neonates.
Activity, Dietary Intake, and Weight Changes in a Longitudinal Study of Preadolescent and Adolescent Boys and Girls
Authors: Berkey Catherine S. , Rockett Helaine R. H. , Field Alison E. , Gillman Matthew W. , Frazier A. Lindsay , Camargo Carlos A. , MD Jr, , Colditz Graham A. 
Published: August 2004

Objective.To examine the role of physical activity, inactivity, and dietary patterns on annual weight changes among preadolescents and adolescents, taking growth and development into account.Study Design.We studied a cohort of 6149 girls and 4620 boys from all over the United States who were 9 to 14 years old in 1996. All returned questionnaires in the fall of 1996 and a year later in 1997. Each child provided his or her current height and weight and a detailed assessment of typical past-year dietary intakes, physical activities, and recreational inactivities (TV, videos/VCR, and video/computer games).Methods.Our hypotheses were that physical activity and dietary fiber intake are negatively correlated with annual changes in adiposity and that recreational inactivity (TV/videos/games), caloric intake, and dietary fat intake are positively correlated with annual changes in adiposity. Separately for boys and girls, we performed regression analysis of 1-year change in body mass index (BMI; kg/m2). All hypothesized factors were in the model simultaneously with several adjustment factors.Results.Larger increases in BMI from 1996 to 1997 were among girls who reported higher caloric intakes (.0061 ± .0026 kg/m2 per 100 kcal/day; β ± standard error), less physical activity (−.0284 ± .0142 kg/m2/hour/day) and more time with TV/videos/games (.0372 ± .0106 kg/m2/hour/day) during the year between the 2 BMI assessments. Larger BMI increases were among boys who reported more time with TV/videos/games (.0384 ± .0101) during the year. For both boys and girls, a larger rise in caloric intake from 1996 to 1997 predicted larger BMI increases (girls: .0059 ± .0027 kg/m2 per increase of 100 kcal/day; boys: .0082 ± .0030). No significant associations were noted for energy-adjusted dietary fat or fiber.Conclusions.For both boys and girls, a 1-year increase in BMI was larger in those who reported more time with TV/videos/games during the year between the 2 BMI measurements, and in those who reported that their caloric intakes increased more from 1 year to the next. Larger year-to-year increases in BMI were also seen among girls who reported higher caloric intakes and less physical activity during the year between the 2 BMI measurements. Although the magnitudes of these estimated effects were small, their cumulative effects, year after year during adolescence, would produce substantial gains in body weight. Strategies to prevent excessive caloric intakes, to decrease time with TV/videos/games, and to increase physical activity would be promising as a means to prevent obesity.
Does Candidemia Predict Threshold Retinopathy of Prematurity in Extremely Low Birth Weight (≤1000 g) Neonates?
Authors: Karlowicz M. Gary , Giannone Peter J. , Pestian John , Morrow Ardythe L. , Shults Justine 
Published: August 2004

Background.Extreme prematurity is a risk factor for both candidemia and threshold retinopathy of prematurity (ROP) and may confound the reported association between these conditions.Objective.To determine if candidemia is an independent risk factor for threshold ROP.Methods.A cohort study was conducted of infants weighing ≤1000 g at birth using a prospectively maintained neonatal database. The study included infants admitted to the neonatal intensive care unit at ≤3 days of age between January 1, 1993 and December 31, 1997. We excluded infants not screened for ROP because they died, were discharged, or transferred. Threshold ROP (ie, requiring ablative therapy within 72 hours of diagnosis) was defined by the criteria of the American Academy of Pediatrics Section on Ophthalmology ROP subcommittee. Candidemia was defined as Candidaspecies growth from at least 1 blood culture. Cox proportional hazards regression was used to determine independent risk factors for threshold ROP.Results.Six hundred fourteen infants weighing ≤1000 g at birth, of which 165 were excluded: 120 died before ROP screening, 40 were admitted &gt;3 days of age, and 5 were discharged or transferred before ROP screening. A total of 449 infants were included in the study; 58 (13%) developed threshold ROP. Candidemia occurred in 58 (13%) infants before developing the worst stage of ROP. Candidemia occurred in 27 of 73 (37%) at 23 to 24 weeks' gestational age (GA), 25 of 197 (13%) at 25 to 26 weeks' GA, and 6 of 129 (5%) at 27 to 28 weeks' GA, 0 of 50 &gt;28 weeks' GA. Similarly, threshold ROP occurred in 25 of 73 (34%) at 23 to 24 weeks' GA, 26 of 197 (13%) at 25 to 26 weeks' GA, and 6 of 129 (5%) at 27 to 28 weeks' GA, and 1 of 50 (2%) &gt;28 weeks' GA. Threshold ROP developed in 19 of 58 (33%) infants with a history of candidemia and 39 of 391 (10%) without candidemia. Proportional hazards analysis indicated that GA in weeks (hazard ratio = .75; 95% confidence interval [CI]: .61, .93) and non-black ethnicity (hazard ratio = 1.8; 95% CI: 1.05, 3.08) were significantly associated with threshold ROP. After controlling for GA and other factors, candidemia did not remain significantly associated with threshold ROP (hazard ratio = 1.6; 95% CI: .89, 2.89).Conclusion.Candidemia may not be an independent risk factor for threshold ROP in extremely low birth weight infants. The magnitude of the previously reported association between candidemia and threshold ROP (more than fivefold) is unlikely and much of the clinically observed association appears to be mediated by gestational age.
Systemic Candidiasis in Extremely Low Birth Weight Infants Receiving Topical Petrolatum Ointment for Skin Care: A Case–Control Study
Authors: Campbell Judith R. , Zaccaria Elena , Baker Carol J. 
Published: August 2004

Background and Objective.An increase in the incidence of systemic candidiasis (SC) followed a change in skin care for extremely low birth weight (ELBW) infants in our neonatal intensive care unit (NICU). We sought to determine whether the use of topical petrolatum ointment (TPO) for skin care of ELBW infants was associated with risk for SC.Study Design.Case–control study.Setting.A 48-bed NICU in a private hospital in Houston, Texas.Patients.Ten ELBW infants with and 30 without SC admitted to the NICU from December 1, 1997 through July 31, 1998.Methods.ELBW infants with SC were identified using hospital microbiology and infectious disease consultation databases. A case was defined as an infant weighing ≤1000 g at birth withCandida spp isolated from a normally sterile body site. Three infants without SC were matched to each case by birth weight, admission date, and survival to the age of SC onset for the case. Data were collected by retrospective medical record review. Molecular analysis of Candida isolates was performed by karyotyping and restriction fragment length polymorphism using pulsed-field gel electrophoresis.Results.Case infants had a mean (± standard deviation) age of onset of 21.5 ± 24 days. Infants with SC and controls did not differ in birth weight, gestational age, or duration of therapy with steroids, antibiotics, insulin, or total parenteral nutrition. Although cases were more likely to be born vaginally and had a longer duration endotracheal intubation than controls, these differences were not significant. The odds ratio for skin care with TPO in case infants versus control infants was 11 (95% confidence interval: 1.9–63). Skin care with TPO was discontinued and the incidence of SC decreased to baseline. Several Candida spp and genetic profiles were identified, suggesting that there was not a common source outbreak.Conclusions.We conclude that the use of TPO promoted an increase in the incidence of SC in ELBW infants. Additional investigation of potential infectious risks for ELBW infants receiving TPO skin care is warranted.
Factors Associated With Age at Operation for Children With Congenital Heart Disease
Authors: Chang Ruey-Kang R. , Chen Alex Y. , Klitzner Thomas S. 
Published: August 2004

Objective.
Previous studies have shown that children with congenital heart disease (CHD) who live in nonurban areas or who do not have private insurance are at risk for delayed referral to a pediatric cardiologist. However, the effect of these factors on the age at which cardiac surgery is performed has not been evaluated. This study is designed to evaluate the factors that influence the age at which definitive surgical repair is performed.

Methods.
Data on hospital discharges for 1995 and 1996 in California were obtained from the Office of Statewide Health Planning and Development database. Children &lt;18 years who underwent surgical repair for atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), or atrioventricular canal (AVC) were included in the study. Age at surgery was evaluated using type of CHD, gender, race, type of insurance, surgical centers, urban or rural home location, and distance between home and surgical center as independent variables.

Results.
In 1995–1996, 666 children underwent ASD closure (mean age: 5.1 years; median: 4.0 years), 582 VSD closure (mean age: 2.8; median: 1.1 years), 394 TOF repair (mean age: 1.7; median: .9 years), and 177 AVC repair (mean age: 1.1; median: .6 years). Comparing median and mean age at surgery, we found: AVC&lt;TOF&lt;VSD&lt;ASD (&lt; indicates younger than). A consistent trend for all 4 types of CHD was seen indicating that for median age at operation: private insurance&lt;managed care&lt;Medicaid. Gender or race had no effect on age at operation, although Asians tended to be older at surgery for all 4 types of CHD. There is a significant negative correlation between the case volume of surgical centers and median age at operation for ASD (r = −.37), VSD (r = −.49), TOF (r = −.63), and AVC (r = −.17). In addition, significant positive correlation was found between degree of urbanization of home locations (measured by population density) and median age at operation for ASD (r = .50), VSD (r = .77), and TOF (r = .18). No significant correlation was found between distance to surgical center and age at operation.

Conclusions.
Many medical and nonmedical variables play important roles in determining age for definitive repair of CHD in children. Type of insurance, a recognized surrogate for access to care, may play an important role. In addition, centers with higher surgical case volume were more likely to operate at a younger age. Finally, children in urban areas tend to be older at the time of surgery for ASD, VSD, and TOF.
Structural and Functional Brain Integrity of Fetal Alcohol Syndrome in Nonretarded Cases
Authors: Clark Campbell M. , Li David , Conry Julianne , Conry Robert , Loock Christine 
Published: August 2004

Purpose.
To determine the structural and functional integrity of the brain in a sample of nonretarded individuals diagnosed with fetal alcohol syndrome.

Subjects.
The sample consisted of nineteen individuals who met the diagnostic criteria for fetal alcohol syndrome.

Methods.
Intellectual function was assessed using the Wechsler Adult Intelligence Scale-Revised. Structural integrity of the brain was assessed using magnetic resonance imaging whereas functional integrity was assessed using positron emission tomography and 18F-fluorodeoxyglucose.

Results.
The mean Full Scale IQ was 80.2 (range: 66–92). Only 1 magnetic resonance imaging was found to be abnormal. This abnormality was found for the subject with the lowest IQ. Decreases in relative regional cerebral metabolic rates were found in 5 brain regions comprising the thalamus and basal ganglia.

Conclusion.
These results when coupled with previous findings suggest a continuum of neuropathology in fetal alcohol syndrome. For cases with relatively mild intellectual deficits, the cause of the deficit is at a micro-level rather than a macro-level.