bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytokine and Cellular Inflammatory Sequence in Enteroviral Meningitis
Authors: Sato Masatoki , Hosoya Mitsuaki , Honzumi Ken , Watanabe Mikako , Ninomiya Norio , Shigeta Shiro , Suzuki Hitoshi 
Published: August 2004

Objective. To clarify the sequence of cytokines and inflammatory cells in enteroviral meningitis.Methods. Cerebrospinal fluid (CSF) was collected from 86 patients who received a diagnosis of enteroviral meningitis after detection of the enteroviral genome in the CSF using polymerase chain reaction. Twenty-one of 86 patients had repeated lumbar punctures. Cytokine concentrations were measured acutely and in 32 samples collected during recovery.Results. The proinflammatory cytokines (interleukin [IL]-6, IL-8, and interferon-γ) were detected at significantly higher concentrations during the acute phase when enteroviral genomes were present. Proinflammatory cytokines decreased to normal levels in the recovery phase when enteroviral genomes disappeared. Anti-inflammatory concentrations (IL-10 and transforming growth factor-β1) were significantly higher in the recovery phase than in the acute phase. Of the 86 CSF samples collected in the acute phase, 11 had no pleocytosis (&lt;10 white blood cells/mm3). In 7 of those 11 CSF samples, IL-6 and IL-8 levels were as high as those in the 75 samples with pleocytosis (≥10 white blood cells/mm3). Seven patients were considered to be in the initial stage of their illness when production of proinflammatory cytokines were high but leukocytes had not yet infiltrated the cerebrospinal cavity.Conclusions. The inflammatory process observed in human enteroviral meningitis is comparable with that observed in animal models: 1) infection induces proinflammatory cytokine production, followed by infiltration of white blood cells into the infected area, and 2) inflammation is terminated by the anti-inflammatory cytokines that are produced when pathogens are eliminated.
Entertainment Television as a Healthy Sex Educator: The Impact of Condom-Efficacy Information in an Episode ofFriends
Authors: Collins Rebecca L. , Elliott Marc N. , Berry Sandra H. , Kanouse David E. , Hunter Sarah B. 
Published: August 2004

Context. Television is often decried as a negative influence on the sexual attitudes and behavior of America’s adolescents. However, television occasionally includes messages about the risks of having sex that may have a positive effect on youth.Objective. To assess the impact of condom-efficacy messages in an episode of Friends on teens.Design, Setting, and Participants. A national sample of 506 adolescents 12 to 17 years old who had been regular viewers of Friends the previous year were surveyed by telephone shortly after the episode aired.Outcome Measures. Viewership of the Friends episode, recall of the condom-efficacy message, beliefs about condoms, self-reported change in condom knowledge, and discussions of condom efficacy with parents.Results. At least 27% of the sample saw the episode, and 65% of these viewers recalled its depiction of condom failure resulting in pregnancy. Forty percent of the viewers watched with an adult. Ten percent of viewers talked to an adult about condom efficacy as a result of the show. Compared with other viewers, youth who talked with an adult were more likely to report learning about condoms from the episode and appeared less likely to reduce their perceptions of condom efficacy after the episode.Conclusions. Entertainment television can serve as a healthy sex educator and can work in conjunction with parents to improve adolescent sexual knowledge.
Analgesia for Children With Acute Abdominal Pain: A Survey of Pediatric Emergency Physicians and Pediatric Surgeons
Authors: Kim Michael K. , Galustyan Sergey , Sato Thomas T. , Bergholte Jo , Hennes Halim M. 
Published: August 2004

Objective. To evaluate the current opinion and practice of pediatric emergency medicine physicians (PEM) and pediatric surgeons (PS) on the use of opioid analgesia in children with acute abdominal pain during their evaluation in the emergency department.
Methods. All members of the American Academy of Pediatrics in the Section of Emergency Medicine and the American Pediatric Surgeons Association were mailed a copy of the survey. Inclusion criteria were board-eligible or -certified PEM, or PS certified by American Board of Surgery or Royal College of Surgeons currently in practice whose patient population includes children. Information on primary patient population, years in practice, practice setting, willingness to provide analgesia for acute nontraumatic abdominal pain in children, and the factors influencing their decision were requested. Data were analyzed with the Student t test and χ2 analysis.
Results. Of 1441 surveys sent, 54 were returned because of incorrect addresses. Of the 1387 presumed received, 702 completed surveys were returned with a response rate of 51%. However, of those who responded, 574 (82%) respondents met our inclusion criteria, and 385 (67%) were PEM and 189 (33%) were PS. Compared with PEM, more PS had &gt;10 years of work experience and were in private practice. More PEM were willing to provide analgesia before definitive diagnosis. However, the overall willingness to provide analgesia was low in both groups. Among the physicians with &lt;10 years of experience, there was no statistical difference between PEM and PS in willingness to provide analgesia. However, among the physicians with &gt;10 years of experience, 61% of PS were less likely to provide analgesia compared with 38% of the PEM (Δ = 23%; 95% confidence interval 13%, 33%). Of the 74 PEM who made optional general comments, 64 (87%) cited disapproval by the PS as the main barrier in providing analgesia.
Conclusions. The practice of providing analgesia for children with acute abdominal pain is divergent between PEM and PS. More experienced surgeons are less likely to provide analgesia for children with acute abdominal pain. The perceived disapproval of providing analgesia to children with acute abdominal pain by PS is a barrier influencing PEM practice.
Intervention With Parental Smokers in an Outpatient Pediatric Clinic Using Counseling and Nicotine Replacement
Authors: Winickoff Jonathan P. , Buckley Valerie J. , Palfrey Judith S. , Perrin James M. , Rigotti Nancy A. 
Published: August 2004

Objective. To evaluate the feasibility of implementing a smoking cessation intervention for parents at the time of the pediatric visit.Methods. A prospective cohort of smoking parents whose child was seen in an outpatient pediatric practice was offered the Stop Tobacco Outreach Program, which includes 3 brief counseling sessions, written materials, free nicotine replacement therapy (NRT), proactive referral to a free state telephone quitline, and fax referral to the parents’ primary clinician. The primary outcome was completion of all three counseling sessions. Other outcomes were quit attempts, cessation, NRT use, state quitline use, and household smoking assessed at 2-month follow-up.Results. One hundred fifty-eight smoking parents met eligibility criteria and 100 (63%) enrolled in the study. Of the 100 enrollees, 81% completed all three counseling sessions and 78% accepted free NRT at the time of enrollment. At 2-month follow-up, of the 100 enrollees, 56% reported making a quit attempt of ≥24 hours, 18% reported 7-day tobacco abstinence, 34% used NRT, and 42% received additional counseling from the state telephone quitline. The mean number of cigarettes smoked inside the home and car declined over 2 months (home, 5.1 vs 1.4; and car, 2.5 vs 1.4).Conclusions. This study demonstrates the feasibility of engaging parents in a smoking cessation intervention at the time of a child’s clinic visit. This approach may be an effective way to reach smokers who otherwise are unlikely to access smoking cessation interventions. High rates of program enrollment, use of NRT, and completion of telephone counseling in this study support the hypothesis that a child’s clinic visit is a teachable moment to address parental smoking cessation.
Short-Chain Acyl-CoA Dehydrogenase Deficiency: Studies in a Large Family Adding to the Complexity of the Disorder
Authors: Bok Levinus A. , Vreken Peter , Wijburg Frits A. , Wanders Ronald J. A. , Gregersen Niels , Corydon Morten J. , Waterham Hans R. , Duran Marinus 
Published: August 2004

Objective. To understand the expanding clinical and biochemical spectrum of short-chain acyl-CoA dehydrogenase (SCAD) deficiency, the impact of which is not fully understood.
Study Design. We studied a family with SCAD deficiency and determined urinary ethylmalonic acid excretion, plasma C4-carnitine, SCAD enzyme activity in fibroblasts and lymphocytes, DNA mutations in the SCAD gene, and clinical expression. The index patient was born prematurely and had otherwise unexplained cholestasis and hepatomegaly during the first year of life. His mother developed a hemolysis-elevated liver enzymes-low platelets (HELLP) syndrome while pregnant with the index patient.
Results. Two siblings had a homozygous inactivating 1138C&gt;T mutation, whereas the father was compound heterozygous for this mutation and the common 625G&gt;A polymorphism. There was a good correlation between the type of SCAD mutation, the residual SCAD enzyme activity, and the levels of urinary ethylmalonic acid and plasma C4-carnitine in each of the eight family members. Retrospective acylcarnitine analysis of the index patient’s Guthrie screening card confirmed the abnormal increase of C4-carnitine, suggestive of SCAD deficiency. None of the family members had hypotonia, developmental delay, or episodes of ketotic hypoglycemia.
Conclusion. Homozygosity for an inactivating SCAD mutation does not necessarily result in disease. The previously held opinion that SCAD deficiency is always a serious disorder may have been influenced by a clinical bias. Homozygosity for an inactivating 1138C&gt;T SCAD mutation was assessed by neonatal screening of blood spot acylcarnitines. SCAD deficiency may be associated with maternal HELLP syndrome.
Effects of Early Childhood Supplementation on the Educational Achievement of Women
Authors: Li Haojie , Barnhart Huiman X. , Stein Aryeh D. , Martorell Reynaldo 
Published: August 2004

Objective. Malnutrition during early childhood has been suggested to cause functional disadvantages in adults, including reduced intelligence and lower educational achievement (EA). We assessed the effects of improved nutrition in early life on the EA of women in 4 rural Guatemalan villages.
Methods. The study sample comprised 130 female singletons exposed to either Atole (53%, 91 kcal and 6.4 g protein/100 mL) or Fresco (47%, 33 kcal/100 mL, no protein) during the prenatal period and the first 2 years of life. EA was assessed at the ages of 22 to 29 years by knowledge, numeracy, and several reading tests. A summary measure of EA was computed based on 5 tests, and outcome variables were categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering.
Results. Overall, 36.2% of women completed primary school. Women exposed to Atole had better EA than those exposed to Fresco (odds ratio [OR]: 2.8; 95% confidence interval [CI], 1.4, 5.4), with a significant treatment-by-schooling interaction. Atole was not associated with EA (OR: 1.5; 95% CI: 0.7, 3.2) among women who did not complete primary school, whereas among those who completed primary school, Atole was associated with improved EA (OR: 13.7; 95% CI: 3.7, 50.8).
Conclusions. We conclude that better nutrition during early childhood improved adult EA, but only among children who completed primary school.
Closure of Patent Ductus Arteriosus With Oral Ibuprofen Suspension in Premature Newborns: A Pilot Study
Authors: Heyman Eli , Morag Iris , Batash David , Keidar Rimona , Baram Shaul , Berkovitch Matitiahu 
Published: August 2004

Objective. Patent ductus arteriosus (PDA), a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants with respiratory distress syndrome.Methods. Twenty-two preterm newborns (gestational age: 27.5 ± 1.75 [range: 23.9–31 weeks]; weight: 979 ± 266 [range: 380-1500 g]) with PDA and respiratory distress syndrome were studied prospectively. They received oral ibuprofen suspension 10 mg/kg/body weight for the first dose, followed at 24-hour intervals by 2 additional doses of 5 mg/kg each, if needed, starting on the second day of life. Echocardiography was performed before treatment and 24 hours after each dose. Every child underwent cranial ultrasonography before and after each ibuprofen dose. The rate of ductal closure, the need for additional treatment, side effects, complications, and the infants’ clinical courses were recorded.Results. Ductal closure was achieved in all newborns except for 1 (95.5%), in whom clinically nonsignificant ductal shunting persisted. No infant required surgical ligation of the ductus. There was no reopening of the ductus after closure had been achieved. Fourteen newborns were treated with 1 dose of ibuprofen, 6 were treated with 2 doses, and the remaining 2 were treated with 3 doses. The survival rate at 1 month was 86.4% (19 of 22). Three (13.6%) infants died from the following causes: 1 who was born at 24 weeks’ gestation with a birth weight of 380 g died as a result of extreme prematurity complications, necrotizing enterocolitis, and low birth weight; 1 died as a result of Candida sepsis; and the third died as a result of Klebsiella sepsis. Intraventricular hemorrhage was observed in 7 infants. The classification was changed from grade 2 to grade 3 in 1 and from grade 0 to grade 1 or higher in 3 others. The rate of survival to discharge was 86.4% (19 of 22). No bronchopulmonary dysplasia was observed in the study group, and there was no case of tendency to bleed. There were no significant differences in the levels of serum creatinine before and after treatment with oral ibuprofen.Conclusions. Oral ibuprofen suspension may be an effective and safe alternative for PDA closure in premature infants with PDA. However, larger comparative studies are warranted.
Disparity Between Pediatricians’ Knowledge and Practices Regarding Perinatal Human Immunodeficiency Virus Counseling and Testing
Authors: Kline Mark W. , O’Connor Karen G. 
Published: August 2004

Objectives. This survey of members of the American Academy of Pediatrics (AAP) was initiated by the AAP Committee on Pediatric AIDS to assess the knowledge, attitudes, and behaviors of pediatricians regarding prenatal and neonatal screening as a means to reduce mother-to-child transmission of human immunodeficiency virus (HIV).
Methods.  The survey consisted of a 4-page, self-administered questionnaire, which was mailed to a random sample of 1647 active US members of the AAP. The original and 5 subsequent mailings to nonresponders were conducted from July to November 2001.
Results. Completed questionnaires were received from 982 pediatricians, for a response rate of 59.6%. Nearly all pediatricians (96.6%) agree on the importance of knowing the HIV status of pregnant women, and more than three-fourths (78.5%) do not think that HIV screening during pregnancy or postpartum should be limited to women with perceived risk for infection. Approximately 6 (58.5%) of 10 pediatricians indicate that they counsel or provide education on HIV screening to pregnant women or mothers of newborns whose HIV status is unknown; 41.5% do not. Pediatricians reported evaluating an average of 56 newborns each during the 3 months before the survey. The HIV infection status of the mother was unknown for 40.6% of these cases. During the same time period, pediatricians said that they discussed a newborn or maternal HIV screening test with only 10.4% of the mothers whose HIV infection status was unknown. Reasons given for not counseling mothers with unknown HIV infection status about maternal and/or newborn screening for HIV included low prevalence of HIV in the pediatrician’s practice area (65.4%), assessment by the pediatrician that the parents did not fit the profile of those “at risk” for HIV infection (56.1%), fear of offending the parents (50.2%), parental lack of understanding regarding the importance of screening (50.1%), and lack of sufficient time for counseling (44.4%).
Conclusions. Pediatricians exhibit a high degree of understanding of the importance of HIV screening as a means to reduce mother-to-child transmission of HIV, but this does not always translate into their clinical practices.
Circumstances Surrounding End of Life in a Pediatric Intensive Care Unit
Authors: Garros Daniel , Rosychuk Rhonda J. , Cox Peter N. 
Published: August 2004

Objective. Approximately 60% of deaths in pediatric intensive care units follow limitation or withdrawal of life-sustaining treatment (LST). We aimed to describe the circumstances surrounding decision making and end-of-life care in this setting.Methods. We conducted a prospective, descriptive study based on a survey with the intensivist after every consecutive death during an 8-month period in a single multidisciplinary pediatric intensive care unit. Summary statistics are presented as percentage, mean ± standard deviation, or median and range; data are compared using the Mantel-Haenszel test and shown as survival curves.Results. Of the 99 observed deaths, 27 involved failed cardiopulmonary resuscitation; of the remaining 72, 39 followed withdrawal/limitation (W/LT) of LST, 20 were do not resuscitate (DNR), and 13 were brain deaths (BDs). Families initiated discussions about forgoing LST in 24% (17 of 72) of cases. Consensus between caregivers and staff about forgoing LST as the best approach was reached after the first meeting with 51% (35 of 68) of families; 46% (31 of 68) required ≥2 meetings (4 not reported). In the DNR group, the median time to death after consensus was 24 hours and for W/LT was 3 hours. LST was later withdrawn in 11 of 20 DNR cases. The family was present in 76% (45 of 59) of cases when LST was forgone. The dying patient was held by the family in 78% (35 of 45) of these occasions.Conclusions. More than 1 formal meeting was required to reach consensus with families about forgoing LST in almost half of the patients. Families often held their child at the time of death. The majority of children died quickly after the end-of-life decision was made.
Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital
Authors: Ramirez Susan , Hild Tannaz G. , Rudolph Colin N. , Sty John R. , Kehl Susan C. , Havens Peter , Henrickson Kelly , Chusid Michael J. 
Published: August 2004

Objective. To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children’s hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites.
Methods. Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children’s Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002.
Results. During the 7-year period of the study, there was an increase in the isolation of F necrophorum from patients who were seen at Children’s Hospital of Wisconsin, as well as the number of cases of LS. There was 1 isolation of F necrophorum from clinical specimens per year from 1996 to 1999, which increased to 10 isolates of the organism from January 2000 to January 2002. During the most recent period, January 2001–January 2002, 5 cases of LS were diagnosed, a distinctive entity not recognized previously at the institution.
Conclusions. The cause for the recent increase in the number of serious infections caused by F necrophorum infection diagnosed at our institution is unclear but does not seem to be related to changes in microbiologic techniques or patient demography. We speculate that it could be attributable, in part, to alterations in antibiotic usage patterns in our region. Clinicians need to be aware of the increasing clinical importance of F necrophorum infections and the life-threatening nature of LS.
Warfarin Therapy in Children Who Require Long-Term Total Parenteral Nutrition
Authors: Newall Fiona , Barnes Chris , Savoia Helen , Campbell Janine , Monagle Paul 
Published: August 2004

Objective. To determine whether warfarin can be safely administered to children who require long-term total parenteral nutrition (TPN), for the purpose of preventing central venous access device (CVAD)-related thrombosis.Methods. A prospective cohort study was conducted of 8 children with short-gut syndrome or small intestinal anomalies. All patients received oral anticoagulant therapy (warfarin) managed by the hematology department at a tertiary pediatric center. Data collected included demographic details, nutritional intake, age, weight, history of deep vein thrombosis, number and functional duration of CVADs, warfarin requirements, and adverse event rates.Results. A total of 15.2 warfarin years were studied prospectively. The target therapeutic range was achieved 51.1% of time. The mean dose of warfarin required to achieve the target therapeutic range (international normalized ratio) of 2.0 to 3.0 was 0.33 mg/kg/d. The mean duration between warfarin monitoring tests was 6.6 days. The median vitamin K intake per patient was 0.367 mg/kg/d (range: 0.018–2.85 mg/kg/d). Before commencing anticoagulant therapy, the mean CVAD duration was 160.9 days. Concomitant warfarin therapy was associated with a mean CVAD duration of 351.7 days. There were no major bleeding events, and no clinical extension of thrombosis was observed.Conclusions. This is the first published study to report uniform warfarin prophylaxis for CVADs in children. Warfarin therapy can be administered safely in children who require long-term TPN. Warfarin prophylaxis seems to prolong CVAD survival